Running head: POPULATION ANALYSIS

A Population Analysis of Stanislaus County

Sierra Chimente, Heidi Clavin, Cristina Escrito, Ashley Green, Cuili Luo,
Chomphunuch Marino, Savannah Perez, JoAnne Saba, Fatima Serrato, Ana Uy
California State University, Stanislaus

POPULATION ANALYSIS

A Population Analysis of Stanislaus County

The characteristics of the population have a significant impact on the health of a
community, and it is important for community health nurse to examine the population as a whole
(Allender, Rector, & Warner, 2014). Population analysis will help community health nurses to
identify vulnerable populations and offer rich information about the health and health needs of
the community.
Stanislaus County consists of a rich diversity of people with a variety of features. In order
to better understand the health-related information about this community, a group project was
conducted to analysis population variables using the Community Profile Inventory (Allender, et
al., 2014). This project examines Stanislaus County as whole and focuses on the aging
population as an aggregate through research reports, statistics collection, and community
member interviews. This paper will analyze the population variables in Stanislaus County and its
aging population in size, density, composition, rate of growth or decline, cultural differences,
social class, mobility, poverty level, education level, unemployment rate, population by age,
health status, and environmental health status.
Size and Population Density
Determining the size and density of a population in Stanislaus County will facilitate a
deeper investigation of the health status of the residents as well as specific issues of health care
access. This information helps ascertain if the number of health services, resources, and facilities
are keeping up with population growth and density. In addition, it will assist in developing health
programs to improve the well being of the county residents, particularly the aging population
(Allender, et al., 2014).
Stanislaus County is located in Californias Central Valley (Stanislaus County Profile,

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2015). The 1,521 square miles size of the county includes nine cities (i.e., Ceres, Modesto,
Patterson, Newman, Hughson, Riverbank, Oakdale, Turlock, and Waterford), of which Modesto
is the largest. Also, there are 13 unincorporated communities within the county (i.e., Denair,
Empire, Grayson, Hickman, Keyes, Knights Ferry, La Grange, Monterey Park Tract, Riverdale
Park Tract, Salida, Valley Home, Vernalis, and Westley). Additionally, there are numerous
unincorporated islands located in and around the cities that make up the balance of the
unincorporated population statistic.
According to the United States (US) Census Bureau (2014), there were 526,042 people
residing in Stanislaus County in 2013, which is less than most other counties in the area. In the
same year, California had 38,332,521 residents and United States was estimated having
316,128,839 residents. The city with the highest population is Modesto, having 206,785 residents
in 2013. Interestingly, the greatest change in population occurred in Hughson, going from 6,640
in 2010 to 7,118 in 2013, resulting in a 6.7% growth. Oakdale had the second highest change at
1.19%. The population has grown mainly in the cities, but the total population in Stanislaus
County shows very little difference. Overall, the countys population increased by 2.2 % since
2010.
Like population size, population density may also be used to describe and understand
people. Conklin (2004) stated that population density plays a vital role in explaining human
behavior and that as population density increases, stress on the residents will also increase.
According to US Census Bureau (2014), in 2010 there were 344.2 persons per square mile in
Stanislaus County while California had 239.1. Stanislaus County has less population density than
most other counties in the area. San Joaquin County, located at the northwest border of
Stanislaus, is 44% larger with population density of 498. The county with the highest population

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density in the local area is Alameda County with a population density of 2,077 approximately 6.0
times bigger than Stanislaus.
While US Census Bureau (2014) shows that the Stanislaus Countys total population has
barely shifted in recent years, the numbers aging population expanded nearly 12% during those
years. Like the nation as a whole, Stanislaus County also appeared to be aging. However,
residents are somewhat younger compared to California residents. For example in 2013,
Stanislaus Countys 65 years and over residents were 11.7%, while California was 12.5% of its
population (US Census Bureau, 2014).
Overall, the importance of determining the size and density of the population greatly
impacts how resources and facilities are to advance according to how the population changes:
whether it increases or decreases. The size and density information help assist health providers to
conform to the specific health needs of the elderlies of the population, while also creating
particular procedures and health programs that benefit the seniors and majority of the population.
Composition and Population by Age
Consistent with the 2010 demographic data of Modesto City received from Leepao
Khang (personal communication, February 24, 2015), a Stanislaus County Health Services
Agency (SCHSA) epidemiologist, about 49% of Modesto population is male, and 51% is female.
Similarly, 49.5% of Stanislaus County population is male and 50.5% is male (Tong & Hutchins,
2013). These numbers are also analogous comparing to the demographic data of male and female
population in California and the US, which are about 50% and 50% in California, and 40% and
51% in the entire nation respectively (US Census Bureau, n.d.a). According to these numbers,
population by sex of the city, the state, and the nation are roughly half male and half female.
Both Modesto and the State of California had the average number of persons per

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household of about 2.9 from the year 2009 to 2013 while the country had 2.63 (US Census
Bureau, n.d.a). Family households encompassed 71% of the total households in Modesto, and the
rest were non-family households (L. Khang, personal communication, February 24, 2015). The
percentage of married couple families, with or without children, in Modesto decreased from
51.5% in 2000 to 48% in 2010. Single-mother families comprised 15.6%, which is more than
twice the percentage of single-father families of 7%. Approximately 39% of the total households
contained individuals under 18 years old, and 25% had people at the age of 65 and older. About
23% of people in Modesto lived alone (L. Khang, personal communication, February 24, 2015).
In terms of population by age, roughly 27% of population in Modesto is under the age of
18 years old (L. Khang, personal communication, February 24, 2015). People from age 18 to 64
years old make up approximately 61% of the population, and those who are from the age of 65
and over are accountable for about 12%. Comparing to the average age of California population,
which is 35 years old, the average age of people in Stanislaus County was 33 years old (Tong &
Hutchins, 2013). Though Stanislaus population were younger than those of the State, people in
Stanislaus County were aging as the average age increased from 29 years old in 1980 to 33 years
old in 2010 (Tong & Hutchins, 2013).
Focusing only on the geriatric population, the percentage of elderly population (age 65
years and older) is 12%, which is a 1% increase from the year 2000 (L. Khang, personal
communication, February 24, 2015). According to Khang, there were more female elderly than
male in Modesto as 5% of all male population in Modesto was 65 year olds and older, and about
7% was female (personal communication, February 24, 2015). The percentages were similar in
2000, for which male elderly was 4% and female elderly was 7%. Households with individuals
age 65 years old or older were approximately 25%, which was higher than 22.4% in 2000, and

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the percentage of those who live alone (23%) was 9% elderly of age 65 years and older, which
were similar to 8.6% of those who live alone in 2000 (22.5%) (L. Khang, personal
communication, February 24, 2015). From these data, the percentage of elderly population by
sex, households, and age, remained relatively the same from the year 2000 to 2010.
The overall dependency ration or ratio of the dependent-age population, defined as
children from age 0 to 17 and elderly from age 65 and older, to the working population, defined
as people from age 18 to 64, in the US was 58.9 (File & Kominski, 2012). The US child
dependency ratio (calculated from children age 0 to 17) was 38.2, and elderly dependency ratio
(calculated from elderly age 65 and older) was 20.7 (US Census Bureau, 2012). California had a
lower overall dependency ratio (57.1) and elderly dependency ratio (17.9) than the average
national ratio, which mean less overall dependent people and elderly people for working people
to support (US Census Bureau, 2012). However, Californias child dependency ratios (39.2)
were higher, and that means that there was more young population for the working population to
take care of in California than national average (File & Kominski, 2012). The overall
dependency ratio of Modesto City (65.8) was rather high comparing to the State and the national
average, and that means that there were more dependent populations relating to functioning
population in Modesto (File & Kominski, 2012).
In 2000, the US elderly dependency ratio was 20.1, which means that the ratio increased
by 0.6 in the past 10 years (US Census Bureau, 2012). Similarly, the ratio increased by 0.8 in
California. According to the US Census Bureau (2010a), the elderly dependency ratio was
anticipated to increase rapidly to 35 in 2030 the aging baby boomers. The ratio will increase
gradually after 2030 to around 37 in 2050. This prediction suggested that the weight would be
greater for the working population as they would have to support additional elderly people.

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Moreover, minority population would encompass 42% of the elderly people in 2050, which is
more than twice the percentage in 2010 (US Census Bureau, 2010a). In 2050, 20% of the elderly
population would be Hispanic compared to the current 7% (US Census Bureau, 2010a). The fast
escalation of the life expectancy for elderly male population over the coming decades was also
projected, and the percentage of elderly female population would decrease from 57% to 55% in
2050 (US Census Bureau, 2010a).
Rate of Growth or Decline
Stanislaus County saw substantial population growth between 1990 and 2000, increasing
by 20.6% from 370,522 to 446,997 (Stanislaus Local Agency Formation Commission [LAFCO],
2006). Of note are the changes in ethnicity and age. As noted by The United States Census
Bureaus year 2000 report, those of Hispanic and Latino origin numbered 141,871, or 31.7% of
the Stanislaus County population. In 2010, that number rose to 215,658 or 41.1% (United States
Census, 2010b). There have also been significant changes in the elderly population. According to
the US Census Bureau (2010b), in the year 2000, those 65 and older represented 10.5% of the
Stanislaus County population. The last three years show a particularly dramatic increase in the
elderly population. The Modesto Bee cites 2013 census data, stating that Stanislaus Countys
overall population has grown two percent from 514,451 in 2010 to 525,491 in 2013 (US Census
Bureau, 2013). The 65 and older age group increased 11.8% from 2010 to 2013, adding 6,484
Stanislaus seniors. Also of note are the fact that, within the same period, other age groups either
declined or increased at a much lower rate. The 18-64 year old age group increased by only
1.7%. The 14-17 year old age group decreased by 4.2%, 5-13 age group increased by 0.6%, and
the under 5 year old group decreased by 1.7% (US Census Bureau, 2013).
An implication for the population as a whole is the access to and provision of medical

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services. Due to the implementation of the Affordable Care Act, more people than ever have
access to health care insurance. It is likely that having health insurance will extend the lifespan
of Stanislaus County residents, adding to the increase in the elderly population. The Latino
population represented 41.1% of the total 2013 Stanislaus County Census, and the county is
likely to continue to see an increase in the Hispanic and Latino elderly population (US Census
Bureau, 2013). In a 2013 study by the Population Reference Bureau (PRB), life expectancy of
Hispanics has been found in some studies to rival that of whites (Scommegna, 2013). Cohesive
families are prevalent in Hispanic culture (Allender et al., 2014), which is important at any age,
but could make a profound difference in their life expectancy. This obviously places added
demand on the county to provide services to these groups.
Another implication for the aging population is that they are increasingly vulnerable to
abuse. Elder abuse alleged reports in 2010-2011 numbered 1,650 (Stanislaus County Health
Services Agency [SCHSA], 2013a). In 2011-2012 that number increased to 1,770. In 2012-2013
the number was 2,074. If these numbers are any indication, it can be expected that 2015 numbers
can be estimated to be in the range of 2,500 to 3,000. Despite the growing need, government
spending on elders cannot be counted on to increase. Public health nurse, Fred Gack, has
confirmed that there has been no increase in government funds for their multi-service senior
program since the recent recession (F. Gack, personal communication, February, 2015). Also
contributing to lack of funds, is the countys current high unemployment rate of 10.5% (State of
California Employment Development Department, 2015). Socially, elders may experience more
isolation as a result of children and grandchildren moving to other locations. This could place
them at a higher risk for depression and suicide. A declining working age population may also
affect the number of caregivers for the elderly, putting them at risk for injury and illness. While

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increases in spending on senior programs will benefit this population, there is no guarantee that
the younger age groups will make this a priority. Younger generations may even resist changes
that could benefit the aging population because their own population has not fluctuated so
drastically (Allender, et al., 2014). In addition, the concern for senior resources and programs
was not one of the top five concerns of the community. The number one concern was crime,
followed by neighborhood safety, alcohol and drugs, quality of schools, and homelessness
(SCHSA, 2013a).
Although there is an obvious need for improvement, SCHSA (2013a) does cite a list of
resources currently offered for the elderly. The Area Agency for Aging connects seniors with
resources on how to obtain free meals, home delivered meals, and farmers market coupons.
Help is also offered to obtaining free assistive telephones, help applying for utilities discounts. In
addition, employment training for low income seniors is offered through Senior Community
Service Employment Program (SCSEP).
A positive finding of the SCHSA (2013a) was that 82% of all Stanislaus County residents
and 98% of Stanislaus County seniors have health insurance coverage. Currently there is a health
provider shortage with ratios of one health care provider for every 1,525 residents and one
mental health provider for every 1,615 residents (SCHSA, 2013a). In order to keep up with
population needs, funds need to be directed towards hiring more health care providers. More jobs
will need to be created in health care facilities, nursing homes, home health, home equipment
companies, and hospice. Hopefully some of these jobs would attract the younger age groups to
live and work in Stanislaus County. Alternatively, the elderly community could find support
amongst each other, attend church social groups, or make connections by volunteering in the
community.

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Cultural

The functional definitions of race and ethnicity according to Tong, Hutchins, and Hooda
(2013) encompass two different ideas. Race is viewed as skin color and origin, while ethnicity is
developed through culture and language. Though national surveys provide an abundant amount
of race identifiers, only two ethnicities, Hispanic/Latino or Not Hispanic/Latino are analyzed in
these reports.
Using information from the 2000 census, the SCHSA (2008) made a fifteen-year
projection of the distributions of races in Stanislaus County as reported in the Stanislaus County
Community Health Assessment. It was estimated that in 2015, the population would be
comprised primarily by Hispanics and Caucasian/White with them accounting for 46% and
43.3% of the inhabitants, respectively. Other races accounted for were Asians at 5.1%, African
Americans at 2.7%, American Indians at 0.8%, Pacific Islander at 0.3%, and multi-race 1.8% of
the remaining population. The distribution of races in the population were projected to be
weighted rather differently for 2005, only ten years prior. It was estimated that
Caucasian/Whites in Stanislaus County would account for over half of its inhabitants at 51.6%.
The Hispanic population trailed behind at only 38.2% of citizens, while distribution of Asians,
African Americans, Pacific Islanders, and multi-race were similar to that for the 2015
projections. The 2010 census, though five years ago, displays that Stanislaus county began
making the shift toward the projected distributions (Advancement Project, 2011). At this time
Caucasians still comprised 46.7% of the population while Hispanic/Latino made up 41.9%. The
remaining aforementioned races were within a one percent range of the projected percentage.
More conclusive data cannot be examined until the 2020 census.
There is minimal information about the culture distribution of the senior aggregate due to

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the sample size restrictions (J. Buttle, personal communication, February 25, 2015). Because of
this, there is no definitive data, only estimated information . In accordance to the U.S Census
Bureau's (n.d.b), 2011-2013 American Community Survey, the senior aggregate is primarily
Caucasian/White at 84.4% of this sample population. The remainder of this population is made
of 2.1% African American/Black, 0.7% American Indians, 4.7% Asians, 0.5% Pacific Islanders,
and 2.5% multi-race. It is important to note that this fact sheet did not include Hispanic as their
own race but distributed them across the races mentioned.
Subcultures of this population include the minority groups such as Asians, Pacific
Islanders, African Americans, and American Indians. Though most of these minorities have
many of the same health needs as Caucasians and Hispanics, it is important to understand their
unique practices. It would be difficult to outline each individual preference of the cultures,
however, Leininger and McFarland (2002) outlines three modalities to guide culturally
competent care to patients of varying cultures. Her ideas include allowing a patient to preserve,
negotiate, or restructure his or her culture. This theory best accommodates the well being of the
patient/client and their personal ideals and beliefs about health care and health care practices.
Particular to this aggregate, veterans are an important subculture to consider. Veterans
account for approximately 55.5% of Stanislaus County citizens aged sixty-five years or older
(U.S. Census Bureau, n.d.b). Veterans do not have any special practices, though some may have
special needs that need to be met. Many come back from war not the same as when they left (V.
Stigall, personal communication, February 24, 2015). Veterans Affairs clinics as well as
Veterans of Foreign Wars offers services, such as civilian re-entry, health services, and
counseling, which assist veterans with many of their basic needs. In addition, it provides
veterans with friends and a support group in which they can turn to.

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Social Class and Poverty Level

Poverty Level
Poverty level or poverty threshold can be defined as the minimum income deemed
adequate to maintain and support basic living essentials. This number can fluctuate and is
dependent on the cost of essential resources (housing, food, etc.) that an average adult consumes
and needs in one years time. Determining poverty statistics is an essential variable in
determining health disparities and the needs of a particular community. When looking at
Stanislaus County based on the 2009-2013 United Sates Census Bureau Report it was found that
18.3% of all individuals between the ages of eighteen to sixty-five fell below the poverty line
(US Census Bureau, 2013). These families that fall below the poverty line require government
aid to sustain and attain needed resources according to Mrs. Bertrand, who has worked at an
underprivileged school and witnessed firsthand the resources and needed services available to
such families (personal communication, February 24, 2015). According to Bruce Bartlett (2013)
from the New York Times, 16.4% of Americans use the school lunch program, 16.9% accept
housing subsides, and 17.6% use supplemental nutritional assistance.
Social Class
Social economic class is not clearly defined by the US Census Bureau, but is categorized
based on income with education, occupation, and prestige having a large impact on that number.
According to David Francis (2013) from the U.S News and Reports there are three
socioeconomic classes, which include low, middle, and upper class. Low socio economic class is
seen as those people that fall below the poverty line. In the United States, a family can be seen
below the poverty line if their total income is $23,050 or less for a family of four (Francis, 2013).
The total percentage of Americans below this level was stated to around eighteen percent. The

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next level is middle class, which captures the majority of the population. The can be further
broken down based on loose definitions to blue-collar, white collar, and professional class, but
overall captures an annual income of greater than $24,000 to $150,000 a year. The current
percentage of the population reflected in this group is 76.1% (Francis, 2013). The next socio
economic class is upper class or the upper five percent because it usually always only
represents five percent give or take, which currently stands true (Francis, 2013).
The Elderly Populations Poverty Level and Social Class
The elderly, individuals whose age is 65 years or older, are growing in number with the
aging of the baby boomers. Since their number is increasing they are beginning to take up a
larger percentage of the population. When looking at the elderly population, it was found that
10.8 percent of this population was below the poverty line (US Census Bureau, 2013). This
statistic and the fact that their percentage is growing depict possible health disparity in the
United States. Social economic class doesnt have a strict definition and is based on education,
occupation, prestige, and not just income. Since the education, occupation, and prestige of a
person has a large influence or are correlated with their income, the annual income statistics can
display their social class. This doesnt hold true for the elderly community who may have high
education and a prestigious occupation before retirement, but who has experienced a decline in
income that of a lower class due to retirement (Francis, 2013). The average retirement income is
$22,778 annually, which may only cover a household of one or two. This amount contrasts to
their preretirement income putting in a level at or barely above the poverty line (US Census
Bureau, 2013). This fact clearly can have a large impact on the health services this population
will need.
The statistics mentioned brings forth a need to provide needed health services and

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priorities for this high-risk population. The focus must be on continued prevention and control of
health problems associated with the geriatric population. Development of health insurance
schemes to cover their care and costly medications when income is low. Government aid and
private provisions are also needed to provide medical aids and necessities like hearing aids,
prosthesis, walkers, canes, and house modifications. Special programs for education and physical
therapy to insure and maintain health can also be beneficial to a population who may not have
access or knowledge to access medical information, and whose body needs further exercise and
therapy to insure health and mobility. All of these concepts are a must for a population whose
income restricts their access to medical services mentioned (Shirvastava, 2013)
Mobility
According to the US Census Bureau (2013), 81.4% of the population in Stanislaus
County remained in the same home versus 50.8% in the 2000 Census (it was actually reporting
residency from 1995). This goes to show how more people are currently remaining in the same
home, which means that less of them are moving elsewhere. As a matter of fact this is further
proven by the following statistics. In comparing the 2013 from the 2000 Census, the number of
residents that reported moving to a different home within the U.S. was 18.2% versus 46.5%,
moving within the same county was 13.9% versus 46.5%, and moving to a different county was
4.2% versus 15.4% (US Census Bureau, 2013). With such a significant decline in mobility or
changing of residency, the author wondered what factor or factors might have contributed to
such results. Ms. Arce a real estate agent from PMZ Real Estate was interviewed. She reported
that before the recession people moved about every 5 years, since the market was going up
people would make profit from their homes known as equity and then they would upgrade to a
bigger home (N. Arce, personal communication, February 23, 2015). Once the recession

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occurred more foreclosures were seen and people were displaced. Now, that the economy is
stabilizing people are appreciating it and thus remaining in their home longer (N. Arce, personal
communication, February 23, 2015). Stanislaus County was ranked as one of the nations leaders
in foreclosures from 2007 to 2012 (Tong, et al., 2013). Gina, a Social Worker for Golden Valley
Health Centers reported that more people would like to move, but they cant because they dont
have the financial resources to do so (G. Lima-Vieira, personal communication, February 26,
2015).
In speaking with a couple of key informants within the community of Modesto, it was
concluded that the homeless are considered a highly mobile population. Blanca a social worker
for one of the shelters in Modesto said that lot of the homeless come from the Bay area with the
expectation that there will be more job opportunities in the Central Valley, which is actually not
the case (B. Martinez, personal communication, February 23, 2015). Their health is greatly
affected because a lot of them come in with disease processes in advanced stages; in addition a
lot of hypothermia is seen from being out in the cold. For a lot of them it is also hard to get
Medical/Medicare because they dont have a mailing address as a result the shelter is used as
their mailing address (B. Martinez, personal communication, February 23, 2015). Specific to the
elderly, the ones who are cognitively low-functioning do not get their medications and so their
mental or physical health deteriorates. A lot of depression and anxiety is seen amongst the
elderly because they are aging and dont have the financial means to support themselves and/or
families (G. Lima-Vieira, personal communication, February 26, 2015). However, Golden
Valley clinics, shelters, The Gospel, Food Banks, and The Salvation Army to mention a few
work in unison to meet the needs of such highly mobile population, like the homeless (G. LimaVieira, personal communication, February 26, 2015 & B. Martinez, personal communication,

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February, 23, 2015).

In addition to how the elderly are affected within the homeless population, the elderly in
general were taken into consideration as well. Juanita a Social Worker Case Manager for MultiSenior Service Program (MSSP) expressed that the biggest thing that affects the elderly when
they move is that they lack the knowledge of what resources are offered in certain cities or
counties, especially if they are monolingual (J. Salcedo, personal communication, February 20,
2015). If the services being offered are not coordinated to where that particular individual is
moving, it is noted how their health begins to deteriorate. For those who do not belong to MSSP,
they can easily fall into the crack (J. Salcedo, personal communication, February 20, 2015). In
Juanitas case load of clients, within the past 6 months she has had at least 2 clients move (J.
Salcedo, personal communication, February 20, 2015).
Education
There is a link between education and health. (Ross & Wu, 1995). By affecting the
socioeconomic status of the individual, it greatly influences social-psychological resources and
health lifestyle. The percent of those in Stanislaus County that have a high school education or
higher is 76.4%, while in California, it is currently at 81.2%, and in the nation it is 86.0%. (US
Census Bureau, 2014). Regarding those who have a bachelors degree or higher, Stanislaus
County has 16.4%, California has 30.7%, and the nation has 28.8%. According to Learning
Quest Adult Literacy (n.d.), over 100,000 adults in Stanislaus County have difficulty using an
ATM machine or reading a bus schedule; this is nearly 20% of the countys population.
With regards to the elderly population, there is little data about the education level of the
elderly population specifically in Stanislaus County. As cited by Kingston (2009), only one
percent of the education budget is currently spent on the oldest third of the population. With

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regards to attending a university like California State University, Stanislaus, according to the
research analyst in the Office of Institutional Research, the number of state-supported new and
continuing student enrollment in Fall 2013 were only nine students age 65 and older (L. Fields,
personal communication, February 24, 2015).
At Modesto Junior College (MJC), the closest statistic regarding the elderly aggregate
population is that 10.7% of students in the 2012-2013 academic year were 40 years and older (L.
Hoile, personal communication, March 5, 2015). Linda Hoile, the marketing and public relations
officer at MJC, stated that the colleges Community Education department has a very large
number of senior citizens who participate in their travel excursions and in a program that is
specifically set up for senior citizens called the Modesto Institute for Continued Learning
(MICL) (personal communication, March 5, 2015). MICL offers classes, speakers, films,
exercise activities, daytime excursions, and many more for a single membership fee of $40 per
semester. The MICL semester is divided into three 5-week sessions referred to as A, B, and C
Sessions. Classes meet weekly for two hours, at 10:00 a.m. or 1:00 p.m. and arranged so
members can attend as many classes as they like for one fee each semester. The single member
fee also covers registration and includes other campus services, such as use of the library and
bookstore.
Unemployment
According to the January 2015 report from California Labor Market Information (2015),
the unemployment rate of December 2014 was 10.5% in the Stanislaus County, which was down
from 10.7% comparing with November 2014. Also, the unemployment rates have been dropping
since 2010. Stanislaus County Profile (2015) reported that the annual unemployment rates
improved from 17.3% in 2010 to 15.2% in 2012 and 11.1% in 2014. Economists also forecast the

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unemployment in Stanislaus County will continue to decrease in 2016. However, when compare
to the state and national level, Stanislaus Countys unemployment rates were significantly
higher. The annual unemployment rates throughout the nation were 9.6% in 2010, 8.1% in 2012,
7.4% in 2013, and 6.2% in 2014. (Bureau of Labor Statistics [BLS], 2015).
Since the traditional working age is 16 to 64 years old, many seniors have retired while
others are still working after they past traditional retirement age. The national labor force
participation rate for those 65 years and older was 13.2% in 2002 and 18.5 in 2012, but labor
force participation rates for 16 years and older were 66.6 in 2002 and 63.7% in 2012 (BLS,
2013). The annual unemployment rates of people over 65 remained lower than the national
unemployment rates. The unemployment rates in the fourth quarter were 5.0% in 2013 and 4.3%
in 2014 (BLS, 2015). However, N. Mukhtar, who is an employment specialist working for
Stanislaus County Alliance Worknet over ten years, stated that workers who lose their jobs in
their fifties and sixties were generally harder to continue their career (personal communication,
February 18, 2015).
Health Status
There are several health indicators, which affect the health status of individuals and can
have a large impact on communities. According to the Center of Disease Control and Prevention
(CDC) (2014a), some of the major modifiable contributing factors of illnesses associated with
chronic disease are tobacco use (including secondhand and third-hand smoke exposure), poor
nutrition, decreased availability to physical activity opportunities, and decrease in services to
prevent and control high blood pressure and high cholesterol, (SCHSA, 2013b). The following
risk factors not only affect individuals but also play a larger part in affecting families and
communities.

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In 2013, the California Department of Public Health [CDPH] reported the following top
ten causes of death in the state of California: heart disease, cancer, chronic lower respiratory
diseases, Alzheimers disease, accidents, diabetes mellitus, influenza and pneumonia, disease
and cirrhosis of the liver, essential hypertension, and hypertensive renal disease, (CDPH, 2015).
According to Stanislaus County: Changes in County Health Status Profiles Health Status
Indicators from 2004 to 2013, the mortality rate decreased by 30.8% for coronary heart disease,
26.7% stroke, 39.6% motor vehicle accidents, and 12.8% for all cancer types, (SCHSA, 2013b).
There was no significant change in the rate of accidents (unintentional types), breast cancer
(female only), diabetes, drug induced deaths, firearm-related deaths, homicide, and suicide,
(SCHSA, 2013b). There was an increase in incidences of chlamydia, up by 38.7%. (SCHSA,
2013b). According to Jew-Lochman (2008), over seventy-one percent of the 2005 HIV disease
deaths occurred among California residents between the ages of 35 to 54. The infection rates for
residents in age groups from 25 to 64 decreased over the 5-year period but increased for residents
65 to 74 years of age, (p.1).
Obesity Rates
Individuals who are overweight or obese are at a higher risk for developing heart disease,
stroke, and type II diabetes (Tong, et al., 2013). According to the CDC, obesity rates are higher
among middle age adults, at 39.5% and the rate of obesity for over 60 or above is 35.4% (CDC,
2014b). California has an obesity rate of 20% to less than 25% (CDC, 2014b). Compared to
California as a whole, Stanislaus county residents have a higher obesity rate (SCHSA, 2012a).
In Stanislaus County, only one quarter of the adult population is at a normal weight;
leaving two-thirds of the adult population in the overweight and obese category. Two out of
every three adults in this county are in the overweight or obese category; this is 18% higher than

POPULATION ANALYSIS

20

the California average (SCHSA, 2014). The retail food environment of Stanislaus County was
compared to the obesity prevalence, and studies showed that the higher the retail food
environment index the higher the obesity rate. There is also a statistically significant gender
disparity, with a higher percentage of men overweight than women (Tong, et al., 2013). African
Americans and whites were the two ethnicities with the highest percentage of adults being
overweight or obese; however Asian adults experienced the largest increase in the percentage of
overweight/obese individuals.
Tobacco and Substance Abuse
Smoking and tobacco use is a risk factor for several diseases such as heart disease,
emphysema, and other forms of chronic obstructive pulmonary disorder and research has found
that smoking causes approximately one-third of all cancers (Tong, et al., 2013). The prevalence
of tobacco use has unsteadily declined in the past decade, with a 21.2% decline in tobacco use in
Stanislaus County compared to the 19.3% decrease in the state of California as a whole (Tong, et
al., 2013). This decrease can most likely be attributed to the major anti-tobacco efforts that have
been put in to place the last decade; these include smoke-free restaurants and government
buildings as well as increased support for individuals trying to quit smoking. Alcohol abuse is
also a risk factor for several diseases and excessive use has long-term effects, which include
neurological, cardiovascular, and psychiatric problems, liver disease, and cancer. Alcohol use
also affects economic aspects of society, with costs of $223.5 billion nationally for alcohol
misuse (Tong, et al., 2013).
Drug and alcohol abuse is a serious problem in Stanislaus County, with long-term users
starting as young as 12 years of age (SCHSA, 2010a). Stanislaus County ranked eighth highest in
drug induced deaths in 2006 at 19.1 deaths per 100,000 people in all California counties

POPULATION ANALYSIS

21

(SCHSA, 2010a). In 2010, 2.6 million people currently using illicit drugs in California (SCHSA,
2010a). In 2013, 9% to 12.9% of the population in California were active smokers, which,
compared to other states, is among the lowest rates of smoking in the nation (CDC, 2015).
Immunization Rates
Since the Immunization Assistance Program grant started in 2011, immunization rates
have increased. This funding enabled the Stanislaus County Health Services Agency Public
Health division to administer approximately 25,500 immunizations to Stanislaus County
residents in the 2011-2012 fiscal year (SCHSA, 2012b). This represents a 34% increase from the
2009-2011 fiscal year. In total, there were approximately 8,400 flu shots, 4,100 flu mist, 500
pneumonia, and 2,600 pertussis (Tdap) at community health clinics in Stanislaus County. This
funding source mainly focuses on the 0-18 year old population, however a significant amount of
the flu shots and almost all of the pneumonia vaccines were administered to the elderly
population (SCHSA, 2012b).
Rebecca Evans, public health nurse at Stanislaus County Health Department, noted that
the she has not seen a decrease in the rate of immunizations and that most people want to
vaccinate their children and protect them from diseases (personal communication, February 24,
2015). She specifically noted that among the elderly population, most people want to get their
vaccines, especially for pneumonia, shingles and influenza. She stated, Most of the elderly are
receiving their vaccines from their primary care physicians and not at the Health Department,
(R. Evans, personal communication, February 24, 2015). In contrast to Ms. Evans observation
regarding immunization rates in Stanislaus County, nationally, rates are apparently much lower.
Fox News reported that, according to a CDC report, in 2012 immunizations for adults were
drastically low, (Fox News, 2014). Only 64.2 percent of adults were up-to-date with their tetanus

POPULATION ANALYSIS

22

shots, 20 percent of adults at high risk for pneumonia received the pneumococcal vaccine, and
14.2 percent of adults had received the Tdap vaccination, (Fox News, 2014).
Injury and Violence Prevalence
Nationally, injuries are the leading cause of death for individuals aged 1 to 44, and in
Stanislaus County three separate types of injuries were ranked among the fifteen most common
underlying causes of death (Tong, et al., 2013). Injuries can have several long-term effects on
health, such as life-long disabilities, lowered quality of life, shortened life span, and
psychological effects. Injuries are often classified by their severity and their cause, with the fatal
injury rate being highest among middle-aged adults and the non-fatal injury rate being highest
among adults aged 65 and over (Tong, et al., 2013). Seniors age 65 and over also had the highest
rate of unintentional non-fatal hospitalizations, with most of these hospitalizations attributed to
falls. Intentional injury rates are highest among the adult population, but are relatively low in the
senior population over age 65 compared to the rest of the adult population (Tong, et al., 2013).
The fatal injury rate due to violent assault was relatively low in Stanislaus County compared to
the non-fatal injury rate due to assault. Seniors aged 65 years and older and children aged 0-4
had the lowest incidence of assault (Tong, et al., 2013).
STI and HIV/AIDS Rates
Sexually transmitted infections are the most commonly reported conditions that health
care providers are legally obligated to report in the state of California (Tong, et al., 2013).
Chlamydia is one type of sexually transmitted infection that is most prevalent in Stanislaus
County. Stanislaus County is also ranked 42nd among the counties in California with an average
of 1,947 cases reported between 2010-2012 (CDPH, 2014). The Chlamydia infection rate is 3.3
times higher in women in Stanislaus County than in men (Tong, et al., 2013). Gonorrhea is the

POPULATION ANALYSIS

23

second most frequent sexually transmitted infection on Stanislaus County, with an average case
rate between 2010-2012 of 94.3 for women and 88 for men (CDPH, 2014). Syphilis is another
type of STI that is dramatically increasing in rates of infection for both Stanislaus County and
California in general, with the rate in Stanislaus County doubling in number since 2009 (Tong, et
al., 2013). HIV/AIDS is also a growing concern for California in general and Stanislaus County.
The rate of reported AIDS cases in California between 2010-2012 was 8.6 cases per 100,000
individuals (CDPH, 2014). In Stanislaus County specifically, there was an average of 13.3 cases
of AIDS between 2010-2012, which ranked them 30th in the state of California.
Environmental Health Status
According to California Breathing, in 2011-2012, Stanislaus County had approximately
62,000 children and adults who were diagnosed with asthma, (California Breathing, 2015).
Stanislaus county residents, ages 65 and greater, have a 16.2% active rate of asthma, as
compared to the state of California, which has an 8.2% active rate, (California Breathing, 2015).
Asthma in California is related to the regularly poor outdoor air quality. Based on short-term
particle pollution, Stanislaus County ranks as the 20th most polluted county in the nation, and
Modesto is ranked as the 17th worst in the U.S. Metropolitan Statistical Areas, (SCHSA, 2010b).
The toxic release in inventory for Stanislaus County is 125, 323.47 lbs. for a total of 27 facilities,
total released per square mile is 82.76 lbs. and it ranked 1,382 out of 2,319 counties, (United
States Environmental Protection Agency, 2013). The toxic release inventory for the State of
California is 47.61 million lbs., for a total of 1,263 facilities, with a total release of 290.86 lbs.
per square mile. California ranked 41 out of 56 states/territories (United States Environmental
Protection Agency, 2013). Due to the poor air quality in the Stanislaus County, the aging
population is at risk for asthma and other lung diseases.

POPULATION ANALYSIS

24

The elderly are at higher risks for infection as their lungs lose elasticity, which results in poor
recoiling and shallow breathing, (Podnos, Jimenez & Wilson, 2002). Due to years of exposure to
many environmental pollutants, there can be a decrease in ciliary action and greater mucus
production in the lungs, (Podnos et al., 2002). These factors result in reduced oxygenation of the
arterial blood and oxygen delivery to peripheral tissues, (Podnos et al., 2002). All of these
factors create a higher risk of infection to the elderly population.
As people age, various physiological changes occur, which can increase their risk of
exposure to infections and illnesses. Food safety and contamination can cause many illnesses
that are harder for the elderly to overcome. In 2013, the incident rate for E.coli in Stanislaus
County was 2.3 per 100,000, compared to the state of California, which had an incident rate of
0.9 (CDPH, 2014). Exposure to E.coli can increase the risk for intra-abdominal sepsis and can
affect all age groups but tends to take a greater toll on the elderly population (Podnos, et al.,
2002).
Conclusion
The population analysis presented in this paper investigated the community health
implication and helps the community health nurse identify the major health issues and health
needs of the population in Stanislaus County, especially its aging population. Community health
nurses could use this valuable information to plan public health programs to address the major
needs of the community, implement the most effective care to those in greatest need, and
evaluate the health outcomes of the community. This assessment data also enables public health
nurses to collaborate with other professionals and agencies to address the health issues that
concern the community the most. More importantly, the population analysis could ensure the
public resources are matched with the people in-need and ultimately maximize health benefit of

POPULATION ANALYSIS
the whole community.

25

POPULATION ANALYSIS

26
References

Adult Literacy. (n.d.). Retrieved from http://lqslc.com/our-programs/adult-literacy/

Advancement Project (2011). Population characteristics-ethnicity/race of Stanislaus County
based off of the 2010 U.S. decennial census. Retrieved from
http://www.healthycity.org/c/chart/geo/county/zt/06099/report_geo//yk/20150224203804
876#/report/[[2797,0,[],1,[0]]]/rank/[0,0,0,0,1,0]/yk/20150227154517127
Allender, J. A., Rector, C., & Warner, K. D. (2014). Community Public Health Nursing:
Promoting the Public Health. Philadelphia, PA: Lippincott Williams and Wilkins.
Barlett, B. (2013). Poverty, government and social class. New York Times. Retrieved from
http://economix.blogs.nytimes.com/2013/11/12/poverty-government-and-socialclass/?_r=0
Bureau of Labor Statistics. (2015). Labor force statistics from the current population survey.
Retrieved from http://data.bls.gov/timeseries/LNU04000000?years_ option= all_years
&periods_option=specific_periods&periods=Annual+Data
California Breathing. (2015). Initiatives and information for asthma advocates in California.
Retrieved from http://californiabreathing.org/asthma-data/county-asthmaprofiles/stanislaus-county-asthma-profile
California Department of Public Health. (2014). County health status profiles 2014 [pdf].
Retrieved from
http://www.cdph.ca.gov/programs/ohir/Documents/OHIRProfiles2014.pdf
California Department of Public Health. (2015), Californias leading cause of death for 2013
[pdf]. Retrieved from http://www.cdph.ca.gov/programs/ohir/Pages/CHSP.aspx
California Labor Market Information. (2015). Immediate release Modesto metropolitan

POPULATION ANALYSIS

27

statistical area Stanislaus County [pdf]. Retrieved from

http://www.calmis.ca.gov/file/lfmonth/ mode$pds.pdf
Centers of Disease Control and Prevention. (2014a). Adult obesity facts. Retrieved from
http://www.cdc.gov/obesity/data/adult.html
Centers of Disease Control and Prevention. (2014b). Prevalence of self-reported obesity among
U.S. adults by state and territory, BRFSS, 2013. Retrieved from
http://www.cdc.gov/obesity/data/prevalence-maps.html
Centers of Disease Control and Prevention. (2015). Current cigarette smoking among adults in
the United States. Retrieved from
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.ht
m#2013
Conklin H. (2004). Population growth density and the cost of providing health services.
Retrieved from http://www.ncsociology.org/sociationtoday/v21/review2.htm
File, T., & Kominski, R. (2012). Dependency ratios in the United States: A state and
metropolitan area analysis [pdf]. Retrieved from https://www.census.gov/hhes/wellbeing/files/Dependency%20Ratios%20in%20the%20United%20States.pdf
Fox News. (2014). CDC adult vaccination rates are drastically low. Retrieved from
http://www.foxnews.com/health/2014/02/07/cdc-adult-vaccination-rates-are-drasticallylow/
Francis, D. (2013). Where do you fall in the American economic class system? U.S. News and
World Report. Retrieved from http://money.usnews.com/money/personalfinance/articles/2012/09/13/where-do-you-fall-in-the-american-economic-class-system

POPULATION ANALYSIS

28

Jew-Lochman, S. (2008). Human immunodeficiency virus disease deaths [pdf]. Retrieved from
http://www.cdph.ca.gov/pubsforms/Pubs/OHIRhivDeaths2005.pdf
Kingston, P. (2009). Older people's education 'neglected'. The Guardian. Retrieved from
http%3A%2F%2Fwww.theguardian.com%2Feducation%2F2009%2Fjan%2F20%2Ffurth
ereducation-longtermcare
Leininger, M. M., & McFarland, M. R. (2002). Transcultural nursing concepts, theories, research
and practice. NY: McGraw-Hill
Podnos, Y. D., Jimenez, J. C., & Wilson, S. E. (2002). Intra-abdominal sepsis in elderly persons.
Oxford Journals Clinical Infectious Diseases, 35(1), 62-68.
Ross, C., & Wu, C. (1995). The links between education and health. American Sociological
Review, 60(1), 719-745
Scommegna, P. (2013). Exploring the paradox of U.S. Hispanics longer life expectancy.
Population Reference Bureau. Retrieved from
http://www.prb.org/Publications/Articles/2013/us-hispanics-life-expectancy.aspx
Shiravastava, S. (2013). Health-care of elderly: Determinates, needs and services. International
Journal of Preventative Medicine, 4(10), 1224-1225.
Stanislaus County Health Services Agency. (2008). Stanislaus County community health
assessment [pdf]. Retrieved from
http://www.schsa.org/PublicHealth/pdf/dataPublications/demographics.pdf
Stanislaus County Health Services Agency. (2010a). Leading the way to a healthier Stanislaus.
Retrieved from www.schsa.org/PublicHealth/ppt/mapp/MAPPWorkshop.ppt
Stanislaus County Health Services Agency. (2010b). Stanislaus County asthma report card
2010: Description of the asthma burden in Stanislaus County to promote policy change

POPULATION ANALYSIS

29

and support interventions [pdf]. Retrieved from

http://www.hsahealth.org/publichealth/pdf/coaltionPartnerships/asthma/asthmareportcard
2010.pdf
Stanislaus County Health Services Agency. (2012a). Targeting our epidemic of obesity and
diabetes [pdf]. Retrieved from
http://www.schsa.org/pdf/communityHealthReport/2012/ph-report2012.pdf
Stanislaus County Health Services Agency. (2012b). The Board of Supervisors of the County of
Stanislaus: Action agenda summary [pdf]. Retrieved from
http://www.stancounty.com/bos/agenda/2012/20120626/B04.pdf
Stanislaus County Health Services Agency. (2013a). Community health assessment-2013/2014:
Executive summary. Retrieved from
http://www.schsa.org/PublicHealth/pdf/dataPublications/communityHealthAssessment/2
013Stanislaus County Health Services Agency. (2013b). Framework for a thriving Stanislaus:
Healthy people 2020 and community transformation [pdf]. Retrieved from
http://www.schsa.org/pdf/communityHealthReport/2013/ph-report2013.pdf
Stanislaus County Health Services Agency. (2014). Community health assessment [pdf].
Retrieved from
http://www.stancounty.com/bhrs/pdf/CommunityHealthAssessment/BriefCommunityHea
lthAssessment2013.pdf
Stanislaus County Profile. (2015). Community profile: The vibrant nature of Stanislaus County
[pdf]. Retrieved from http://www.stancounty.com/budget/fy2014-2015/firstquarter/community-profile.pdf

POPULATION ANALYSIS

30

Stanislaus Local Agency Formation Commission. (2006). Municipal service review [pdf].
Retrieved from http://www.stanislauslafco.org/info/PDF/FireMSR/Ch4-Growth.pdf
State of California Employment Development Department (2015). Immediate metropolitan
statistical area [pdf]. Retrieved from
http://www.calmis.ca.gov/file/lfmonth/mode$pds.pdf
Tong, O., & Hutchins, S. (2013). Community health needs assessment of Stanislaus County 2013
[pdf]. Retrieved from http://www.schsa.org/publichealth/pdf/dataPublications/2013Stanislaus-County-Health-Needs-Assessment-for-Memorial-Medical-CenterFullReport.pdf
Tong, O., Hutchins, S., & Hooda, C. (2013). 2013 Stanislaus County community health
assessment [pdf]. Retreived from
http://www.schsa.org/PublicHealth/pdf/dataPublications/communityHealthAssessment/0
13-Stanislaus-County-Community-Health-Assessment.pdf
United States Census Bureau. (n.d.a). Quickfacts beta. Retrieved from
http://www.census.gov/quickfacts/
United States Census Bureau. (n.d.b). 2011-2013 American community survey 3-year estimates.
Retrieved from
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk
United States Census Bureau. (2012). Table 17 age dependency ratios by state: 2000 and 2010
[pdf]. Retrieved from https://www.census.gov/compendia/statab/2012/tables/12s0017.pdf
United States Census Bureau. (2010a). Aging boomers will increase dependency ration, Census
Bureau projects. Retrieved from
http://www.census.gov/newsroom/releases/archives/aging_population/cb10-72.html

POPULATION ANALYSIS

31

United States Census Bureau. (2010b). Profile of general demographic characteristics: 2010.
Retrieved from
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmktes
United States Census Bureau. (2013). Profile of selected social characteristics. Retrieved from
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF
United States Census Bureau. (2014) Stanislaus County, California. Retrieved from
http://quickfacts.census.gov/qfd/states/06/06099.html
United States Environmental Protection Agency. (2013). Toxic release inventory program.
Retrieved from http://www2.epa.gov/toxics-release-inventory-tri-program/2013-trinational-analysis-where-you-live