GREATER PASADENA Oral Health Needs Assessment

February 2019

Funded by the CDPH under Contract #17-10700

Greater Pasadena

Oral Health Needs Assessment

Pasadena Public Health Department

Prepared by

Pasadena Local Oral Health Program

For more information please contact:

Pasadena Local Oral Health Program

1845 N. Fair Oaks Ave.

Pasadena, CA 91103

Phone: (626) 744-6073

Website: https://www.cityofpasadena.net/public-health/local-oral-health-program/

Suggested citation: Pasadena Public Health Department. Greater Pasadena Oral Health Needs Assessment. February 2019.

TABLE OF CONTENTS Executive Summary......................................................................................................................... 1

Introduction ................................................................................................................................... 3

Background ........................................................................................................................................... 3

Regions of Focus ................................................................................................................................... 3

Methods ......................................................................................................................................... 4

Needs Assessment Process ................................................................................................................... 4

Advisory Committee ............................................................................................................................. 5

Data Sources and Collection ................................................................................................................. 5

Findings .......................................................................................................................................... 6

Demographics ....................................................................................................................................... 6

Disease Burden ..................................................................................................................................... 8

Risk Factors and Protective Factors .................................................................................................... 11

Access to Services ............................................................................................................................... 13

Dental Utilization ................................................................................................................................ 17

Community Input ................................................................................................................................ 26

Appendices ................................................................................................................................... 28

Appendix 1: Oral Health Advisory Committee and Staff .................................................................... 29

Appendix 2: Key Informant Interviewees ........................................................................................... 31

Appendix 3: Key Informant Interview Survey ..................................................................................... 32

References .................................................................................................................................... 34

1

EXECUTIVE SUMMARY

Oral health plays an important role in overall health and well-being. Poor oral health affects one’s

ability to eat nutritious foods, talk and interact with others, and concentrate at work or school.1 The

ability to smile can have a large impact on self-esteem and how a person is perceived by others,

which can affect the ability to succeed in school or get a job. Oral health is a particularly important

issue in children’s health and development: tooth decay is the number one chronic health condition

in children, five times more common than asthma.1

The Pasadena Public Health Department’s Local Oral Health Program conducted this Oral Health

Needs Assessment to understand the state of oral health in Pasadena and establish baseline

measures to evaluate progress over time. Community partners and stakeholders played a key role in

the development of this Needs Assessment by contributing program data, participating in key

informant interviews, and providing feedback on preliminary results. The findings from this Needs

Assessment will be used to develop an Oral Health Improvement Plan to guide collective impact

efforts focused on improving oral health in Pasadena. A summary of key findings is provided below.

Additional details and data source information for each key finding can be found throughout the

Needs Assessment report.

Key Findings from the Oral Health Needs Assessment

Disease Burden

Approximately 22% of children enrolled in Head Start in Pasadena were identified as needing

dental treatment as of October 2018.

Approximately 29% of preschool children screened by Young & Healthy’s Teeny Teeth

program in 2018 were identified as needing dental treatment.

Over three-quarters of all children at Washington Elementary School (76%) and over half of all

children at Altadena Elementary School (53%) were identified as needing dental treatment in

Fall 2018.

Almost one-fifth (19%) of kindergartners in the Pasadena Unified School District had

untreated dental decay during the 2017-2018 school year.

Risk Factors and Protective Factors

Approximately 13% of Pasadena adults were current smokers in 2014.

Approximately 14% of Pasadena adults reported drinking soda or sugar-sweetened beverages

at least one time per day in 2014.

Pasadena tap (drinking) water is 100% fluoridated.

2

Access to Services

As residents of Los Angeles County, Pasadena residents covered by Medi-Cal can receive

dental care from providers either through the Dental Fee-For-Service (FFS) system or the

Dental Managed Care (DMC) system. There are three plans available to Medi-Cal beneficiaries

that choose to participate in a DMC plan: Premier Access Dental, LIBERTY Dental, and Health

Net Dental.

Thirty-nine dental providers in the greater Pasadena area accept Medi-Cal Dental Fee-For-

Service (across all specialties).

The highest concentration of dental providers is located in Pasadena’s central commercial

area. Northwest Pasadena (an area with higher poverty rates) has comparatively fewer dental

providers, but is home to two large Federally Qualified Health Centers with dental clinics

(ChapCare and Wesley Health Centers-JWCH Institute).

Dental Utilization

In the San Gabriel Valley Service Planning Area (SPA 3), there are more children who have

never been to the dentist and fewer children who visited the dentist within the last year,

compared to California. Similarly, in SPA 3, there are fewer adults who visited the dentist

within the last year and more adults who visited the dentist over one year ago compared to

California.

In 2016, slightly more than half (56%) of the pregnant women surveyed in Pasadena reported

visiting the dentist during pregnancy. The top three reasons for not visiting the dentist during

pregnancy were: “I didn’t need to go” (30%), “I didn’t have dental insurance” (21%), and “I

didn’t think of it” (11%).

In 2017, 28% of Medi-Cal beneficiaries in Greater Pasadena had an annual dental visit and

19% had a preventive dental visit. These rates are both lower than California rates (30% and

21%, respectively).

In 2017, less than one-fifth (16%) of Medi-Cal beneficiaries 6-14 years of age had at least one

dental sealant.

There are significant disparities in utilization of an emergency department (ED) for dental

conditions. ED visits for dental conditions among African Americans are almost 4 times higher

than their White counterparts (40 visits/10,000 population vs. 11 visits/10,000 population).

Community Input

Seventeen key informant interviews were conducted with leaders of local organizations

serving the Pasadena community.

Education emerged as an important theme: two of the top three oral health needs identified

by key informants, as well as the top barrier to utilization of oral health services, all focused

on the need for increased education on oral health.

3

INTRODUCTION

Background Oral health is essential to overall health. It affects almost every aspect of our lives, from how we look,

to what we eat, to where we work. Although safe and effective methods exist to improve oral health

and prevent disease, many Americans still suffer from poor oral health. Children are particularly

affected, with more children suffering from dental caries than any other chronic childhood disease,

even asthma.1 Recognizing the importance of oral health in contributing to overall health, the

California Department of Public Health created the 2018-2022 California Oral Health Plan. Through

the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, funds were allocated to

local health jurisdictions to implement local activities supporting the Oral Health Plan. The Pasadena

Public Health Department conducted the Oral Health Needs Assessment to understand the state of

oral health in Pasadena and establish baseline measures to evaluate progress over time. A Pasadena

Oral Health Improvement Plan will then be developed to outline priority objectives and strategies for

improving oral health in Pasadena based on the California Oral Health Plan, findings of the Needs

Assessment, and community input.

Regions of Focus Pasadena is one of three cities in California with its own local health department. As such, the

primary focus of the Pasadena Local Oral Health Program is the city of Pasadena. Data for this Needs

Assessment was designed to include city-level data, but when that level of granularity was not

available, higher geographic levels were used. The three primary geographic regions used in this

report are: City of Pasadena (Figure 1), Greater Pasadena (Figure 1), and Service Planning Area (SPA) 3

– San Gabriel Valley (Figure 2). Greater Pasadena is made up of the following nine ZIP codes: 91001,

91030, 91101, 91103, 91104, 91105, 91106, 91107, and 91108.

FIGURE 2. LOS ANGELES COUNTY AND

SERVICE PLANNING AREA (SPA) 3 - SAN

GABRIEL VALLEY

FIGURE 1. CITY OF PASADENA

4

METHODS

Needs Assessment Process

This Needs Assessment was developed using a framework from the Association of State and

Territorial Dental Directors2 (Figure 3). There are seven steps in this process: 1) Identify partners and

form advisory committee, 2) Conduct self-assessment to determine goals and resources, 3) Plan

Needs Assessment, 4) Collect data, 5) Organize and analyze data, 6) Utilize data for program planning,

advocacy and education, and 7) Evaluate Needs Assessment.

FIGURE 3. NEEDS ASSESSMENT PROCESS2

Step 1: Identify partners and form advisory committee

Step 2: Conduct self-assessment to determine goals

and resources

Step 3: Plan Needs Assessment

Step 4: Collect data Step 5: Organize and analyze

data

Step 6: Utilize data for program planning, advocacy

and education

Step 7: Evaluate Needs Assessment

5

Advisory Committee

An Advisory Committee composed of 31 local partners with experience working on oral health issues

in Pasadena was convened to guide the development of this Oral Health Needs Assessment. Advisory

Committee members were involved throughout the entire process to ensure community input and

involvement in the Local Oral Health Program’s activities. Advisory Committee members played a key

role in the data collection process by providing program-specific data to supplement existing

secondary data sources. The Advisory Committee also reviewed preliminary data and provided input

on the areas of greatest need based on the Needs Assessment findings and their personal

experiences working in the community.

Data Sources and Collection

Secondary Data

Secondary data from a variety of sources was used to obtain population-level quantitative data,

including the U.S. Census and the California Health Interview Survey, the largest state health survey

in the country.3 The Pasadena Public Health Department, with the help of the California Department

of Public Health, also successfully made a request to the California Department of Health Care

Services for Medi-Cal Dental utilization data at the local-level (it was previously only available at the

county-level).

Program data from various organizations in Pasadena was used to supplement the population-level

secondary data. The Pasadena Public Health Department worked with members of the Advisory

Committee to collect and analyze programmatic data. Organizations that provided data for this

Needs Assessment include Young & Healthy, Pasadena Unified School District, Options for Learning

Head Start, Pacific Clinics Head Start, ChapCare, JWCH Institute, San Gabriel Valley Dental Society,

and the Pasadena Public Health Department Health Insurance Enrollment Program.

Primary Data

The Pasadena Maternal and Infant Health Assessment (MIHA) is a population-based survey

distributed to a sample of new mothers in Pasadena designed to be representative of the larger

population. This survey is designed, collected, and analyzed by the Pasadena Public Health

Department. Data in this Needs Assessment is from the 2016-2017 MIHA. The 2018-2019 MIHA is

currently under development and will continue to include measures on oral health and pregnancy.

For this Needs Assessment, seventeen key informant interviews were conducted with key

stakeholders in the Pasadena community. These interviews lasted approximately one hour and took

place over a two week period during November 2018. Pasadena Local Oral Health Program staff

designed the questionnaire, conducted the interviews, and analyzed all resulting qualitative data.

The questionnaire and a list of interviewees is included in the appendix.

6

FINDINGS

Demographics

Population by Age

The population of the city of Pasadena is 141,231, which is approximately 1.4% of the Los Angeles

County population.4 There are 25,761 children under 18 years of age in Pasadena, which is

approximately 18% of the population. Pasadena residents are generally older than LA County

residents, with a median age of 38 years in Pasadena compared to 36 years in LA County. In addition,

compared to LA County, a greater percentage of the population in Pasadena is over 60 years of age,

and less of the population is under 24 years of age4 (Figure 4).

FIGURE 4. POPULATION BY AGE, CITY OF PASADENA, 2013-20174

Population by Race The majority of Pasadena residents (53.9%) identify as White, followed by Asian (16.3%) and Black/

African American (10.2%)4 (Figure 5). A lower percentage of Pasadena residents (34.4%) identify as

Hispanic compared to the percentage in LA County (48.4%).4 In both Pasadena and LA County,

Hispanic children make up a larger percentage of the population when considering only children

under 18 years of age (48.8% vs. 34.4% in Pasadena and 61.9% vs. 48.4% in LA County).5

6.4%

4.8% 4.5%4.9%

6.6%

18.3%

14.5%

12.9%

6.2%5.5%

8.3%

4.8%

2.4%

6.3% 6.1% 6.2%6.6%

7.5%

15.8%

13.8% 13.7%

6.2%

5.3%

7.0%

3.7%

1.8%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

<5 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-59 60-64 65-74 75-84 85+

Pasadena Los Angeles County

7

FIGURE 5. POPULATION BY RACE, CITY OF PASADENA, 2013-20174

Education and Socio-Economic Status of Children

A higher percentage of children in Pasadena (28.0%) attend private schools compared to the

percentage in LA County (11.7%)5 (Figure 6). In regards to socio-economic status, 20.5% of Pasadena

children lived in households that received public assistance, compared to 27.2% in LA County.5

Additionally, 18.4% of Pasadena children lived in households with income below the poverty level,

compared to 24.0% in LA County.5

FIGURE 6. PUBLIC AND PRIVATE SCHOOL ENROLLMENT, 2013-20175

53.9%

16.3%

10.2%

0.3% 0.2%

15.1%

4.0%

51.8%

14.5%

8.2%

0.7% 0.3%

20.8%

3.8%

0%

10%

20%

30%

40%

50%

60%

White Asian Black or AfricanAmerican

American Indianand Alaska Native

Native Hawaiianand Other Pacific

Islander

Some other race Two or moreraces

Pasadena Los Angeles County

88.3%

72.0%

11.7%

28.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Los Angeles County Pasadena

Public Private

8

Disease Burden

Dental caries is the most common chronic childhood disease, affecting 5 times as many children as

asthma.1 Poor oral health can affect all aspects of a child’s life, from what they eat, to how they look,

to how they communicate with peers. It can also lead to school absenteeism, difficulty learning, and

diminished self-esteem. These all have a significant effect on a child’s overall health and wellbeing.1

Preschool Children Oral health screenings and dental assessments administered through preschool programs provide a

snapshot of the oral disease burden among children ages 0-5 in Pasadena. In 2018, 199 children were

screened at six Pasadena preschools through the Young & Healthy Teeny Teeth Program. Of those

screened, 23.1% were identified as having possible signs of cavities and 6.0% were identified as

needing immediate treatment6 (Figure 7). Children in the Options for Learning Head Start Program,

which operates in Pasadena and Eagle Rock and is the only administrator of Head Start in Pasadena,

are required to visit a dentist annually and report the results from their visit back to Options for

Learning. As of late October 2018, 454 of the total 515 children (88.2%) enrolled had record of at

least one dental visit. Of these 454 Head Start children, 22.5% were identified as needing dental

treatment7 (Figure 8).

*Teeny Teeth data includes children screened at all four PUSD full-day preschools, as well as the Pasadena City College Child Development Center and Families Forward Learning Center. N=199 children.

77.5%

22.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Head Start**

Did not need treatment Needed treatment

70.9%

23.1%

6.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Teeny Teeth*

Needed immediate treatment

Had possible signs of cavities

Did not need treatment

FIGURE 7. ORAL HEALTH OF PRESCHOOL CHILDREN

SCREENED IN TEENY TEETH PROGRAM6

FIGURE 8. ORAL HEALTH OF CHILDREN

ENROLLED IN HEAD START7

**Options for Learning Head Start data includes 5 Pasadena sites and 3 Eagle Rock sites. N=454 children.

9

Kindergarten Children State law (AB1433) requires that all California public school children present proof to their school of

receiving an oral health assessment by May 31 of their kindergarten year (or first grade if they did not

attend public school for kindergarten), unless the parent completes a waiver. In Pasadena, Young &

Healthy (a local nonprofit) partners with the Herman Ostrow School of Dentistry at the University of

Southern California (USC) to provide in-school oral health screenings for all, or nearly all, kindergarten

classrooms in the Pasadena Unified School District (PUSD). The results from these screenings

combined with the AB1433 data show that around 19% of PUSD kindergartners had untreated dental

decay during the 2017-2018 school year. This represents an increase from the 2016-2017 school year,

when 17% of PUSD kindergartners were identified as having untreated dental decay8 (Figure 9). A

higher percentage of PUSD kindergartners have been identified as having untreated dental decay

compared to all public school kindergartners across Los Angeles County (17% vs. 12% for 2016-2017)9

(Figure 10).

FIGURE 9. PERCENTAGE OF PUSD KINDERGARTENERS WITH UNTREATED DENTAL DECAY, 2014-20188

FIGURE 10. PERCENTAGE OF PUSD KINDERGARTENERS WITH UNTREATED DENTAL DECAY COMPARED TO LA

COUNTY, 2016-2017 SCHOOL YEAR9

17.2%

11.4%

17.2%

19.1%

0%

5%

10%

15%

20%

25%

2014-2015 2015-2016 2016-2017 2017-2018

17.1%

12.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

PUSD Los Angeles County

*Slight difference between rates reported in Figures 8 and 9 for 2016-2017 school year due to different data sources

10

Elementary and Middle School Children During November and December 2018, children at four Pasadena Unified School District (PUSD)

elementary schools (out of eighteen total) and two PUSD middle schools (out of six total) received

oral health screenings. Screenings were performed by a faculty dentist and a team of dental students

from the USC Herman Ostrow School of Dentistry. Young & Healthy coordinated these screenings in

partnership with PUSD.

Elementary school: Screenings were performed at Altadena, Jackson, Longfellow, and Washington

Elementary Schools. At Altadena, Jackson, and Washington, all students in attendance in all grades

were screened. At Longfellow, students in grades 1-5 were screened (kindergartners were screened

separately as part of the kindergarten-specific screenings described on page 9). Over three-quarters

of all children at Washington (76.2%) and over half of all children at Altadena (52.7%) were identified

as needing some type of dental treatment.10 Additionally, 14.2% of Washington students and 10.7%

of Altadena students needed urgent treatment or had an infection present. At Longfellow and

Jackson, over one-quarter of the students screened were identified as needing dental treatment

(31.6% and 26.7% respectively)10 (Figure 11).

FIGURE 11. RESULTS OF PUSD ELEMENTARY SCHOOL ORAL HEALTH SCREENINGS, 201810

Middle school: Screenings were performed at Eliot and Washington Middle Schools. At Eliot, all

students in attendance during five Physical Education (PE) periods were screened. At Washington, all

students in attendance during two PE periods were screened. Similar to the elementary school data,

approximately three-quarters (74.9%) of children screened at Washington Middle School were

identified as needing dental treatment. The majority of students screened (70.7%) were identified as

needing early treatment, while 4.2% either needed urgent treatment or had an infection present. At

23.8% 47.3% 68.4% 73.3%

62.0%

42.0%

25.1%22.6%

11.5%10.7% 4.5% 2.6%

2.7% 0.0% 2.1% 1.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Washington (n=442) Altadena (n=205) Longfellow (n=335) Jackson (n=580)

No treatment needed Early treatment needed* Urgent treatment needed** Infection present

76.2%

52.7%

31.6% 26.7%

*Early treatment needed indicates the child may have a small cavity, have clear plaque buildup, need a sealant, and/or other similar dental problem. **Urgent treatment needed indicates the child has a more urgent need than those listed above as “early treatment,” but no infection is present.

11

Eliot, a lower percentage of middle school students were identified as needing any treatment

(29.2%). However, like Washington, most of the students identified as needing treatment needed

early treatment rather than urgent (27.7% vs. 1.5%)10 (Figure 12).

FIGURE 12. RESULTS OF PUSD MIDDLE SCHOOL ORAL HEALTH SCREENINGS, 201810

Risk Factors and Protective Factors

Like many chronic diseases, the risk of developing oral disease is impacted by certain behaviors and

environments that can act as risk and protective factors. Two of the main risk factors for decreased

oral health are use of tobacco products and consumption of sugar-sweetened beverages. One of the

main protective factors is community water fluoridation.

Tobacco Products

The link between use of tobacco products and adverse oral health outcomes has been well

documented in scientific literature. Smoking has been associated with oral cancer, periodontitis (gum

infection), tooth loss, dental caries, and failure of dental implants.11 According to the California

Health Interview Survey, approximately 12.9% of Pasadena adults over 18 years of age are current

smokers.12 This is about the same as the percentage of current smokers in Los Angeles County

(12.0%) and California (12.6%). However, there is a slightly higher percentage of current smokers in

Glendale (14.1%) and a slightly lower percentage of current smokers in Santa Monica (10.4%), two

comparable cities to Pasadena on various population characteristics, including size, income, and age

distribution12 (Figure 13).

25.1% 70.8%

70.7%

27.7%

2.4% 1.5%1.8% 0.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Washington (n=167) Eliot (n=202)

No treatment needed Early treatment needed* Urgent treatment needed** Infection present

*Early treatment needed indicates the child may have a small cavity, have clear plaque buildup, need a sealant, and/or other similar dental problem. **Urgent treatment needed indicates the child has a more urgent need than those listed above as “early treatment,” but no infection is present.

29.2%

74.9%

12

FIGURE 13. PERCENTAGE OF ADULTS (18+) WHO ARE CURRENT SMOKERS, 201412

Soda and Sugar-Sweetened Beverages

Consumption of sugar-sweetened beverages has been linked to an increased risk of developing

cavities, regardless of socio-demographic characteristics and use of fluoride toothpaste.13 An

estimated 14.2% of Pasadena adults (age 18 and over) report drinking soda or sugar-sweetened

beverages at least one time per day. This is a lower percentage than LA County and California

averages (17.7% and 17.4% respectively), but higher than comparison cities of Glendale and Santa

Monica (10.9% and 10.3% respectively)14 (Figure 14).

FIGURE 14. PERCENTAGE OF ADULTS WHO DRINK SODA OR SUGAR-SWEETENED BEVERAGES AT LEAST 1 TIME PER

DAY, 201414

10.4%

14.1%

12.9%12.0%

12.6%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Santa Monica Glendale Pasadena LA County California

10.3% 10.9%

14.2%

17.7% 17.4%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Santa Monica Glendale Pasadena LA County California

13

Community Water Fluoridation Community water fluoridation (i.e. the inclusion of fluoride in a community’s drinking water supply)

has been shown to be a safe and effective intervention to reduce cavities.15,16 It has been so

successful in reducing the prevalence of tooth decay that the U.S. Centers for Disease Control and

Prevention identified it as one of the ten great public health achievements of the 20th century.16,17 In

line with these findings and recommendations, Pasadena water is fluoridated. The Metropolitan

Water District (MWD), a consortium of cities and water agencies across Southern California that

import water from the Colorado River and from Northern California, provide about 60% of

Pasadena’s water. MWD fluoridates their water supply to 0.6 to 1.0 parts per million (ppm). This

water is then mixed with local Pasadena groundwater, which has naturally occurring fluoride levels of

0.5 to 1.5 ppm. This mixture of MWD water and local groundwater results in a concentration of

fluoride ranging from 0.4 to 1.4 ppm in Pasadena’s water, with an average concentration of 0.8

ppm.18

Access to Services

Access to Dental Providers

Data on the number and geographic distribution of dental providers in Pasadena was provided by the

San Gabriel Valley Dental Society. There are approximately 164 dental providers in the greater

Pasadena area (defined here as including the cities of Pasadena, South Pasadena, Altadena, and San

Marino) who are members of the San Gabriel Valley Dental Society. There are an estimated 68

additional dental providers in the greater Pasadena area who are not members of the San Gabriel

Valley Dental Society. These figures together produce approximately 232 dental providers in the

greater Pasadena area.19 However, it is important to note these numbers are approximate and may

include multiple providers in the same dental office.

A geographic distribution of dental providers in the greater Pasadena area, compared to the

distribution of poverty by census tract, is presented in Figure 15. Because Pasadena has centralized

commercial centers and city zoning laws, the highest concentration of dental providers is in the

commercial downtown and central areas of the city. Because of this central clustering, Northwest

Pasadena (an area with higher poverty rates) has comparatively fewer dental providers. Though this

could normally indicate geographic access to care issues, large low- to no-cost dental providers, such

as Pasadena’s two Federally Qualified Health Centers, ChapCare and Wesley Health Centers-JWCH

Institute, are situated in the middle of the Northwest Pasadena area and report regular openings in

their dental appointment schedule.

14

FIGURE 15. DISTRIBUTION OF DENTAL PROVIDERS19 COMPARED TO DISTRIBUTION OF POVERTY BY CENSUS TRACT20

Medi-Cal Dental Providers

Medi-Cal dental coverage is offered through two systems: Dental Fee-For-Service (FFS) and Dental

Managed Care (DMC). Dental FFS (also commonly referred to as “Denti-Cal”) is the only system

offered in all counties in California except Los Angeles and Sacramento. In Sacramento, DMC is

required for almost all beneficiaries (with a few exceptions). Los Angeles is the only county to offer

beneficiaries a choice between DMC and FFS. Medi-Cal beneficiaries in Los Angeles County must opt-

in if they wish to join a DMC plan, otherwise they will be automatically enrolled in the FFS delivery

system.21

If a beneficiary wishes to participate in DMC, there are three managed care plans to choose from:

Health Net Dental, LIBERTY Dental, and Premier Access Dental. In Los Angeles County, DMC plans are

also called Prepaid Health Plans (PHP). In the greater Pasadena area (defined here as including the

cities of Pasadena, South Pasadena, Altadena, and San Marino) there are 44 total unique providers in

the Health Net Dental plan,22 24 in the LIBERTY Dental plan (accepting new patients only),23 and 35 in

the Premier Access Dental plan.24 These are the counts of unique providers within each plan, but are

not unique across plans since many providers accept multiple plans. Table 1 provides a breakdown of

the providers by plan and specialty.

15

TABLE 1. PROVIDERS IN GREATER PASADENA ACCEPTING DENTAL MANAGED CARE BY PLAN AND SPECIALTY22,23,24

Specialty Health Net Dental LIBERTY Dental* Premier Access Dental

General 44 21 13

Endodontist 1 2 6

Oral surgeon 0 0 6

Orthodontist 0 1 5

Pedodontist 0 0 1

Periodontist 0 1 4

Prosthodontist 0 0 0

Total unique providers** 44 24 35 *Only includes providers accepting new patients. LIBERTY Dental’s provider directory does not allow searches of providers not

accepting new patients.

**Some providers in the Health Net and LIBERTY plans are listed as both a general dentist and a specialist. This total reflects the

number of unique providers within each plan, not including these duplicates. However, there are many providers that accept multiple

plans so these totals are not unique across plans. These totals also many include multiple providers in one office.

Note: Data is as of February 4, 2019 and includes providers in Pasadena, South Pasadena, Altadena, and San Marino. Data is from online

provider directories for each plan and is subject to change.

There are 39 dental providers in the greater Pasadena area (again defined here as the cities of

Pasadena, South Pasadena, Altadena, and San Marino) that accept Dental Fee-For-Service (across all

specialties).25 This includes two Federally Qualified Health Centers (FQHCs), ChapCare and Wesley

Health Centers-JWCH Institute. A geographic distribution of these providers is presented in Figure 16.

These providers are not unique from the DMC providers above, as many providers accept both FFS

and DMC.

FIGURE 16. DISTRIBUTION OF MEDI-CAL DENTAL FEE-FOR-SERVICE PROVIDERS25

16

Other Supportive Community Resources Community, educational, and government organizations also play an important role in supporting

oral health in Pasadena. Table 2 below lists some of the main organizations that play a role in

Pasadena oral health efforts, either by connecting community members to dental care, providing

education, or assisting with insurance enrollment. Most organizations listed below focus specifically

on underserved and low-income populations. There are numerous organizations working towards

improving health and wellbeing in Pasadena, so this is not an exhaustive list. A more comprehensive

list of organizations and resources available to Pasadena residents (including, but not limited to, oral

health) is provided in the Pasadena Survival Guide 2016-2018. This is available freely online and can

be accessed at https://www.cityofpasadena.net/wp-content/uploads/SURVIVAL-GUIDE-2016-

2018.pdf. There is also a list of community resources included in the Greater Pasadena Community

Health Needs Assessment. This can be found on the Pasadena Public Health Department’s data page:

https://www.cityofpasadena.net/public-health/data/.

TABLE 2. ORAL HEALTH COMMUNITY RESOURCES

Organization

Connect individuals/ families to dental care

Offer oral health

education

Offer insurance

enrollment services

Offer general health

education programs

Young & Healthy X X X X

Pasadena Unified School District X X X

Pacific Clinics Early Head Start X X X

Options for Learning Head Start X X X

Families Forward Learning Center X X

Day One X X

Women, Infants, and Children (WIC)

Program X X

Black Infant Health Program X X

Foothill Unity Center X X X X

Child Health and Disability Prevention

Program X

Pasadena Public Health Department Health

Insurance Enrollment Program X

Department of Public Social Services X

17

Dental Utilization

Dental utilization rates give a picture of how different populations access dental services. Utilization

data is presented below for the general population (including children, adults, and pregnant women),

the Medi-Cal population, and the patient population at Pasadena’s two Federally Qualified Health

Centers (FQHCs). Data is also included on emergency department visits for dental conditions.

Population-Based Utilization

Children: According to the California Health Interview Survey (CHIS), there is consistently a higher

percentage of children in the San Gabriel Valley Service Planning Area (SPA 3) that have never been to

the dentist compared to the percentage across California26 (Figure 17). During 2015-2016, 18.1% of

children in SPA 3 had never been to the dentist, compared to 14.1% in California. SPA 3 also has a

slightly lower percentage of children who visited the dentist within the last year than across

California, although the gap has narrowed in recent years26 (Figure 18). These two indicators suggest

children in SPA 3 are visiting the dentist at lower-than-average rates.

FIGURE 17. PERCENTAGE OF CHILDREN* WHO HAVE NEVER BEEN TO THE DENTIST26

FIGURE 18. PERCENTAGE OF CHILDREN* WHO VISITED THE DENTIST WITHIN THE LAST YEAR26

21.7%**20.0%**

18.1%**17.7%

15.1%14.1%

0%

5%

10%

15%

20%

25%

2013-2014 2014-2015 2015-2016

SPA 3 CA

68.1%

79.4% 81.6%**78.7% 81.4% 82.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2013-2014 2014-2015 2015-2016

SPA 3 CA

*Includes all children ages 3-11 and those under 3 who have teeth **Estimate is statistically unstable Note: Estimates pooled across 2013-2014, 2014-2015, and 2015-2016 for statistical stability

*Includes all children ages 3-11 and those under 3 who have teeth **Estimate is statistically unstable Note: Estimates pooled across 2013-2014, 2014-2015, and 2015-2016 for statistical stability

18

Adults: CHIS data also indicates that adults in SPA 3 are visiting the dentist at rates lower than

California rates. In 2016, a lower percentage of adults in SPA 3 reported visiting the dentist within the

last year (66.9%) and a higher percentage of adults in SPA 3 reported visiting the dentist over one

year ago (31.9%), compared to the percentages across California (70.3% and 27.3%, respectively)27

(Figures 19 and 20).

FIGURE 19. PERCENTAGE OF ADULTS (18+) WHO VISITED THE DENTIST WITHIN THE LAST YEAR27

FIGURE 20. PERCENTAGE OF ADULTS (18+) WHO VISITED THE DENTIST OVER ONE YEAR AGO27

Pregnant Women: Visiting a dentist during pregnancy is an important part of ensuring a healthy

pregnancy for the mother and baby.28 Despite studies showing the safety of receiving routine dental

care during pregnancy, many women do not visit the dentist during their pregnancy.29,30 Pregnancy is

a particularly important time to visit the dentist because hormonal changes during pregnancy can

increase the risk of developing gingivitis.31 A dental visit during pregnancy can also provide an

opportunity for dental providers to counsel expectant mothers on proper oral care for their children

and how to avoid transmission of caries-causing bacteria from mother to child.29,30

60.8%

66.9%

68.7%

70.3%

56%

58%

60%

62%

64%

66%

68%

70%

72%

2013-2014 2016

SPA 3 CA

34.9%31.9%**

29.3%27.3%

0%

5%

10%

15%

20%

25%

30%

35%

40%

2013-2014 2016

SPA 3 CA

Note: Estimates pooled across 2013-2014 for statistical stability; 2015 data not available

**Estimate is statistically unstable Note: Estimates pooled across 2013-2014 for statistical stability; 2015 data not available

19

According to the 2016-2017 Pasadena Maternal and Infant Health Assessment, a population-based

survey distributed to a sample of new mothers in Pasadena, 55.8% of survey respondents reported

visiting the dentist during pregnancy.32 This is higher than in Los Angeles County and California (37.4%

and 43.0%, respectively)33 (Figure 21). The top three reasons identified by Pasadena women for not

visiting the dentist during pregnancy were “I didn’t need to go” (29.8%), “I didn’t have dental

insurance” (21.1%), and “I didn’t think of it” (10.5%)32 (Figure 22).

FIGURE 21. PERCENTAGE OF PREGNANT WOMEN WITH A DENTIST VISIT DURING PREGNANCY32,33

FIGURE 22. MAIN REASON WHY PREGNANT WOMEN DID NOT SEE A DENTIST DURING PREGNANCY32

55.8%

37.4%

43.0%

0%

10%

20%

30%

40%

50%

60%

Pasadena LA County California

29.8%

21.1%

10.5%

8.8%

7.0%

7.0%

5.3%

5.3%

1.8% 3.5%

I didn't need to go

I didn't have dental insurance

I didn't think of it

I was too busy

I didn't want to

I read or heard somewhere Ishouldn't when pregnantI thought it would cost too much

My doctor or nurse told me NOTto

20

Medi-Cal Dental Utilization Annual Dental Visit: The California Department of Health Care Services (DHCS), which administers

the Medi-Cal Program, tracks various measures of dental utilization by Medi-Cal beneficiaries. In

2017, the percentage of beneficiaries in Greater Pasadena with an annual dental visit was slightly

lower than the percentage in California (27.6% vs. 29.9%)34 (Figure 23). Across age groups, children

ages 6-9 have the highest utilization rate (61%), with utilization steadily declining in older age

categories34 (Figure 24). A similar trend is seen statewide (data not shown).

Preventive Dental Visit: DHCS also tracks the percentage of Medi-Cal beneficiaries who received at

least one preventive dental service. In 2017, 19.1% of Medi-Cal beneficiaries in Greater Pasadena had

a preventive dental visit, slightly lower than the 21.4% with a preventive visit across California34

(Figure 23). Broken down by age group, children ages 6-9 again have the highest utilization rate (56%)

with a consistent decline in utilization among older children. Across all age groups, the percentage of

Medi-Cal beneficiaries in Greater Pasadena with a preventive dental visit is lower than the

percentage with an annual dental visit34 (Figure 24).

FIGURE 23. PERCENTAGE OF MEDI-CAL BENEFICIARIES WITH AN ANNUAL AND PREVENTIVE DENTAL VISIT IN

GREATER PASADENA AND CALIFORNIA, 201734

27.6%

19.1%

29.9%

21.4%

0%

5%

10%

15%

20%

25%

30%

35%

Annual visit Preventive visit

Greater Pasadena California

Note: Percentages calculated based on the total number of Full Scope Eligibles with no continuous eligibility requirements

21

FIGURE 24. PERCENTAGE OF MEDI-CAL BENEFICIARIES WITH AN ANNUAL AND PREVENTIVE DENTAL VISIT IN

GREATER PASADENA, BY AGE GROUP, 201734

Sealants: Dental sealants are a safe and effective way to prevent cavities. In fact, sealants on a

permanent molar have been shown to reduce the risk of cavities by 80%.35 Sealants are a covered

service under Medi-Cal Dental for children and adolescents up to age 21. In Greater Pasadena, 16.5%

of Medi-Cal beneficiaries 6-14 years of age had at least one dental sealant.34 Broken down by age,

there is a higher percentage of children ages 6-9 with at least one dental sealant than children ages

10-14 (18.4% vs. 14.9%)34 (Figure 25).

FIGURE 25. PERCENTAGE OF MEDI-CAL BENEFICIARIES AGES 6-14 WITH A DENTAL SEALANT, 201734

26%

59%61%

56%

46%

24%

19%18%

52%56%

51%

38%

19%

10%

0%

10%

20%

30%

40%

50%

60%

70%

Age 0-2 Age 3-5 Age 6-9 Age 10-14 Age 15-18 Age 19-20 Age 21+

Annual visit Preventive visit

16.5%

18.4%

14.9%16.3%

17.7%

15.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

All Ages Age 6-9 Age 10-14

Greater Pasadena California

Note: Percentages calculated based on the total number of Full Scope Eligibles with no continuous eligibility requirements

22

Dental Benefit Utilization: The Pasadena Public Health Department (PPHD) provides Medi-Cal

enrollment services to assist eligible community members to sign up for benefits. PPHD staff attempt

to contact all enrolled clients 4-6 months after enrollment to offer utilization assistance and

determine if benefits have been utilized. Among those enrolled in Medi-Cal at PPHD, about one-third

utilized their dental benefits within 6 months of enrollment36 (Figure 26).

FIGURE 26. PERCENTAGE OF CLIENTS ENROLLED IN MEDI-CAL AT PPHD WHO UTILIZED DENTAL BENEFITS WITHIN 6

MONTHS OF ENROLLMENT36

FQHC Dental Utilization

There are two Federally Qualified Health Centers (FQHCs) located in Pasadena: ChapCare and Wesley

Health Centers-JWCH Institute. Both provide medical and dental services to low-income populations.

ChapCare provides dental services to patients of all ages, including regularly serving children 0-5

years of age. JWCH Institute also provides dental services to patients of all ages, but the vast majority

of their patients are over 18 years of age.

Sealants: In 2016, about half (49%) of all ChapCare patients 6-9 years of age who received an oral

assessment and were at moderate to high risk for caries received a sealant.37 This is less than LA

County and California averages for the same time period37 (Figure 27). In Fiscal Year 2017-2018

ChapCare’s percentage of children 6-9 years of age receiving a sealant increased to 57%.38

Unfortunately, comparable data for LA County and California is not available for this more recent

time period. Data on the percentage of children receiving sealants at JWCH Institute is not available

due to their low number of dental patients 6-9 years of age.

37.6%30.3% 31.3%

40.5% 53.5%

68.8%

22.0%16.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

FY 2014-2015 (n=205) FY 2015-2016 (n=142) FY 2016-2017 (n=16)

Yes No Unknown

23

FIGURE 27. DENTAL SEALANTS ON A PERMANENT FIRST MOLAR TOOTH AMONG 6-9 YEAR-OLDS AT AN FQHC,

201637

Dental utilization of children at ChapCare: Dental utilization rates reflect the percentage of all

ChapCare patients 0-5 years of age (including medical and dental patients) who received dental

services. During Fiscal Year 2016-2017, 54% of all ChapCare patients received any dental care, and

37% received preventive dental care. Utilization rates have been steadily increasing over time,

although the percentage of children receiving a preventive dental service is increasing at a slower

rate than the percentage of children receiving any dental service39 (Figure 28).

FIGURE 28. PERCENTAGE OF CHAPCARE PATIENTS AGES 0-5 WHO RECEIVED DENTAL SERVICES39

49.0%

58.1%

51.8%

0%

10%

20%

30%

40%

50%

60%

70%

ChapCare Los Angeles County California

21.4%

36.9%

53.7%

21.3%

31.8%

37.3%

0%

10%

20%

30%

40%

50%

60%

FY 2014-2015 (n=2473) FY 2015-2016 (n=2037) FY 2016-2017 (n=1848)

% received any dental care % received preventive care

Note: Includes data from two ChapCare clinics in Pasadena and one in El Monte

ChapCare FY17/18: 57%

24

Dental utilization at JWCH Institute: Dental utilization rates from JWCH Institute reflect the

percentage of patients that received dental services among all patients seen at either the Andrew

Escajeda (medical) or Michael Antonovich (dental) clinics in Pasadena. This data includes patients of

all ages. The vast majority (99% in 2018) of patients seen at the Pasadena JWCH clinics are over 18

years of age. In 2018, 65% of patients at Pasadena JWCH clinics received any dental care, and 63%

received preventive care. This represents a slight decline from 2016. Across all years, the utilization

rate of preventive care closely matches the utilization rate of any dental care40 (Figure 29).

FIGURE 29. PERCENTAGE OF JWCH INSTITUTE PATIENTS AT PASADENA CLINICS WHO RECEIVED DENTAL SERVICES40

Emergency Department Visits for Dental Problems

High rates of emergency department (ED) visits for non-urgent or preventable dental conditions

indicate many people may lack access to regular, preventive dental care. Visiting an ED for a dental

issue can also result in a lower quality of care because there is often not a dentist on staff to treat the

underlying condition.41 In Greater Pasadena, there were approximately 13.9 ED visits for dental

problems per 10,000 people. This is lower than LA County or California estimates (22.9/10,000 and

36.6/10,000, respectively)42 (Figure 30). However, there are significant disparities in dental ED visits in

Greater Pasadena by race and age. There are significantly higher rates of ED visits for dental

conditions among 20-24 and 25-44 year olds as well as among African Americans of all ages42 (Figures

31 and 32).

75% 74%

65%72% 71%

63%

0%

10%

20%

30%

40%

50%

60%

70%

80%

2016 (n=710) 2017 (n=831) 2018 (n=772)

% received any dental care % received preventive care

25

FIGURE 30. AGE-ADJUSTED ED RATE DUE TO DENTAL PROBLEMS, 2013-201542

FIGURE 31. AGE-ADJUSTED ED RATE DUE TO DENTAL PROBLEMS BY RACE/ETHNICITY, 2013-201542

FIGURE 32. AGE-ADJUSTED ED RATE DUE TO DENTAL PROBLEMS BY AGE, 2013-201542

13.9

22.9

36.6

0

5

10

15

20

25

30

35

40

Greater Pasadena Los Angeles County California

ED v

isit

s/1

0,0

00

po

pu

lati

on

13.9

11.1

15.4

40.2

2.0

4.6

0 5 10 15 20 25 30 35 40 45

Overall

White, non-Hispanic

Hispanic

Black or African American

Asian or Pacific Islander

American Indian or Alaka Native

ED visits/10,000 population

13.9

6.7

7.9

11.6

21.9

21.0

12.6

9.8

3.0

7.4

12.2

0 5 10 15 20 25

Overall

85+*

65-84

45-64

25-44

20-24

18-19

15-17

10-14

5-9

0-4

ED visits/10,000 population

Note: Cases include a primary diagnosis of teeth or jaw disorders, jaw pain, diseases of oral soft tissues (excluding gum and tongue lesions), fitting and adjustment of dental prosthetic or orthodontic devices, orthodontics aftercare, and dental examination.

*Value may be statistically unstable and should be interpreted with caution

Significantly worse than the overall value

No significant difference with the overall value Significantly better than the overall value

No data on significance available

Significantly worse than the overall value

No significant difference with the overall value

Significantly better than the overall value

26

Community Input

Community input was collected through 17 key informant interviews with stakeholders in education,

dental care, government, and community-based organizations. This qualitative data helped capture

the experiences of Pasadena community members in accessing dental care. Questions focused on the

greatest oral health needs, the greatest barriers to accessing care, the top vulnerable populations,

and the top community strengths promoting oral health. Education emerged as an important theme

across questions: two of the top three oral health needs as well as the top barrier identified by key

informants all focused on the need for increased education on oral health. Tables with the top needs,

barriers, at-risk groups, and community strengths identified by key informants are included below. A

copy of the full interview instrument and a list of interviewees is included in the appendix.

TABLE 3. TOP ORAL HEALTH NEEDS IDENTIFIED BY KEY INFORMANTS

Oral Health Need Number of mentions

Education on the importance of oral health to overall health 5

Access to low-cost services 4

Education on the importance of oral health for very young children 4

Dental care for adults 3

Regular dental visits 3

Education on available resources 3

Specialty care for low-income populations 3

Dental care for seniors 2

Sealants for children 2

Orthodontia 1

TABLE 4. TOP BARRIERS TO UTILIZATION OF ORAL HEALTH SERVICES IDENTIFIED BY KEY INFORMANTS

Barrier Number of

mentions

Lack of education on the importance of going to the dentist 6

Fears/ traumas associated with going to the dentist 5

Lack of education on availability of Medi-Cal dental benefits and what is covered 5

Negative past experiences with a dentist incorrectly billing services 4

Lack of transportation 4

Lack of knowledge of available dentists and ability to choose 4

Not enough providers for low-income populations (especially specialty care) 4

High cost of services 4

Fear of going to dentist because of undocumented status of either the patient or family members

3

Limited insurance coverage 3

Lack of trust between community and dentists 3

27

TABLE 5. TOP VULNERABLE POPULATIONS IDENTIFIED BY KEY INFORMANTS

Vulnerable Population Number of mentions

Low income populations 8

Children 6

Recent immigrants/undocumented 5

Seniors 4

Homeless 4

People with special needs/physical disabilities 3

Adults 2

Working class (those just above the cutoff for Medi-Cal but still struggling to make ends meet) 2

Residents of Northwest Pasadena 2

TABLE 6. TOP COMMUNITY STRENGTHS IDENTIFIED BY KEY INFORMANTS

Community Strength Number of

mentions

Young & Healthy 6

Having our own public health department and dedicated local oral health program 6

Mobile dental clinic 3

Kindergarten screenings 3

Organizations working together 3

Many dental providers in the area 3

Connection between Public Health Department's LOHP, nutrition program, and tobacco program

2

Partnerships with local universities for trainings, screenings, or provision of services 2

Many organizations and resources available to help 2

28

APPENDICES

Appendix 1: Oral Health Advisory Committee and Staff

Appendix 2: Key Informant Interviewees

Appendix 3: Key Informant Questions

29

Appendix 1: Oral Health Advisory Committee and Staff In alphabetical order by first name

Advisory Committee

Name Affiliation/Organization

America Rincon Pasadena Public Health Department – Tobacco Control Program

Ana Ortiz, DDS Wesley Health Centers – JWCH Institute

Andrea Lymbertos Pacific Clinics – Early Head Start

Angelica Hernandez Foothill Unity Center

Angelo Reyes Pasadena Public Health Department – Health Insurance Enrollment Program

Ann Rector Pasadena Unified School District

Charlene Chen Pasadena Public Health Department – Women, Infants and Children (WIC) Program

Claudia Morales Day One

Dara Griffin Prototypes

Evelina Markarian Pacific Clinics – Early Head Start

Gladys Partida Options for Learning – Head Start

Iris M. Paiso, DDS ChapCare

Janette Montoya Options for Learning – Head Start

Joanna Rawley Pasadena Public Health Department – Child Health & Disability Prevention (CHDP) Program

Judith Dunaway Pasadena Public Health Department – Health Policy & Promotion

Kira Abdullah-Watson Pasadena Public Health Department – Black Infant Health (BIH) Program

Lee Adishian San Gabriel Valley Dental Society

Mary Urtecho-Garcia Pasadena Public Health Department – Nutrition & Physical Activity Program

Matt Feaster Pasadena Public Health Department – Epidemiology

Michael Johnson Pasadena Public Health Department – Director of Public Health

Nancy Pinunes Foothill Unity Center

Nicole Bernard Pasadena Public Health Department – Tobacco Control Program

Nina Paddock Pacific Clinics – Early Head Start

Statice Wilmore Pasadena Public Health Department – Tobacco Control Program

Stephanie Campbell Denti-Cal

Teresa Mendenhall Pasadena Public Health Department – Community Health Services

Tiffany Walker ChapCare

Valerie Guzman Options for Learning – Head Start

Whitney Harrison Young & Healthy

30

Yesenia Marques ChapCare

Ying-Ying Goh, MD Pasadena Public Health Department – Health Officer

Local Oral Health Program (LOHP) Staff

Name Affiliation/Organization

Gabriela Gorostieta Pasadena Public Health Department – LOHP

Kristin Snowden Pasadena Public Health Department – LOHP

Nicole Evans Pasadena Public Health Department – LOHP

Remy Landon Pasadena Public Health Department – LOHP

Ty Marin Pasadena Public Health Department – LOHP

31

Appendix 2: Key Informant Interviewees In alphabetical order by first name

Name Affiliation/Organization

Adrienne Floriano Pasadena Unified School District

Ana Ortiz, DDS Wesley Health Centers – JWCH Institute

Angelica Hernandez Foothill Unity Center

Ann Rector Pasadena Unified School District

Claudia Hathcock Day One

Gladys Partida Options for Learning – Head Start

Iris M. Paiso, DDS ChapCare

Lee Adishian San Gabriel Valley Dental Society

Mary Urtecho-Garcia Pasadena Public Health Department – Nutrition and Physical Activity Program

Mylene Diaz WIC Program

Nina Paddock Pacific Clinics – Early Head Start

Puja Shah, DMD Denti-Cal

Statice Wilmore Pasadena Public Health Department – Tobacco Control Program

Stephanie Campbell Denti-Cal

Teresa Smith Pasadena Public Health Department – Black Infant Health Program

Terry Bright Elizabeth House

Whitney Harrison Young & Healthy

32

Appendix 3: Key Informant Interview Survey

KEY INFORMANT INTERVIEW Pasadena Public Health Department Local Oral Health Program

Interviewer’s Initials: __________ Date: _______________ Start time: _________________ End time: ________________ Key Informant Name: _________________________________ Title: ___________________________ Agency/Organization/Affiliation to Pasadena: _________________________________ # of years living in Pasadena area: ________ # of years in current position: ________ # of years at current organization: ________

Introduction: Good morning/afternoon. My name is [interviewer’s name]. Thank you for agreeing to participate in this interview today. This interview is designed to take around 45 minutes to 1 hour. When California voters approved Proposition 56 (The Tobacco Tax), a portion of the funds were distributed to the California Department of Public Health, which allocated funds to new Local Oral Health Programs across the state, including one here in Pasadena. We are currently gathering local data as part of a Community Health Needs Assessment to understand the current state of oral health in Pasadena and identify areas of need. Community input is essential to this process. Key informant interviews are being used to understand what oral health resources and programs are currently available, what the largest areas of need are, and what can be done to improve the quality of oral health in Pasadena. You have been selected for a key informant interview because of your knowledge, insight, and familiarity with oral health efforts in Pasadena. The themes that emerge from these interviews will be summarized and used in our planning efforts; however, individual interviews and names will be kept strictly confidential. We would like to acknowledge your participation in this Community Health Needs Assessment, but the information you provide during this interview will not be connected to your name. Do we have your permission to include your name as a participating community member (not linked to information you provide)? [ ] Check if participant agreed Next I’ll be asking you a series of questions about oral health in the greater Pasadena area. The “greater Pasadena” area encompasses the cities of Pasadena, Altadena, and Sierra Madre. As you consider these questions, keep in mind the broad definition of oral health used by the California Department of Public Health: “Good oral health means being free of tooth decay and gum disease, as well as being free of chronic oral pain, oral cancer, birth defects such as cleft lip and palate, and other conditions that affect the mouth and throat.” Feel free to draw from experiences both in your current position and as a community member while answering questions. Do I have your permission to record this interview? [ ] Check if the participant agreed

33

General Questions (asked to everyone): 1. What are the major population groups that your organization serves?

a. Probe: Do you serve people of a specific age, race, gender, or income? b. Probe: Do you serve people in a specific geographic region?

2. What, if any, oral health-related programs and/or services does your organization provide for

this(these) population(s)? a. Probe: Do any of the services you provide indirectly promote oral health?

3. What do you consider are some of the oral health needs for greater Pasadena residents that

are not being addressed?

4. In your opinion, what are the barriers to utilization of oral health services among the population you work with?

5. Are there people or groups of people in greater Pasadena whose oral health may not be as

good as others? a. Probe: Who are these persons or groups (whose oral health is not as good as others)? b. Probe: Why do you think their oral health is not as good as others?

6. What do you think would be the most effective strategies to combine oral health education

and/or prevention services with the work of your organization?

7. What recommendations or suggestions do you have to improve oral health in greater Pasadena?

a. Probe: Have you heard of any effective models or programs that have been used elsewhere?

8. What do you consider are some of the current community strengths promoting oral health in

the greater Pasadena area? Organization-specific Questions: For organizations that work with children: In your opinion, how and to what extent does oral health impact a child’s readiness to learn?

For tobacco-related organizations (PPHD Tobacco Control Program, Day One): What are the barriers to providing tobacco cessation counseling in dental offices?

For dental providers (ChapCare, JWCH, San Gabriel Valley Dental Society, Denti-Cal): 1. What are the barriers to providing tobacco cessation counseling in dental offices? 2. What are the barriers to receiving referrals from non-dental providers?

a. Probe: Why do you think nonprofits, family medicine providers, pediatricians, etc. do not provide referrals to dental providers?

3. What are the barriers for providers to accept Denti-Cal?

Close: Thanks so much for sharing your concerns and perspectives on these issues. The information you have provided will contribute to develop a better understanding of factors impacting oral health in Pasadena. Thank you!

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REFERENCES 1 U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000. 2 Association of State and Territorial Dental Directors. Assessing Oral Health Needs: ASTDD Seven-Step Model. Accessed online at https://www.astdd.org/oral-health-assessment-7-step-model/ on February 6, 2019. 3 UCLA Center for Health Policy Research. California Health Interview Survey. Accessed online at http://healthpolicy.ucla.edu/chis/Pages/default.aspx on February 6, 2019. 4 U.S. Census Bureau, 2013-2017 American Community Survey 5-Year Estimates. Table DP05: Demographic and Housing Estimates. Retrieved December 2018. 5 U.S. Census Bureau, 2013-2017 American Community Survey 5-Year Estimates. Table S0901: Children Characteristics. Retrieved December 2018. 6 Young & Healthy Teeny Teeth program data. Received October 2018 7 Options for Learning Head Start program data. Received October 2018 8 Data collected by Pasadena Unified School District. Data processed and analyzed by Pasadena Public Health Department Local Oral Health Program. Received November 2018 9 California Dental Association. AB1433 Reported Data. Accessed online at https://www.cda.org/PublicResources/CommunityResources/KindergartenOralHealthRequirement/AB1433Results/tabid/253/u1074q/5061736164656E61/Default.aspx on December 6, 2018. 10 Young & Healthy program data. Received December 2018. 11 U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 12 UCLA Center for Health Policy Research. AskCHIS Neighborhood Edition. Current smoker (18+) comparing Pasadena, Glendale, Santa Monica, Los Angeles County, and California. Available at http://askchisne.ucla.edu. Accessed on December 13, 2018. 13 Bernabé E, Vehkalahti MM, Sheiham A, Aromaa A, & Suominen AL. 2014. Sugar-sweetened beverages and dental caries in adults: a 4-year prospective study. Journal of dentistry, 42(8), 952-958. 14 UCLA Center for Health Policy Research. AskCHIS Neighborhood Edition. Sugar drink consumption 1+ times per day (18+) comparing Pasadena, Glendale, Santa Monica, Los Angeles County, and California. Available at http://askchisne.ucla.edu. Accessed on December 13, 2018. 15 Murthy VH. 2015. Surgeon general’s perspectives: Community water fluoridation–One of CDC’s “10 great public health achievements of the 20th century.” Public Health Reports 130(4):296–298. 16 Community Preventive Services Task Force. Oral Health: Preventing Dental Caries, Community Water Fluoridation. Accessed online at https://www.thecommunityguide.org/findings/dental-caries-cavities-community-water-fluoridation on January 31, 2019. 17 Centers for Disease Control and Prevention. 1999. Achievements in public health, 1900–1999: Fluoridation of drinking water to prevent dental caries. Morbidity and Mortality Weekly Report 48(41):933–940. 18 Pasadena Water and Power 2017 Consumer Confidence Report on Water Quality. Accessed online at https://ww5.cityofpasadena.net/water-and-power/waterqualityreports/ on December 5, 2018. 19 California Dental Association database, extracted by the San Gabriel Valley Dental Society. Received December 2018. 20 U.S. Census Bureau, 2013-2017 American Community Survey 1-Year Estimates. 21 California Department of Health Care Services. Medi-Cal Dental Managed Care. Accessed online at https://www.dhcs.ca.gov/services/Pages/DentalManagedCare.aspx on February 4, 2019. 22 Health Net Dental. Los Angeles Medi-Cal – Find a Dentist. Accessed online at https://www.healthnet.com/portal/member/content/iwc/hndental/find_a_dentist_lossangeles_medical_search.action on February 4, 2019.

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23 LIBERTY Dental Plan. California Dentist Search. Accessed online at https://www.libertydentalplan.com/LIBERTY-Dental-Plan-of-California/California-Dentist-Search.aspx on February 4, 2019. 24 Premier Access Dental. Find a Dentist. Accessed online at https://www.premierlife.com/secure/PAWEBSITE.PROVIDER.UI/WBSPrvNewSearch.aspx?logarea=Member on February 4, 2019. 25 Department of Health Care Services. Denti-Cal Provider Directory. Accessed online at https://www.denti-cal.ca.gov/find-a-dentist/home on December 13, 2018 26 UCLA Center for Health Policy Research. AskCHIS 2013-2016. Time since last dental visit (San Gabriel Valley Service Planning Area). Available at http://ask.chis.ucla.edu. Accessed on October 29, 2018. 27 UCLA Center for Health Policy Research. AskCHIS 2013-2014, 2016. Time since last dental visit (San Gabriel Valley Service Planning Area). Available at http://ask.chis.ucla.edu. Accessed on October 29, 2018. 28 Brown A. 2008. Access to oral health care during the perinatal period: A policy brief. National Maternal and Child Oral Health Resource Center. Accessed online at https://www.mchoralhealth.org/PDFs/PerinatalBrief.pdf on January 31, 2019. 29 Kumar J & Samelson R. 2009. Oral health care during pregnancy recommendations for oral health professionals. New York State Dent J, 75(6), 29-33. 30 Rainchuso L. 2013. Improving oral health outcomes from pregnancy through infancy. American Dental Hygienists' Association, 87(6), 330-335. 31 American Dental Association. 2011. Oral health during pregnancy: What to expect when expecting. Journal of American Dentistry 142(5). Accessed online at https://www.ada.org/~/media/ADA/Publications/Files/for_the_dental_patient_may_2011.pdf?la=en on January 31, 2019. 32 Pasadena Maternal and Infant Health Assessment, 2016-2017. Data prepared by Pasadena Public Health Department. 33 Maternal and Infant Health Assessment (MIHA) Survey, 2015-2016. Data prepared by California Department of Public Health; Center for Family Health; Maternal, Child and Adolescent Health Program; Epidemiology, Surveillance and Federal Reporting Branch. Data sent from the California Department of Public Health, Office of Oral Health in June 2018. 34 Department of Health Care Services Data Warehouse as of November 2018. Data sent from the California Department of Public Health, Office of Oral Health in January 2019. 35 Wright JT, Tampi MP, Graham L, et al. Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry. J Am Dent Assoc 2016;147(8):631-45. 36 Pasadena Public Health Department, CHOEUR grant. Received October and December 2018. 37 Health Resources and Services Administration, Bureau of Primary Health Care. 2016. Uniform Data System reported data. Data sent from the California Department of Public Health, Office of Oral Health in June 2018. 38 ChapCare internal tracking data: Sealants. Fiscal Year 2017-2018. Received November 16, 2018. 39 ChapCare internal tracking data: Dental utilization. January 2015-February 2018. Received November 16, 2018. 40 Wesley Health Centers-JWCH Institute internal tracking data. 2015-2018. Received December 17, 2018. 41 Lee HH, Lewis CW, Saltzman B, & Starks H. 2012. Visiting the emergency department for dental problems: trends in utilization, 2001 to 2008. American journal of public health, 102(11), e77-e83. 42 California Office of Statewide Health Planning and Development. Data maintained by Conduent Healthy Communities Institute. Accessed online at http://www.healthypasadena.org/ on February 4, 2019.