Community Assessment Final

RUNNING HEAD: Community Health Needs Assessment 1
Community Health Needs Assessment:
An Analysis of Pima County, Arizona
Group 6: K. Carroll, A. Haber, H. Lieberman, S. Kinlichee, A. Soublet
Mel and Enid Zuckerman College of Public Health
University of Arizona
March 19, 2018

Table of Contents
Introduction………………………………………………………………………………………..
Geography and Environment……………………………………………………………………...
Demographic Information………………………………………………………………………....
Socioeconomic Stratification……………………………………………………………………...
Health Statistics…………………………………………………………………………………...
Local Health Resources…………………………………………………………………………...
Cultural Factors…………………………………………………………………………………...
Community Political/Governmental Organizations……………………………………………….
Housing…………………………………………………………………………………………….
Food Supply………………………………………………………………………………………..
Education…………………………………………………………………………………………..
School Health and Nutrition Programs…………………………………………………………….
Social Welfare Programs…………………………………………………………………………..
Transportation……………………………………………………………………………………..
Occupational Data………………………………………………………………………………….
Other Community Factors Impacting Health……………………………………………………….
Summary…………………………………………………………………………………………
References………………………………………………………………………………………...
Table of Tables
Table 1:Pima County Household Income in the Past 12 Months………………………………....
Table 2: Pima County Population by Age…………………………………………………….
Table 3: Top ten Employers Pima County…………………………………………………...
Table of Figures
Figure 1: Number of Reported Cases of Coccidioidomycosis 1998-2016……………………….
Figure 2: Tohono O’odam Tribal Districts and Pascua Yaqui Tribes………………………….....
Figure 3. Median Household Income by Race and Ethnicity……………………………………
Figure 4: Pima County Mortality by Year 2006-2015……………………………………………
Figure 5: Leading Causes of Death in Pima County………………………………….
Figure 6:Map of Food Supply in Pima County…………………………………………………..
Introduction
Many components affect the overall health of individuals and their communities.
Community health assessments are crucial when analyzing the health status of populations. The
health of the community is not only affected by their rate of disease, but by all factors
influencing one’s health. Pima county, located in Southern Arizona, is a diverse and thriving
community. The diversity of this county is evident among the different makeup of various race
and ethnicities, both men and women of all ages. This community health assessment aims to
identify the factors that affect the health of Pima County citizens, as well as examine the areas
deserving focus from the local government within the community.
Geography and Environment of Pima County
Pima County spans across 9,200 square miles in which mountainous range, desert
plateaus, and urban areas fill in Southern Arizona (Pima County, 2018a). Pima County has a
remarkable niche for hikers, bikers, and outdoors people; as well as an urban appeal within
certain city limits. Tucson is Pima County’s largest city. In adherence to the active lifestyle, most
Pima County people thrive on, the county has made an effort to construct a 131-mile multi-use
path connecting Tucson, Marana, and Oro Valley (Pima County, 2018b). This path can be used
by walkers, joggers, and cyclists’ alike. In addition, to this multi-use path, Pima County has
many parks, recreation centers, and hiking trails. However, the majority of these resources reside
within the areas that are more densely populated (Pima County, 2018a).
Furthermore, Pima County Department of Environmental Quality protects public health
and the environment. This department aids Pima County by monitoring air and water quality,
hazardous waste, solid waste, and pollution prevention (Pima County, 2018c). Pima County has
a 45.0 air quality index (HealthGrove, 2015). Air quality index is measured on a scale from zero
to five-hundred; therefore, Pima County stands in “good” range for air quality (HealthGrove,
2015). Air Quality can drastically impact an individual’s health; poor, bad air quality can lead to
asthma, cardiovascular disease, or even death (National Institute of Environmental Health
Services, 2018).
Valley Fever (Coccidioidomycosis) is another infectious disease prevalent in Pima
County. Valley Fever is a fungal infection caused by a fungus in the soil. According to the
Center for Disease Control (2017), approximately 10,000 cases occur each year nationally.
However, Arizona and California house the most cases of Valley Fever. In the figure below
Arizona and California are compared to all other states that reported Valley Fever in 2016.
Figure 1. Number of Reported Coccidioidomycosis Cases, 1998-2016 (Centers for Disease
Control, 2017)
In which, nearly two-thirds of reported cases are in Arizona (Arizona Department of Health
Services, 2016). Per Arizona Department of Health Services, 94 percent of Arizona cases are in
Pima, Maricopa, and Pinal Counties. The most at-risk age group for Valley Fever is ages 55-64.
Moreover, males are more susceptible to Valley Fever than females. In 2016 there were 705
hospitalizations for Valley Fever. Pima County accounted for 16 percent of deaths attributable to
valley fever (Arizona Department of Health Services, 2016).
Population Density
The projected population in 2016 of Pima County is approximately 980, 263 people (U.S.
Census Bureau, 2016). The vast majority of the population resides on the East side of the county.
In total Tucson, Marana, Oro Valley, Sahuarita comprise about 888, 032 people. Each square
mile has approximately 106 people (U.S. Census Bureau, 2010).
Rural Population
Per Crosby et. al (2012) individuals who reside in rural areas tend to have higher rates of
obesity, diabetes, cancer, and injuries. Moreover, most are at high risk for negative behavior like
smoking, physical inactivity, poor diet, and limited use of seatbelts (Crosby et. al, 2012). In Pima
County 26.6 percent of adults are obese (Centers for Disease Control, 2013). Pima County has a
higher percentage of smokers than both Arizona and the U.S. at 79.9 percent (Pima County,
2012). Pima County also has a higher prevalence of diabetes than Arizona and the U.S. at 12
percent.
Tribal Reservations
What is now known as Pima County has been home to the Tohono O’odam and Pascua
Yaqui tribes for centuries. Majority of the Tohono O’odam tribal land is outside main city limits,
most commute an hour for groceries, work, or school. The Tohono O’odam reservation has a
population of 7, 174 people (U.S. Census Bureau).

Figure 2. Tohono O’odam Tribal Districts and Pascua Yaqui Tribes (Pima County GIS, 2016)
Pima County History
Pima County was created in 1854 by land acquired from Mexico by the Gadsden
Purchase; which included most of Southern Arizona. Arizona became an official territory in
1863. At the time, Tucson was thriving in prosperity and grew in population. Therefore, from
1867 to 1877, Tucson was the territorial capital of Arizona (City of Tucson, 2018).
Demographic Information
Pima County is a diverse county in which many races reside in such as White, African
American, American Indian, Asian, Native Hawaiian and other Pacific Islanders (U.S. Census
Bureau 2016). Each racial group has its own unique characteristics in which attribute to the
diversity of Pima County. Pima County has a population of 980, 263 (Suburban Stats, 2017).
Pima County has a fairly even split between sexes. The female population accounts for 50.9
percent of the total population. In comparison to the male population which consists of 49.1
percent of the population (Suburban Stats, 2017). Moreover, the median age of the general
population in Pima County is 38 years (U.S. Census Bureau).

Sex and Age Composition by Racial Groups
Per Suburban Stats (2017) the White population of Pima County comprises 77.3 percent
(estimated to be about 728, 751 people) of the total population. When broken down by sex there
are roughly 356, 565 White males and 372, 186 White females. The median age for White
people living in Pima County is 40 and 42, respectively. The African American population in
Pima County is 34, 674 people. Moreover, there is roughly 18, 940 African American males and
15, 734 females in Pima County. The median age of African American people living in Pima
County is 31 and 30, respectively. The American Indian population in Pima County is 32, 605
people. In which there are 16, 676 American Indian females and 15, 929 males. The Asian
population in Pima County is 25, 731. There is roughly 11, 695 Asian males and 14, 036 Asian
females. The Native Hawaiian and other Pacific Islanders population in Pima County is 2, 122.
Of which 498 are Native Hawaiian. When broken down by sex there are 1, 053 Native Hawaiian
males and 1, 069 Native Hawaiian females.
Socioeconomic Stratification
Per Barr (2012) socioeconomic stratification is defined as “one’s access to resources as
well as to one’s place in a hierarchy of influence and prestige”. In which level of income,
education, and occupational status can be a form of measurement (Barr, 2012). Level of income
can impact health outcomes of individuals and families by accessibility to health care, nutritious
food, and location of residence. These factors contribute to the overall health status of the
individual. Those who fall under the lower socioeconomic status side tend to have little or no
access to health care. In addition to living in food deserts based on their location in the county.
Approximately 18.2 percent of Pima County lives at or below the federal poverty line (U.S.
Census Bureau).
Table 1: Pima County Household Income in the Past 12 Months
Subject Households Families Married-couple Non-family
families households
Total 395, 290 243, 175 171, 988 152, 215
Below $10,000 8.1% 5.1% 2.0% 14.4%
$10,000-$14,999 6.2% 3.9% 2.1% 10.4%
$150,000-$199,999 3.8% 5.2% 6.8% 1.3%
$200,000 or higher 3.3% 4.5% 6.1% 1.1%
Median Income 46,764 58, 613 71, 680 29, 797
Mean Income 64, 779 77, 019 91, 105 42, 438
(U.S. Census Bureau, 2012-2016)
According to the data provided in table 1, the median household income in Pima County is 46,
764 dollars. The average household size in Pima County is 3 (U.S. Census Bureau). Pima
County’s labor force, people 16 years and older, consists of 58.3 percent of the population.
In comparison to individual income, the median family household income for Pima
County is 58, 613 dollars (U.S. Census Bureau). From the data provided Non-family households
make the least amount of income as 14.4 percent of this population makes less than 10,000
dollars annually. In comparison married couples tend to make more income than both individual
and family households at 71,680 dollars. In addition, 6.1 percent of this population makes more
than 200,000 dollars per year. However, male full-time workers tend to make more than female
full-time workers. On average, a male full-time worker will make 7, 651 dollars more a year than
full-time female workers in Pima County (Data USA, 2015).
Median Household Income by Race and Ethnicity, 2016
Figure 3. Median Household Income by Race and Ethnicity (Making Action Possible for
Southern Arizona, 2016)
Based on figure 3 White, non-Hispanics make the most income at 52,000 dollars per year
compared to other races. American Indian and Alaska Natives make 26,000 dollars a year which
drastically falls short of the Pima County median household income of 46. 764 dollars. The
Hispanic median household income was at 37, 707 dollars, which is 14.8 percent lower than the
national median household income (Making Action Possible for Southern Arizona, 2016).
Moreover, the per capita for each race and ethnicity are consistent with median household
income. Per capita by race and ethnicity is calculated by the total income of that race or ethnicity
divided by the population of that race or ethnicity (Collins Dictionary, n.d). In Pima County
White, non-Hispanic have the highest per capita at 33, 493 dollars. Like median household
RUNNING HEAD: Community Health Needs Assessment
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income American Indian and Alaskan Natives have the lowest per capita at 13, 086 dollars (See
figure A1 in Appendix A).
Further, 18.2 percent of Pima County lives under the federal poverty line. The federal
poverty guidelines are determined by the Department of Health and Human Services in which
determines eligibility for federal programs. An example of this is a family of four would have to
make less than 20, 780 dollars a year to be considered living in poverty (HealthCare, 2018). Per
Arizona Health Matters (2016a) 32.3 percent of American Indian and Alaskan Natives live
below the federal poverty line. Compared to the overall Pima County percentage of 18.2 percent,
American Indian and Alaskan Native are 55.5 percent more likely to live below the federal
poverty line. See Figure A2 in Appendix A for Families Living Below Poverty Level by Race &
Ethnicity in Pima County.
In addition, education attainment can be a critical component of one’s income. Some
individuals will go to college to receive a bachelor’s degrees. By obtaining a degree one can
increase their social mobility. Social mobility is defined as the movement from one section of the
social stratification to another (Encyclopedia Britannica, n.d). Most aim to improve their
socioeconomic status by moving up in the system. According to figure A1 in Appendix A,
American Indian and Alaskan Natives have the lowest percentage of individuals who obtained a
Bachelor’s degree at 11.8 percent. They also have the highest percentage of their population
living below the federal poverty line. Moreover, Asians have the highest percentage of
bachelor’s degree graduates at 50.5 percent (Arizona Health Mattersb). Although Asians are not
the highest earning race in Pima County, they are the biggest earners nationally (See figure 3 on
page 7).
Health Statistics
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Health status is a very important measurement when assessing the standing of a
community. Due to Pima County’s vast diversity, the health status adapts to changes frequently.
Health status can be measured a number of ways. Morbidity, or the presence of a disease or
disease like-symptoms, can have a large impact on a community. Measures of morbidity are able
to tell us the likelihood of who can become ill among a population (Morbidity Frequency
Measures, 2012). On the other hand, mortality is the incidence of death among a population.
There are a number of ways to measure both morbidity and mortality; through looking at
diseases, causes of death, and other factors, the health problems within a community can be
assessed. Taking morbidity and mortality measurements into consideration is key when
analyzing a community because it reveals the relationship between economic and social factors
of health outcomes. The Pima County Office of the Medical Examiner broke down the mortality
among Pima County throughout a number of years. (Pima County Medical Examiner, 2015).
Figure 4 shows the total mortality rate from the year 2006 to 2015. As shown, the rate has
increased in the last 10 years. Of the 9,134 deaths in 2015, only 27 percent of them were reported
to the Medical Examiner for further examination (Pima County Medical Examiner, 2015). The
statistic of only 27 percent of the deaths were reported is an issue that should be assessed.
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Figure 4. Pima County Mortality by Year 2006-2015 (Pima County Health Department, 2017).
Health Conditions
During 2015, the leading cause of death in America was diabetes. Arizona can prove this,
as 12 percent of Pima County is affected by this epidemic. The 12 percent of Pima County is
more than the average for the state of Arizona (11 percent), and the U.S. as well (10 percent)
(Pima County Health Department, 2012). Due to the fact that diabetes is genetic, families and
individuals of all ages have the ability to be impacted by the condition. Due to these statistics, it
is evident that diabetes is a condition that should be analyzed by health professionals to prevent
its potential to increase even more among the population.
The battle against HIV/AIDS and other serious sexually transmitted diseases is one that
presses Pima County. In Pima County alone, HIV/AIDS impacts 15 percent of the community.
Of this 15 percent, men are the majority of victims throughout 2010-2014, accounting for almost
85 percent of the 15 percent. Among the affected population, the average age of those suffering
from HIV/AIDS was between 20-50. The dominant race infected with the epidemic was
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White/Caucasian, and Hispanic/Latino. (Arizona Department of Health Services, 2015).
HIV/AIDS is definitely an epidemic affecting the nation, as well large counties such as Pima
County. For this reason, it is crucial that HIV/AIDS and other sexually transmitted diseases are
accounted for when recognizing the health status of Pima County.
Asthma is another epidemic that deeply affects the population of Pima County. Asthma
and other respiratory conditions are ones that are prevalent throughout America, along with
Arizona. In the state of Arizona alone, 120,000 adolescents suffer from asthma. In 2013, it was
measured that 24 percent of youths were impacted by lifetime asthma (Arizona Department of
Health Services, 2016). Asthma impacts many aspects of the youth’s lives. The condition has
forced them to miss many days of school, not be able to participate in some sports and activities,
and other factors that take elements of childhood out of the youth’s life. Pima County is one of
the counties in Arizona with the highest rates of asthma, with 7.1 percent. Asthma is a condition
that can often lead to hospitalization. The hospitalization rate due to asthma in 2018 was 11.7
percent (Arizona Health Matters, 2018c). This rate is higher than the hospitalization rate for the
state of Arizona.
Causes of Death
The increasing mortality rate can be credited to a combination of aspects. Figure 5 lists the
causes of death within the county during the year 2013. The figure identifies all types of cancer
as the top cause of death, and death due to heroin and nephritis the lowest cause of death among
Pima County residents. Other epidemics such as obesity has also risen; 26.6 percent of adults
were recognized as obese, therefore raising the obesity rate for the entire Pima County (Center
for Disease Control, 2013). Majority of the obesity population were individuals with a Hispanic
background. The figure also recognizes 78 as the median age for death among the community.
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Out of the 20 causes of death listed in figure 5, Pima county performed worse than the state in
four different categories (all being drug related causes) (Pima County Health Department, 2015).
These results can enhance the necessity of drug reform and proper drug resistance abuse
education.
Figure 5. Leading Causes of Death in Pima County (Pima County Health Department, 2015)
Deaths due to Drug Overdose
As shown in table 2, the drug related deaths are a serious problem that Pima County is
facing. In the report completed by the Pima County Medical Examiner, there is a lot information
regarding overdose deaths by drugs. Cocaine, heroin, methamphetamine, and alcohol are the
most abused drug that lead to death (See Appendix B, Figure B1). It is important to recognize
that the drug epidemic is affecting all ages among Pima County. Surprisingly, adults age 50-59
are the group that has the highest amount of overdose deaths, with a total of 74 per 100,000.
Adults age 30-39 and 40-49 are two other age groups in which overdose death seems to be
affecting the most (See Appendix B, Figure B2).
Infant Mortality Rate

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Infant mortality rate is a measurement that has fluctuated frequently throughout history.
Infant mortality rate is a suitable measurement of a community’s health because it is representing
the resources the citizens have available. If there are not proper resources offered for mothers
and children, the rate of mortality is likely to be high. Infant mortality can be due to a number of
causes, such as birth defects, low birth weight, sudden infant death syndrome, and other
conditions (Arizona Health Matters, 2018c). In Pima County, the fetal mortality rate is
approximately 4.2 per 1,000 live births. This rate is lower than the value for Arizona, which is
5.6 as of 2011. Pima county’s rate is also lower than the national rate which was 6.0 (Arizona
Health Matters, 2018c). The trend of infant mortality is significantly decreasing over time. This
trend is worthy of recognition because it proves that the efforts made to ensure the safety of
mothers and children is in fact working; as the implementation of more programs and services to
this population are offered, the rate of infant mortality will decrease even more.
Essentially, there are many factors that must be considered when determining the health
status of a community. Among Pima County, health status, the presence of disease,
morbidity/mortality rates, and other influences differ by age, ethnicity and gender. In the future,
it is important that these impacts of health are assessed in order to ensure the health of Pima
County as a whole.
Local Health Resources
The health statistics of a community are largely impacted by the health services available.
For this reason, it is imperative to look at Pima County’s health care services accessible. Pima
offers programs and resources to all different groups among its community. By combining the
efforts of the government, local health departments, and the community, the goal of achieving
good health among Pima County is easier to be reached. There are a variety of programs aimed
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toward infants, teens, females, males, elderly, and the community as a whole. Every program
shares the same objective; improving the health of citizens and their community.
Community as a Whole
Although majority of the programs offered in Pima County have a target group, there are a
number of organizations aiming to improve the overall health of the community. In particular,
Dispose-A-Med aims to protect the community from the abuse of prescription drugs. Made up of
Pima County citizens who are disturbed by the abuse of prescription drugs among individuals,
the goal of Dispose-A-Med is to implement safe and effective methods of disposing drugs in
order to eliminate the risk these drugs pose. Another program called Faith and Community
Health Network reaches out to all ages of the community. Focusing on mind, body, spirit, and
community, this program gives non-medical assistance to individuals at a high risk of being
readmitted to a hospital. This program is led by Interfaith Community Services along with faith
communities, forming volunteer teams. This program believes that the joint effort between
healthcare services, community resources, and faith communities, patients who are at risk after
leaving the hospital can be helped. (“Faith and Community Health Network”, 2018).
Infant and Child Health
There are many programs aimed toward infants and children under the age of five. First
Things First, a program approved by the voters of Arizona, aims to guarantee that the youngest
members of Arizona, and Pima County community, all experience proper childhood experiences,
in order for them to succeed later on in life. (Pima County, 2018d). This organization is the only
existing public funding source devoted to early childhood entirely (How We Work, 2017). First
things First gives funds to communities so that they can properly prepare children in Arizona for
kindergarten. First Things First has brought about other programs into Pima County Community.
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First Smiles Matter (FSM), a program giving dental screenings and fluoride treatments to infants
and children, is a result of First Things First. All of the screenings FSM provides are given by
medical professionals, and are easily accessible. Besides from children, First Smiles Matter has
extended their care to pregnant women by giving them dental screenings and oral care education,
in order to properly care for their infant. (Pima County, 2018d). First Smiles Matter and First
Things First are two very important programs to Pima County because they are one of the efforts
looking out for infants and children at this age.
Teen Health
Teenagers have access to a vast amount of resources offered by the government and
communities. One in particular offered in Pima County is Project C.O.N.T.A.C.T. This program,
available through the Pima County Health Department, delivers reproductive health care to
teenagers at low cost (Pima County, 2018e). Teenagers, particularly those with no home or who
are at an extreme risk to pregnancy/STDs, have access to counseling and education, condoms,
birth control options, STD testing, and examinations. The services Project C.O.N.T.A.C.T offers
do not require parent consent, and are completely confidential. STAND Youth Tobacco
Coalition is a coalition organized by teenagers. This organization works at the state and local
level on raising awareness about the abuse of tobacco among teenagers, their schools, friends and
families, as well as their community. (Pima County, 2018e). STAND also aims to reduce
exposure to second-hand smoke. Both STAND and Project C.O.N.T.A.C.T are valuable
programs that work to enhance the health of teens, and limit the possibility of them having health
consequences.
Female Health
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Females are a group in society that tend to need much assistance, due to the fact that they carry
children. Luckily for the women in Pima County, there are a variety of programs available. An
important organization is called the WIC (Women, Infant, and Children) Program. This program
gives “checks” to purchase food, as well as nutrition education to families in need. Qualifying
women and children (low-income pregnant women, new mothers, babies and children under the
age of 5 with health problems) have access to nutritional education, growth monitoring,
screening to check for nutritional threats, and resources to human services (Pima County Health
Department, 2018). A program that goes hand in hand with WIC is the Well Woman
HealthCheck (WWHC) Program. WWHC, administered by the Center for Disease Control and
Prevention, is free and offers a variety of services to those females with low-income and no
insurance. Women who utilize their services have access to Tests such as breast exams, pap
smears, mammograms and pelvic exams are offered to ensure the health of these women. (Well
Woman HealthCheck Program, 2018).
Male Health
Males typically live shorter than females, and are more likely to be affected by diseases
(Pima County Medical Examiner, 2018). It also has been said that males neglect to seek medical
care when it is necessary. There are a number of resources available to men that should be used.
The Pima County Health Department lists several resources offering help in areas of HIV/STD
Testing, family planning, tobacco education, and disease prevention. A program taking male’s
needs into account is called CODAC Health, Recovery, and Wellness. This program offers care
for men dealing with addiction, anxiety, depression, trauma, and other serious mental illnesses.
Therapists, case managers, and peer specialists are readily available at CODAC to help improve
the quality of life of their male patients. Along with the supportive care, CODAC offers primary
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care, allowing day-to-day care (Men’s Services). This includes wellness check-ups, screenings,
immunizations, and prescriptions. CODAC’s approach of dealing with both male’s mental and
physical health, their overall health can be maintained at an optimal level.
Elderly Health
Elders in Pima Community are another group that has access to programs to enhance
their health. Seniors can visit the Pima County Health Department to view their list of resources,
including: blood pressure screenings, health education, and case management. (Pima County
Arizona, 2018). Besides these services, elders can also seek help from the Pima Council on
Aging. This nonprofit organization works with communities to help senior health. A program
that the Pima Council on Aging has implemented is the Community Services System. This
service gives at-home care to help those seniors who cannot achieve everyday tasks such as
dressing, bathing, walking, etc. (PCOA Services, 2018). Community Services System aims to
allow vulnerable elders the opportunity to receive care in the comfort of their own home.
Programs aimed towards seniors are vital to communities in order to increase the life expectancy
of individuals.
Cultural Factors
Pima County is an extremely diverse part of Arizona. The county consists of 1.01 million
individuals, 93 percent of them being citizens. Pima County’s consists of 52.8 percent of White
residents, 36.4 percent of Hispanic residents, 3.34 percent of Black residents, 2.8 percent of
Asian residents, and 2.44 percent of Native residents (Pima County Diversity). Hispanic/Latinos
and white account for almost the majority of Pima County. American Indians also are a large
group among Pima County. In 2015, the population of white people was 1.45 higher than any
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other race in Pima County. Black and Hispanic individuals remained the other two groups to
have the highest number of citizens in Pima County, AZ during 2015 (Pima County, 2018a).
Hispanics and Latinos
Hispanics and Latinos make up a large majority of Pima County. They have brought
many aspects of culture to Pima County. One element of their culture is their religious belief, the
catholic faith. 20.8 percent of Pima County’s population follows the beliefs of this religion.
Other religious beliefs that the residents practice are Evangelical Protestant (10 percent of
population) (Pima County, Arizona (AZ) Religion Statistics Profile). Although many do follow
the practices of religion, there is a large majority of citizens in Pima County that do not follow
any religion. The fact that such a large amount of individuals do not follow specific religious
beliefs, it only makes the faiths believed in more evident among the community. Pima County’s
location is extremely close to the Mexican border, explaining why the bulk of the population is
of Hispanic/Latino descent. The large population of Hispanics and Latinos in this area account
for why the majority of the county’s citizens first language is not English. Overall, 22 percent of
the population among Pima County are Spanish speakers (Pima County, 2018a). Compared to
other counties in Arizona, Pima County has a large number of individuals who are other native
speakers (Pima County Diversity). In being that such a large number of individuals are non-
English speakers, Pima County is highly impacted. Due to the high number of Spanish speakers,
the language became very prevalent among the community. Street signs, restaurant menus, and
even subjects in classrooms, shift and adopt spanish to cater to the needs of these individuals.
Native Americans
Tohono O’odham Nation. The Tohono O’odham Nation has lived in its region for
generations and generations. This nation’s reservation is the second largest in the entire nation
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(Tohono O'odam Tribal Government, 2018). Since this organization has been around for such a
number of generations, their traditions and culture has been sort of lost, and taken by other
organizations. There has been a lot of efforts made by members of this organization to preserve
their traditions. A big part aside from reserving their customs are their involvement in health.
Health status seems to impact the group tremendously. For this reason, they have a lot of
solutions set in place. One of the biggest challenges members of the group face is Type II
Diabetes. Today, there is at least 60 percent of Tohono O’odham adults who deal with the
disease (Tohono O'odham Community Action: Wisdom from the Past, Solutions for the Future,
2009). TOCA is an organization that has devoted its’ time to help face the challenges Tohono
O’odham members face. TOCA’s programs cover all areas such as Food and Wellness,
Community Arts and Culture, Basket weavers Organization, and Youth/Elder Outreach, and
these all promote community efficacy (Tohono O'odham Community Action: Wisdom from the
Past, Solutions for the Future, 2009). Food systems in place of within this organization are
mostly targeted to youths, in order to ensure they are receiving the correct nutrients. TOCA’s
efforts really help Tohono O’odham members stay engaged and help them preserve their
traditions, which is one of their main goals.
Pascua Yaqui Tribe. The Pascua Yaqui Tribe is a group that has positive ties to Pima
County. The tribe as a whole has five locations throughout Tucson. This particular tribe is very
diverse, due to the blend of generations among the households. Also, the tribe is young in that
majority of its members are under the age of 18 (Pascua Yaqui Tribe Community Profile, 2016).
Compared to other tribes, the members of the Pascua Yaqui Tribe have a high poverty rate of 39
percent, whereas the poverty rate for the state of Arizona is only 15 percent (Pascua Yaqui Tribe
Community Profile, 2016). As for the tribe’s culture, morality and world view are aspects that
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are very important to them. The merging of Christianity and Yaqui in their beliefs offer spiritual
values and religious practices that preserve their tribe (Pascua Yaqui Tribe, 2016). The tribe is
split into five separate cultural societies; Teopo Yoemina (Church & Altar Society), Matachinim
Society (Soldiers of the Virgin Mary), Kohtumbre Ya’ura (Lenten Society), Wo’I Wiko’o Ya’ura
(Coyote Bow Authority), and Oficio Achalim (Deer Dancer and Pascola) (Pascua Yaqui Tribe,
2016). These five cultural societies each serve their own purpose and promote their own
objectives. The tribe consists of 11 individuals who are dedicated to the advancement and well-
being of the tribe.
The Community's Political/Governmental Organization and Function
A community's political involvement and structure determines the policies and laws that
affect members of the community and shape the outcome of their day to day lives. The
development of roads and bridges, urban planning, public safety, public health, and disaster
preparedness, are some of the many services that Pima County's Government provides.
Government Structure and Function
Pima County's Government is structurally divided into departments which are
Administration, Board of Supervisors, Health and Community Services, Justice and Law
Enforcement, Public Defense Services, Public Works and Fire Safety (Pima County, 2018).
Pima County's Government is run and operated by the Board of supervisors, five members that
are elected for a four-year term and represent the five districts of Pima County (Pima County,
2018). The Pima County Board of Supervisors make decisions and develop and implement the
public policies within Pima County (Pima County, 2018g). The Board of Supervisors works in
collaboration with the County Administrator, Chuck Huckleberry, and the row officers to govern
and implement policies in Pima County (Pima County, 2018). The Board of Supervisors are
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responsible for providing oversight of municipal services which include, but are not limited to,
the development of roads and bridges, libraries, law enforcement, setting the amount of taxes
that are levied and approving the county budget (Pima County, 2018g).
District One, which spans the areas of Oro Valley, the Eastern section of Marana and
Catalina Foothill, Tortolita, Casa Adobes and Catalina and covers over 245 square miles of urban
areas North of Tucson, is represented by Supervisor Ally Miller (Pima County, 2018h). District
one, which has over 196,000 residents, reaches beyond north of the Rillito River, South of the
Pima-Pinal county line, East of Interstate 10, and three miles from Sabino Canyon Road (Pima
County, 2018h). District Two, covering areas of Tucson, Sahuarita, and South Tucson, is
represented by Supervisor Ramon Valadez (Pima County, 2018i). District Three, which covers
areas of Tucson, Marana, Three Points, Sahuarita, is represented by Supervisor Sharon Bronson
(Pima County, 2018j). District Four, consisting of areas within Tucson, Vail, Summerhaven, and
Green Valley, is represented by Supervisor Steve Christy (Pima County, 2018k). District Five,
Covering areas of Tucson, Sahuarita, and Green Valley, is represented by Supervisor Richard
Elias. District Five, is often described as Pima County's most urban district and consists of fifty
registered neighborhood associations and organizations (Pima County, 2018l).
There are seven other elected officials, referred to as row officers or constitutional
officers who serve beside the board as equals. The row officers are Sheriff, County Attorney,
Recorder, Treasurer, Assessor, Superintendent of Schools, and Clerk of the Superior Court (Pima
County, 2018m). These elected officials work in collaboration with the Board of Supervisors and
the County Administrator to ensure that the policies and laws that are set by the Board of
Supervisors are effectively carried out throughout each respective department within Pima
County Pima County, 2018). The County Administrator works to assist and implement the laws
24
and regulations set by the Board of Supervisors and is also responsible for the administration and
oversight of all non elected official department matters and providing oversight and review of
legislative issues and intergovernmental needs (Pima County, 2018m).
The Tohono O’odham Nation and Pascua Yaqui Tribe have their own governmental
system that provides laws and regulations regarding tribal related affairs and provides
governance and oversight of reservation affairs. The Pascua Yaqui tribe resides in Congressional
District 3 and Legislative District 3 (The University of Arizona, n.d.) and the tribes' government
system consists of a tribal council which is composed of eleven elected officials who are
responsible for developing policies and providing governmental oversight to ensures the
wellbeing, protection, and safety of all tribal members. The eleven elected positions are the
position of Chairman which is filled by Robert Valencia, Vice Chairman, Peter Yucupicio,
Treasurer, Raymundo Baltazar, Secretary, Mary Jane Buenamea, and seven council member
positions, currently filled by Herminia Frias, Rosa Soto Alvarez, Francisco Munoz, David
Ramirez, Cruzita Armenta, Antonia Campoy, and Francisco Valencia (Pascua Yaqui Tribe,
2016a). The Pascua Yaqui tribe also has 19 departments that work in tandem with the tribal
council and are in charge of various functions within the tribe (Pascua Yaqui Tribe, 2016b).
These departments are The Office of the Attorney General, Enrollment Department, Education
Department, Facilities Management Department, The Grants & Contracts Administration Office,
Housing Department, Health Services Division, Human Resources Department, Internal Audit
Department, Information Technology Department, Judicial Branch: The Pascua Yaqui Tribal
Court, The Land Department, Procurement Department, Public Safety: The Pascua Yaqui Police
Department, Office of the Prosecutor, Office of the Public Defender, Social Services Department
and The Tribal Employment Rights Office (Pascua Yaqui Tribe, 2016b).
25
The Tohono O’odham Nation is structurally composed of three branches of government,
the Executive branch which consists of the Chairman, Edward D. Manuel and Vice Chairman's,
Verlon M. Jose office (Tohono O’odham Nation, 2016). The Legislative branch which houses
the Legislative Chairman, Timothy Joaquin Gu Achi and Legislative Vice Chairwoman, Lucinda
Allen Sif Oidak as well as two tribal council representatives from each of the twelve districts,
and the Judicial branch which consists of the courts and judges (Tohono O’odham Nation, 2016).
The Tohono O’odham Nation also has several departments that work to ensure the public safety,
physical and mental well being and assess and meet the needs of the tribal population (Tohono
O’odham Nation, 2016). These departments are the Administrative Support Services Office, The
Department of Public Safety, The Department of Planning and Economic Development, The
Department of Natural Resources, The Department of Human Services, The Department of
Membership Services, and The Department of Education (Tohono O’odham Nation, 2016).
Health and Safety Organizations
The Pima County Health Department, Pima County Board of Health and Pima County
Sheriff Department provide governmental oversight for the health and safety of Pima County and
the State of Arizona and influence decision-making regarding the county’s health and quality of
life. The Pima County Health Department is responsible for providing governmental oversight to
ensure the health and safety of residents within Pima County (Pima County, 2018). The Pima
County Health Department provides access to clinics which provide clinical services such as free
vaccinations and behavioral health services which include family planning support services and
preventive health services which include community nutrition programs, chronic disease
prevention, women's health services and family planning, men's health services, senior health
services and teen health services (Pima County, 2018).

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The Pima County Sheriff's Department Mission is to work in collaboration with
surrounding community establishments and public agencies to ensure the public safety of the
residents of Pima County. The Pima County Sheriff's Department provides service to the Pima
County Population to ensure their safety and wellbeing. The Pima County Sheriff's Services are
as follows, child safety seat inspections, civil enforcement, fingerprinting services,
Neighborhood Watch Program, Rape Aggression Defense Classes and crime prevention (Pima
County Sheriff, 2018). The Pima County Sheriff's Department houses the Sheriff, Mark D.
Napier, The Deputy Sheriff and Special Advisor, Dr. Richard Carmona, the CR Support
Specialist, Michelle Yancick, Corrections Officer, Briana Rocha, Search and Rescue Deputy,
Brian Boll, SAV Support Specialist, Harold McGrogan, The Sheriff's Advisory Council,
Community Advisory Council, Corrections Bureau and Operations Bureau, School Resource
Officer Unit and Mental Health Support Team (Pima County Sheriff, 2018). The Pima County
Sheriff's Department provides service to the Pima County Population to ensure their safety and
wellbeing. The Pima County Sheriff's Services are as follows, child safety seat inspections, civil
enforcement, Fingerprinting Services, Neighborhood Watch Program, Rape Aggression Defense
Classes and Crime Prevention (Pima County Sheriff, 2018).
Housing
Housing is a social determinant of health which means it can be an underlying
contributing factor of health inequity. Access to safe housing at affordable prices is important to
support a healthy community.
Quantity and quality of Housing

27
As of 2015, there were 446,000 housing units in Pima County (2013 Housing Profile). Of
those, 232,400 were owner-occupied units (52.1 percent) and 140,000 units (31.5 percent) were
rental units. Vacant units made up 14.1 percent of total housing units and seasonal housing units
made up around 2.3 percent.
Quality of housing in Pima County varies. Of all occupied housing units in Pima County,
81.3 percent have central air and 76.3 percent have a main heating system (2013 Housing
Profile). Unsafe drinking water is present in 15.1 percent of occupied units and 3.7 percent of
units had signs of mice in the last 12 months. Units that had missing roofing material made up
3.0 percent of houses and 9.5 percent of units experienced leaking from an outside structure
(2013 Housing Profile). Owner-occupied housing units with a garage or carport in Pima County
make up 83 percent of the total owner-occupied homes and those with 4+ bedrooms make up 28
percent. 80 percent of owner-occupied units contain two or more bathrooms, 45 percent contain a
separate dining room, and 90 percent have a porch, deck or patio (2013 Housing Profile).
Cost of housing
Housing is considered “affordable” if the owners or renters could occupy the unit without
paying more than 30 percent of their annual household income on rent or on the mortgage and
utilities. This percentage is expected to allow for other necessary costs such as food and car
costs.
The sales housing market has been seeing an increase in new home sales and a decrease
in the average cost of new homes. In 2014, the average cost of a new home in Pima County was
242,000 dollars and the average cost of an existing home was 197,000 dollars (Villavicencio,
2016).
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In 2014, renters who were 80 percent of Pima County’s median household income (AMI)
were spending on average 917 dollars per month and the average property values was 160,000
dollars. Those 50 percent AMI were spending 573 dollars a month on rent with an average
property value of 90,000 dollars. Those 30 percent AMI were spending 344 dollars a month for
rent with an average property value of 53,000 dollars (Pivo and Sanderford, 2016). The
percentage of individuals renting to those buying increased from 35.9 percent in 2010 to 38.2
percent in 2016 (Villavicencio, 2016).
The median monthly spending for total housing expenditures (rent/mortgage, taxes, and
utilities) among all of owner-occupied houses in Pima County was 913 dollars. The monthly
spending among blacks was 1,142 dollars, among Hispanics was 911 dollars, and among the
elderly was 585 dollars. For those living below poverty, the average monthly spending on total
housing costs was 626 dollars. The average mortgage payment in Pima County was 920 dollars.
The average monthly mortgage payment among blacks was 1,019 dollars, among Hispanics was
820 dollars, and among the elderly 716 dollars, and among those living below poverty, 705
dollars (2013 Housing Profile).
Housing for low-income populations
In Pima County, there are 100 low-income housing apartment complexes that have a total
of 7,258 units for rent. They are often income-based that allow the renter to pay a rent based on
their income, and the average contribution in 2016 was 285 dollars per month.
There are specific low-income housing programs for those who are 62 years old or
disabled. The City of Tucson Housing Program provides city-owned units for that population for
30 percent of the individual’s income. The Craycroft Tower Apartments, Lander Gardens, and
Martin Luther King, Jr. Apartments are among the city-owned units available in this program.
29
Other apartments complexes provide reduced rents to this population at a monthly rate of 30
percent of the individual income and the US Housing and Urban Development Department
(HUD) subsidizes the rest of the rent cost (Pima Council on Aging, 2017).
Landlords and developers are also encouraged to offer affordable housing through
government subsidies. This helps tenants pay their rents and fills in the small gap that allows
them to live in a home (Tucson’s Need for Affordable Housing, 2017)
Housing for the homeless
In 2017, there were a total of 1,574 homeless in Pima County. 1,245 of those were single
adults, including 243 U.S Military veterans. 325 individuals were people in families with
children, and 133 of the homeless were youth who were 24 years and younger (AZ Housing
Coalition, 2017).
There are several community resources for the homeless including Old Pueblo
Community Services, Our Family Services, and the Salvation Army. The Old Pueblo
Community Services center offers temporary shelter to veterans and the homeless and provides
help in obtaining long-term housing (Keys to the Future). Our Family Services focuses on street
outreach, shelter, and case management for children, youth, and families (Our Family
Community Services, n.d.). The Salvation Army offers shelter, food, and counseling services to
homeless individuals to lead them to a stable position in society. The Salvation Army offers
shelter to almost 30,000 homeless individuals throughout the country (The Salvation Army, n.d).
Housing challenges in Pima County
The housing challenges in Pima County are rooted in the insufficient income rates
coupled with the lack of affordable housing available to those who need ir. The county has one
of the ten highest poverty rates with a population of 500,000 or more. Although there are more
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affordable housing units in Pima County than there are lower-income households, many of them
are occupied by people who are above the low-income threshold. This situation is called
“gentrification” (Tucson’s Need for Affordable Housing, 2017). Issues arise when people of
higher income invest in lower-income areas by purchasing affordable housing. This inflates
property values, eventually making it unaffordable for the original community to live there. The
low-income population, along with their history and culture, is displaced. Programs such as
Barrio Sustainability fight to prevent gentrification by beautifying their own neighborhoods
(Barrio Sustainability, 2017).
Food Supply
The residents of Pima County are provided food through a variety of sources that include
Grocery Stores, Farmers Markets and Community Gardens, convenience stores, restaurants, food
banks and pantries and organizations that provide charitable food donations. According to the
United States Department of Agriculture and Economic Research Food Environmental Atlas
Pima County has a total of 27 farmers markets, 127 grocery stores, 13 supercenters and club
stores, 290 convenience stores, 52 specialized food stores, 611 fast food restaurants and 651 full
service restaurants (United States Department of Agriculture, 2017). Table 3 details information
on several farmers markets in Pima County.
Table 3. Location of Farmers Markets in Pima County
Farmers Location Hours of Operation and Contact Information

Market
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Green Valley Wednesdays at Summer Hours (May 1- Sept 30): 8:30 am – 12:30
Village Green Valley pm. Winter Hours (Oct – April): 10 am -2 pm.
Farmers’ Village, 101 S. Phone: (520) 490-3315
Market La Canada Website: http://greenvalleyfarmersmarket.com/
Drive Green
Valley, AZ
Marana Farm Saturdays at Hours: 8 am – 2 pm

Stand 12375 N. Phone: (520) 460-6292 Website:
Heritage Park http://www.maranafarmerscoop.com/farmers-
Drive Marana, market/
AZ
Oro Valley Saturdays at Summer Hours (May – October): 8 am- 12 pm

Farmers’ Steam Pump Winter Hours (October – April); 9 am – 1 pm
Market Ranch at Phone: (520) 882-2157 Website:
10901 N http://www.orovalleyaz.gov/residents/farmers-
Oracle Rd Oro market
Valley AZ
Broadway Fridays at Hours: 10 am- 2 pm. Phone: (520) 603-8116

Village 2926 E Website:
Farmers’ Broadway http://www.earthmadefarmersmarkets.com/
Market Blvd. Tucson,
AZ
Community Tuesdays at Hours: 8 am – 12 pm. Phone: (520) 622-0525

Food Bank 3003 S. Website:
Farmers’ Country Club http://communityfoodbank.com/pantry/Communit
Market Dr. Tucson, y-Food-Bank-Farm-Stand
AZ.
El Pueblo Mondays at El Summer Only (May – October) Hours: 3 pm – 5

Seasonal Pueblo Park, pm
Mobile 101 W. Phone: (520) 622-0525 Website:
Market Irvington Rd. http://communityfoodbank.com/pantry/El-Pueblo-
Seasonal-Mobile-Market
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Green Art Fridays and Hours (October – May): 9 am – 2 pm

and Farmers’ Saturdays at Phone: (520) 982-2645
Market 9015 E Tanque Website:
Verde Rd. http://www.artofarizona.com/greenartnfarm.htm
Tucson, AZ
Jesse Owens Fridays at 400 Hours: 9 am – 1 pm Phone: (520) 882-2157

Park S. Sarnoff Dr. Website: http://www.heirloomfm.com/markets/
Farmers’ Tucson, AZ
Market
Rillito Park Sundays at Hours: (April – September) 8 am – 12 pm,

Farmers’ 4502 N. 1 Ave (October – March) 9 am – 1 pm Phone: (520) 882-
st
Market Tucson, AZ 2157

Website: http://www.heirloomfm.com
Rincon Valley Saturdays at Hours: 8am – 1pm

Farmers’ 12500 E. Old Phone: (520) 591-2276
Market Spanish Trail, Website: http://www.rvfm.org/
Tucson, AZ
(Pima County Public Library, 2018)
The U.S. Department of Agriculture (USDA) establishes food insecurity "as a lack of
consistent access to enough food for an active, healthy life"(Feeding America, n.d.). Individuals
who experience food insecurity lack access to the proper resources to ensure a healthy and
balanced diet. These resources include financial resources, transportation resources, and lack of
adequate access to food supply and supermarkets close to their residence (Feeding America,
n.d.). A 2015 Overall County Food Insecurity in Arizona, Pima County by Feeding America
reported that approximately 145,800 people in Pima County, Arizona which is 14.6 percent of
the county's population experience food insecurity (Feeding America, 2015).
Pima County Food Supply

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The figure below illustrates the distribution of grocery stores and food supply throughout Pima
County.
Figure 6. Map of Food Supply in Pima County (ADHS n.d)
The green area on the map indicates the low income areas of Pima County which lack access to
food supply and categorically fit the specifications of a food desert which is an area that lacks
access to fresh fruits, vegetables and other various healthy foods which can be attributed to the
inadequate amount of grocery stores, farmers markets, and healthy food providers (USDA,
2015). The green areas specifically the Tohono O'odham National Reservation have one Grocery
store, BASHAS, that is a WIC approved vendor, and the Dollar General Store, a non-WIC
vendor as their source for food (ADHS n.d). This is a stark contrast to other areas of Pima
County specifically Marana and Tucson, which have access to several grocery stores, farmers
markets and food banks (ADHS).
There are a variety of support services which includes government programs and
community food banks and gardens that provide food and financial resources for individuals who
are experiencing food inadequacy. Supplemental Nutrition Assistance Program (SNAP) is

34
administered by the Arizona Department of Economic Security and provides monthly cash
assistance to provide low-income families with children and vulnerable adults with healthy food
(Association of Arizona Food Banks). SNAP has several nutritional education partners that teach
SNAP recipients how to make informed healthy choices regarding the food that they decide to
purchase and consume (Association of Arizona Food Banks). The Arizona Commodity
Supplemental Food Program is a federal run food distribution program that provides eligible
recipients that are of 60 years of age and older with monthly food boxes in hopes of reducing the
rates of malnutrition, hunger and chronic disease related to inadequate food supply in the elderly
community (Arizona Department of Health Services, 2018). The Food Distribution Program on
Indian Reservations is a federal program run by the United States Department of Agriculture that
supplies USDA certified foods to low-income families and individuals, including the elderly,
residing on Indian Reservations (United States Department of Agriculture, 2017). The Senior
Farmers' Market Nutrition Program provides grants to states and federally recognized Indian
tribal territories to so that they may provide financial support to low-income seniors in the form
of coupons that can be exchanged for various fresh fruits and vegetable at participating farmers
markets, roadside stands, and community-supported agriculture programs (USDA, 2015).
There are several food banks, meal programs and community gardens that are run by
local businesses, faith-based organizations, and governmental organizations that work to provide
food to residents throughout Pima County that are in need of assistance. The Community
Foodbank of Southern Arizona provides perishable and nonperishable food to community
partners throughout Pima County, the State of Arizona and across the country (The Community
Food Bank of Southern Arizona, 2017). The Community Food Bank of Southern Arizona has
three resource centers, in Tucson, Marana, and Green Valley, within Pima County where
35
residents can receive emergency food boxes as well as senior food boxes (The Community Food
Bank of Southern Arizona, 2017). The Community Food Bank of Southern Arizona also has
several programs that supply food to Pima County Residents such as after-school meals and
snacks, Community garden plots that provide neighbors space to grow fresh produce, daily hot
community meals, emergency food boxes (The Community Food Bank of Southern Arizona,
2017). The Community Foodbank of Southern Arizona has also developed the Las Milpitas
Community Farm and school pantries and a community garden program called Farms to Child
Program which aids in creating educational gardens at low-income public schools in Tucson,
(The Community Food Bank of Southern Arizona, 2017). Faith-based organizations such as New
Spirit Lutheran Church, Interfaith Community Services, Christian Faith Center, Christ Church
United Methodist Food Bank, Canyon del Oro Assembly of God, Society of St Vincent de Paul -
St Monica Food Pantry and Tucson Area Christian Fellowship provide food in, various forms
such as emergency food boxes and hot meals, to families and individuals in need (Food
Pantries.org, 2018).
Education
Education is a social determinant of health and plays an important role in an individual’s
overall health and well-being. Higher education attainment is closely related to higher
socioeconomic status, which also is an important determinant of health.
Educational attainments of the Pima County
According to the most recent American Community Survey (ACS) data collected in
2016, 87.7 percent of Pima County individuals over the age of 25 have a high school diploma or
higher (U.S. Census Bureau, 2016). This is higher than the national average of 87.0 percent,
found using the same data source. For Pima County as a whole, the percentage of males and
36
females with a high school diploma or higher are very similar at 87.7 percent and 87.8 percent
respectively. This data can be further broken down by race and ethnicity. Pima County residents
of Hispanic or Latino origin are the population with the lowest percentage of individuals with a
high school degree or higher at 73.3 percent. This is followed by American Indians/Alaska
Natives at 76.3 percent, Asians at 86.6 percent, African Americans at 88.0 percent, and Native
Hawaiians/Pacific Islanders at 93.1 percent. The percentage of whites, not including those of
Hispanic or Latino origin, with a high school diploma or higher was 90.1 percent compared to
whites including those of Hispanic or Latino origin at 94.7 percent. It is interesting to note that
while the percentage of males and females within each race and ethnicity was very similar, this
was not the case for Native Hawaiians/Pacific Islanders. There was a clear difference with the
percentage of men having a high school diploma or higher at 90.2 percent and women at 96.4
percent (U.S. Census Bureau, 2016).
The percentage of Pima County citizens with a bachelor’s degree or higher is 30.8
percent, just slightly higher than the country as a whole at 30.3 percent (U.S. Census Bureau,
2016). Men have a higher percentage of those with a bachelor degree than women at 31.4 and
30.3 percent respectively. The age group of 18-24 years old had a percentage of 7.6 percent of
those with bachelor's degrees and those 25 years and older were at 17.8 percent. Pima County
residents of who are American Indian/Alaskan Native are the population with the lowest
percentage of individuals with a bachelor's degree or higher at 11.8 percent followed by citizens
of Hispanic or Latino origin at 14.4 percent, African Americans at 21.9 percent, and Native
Hawaiian/Pacific Islanders at 25.9 percent. Asians and Whites (including those of Hispanic and
Latino origin), have the highest percentage of individuals with a bachelor's degree or higher at
52.1 percent and 33.8 percent respectively (U.S. Census Bureau, 2016).
37
Graduation and dropout rates generally and by race/ethnic group, and sex
Graduation and dropout rates for Arizona were found using data published on the
Arizona Department of Education “Accountability and Research” website. Pima County has a
dropout rate of 5.3 percent. Females have a higher graduation rate at 85.2 percent compared to
males at 78.5 percent (Arizona Department of Education, 2017a). Asians had the highest
graduation rate at 88.5 percent, followed by whites at 85.4 percent and those of Hispanic/Latinos
origin at 80.3 percent. African Americans graduate at a rate of 77.9 percent and American Indian
or Alaska Natives graduate at a rate of 71.8 percent. Native Hawaiians and Pacific Islanders have
the lowest graduation rates at 70.6 percent. Other special groups include students with
disabilities, the economically disadvantaged, students with limited English proficiency, and
migrants. The economically disadvantaged graduate at a rate of 79.2 percent, students with
disabilities graduate at a rate of 74.4 percent, those with limited English proficiency graduate at a
rate of 41.8 percent, and migrants graduate at a rate of 53.8 percent (Arizona Department of
Education, 2017a).
In total, Pima County had s dropout rate of 5.3 percent. Males had a higher dropout rate
than females at 5.8 and 4.7 percent respectively. American Indians or Alaskan Natives had the
highest rates dropout at 8.9 percent, followed by African Americans with 6.6 percent and those
of Hispanic/Latino origin at 5.8 percent. The Native Hawaiian and Pacific Islander population
had a dropout rate of 4.0, followed by whites at 3.9 percent and Asians at 1.3 percent (Arizona
Department of Education, 2017a). Students with disabilities have a dropout rate of 5.2 percent,
those economically disadvantaged have a dropout rate of 5.3 percent, students with limited
English proficiency have a dropout rate of 6.5 percent, and migrants have a dropout rate of 19.8
percent.
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What are the educational resources available in the county for all age groups (public,
private, home schools, faith-based, other)?
Many resources are available for the different levels of schooling. For elementary
schoolers and their parents, libraries are a great educational resource. The Pima County libraries
are a public resource and have partnered with the Tucson Unified School District (TUSD) to
promote student success. (Pima County Public Library creates partnership with TUSD to help
students be successful, 2015). The libraries offer homework help in basic math, science,
language arts, and social studies as well as on-hand tutors to help children with challenging
topics. A few libraries also offer resources such as after-school programs, cultural and scientific
activities, and reading incentives (Blog Archives, 2015). The libraries also offer resources for
high schoolers such as test prep books and online study aides.
There are 18 school districts in Pima County including Tucson Unified (TUSD),
Sahuarita Unified, and Ajo Unified that encompass 241 non-charter public schools (Pima County
School Superintendent, 2018a). These districts serve 160,000 students. Two of districts, the
Empire and Reddington districts, are transportation districts. Transportation districts are districts
in which schools are not available for children to attend so they are shuttled to other districts to
attend school (Pima County School Superintendent, 2018a). Fourteen of the school districts are
elementary districts. These districts provide education for kindergarten through 8th grade and
then shuttle students to other districts for high school (Pima County School Superintendent,
2018a). One district is an accomodation district. This district educates individuals at the Juvenile
Detention Center as well as juveniles in the Adult Jail (Pima County School Superintendent,
2018a). Joint Technical Education (JTED) gives students a career and technical training by
39
being in a partnership with business and industry stakeholders (Pima County School
Superintendent, 2018a).
Charter Schools are free for all Arizona students and are subsidized by the state. Charter
schools give parent more options for their children and operate with more freedom than public
schools (Pima County School Superintendent, 2018b). Unlike charter schools, private schools do
charge tuition. Pima County has 88 private schools, with 67 percent of them being religiously
affiliated. There are 12,698 private school students in Pima County and 33 percent of them are of
minority populations (Private School Review, n.d).
Home school is an option families may choose if they wish to educate their children at
home rather than sending their children to a traditional school. In Arizona, home school is under
the control of the county. Pima County requires that the student be taught reading, mathematics,
grammar, science, and social studies, but homeschool educators can make their own curricula
(Pima County School Superintendent, 2018c). Students are not required to participate in state
testing however they are able to at no cost if wanted and there are currently no requirements for
the homeschool educators (Pima County School Superintendent, 2018c). The Arizona Families
for Home Education (AFHE) provides support and resources to families who choose to make this
decision. Support groups are offered to build community and to enrich the homeschool
experience (Arizona Families for Home Education, 2018). The Tucson Petting Zoo, Different
Drum Learning, and Quest for Education and Arts also offer enrichment classes for Pima County
home school families (Arizona Homeschool Co-ops & Academic Enrichment Classes, 2017).
Private programs can also support high schoolers and encourage college enrollment.
Programs such as the Tucson Youth Development focus on providing vulnerable high schoolers
with individualized education plans, work and internship experience, and goal setting (Tucson
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Youth Development Programs, n.d.). The Tucson Youth Development program goes as far as to
offer a charter school for teens who are not reaching their potential in public schools. The
Arizona Center for Youth Resources is a similar program and carries out its vision of
“developing the next generation of workers” through educational support and leadership
development (Arizona Center For Youth Resources). Other mentorship programs such as Big
Brother, Big Sister and Mentoring Tucson’s Youth provide private and faith-based mentoring for
at-risk youth to improve their success in school and beyond. All of the resources mentioned are
helping to raise the educational attainment of individuals in Pima County.
Pima Community College (PCC) and The University of Arizona offer higher education
opportunities to students in Pima County and around the country and world. The University of
Arizona offers, bachelors, masters, and doctorate level degrees for students while PCC offers
certificate and associate degrees (Pima Community College, 2018a). Pima County also offers
continuing education degrees and personal interest courses such as classes in art and sports (Pima
Community College, 2018a).
Pima County Community College also offers career training through their Center for
Training and Development (CTD). 90 percent of students complete the program and it has an 85
percent job placement rate. This program provides certificates in nursing, culinary and food
industry, and business technology (Pima Community College, 2018b). PCC also has a program
called the Family Literacy Program that aids parents in getting a GED, getting job skills,
improving parenting skills, and speaking better English. The class allows the family to learn
together by encouraging parents to bring their children (Pima Community College, 2018b).
Literacy Connects is another organization that is nonprofit that offers people of all ages the
41
opportunity to improve reading and writing skills through classes and tutoring in reading,
writing, math and English (Literacy Connects, 2018).
School Health and Nutrition
Providing nutritious foods and health education in schools is important for the success
and well-being of the students. Several programs are available either at the federal, state, county,
and even community level.
School-based services & Requirements
The current federal school nutrition programs for Arizona schools include the National
School Lunch Program (NSLP), the School Breakfast Program (SBP), After School Care Snack
Program (ASCSP), and the Special Milk Program (SMP). In Arizona, the NSLP and the SBP are
required for schools with over 100 students. These are administered by the Arizona Department
of Education through the Food and Nutrition Service (FNS) and the United States Department of
Agriculture (USDA). Schools receive reimbursement from the Department of Education and are
responsible for meeting Federal and state regulations. Applications for these programs are sent
home at the beginning of each year to give families the opportunity to enroll, however families
can apply at any point in the year. Students must be a resident of Arizona to qualify for these
Arizona programs, however citizenship is not a condition of eligibility.
Arizona has close to half a million students who are enrolled in the Free or Reduced
Lunch program (Sunnucks, 2016). In Pima County, about 54 percent of children were approved
for free and reduced price lunch, using the latest data available from the Children’s Action
Alliance (Children approved for free or reduced-price lunch, 2007).
The NSLP and SBP provide healthy meals to children depending on the income level of
the family. These may be free or for a reduced price. Children from families at or below the
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Federal Poverty Level are qualified to receive free meals. For example, a family of four would
have to make less than 44,955 dollars per year in order to qualify (Benefits, n.d). The NSLP was
established in 1946 and provides nutritious lunches to students (National School Lunch Program,
n.d). The SBP was established in 1966 to provide essential nutrients to students before class to
keep them healthy and focused. Breakfast has been shown to lower school absences, behavior
problems, and academic issues. A healthy breakfast is also shown to improve test scores and
increase focus in the classroom (Arizona Department of Education, n.db).
Other federal programs instituted in Arizona include the The Special Milk Program
(SMP) and the Afterschool Care Snack Program (ASCSP). The SMP provides milk to children
who do not take part in other federal nutrition programs. For example, children who are in half-
day pre-kindergarten or kindergarten programs who do not have access to school meals can
qualify. The schools are then reimbursed for the milk they serve through the program (Special
Milk Program, 2018). The ASCP provides reimbursement for snacks to after-school care or
extended day activities. This program is intended to fill the gap between lunch and dinner.
Schools must sponsor or run an afterschool care program in order to be eligible. Such programs
include extended day programs, tutoring, and arts and crafts programs. Competitive sports are
not eligible for ASCP reimbursement. There is no income requirement for students to take part in
ACSP, however it is for students under the age of 18 or children who turn 19 during the school
year (NSLP Afterschool Snack Program, 2017). A similar program in Arizona to the ASCP is the
At-Risk AfterSchool Program. This is a Federally funded program that provides funds for one
snack and one meal per student for schools in an area where at least half of the enrolled children
are signed up for free or reduced lunch (At-Risk Afterschool Program, n.d).
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Schools providing school lunches must comply with Federally determined nutrition
requirements. They must provide fruits and vegetables, whole grains, and milk either at each
meal or as a weekly minimum. Fruits and vegetables must be offered with every lunch and fruit
must be offered with every breakfast. Whole grains are required to be at least 51 percent whole
grain. No added trans-fats are allowed in the meals and there is a limit on the saturated fat
allowed at a max of 10 percent of total calories. Milk is required for every meal and can be either
fat-free or 1 percent (School Nutrition Standards, 2017).
The Arizona Farm to School Programs are newer programs that aim to give children
access to fresh and locally grown foods. The School Garden Grant is new as of 2018 and will
provide funds to help schools establish and maintain a school garden (Arizona Advanced School
Garden Grant, 2018). This will include focusing on native or culturally relevant fruits and
vegetables and encouraging the inclusion of fruit and vegetables at mealtime. The University of
Arizona Community and School Garden Program has similar goals. This program connect school
educators with university students to promote gardens in low-income schools. The students help
start, develop, and maintain the school garden programs. School gardens can even get certified to
allow the cafeterias to serve the produce grown (School Gardening, n.d).
Health and Nutrition Education
School gardens not only provide fresh and local food to students, but they also present an
opportunity to teach students about their community and importance of sound nutrition. The
Green Academy was developed by educators of the TUSD and provides Common Core
approved, garden-based curriculum in math, reading, writing, and science (Green Academy, n.d).
For example, the third grade curriculum includes learning about flower and seed anatomy,
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researching and writing a report about pollinators and making and presenting their information.
(Green Academy Third Grade Garden-Based Curriculum, n.d)
TUSD promotes health and wellness in all schools by requiring that schools implement
nutrition and physical activity education. TUSD Schools use a comprehensive approach to the
teaching of nutrition and physical activity in that they integrate them into daily lesson when
possible.
Social Welfare Programs

There are several local, state and federal organizations that provide financial assistance
and support to residents throughout Pima County that do not have the economic resources to
make ends meet on a month to month basis.
Governmental Programs
Arizona Temporary Cash Assistance for Needy Families (TANF) is a federal program
administered by the U.S. Department of Health and Human Services, Office of Family
Assistance that administers state block grants to provide families with financial assistance and
related support services that aid in helping families reach a status of self sufficiency (U.S
Department of Health and Human Services, 2017). TANF strives to provide eligible families
with the proper assistance to ensure that they have the adequate resources to care for their
children in their home environment, reduce the economic dependency of financially insecure
households through the promotion of job preparation, training and professional development and
the support and promotion of stable two-parent households (U.S Department of Health and
Human Services, 2017). In order to qualify for TANF, Arizona Cash Assistance Program,
recipients must be needy families with dependent children and meet the income eligibility
requirements as well as the citizenship, qualified non-citizen resident status, and Arizona
residency requirements (Arizona Department of Economic Security, 2018).

45
The City of Tucson Environmental Services low income assistance program provides
financial assistance to qualified City of Tucson Residents in the form of a twelve dollar credit
that is applied to their monthly Environmental Services bill (City of Tucson, 2018). The City of
Tucson’s Limited Income Assistance Program provides qualified Tucson Water customers with
financial support to help pay their utility services statement which includes the billing of water,
sewer, wastewater, trash, and recycling services (City of Tucson, 2018). The Pima County Sewer
Outreach Subsidy Program is a low-income subsidy program that was developed in response to
Pima County residents concerns regarding increasing sewer rates (Pima County, 2018d). The
Sewer Outreach Subsidy Program provides 25 percent, 50 percent, or 75 percent discounts on
recipients monthly sewer fees, which includes the flat monthly service fee of 13 dollars (Pima
County, 2018d). The discount that recipients receive is contingent upon their income and
household size (Pima County, 2018d).
Social Services and Community Agencies
The Pima County Community Action Agency provides emergency assistance, rental and
mortgage assistance and utility assistance to low-income families and single individuals in Pima
County (Pima County, 2018e). The Primavera Foundation was originally developed in response
to the growing homeless population in Tucson, Arizona. The Primavera Foundations' work is
based in principles of advocacy and social change and they currently provide several support
services to help Pima County residents find a way out of poverty and rehabilitate them into
financially secure members of society (Primavera Foundation, 2018). Primavera’s provides
emergency rent and utility assistance and applicants eligibility is based upon their eviction
notice, whether they have received rent assistance in the past twelve months, household income
and their ability to pay next month's rent (Primavera Foundation, 2018).
46
Interfaith Community Services is a nonprofit social services agency that serves the
residents of Pima County, Arizona. Interfaith Community Services offers a wide variety of
community services that include support services for senior citizens and individuals living with a
disability, food insecurity, job loss and financial crisis (Interfaith Community Services, 2018).
Interfaith Community Services financial services consist of Emergency Financial Aid which
provides financial assistance with rent, mortgages, utilities, medications and other daily
necessities such as identification cards and transportation-related passes (Interfaith Community
Services, 2018).
Faith-Based Programs
There are several faith-based programs in Pima County that work to serve the needs of
those who do not have access to the proper resources to address their issues alone.
The Society of St. Vincent de Paul of Southern Arizona is a nonprofit organization that offers
support service to any resident of Pima County that is in need. In 2012, Southern Arizona
Society of St. Vincent de Paul donated 7,333,000 dollars to support members of the population
who were suffering and in need (St. Vincent de Paul of Southern Arizona, 2017). The Society of
Saint Vincent de Paul of Southern Arizona provides many support service and its financial
support services include rent and utility assistance (St. Vincent de Paul of Southern Arizona,
2017).
Lutheran Social Services of the Southwest is a nonprofit organization founded in 1970 and is
affiliated with the Evangelical Lutheran Church in America that offers services and resources to
residents of Pima County (Lutheran Social Services of the Southwest, n.d.). Lutheran Social
Services include aging and disability services, children and family services, emergency services,
and refugee and immigration services. The emergency services department mission is to address
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the hunger and homelessness that community members face as well as their extremely difficult
financial circumstance through the development of food pantries, rent & utility assistance
programs, emergency shelter, and disaster preparedness (Lutheran Social Services of the
Southwest n.d.).
Social welfare programs for specific target populations
Tucson Urban League is an affiliate of the National Urban League and is a nonprofit
organization that is dedicated to addressing and serving the economic and social needs of
minority populations in Tucson, Arizona (Tucson Urban League, 2016). Tucson Urban League
has several departments that work to address the most pertinent needs of minority community
members. The Tucson Urban League Case Management Emergency Assistance Services
Program provides utility and rental assistance for families in crisis situations in collaboration
with the Arizona Department of Economic Security, Pima County and Arizona Community
Action Association (Tucson Urban League, 2016).
Chicanos Por La Causa is an organization in Tucson, Arizona that was established in
1969 in response to the farmworkers and Chicanos rights movement led by Cesar Chavez.
Chicanos Por La Causa provides bilingual and bicultural services in Health and Human Services,
Housing, Education, and Economic Development. The Health and Human Services Department
offers Behavioral Health, Domestic Violence, HIV, Immigration, Parenting, Substance Abuse
and Senior Services (Chicanos Por La Causa, 2017a). The Housing Department provides
affordable housing opportunities for low and moderate income households by developing
neighborhood revitalization projects in rural and metropolitan areas. Housing opportunities are
achieved through Chicanos Por La Causa’s work in collaboration with national, private, and
government establishments. Chicanos Por La Causa also specializes in Low Income Housing
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Tax Credit (LIHTC), Housing and Urban Development (HUD) 202, and federal and municipal
grants (Chicanos Por La Causa, 2017b). Chicanos Por La Causa has a scholarship program that
provides financial assistance to Latino students who have displayed extemporary academic
achievements (Chicanos Por La Causa, 2017c).
Jewish Family & Children's Services of Southern Arizona is a nonprofit organization that
was established in 1941 and provides support services for families and individuals who have
experienced a crisis or significant financial difficulties within the Jewish and greater Tucson
community. (Jewish Family & Children's Services of Southern Arizona, 2018). Jewish
Emergency Financial Assistance program provides Jewish families and individuals who are
facing extenuating financial circumstances with short-term emergency financial assistance. The
Emergency Financial assistance program provides financial assistance for rent and mortgage
payments, moving expenses, utilities, transportation and work-related expenses (Jewish Family
& Children's Services of Southern Arizona, 2018).
The Primavera Foundation Project Action for Veterans program provides housing and
short-term financial support services to veterans and veteran families that are faced with the
burden of homelessness or eviction from their current residence. (Primavera Foundation, 2018).
Project Actions’ financial support services include income support services, specifically TANF
and disability benefits and temporary financial assistance is provided to cover rental and utility
deposits, rental and utility assistance, transportation cost, and moving assistance (Primavera
Foundation, 2018).
Transportation
In Pima County, there are various routes of travel individuals may choose to use. The
most common forms of transportation are drove alone, carpool, those who use public transit.
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Transportation is by a car drove alone is the highest rate of travel, with 76.9 percent of
individuals using this method of transportation in 2015. The median auto car per household
within Pima County is 1.67, averaging 9,077 dollars in annual auto ownership cost. (Center for
Neighborhood Technology, 2018). The annual vehicle miles traveled per household averages
around 19,844 miles. In addition, the annual transportation cost generally cost a household
12,303 dollars in Pima County (Center for Neighborhood Technology, 2018).
Followed by driving alone, carpooling is the next most frequently used mode of travel
with 10.1 percent of the population carpooling. In Pima County, 27 percent of one’s income
derives from the overall transportation costs (Center for Neighborhood Technology, 2018).
Lastly, public transit is another commonly used form of transportation accounting for, 2.7
percent of the county using this transportation style. Despite the most common forms of
transportation, residents in the community can also either walk, or ride bicycles to their
destination of choice. Due to workplaces in Pima County being a short distance away from each
other, transportation costs can be seemingly lower.
All residents in the community do not have equal access to reliable transportation.
Socioeconomic status, and accessibility to public transportation can hinder the transportation
access to individuals. However, within Pima County there are a plethora of alternative
transportation agencies available. For example, residents have access transit agencies such as the
city bus, SunLink, train and various shuttles. The annual transit cost in Pima County averages 43
dollars per each individual (Center for Neighborhood Technology, 2018). Sun Van is an option
through Sun Tran that provides transportation to residents with disabilities, unable to use the Sun
Tran’s permanent routes due to their underlying disability (Sun Van, 2018). More than 500,000
trips are ran year round (Sun Tran, 2018). Alongside the Sun Tran, there are other modes of
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transportation for residents with disabilities. The Sun Shuttle Dial-a-Ride, provides door-to-door
transportation services to residents with disabilities who live on the outskirts of Tucson, as well
as City of Tucson residents traveling to regions outside of the City’s limit (Sun Shuttle Dial-a-
Ride, 2018). Dial-a-Ride is under the more commonly known Discount Cab, which range from
taxi cabs, to vans fully capable in loading and unloading wheelchairs (Sun Shuttle Dial-a-Ride,
2018).
The cost of transportation can vary depending on what method you use. For example, the
SunLink streetcar can range from a one-way fare at 1 dollar and 75 cents, or a 1-Day SunGO
ticket valid for 24 hours, for 4 dollars and 50 cents (SunLink, 2018). This pass will give you
transportation access for a full day to whatever destination of your choosing. There are however
some exceptions and discounts for residents. Children ages 5 and under are able to ride for free at
all times (SunLink, 2018). Additionally, seniors, low-income, disabled are able to apply and can
qualify for this same free fare (SunLink, 2018).
Pima County offers a variety of transportation styles all across the county. Pima County’s
transportation agencies and systems have allowed for easier travel around the community.
However, the county still struggles in meeting the transportation needs of the population. Most
shuttles, and busses are limited to destination mile on their bus routes usually about three fourths
of a mile from the rider’s residency (Pima County Transportation, 2018). It is much easier for
residents to access public transportation transit systems if they live in an area closer to the city.
Pima County is working towards improving as well as creating more transportation systems.
Besides driving alone, or public transit, residents in the community are able to walk or
bicycle to and from destination points. In Pima County, there are more than 1,000 bike lanes and
shared routes (Pima Association of Governments, 2018). Bicycling provides a transportation

51
option that is not only more cost effective, but a safer, and healthier mean of transportation.
Bicycling allows an individual to make a commute, while engaging in physical activity.
Bicycling can enhance one’s health, more so than driving alone. Pima County ensures the safety
of bicyclist by a program called Bicycle and Pedestrian Count program. This program was
designed to improve walking and cycling conditions and to encourage more people to try these
healthy transportation alternatives (Pima Association of Governments, 2018).
Pima County has many roads that are in need or repair. The County’s transportation
budget is set at 63.2 million dollars, which is funded through State’s Highway User Revenue
Fund (HURF) (Pima County, 2018f). One of the main problems Pima County faces in
transportation is the worsening condition of the roads. Potholes are among the biggest
transportation problem the County faces. In the dry desert climate, the asphalt roads usually have
a lifespan ranging from 20-30 years, showing deterioration after just five years.To help aide in
the maintenance of the roads, Pima County Board of Supervisors has funded an additional 5
million dollars from the General Fund for Pavement Preservation, resulting in Pima County
being one of many counties funding transportation from this source (Pima County, 2018f). Pima
County has a division dedicated to roadway maintenance. The Maintenance and Operations
Division maintains more than 2,200 miles of roadways. (Pima County Roadway Maintenance,
2018). This division provides services such as Pothole patching street sweeping , shoulder repair
, road grading (dirt roads) , vegetation management , snow and ice control (Mt. Lemmon) , storm
clean-up , any other incidentals (Pima County Roadway Maintenance, 2018). The Pavement
Preservation Program is another service Pima County implements in preserving roadways, as
well as fixing damaged or deteriorating roadways (Pima County, 2018f). Funding for pavement
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repairs and preservation have been remarkably insufficient, with 53 percent of roads in poor or
failed condition (Pima County, 2018f). Occupational Data
Pima County is the 2nd largest county in Arizona with a population of about 1.01 million
people (World Population Review, 2018). In the past two months, Pima County has had an
unemployment rate of 4.0 for the month of November , and a rate of 4.2 for the month of
December (U.S Bureau of Labor and Statistics, 2018). The unemployment rate in Pima County
the past two months has been lower than the total unemployment rate in the state of Arizona
which is currently at 4.8 (U.S Bureau of Labor and Statistics, 2018). Overall, the unemployment
rate of Pima County is constantly changing, however it has significantly increased from 2016-
2018 (U.S Bureau of Labor and Statistics, 2018). Refer to Appendix C, figure C1.
The workforce is usually any individual in the population that is physically capable,
ranging in ages starting at sixteen years olds to about sixty-five years olds. In the civilian work
force, there is a total percent of 58.3 percent of individuals employed ages 16 and up. There are
429,426 total individuals employed in Pima County (Bureau of Labor Statistics, 2017). The most
common job groups in Pima County, AZ, are: Management, Business, Science, & Arts, Sales &
Office, and Service..
Table 2. Pima County Population by Age
Age Group Population Percent
5-14 years old 12.2%
15-17 years old 3.7%

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18-24 years old 12.1%
15-44 years old 39.5%
16 years and over 80.6%
(Pima County, 2018)
Table 4 groups together the population of Pima County by age. Pima County have the
highest population between the ages of 16-18 years old, resulting in the most employed in the
workforce of those age groups (Bureau of Labor Statistics, 2017). The population of females in
Pima County is roughly equivalent to the male population, with females attaining 50.8 percent of
the population, and Males attaining for 49.2 percent of the population (Bureau of Labor
Statistics, 2017). Pima County is primarily made up of Whites accounting for 778,258
individuals resulting in 85.3 percent of the total population (Bureau of Labor Statistics, 2017).
The race category of Whites is primarily high due to Hispanics taken into count. In contrast,
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Native Americans and Pacific Islanders makeup lowest employed making up 0.2 percent of the
population (Bureau of Labor Statistics, 2017). Pima County has a various group of employers
coming from both the private and the public sector. Table 5 shows the top ten employers in Pima
County by rank, with the University of Arizona being the highest.
Table 3. Top Ten Employers Pima County
Rank Business name Number of Employees
1 University of Arizona 14,436
2 Federal Government 10,992
3 Raytheon 10,687
4 Pima County 7,840
5 UA Health Network 7,413
6 City of Tucson 5,909
7 State of Arizona 3,936
8 Tucson Medical Center 2,536
9 VA Healthcare system 2,265
10 Citi Bank Call Center 1,850

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(Employment Summary of Entire Pima County, 2018)
There are a total of 25,787 businesses within the Pima County (Employment Summary
of Entire Pima County, 2018). The total number of employees accounts for 415,408 individuals.
Comparing ethnicities, 65 percent of the County’s workforce is Non-Hispanic, where as 35
percent of the workforce is Hispanic (Employment Summary of Entire Pima County, 2018).
As indicated in Appendix C, Figure C2, the sector of Construction contributes to a vast
amount of the working force in Pima County. There are a total of 2,463 businesses, and 21,849
number of employees in this field (Employment Summary for Entire Pima County, 2018).
Individuals working in this field, may encounter a number of health risks. For example,
construction workers can be exposed to risks in their field of work such as poor air quality,
material and manual handling, electricity, as well as endangerments working with different
machinery (Employment Summary for Entire Pima County, 2018).
Pima County’s Division of Risk Management is a division within the county established
to advocate risk of awareness by involving County members alongside management teams of
risks, organizing risk identification, evaluating practical resolutions of actual and potential
claims (Bureau of Labor Statistics, 2017). The Division of Risk Management works to identify
areas of risk and liability and develop response strategies to decrease loss and increase
opportunities (Bureau of Labor Statistics, 2017).
Other community factors impacting health
Pima County has an array of community and environmental factors that impact the health
of the community. The desert landscape of Pima County provides an environment strongly
receptive to monsoons, fires, drought, and flooding. Alongside, asthma, and obesity are among
some of the major community health risks within the community. Pima County has put into place
56
various plans and programs to improve the overall health of the community. For example, the
Pima County Community Health Improvement plan was designed to promote and support
healthy lifestyles for all Pima County residents (Pima County Health Improvement Plan, 2018).
Pima County also implements a nutritional program called AZ Farmers Market Nutrition
program. This nutrition program supplies coupons that can be used to buy fresh fruits and
vegetables from State-approved farmers, farmer’s markets as well as roadside stands (USDA,
2015).Women, Infants, and Children (WIC) Program is another organization designed to give
nutrition education as well as providing an Electronic Benefit Card (e-WIC-Card) to obtain
nutritional foods aimed to meet the family food budget (Pima County, 2018d). The Women,
Infants, and Children Program is targeted to low-income pregnant women, new mothers, infants
and children up to age five years old who have experienced a health risk (Pima County
Government, 2018).
The Public Health Emergency Preparedness Program was established through the Pima
County Department which focuses on emergency health planning to address biological,
chemical, radiological, or any natural disasters causing public health threats or emergencies
(Public Health Emergency Preparedness Program, 2018). The program’s main goal is to better
protect the residents of Pima County.
The Tobacco and Chronic Disease Prevention Program is a program intended to promote
a widespread approach to tackle tobacco and chronic disease. This program educates the
community through presentations on topics of chronic disease prevention, cardiovascular
disease, and tobacco cessation (Pima County Tobacco and Prevention, 2018). The main goal is to
promote physical activity and provide referrals to community health programs. ASHLine Ask,
Advice, Refer Training is another tobacco prevention method, partnered with Arizona Smokers
57
Hotline (Pima County Tobacco and Prevention, 2018). Guidance measures can be set up at
numerous worksites, or organizations in efforts to denote residents who are ready to quit
smoking (Pima County Tobacco and Prevention, 2018).
Summary
Pima County has a population of 980, 263 comprised of multiple ethnicities and races
(U.S. Census Bureau). Pima County provides the general population with many resources to
improve health outcomes. Pima County has several food programs implemented to aid food
security like: Southern Arizona Food Bank, farmers markets, soup kitchens, and Produce on
Wheels (Produce on Wheels, 2018). In addition to food programs, Pima County strives for an
active county. In total the county has 49 parks and has recently finished constructing “The Loop”
(Pima County, 2018b). In addition to programs for food security and fitness, Pima County has
four free/ low-cost clinics that serve uninsured and underinsured individuals (Pima County,
2018e).
Each race and ethnic group presents it’s own unique challenges. The Hispanic/Latino
population is one that carries a greater disease burden than the general population. Hispanics and
Latinos make up 34.6 percent of the total population in Pima County (US Census Bureau) and
are the largest racial/ethnic group in the country (Center for Disease Control and Prevention,
2017a) yet they are faced with low socioeconomic status, low graduation rates, low quality
housing, and poor health outcomes compared to the general population. Specifically, Hispanic
and Latina women are at a greater risk of becoming obese, and developing obesity-related
diseases such as diabetes.
Although the death rate is 24 percent lower among hispanics, they are about 50 percent
more likely to die from diabetes or liver disease than whites (Center for Disease Control and
58
Prevention, 2017b). In the country as a whole, Hispanic women are more likely to be obese than
Hispanic men and white women (US Office of Minority Health, 2017). The rate of obesity
among Hispanics in Pima County is higher than the national Hispanic obesity rate at 33.1 percent
and 30.6 percent respectively (Center for Disease Control and Prevention, 2017).
Resources for this population include the WIC and SNAP food nutrition programs. These
programs help lessen the burden of buying food, however SNAP does not promote the purchase
of nutritious foods. WIC does include a nutrition education component and only allows for
certain nutritious foods to be purchased. Furthermore, the Pima County Loop provides a safe,
scenic route on which to walk, run and bike. There are no specific programs for Hispanic women
and there is a significant need within this community for gender and culturally sensitive weight
loss intervention for Hispanic women.
The development of an unhealthy diet can be attributed to several factors such as
socioeconomic status, lack of access to adequate food supply, an insufficient supply of culturally
specific education on maintaining a balanced and healthy diet and cultural factors and
expectations present in the Hispanic and Latino community.
Hispanic women in Pima County are among the highest groups of people lacking
resources and as a result experience the most prominent health issues. Obesity is a health disease
a large percent of Hispanics experience. Obesity is a complex disease with diverse health risk
factors such as, low socioeconomic status, access to grocery stores, and geographic location.
Obesity can also lead to additional health risks such as type 2 diabetes and heart disease (Centers
for Disease Control and Prevention, 2018). Low socioeconomic status is a main factor
contributing to obesity among Hispanic women. According to the Center for Disease Control and
Prevention, approximately one third of Pima County population are of low socioeconomic status.
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Low socioeconomic status is factor that directly affects the quality of life. Hispanic women in
Pima County are lacking resources such as access to nutritional foods and culturally relevant
nutritional education to maintain a healthy diet. The shortage of grocery stores in Pima County
places a heavy burden on individuals being able to access such foods and improving their quality
of life.
The goal of this community assessment was to determine the need and resources within
the Pima County community. The assessment revealed a need within the Latina community
regarding access to nutrition and physical activity resources and can be addressed with culturally
competent education.
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77
Appendix A
Socioeconomic Stratification
Figure A1
People 25+ with a Bachelor’s Degree or Higher (Arizona Health Matters, 2016)
Figure A2
Families Living Below Poverty Level (Arizona Health Matters, 2016)

78
Appendix B
Health Statistics
Figure B1
Pima County Overdose Deaths by Drug (Pima County Medical Examiner, 2015)
Figure B2
Pima County Overdose Deaths by Age (Pima County Medical Examiner, 2015)
79
Appendix C
Unemployment Rate
Figure C1
Unemployment rate in Pima County (St. Louis Fed, 2015)
Figure C2
Business by Sector (Employment Summary for Entire Pima County, 2018)

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RUNNING HEAD: Community Health Needs Assessment 1

Community Health Needs Assessment:

An Analysis of Pima County, Arizona

Group 6: K. Carroll, A. Haber, H. Lieberman, S. Kinlichee, A. Soublet

Mel and Enid Zuckerman College of Public Health

March 19, 2018

deserving focus from the local government within the community.

Geography and Environment of Pima County

Furthermore, Pima County Department of Environmental Quality protects public health

asthma, cardiovascular disease, or even death (National Institute of Environmental Health

Valley Fever (Coccidioidomycosis) is another infectious disease prevalent in Pima

Figure 1. Number of Reported Coccidioidomycosis Cases, 1998-2016 (Centers for Disease

valley fever (Arizona Department of Health Services, 2016).

mile has approximately 106 people (U.S. Census Bureau, 2010).

population of 7, 174 people (U.S. Census Bureau).

Pima County History

population in Pima County is 38 years (U.S. Census Bureau).

Sex and Age Composition by Racial Groups

males and 1, 069 Native Hawaiian females.

Per Barr (2012) socioeconomic stratification is defined as “one’s access to resources as

Table 1: Pima County Household Income in the Past 12 Months

Subject Households Families Married-couple Non-family

Total 395, 290 243, 175 171, 988 152, 215

Below $10,000 8.1% 5.1% 2.0% 14.4%

$10,000-$14,999 6.2% 3.9% 2.1% 10.4%

$150,000-$199,999 3.8% 5.2% 6.8% 1.3%

$200,000 or higher 3.3% 4.5% 6.1% 1.1%

Median Income 46,764 58, 613 71, 680 29, 797

(U.S. Census Bureau, 2012-2016)

full-time female workers in Pima County (Data USA, 2015).

Median Household Income by Race and Ethnicity, 2016

Southern Arizona, 2016)

figure A1 in Appendix A).

Ethnicity in Pima County.

In addition, education attainment can be a critical component of one’s income. Some

socioeconomic status by moving up in the system. According to figure A1 in Appendix A,

Health status is a very important measurement when assessing the standing of a

its potential to increase even more among the population.

White/Caucasian, and Hispanic/Latino. (Arizona Department of Health Services, 2015).

accounted for when recognizing the health status of Pima County.

Deaths due to Drug Overdose

affecting the most (See Appendix B, Figure B2).

Infant Mortality Rate

Infant mortality rate is a suitable measurement of a community’s health because it is representing

Local Health Resources

Infant and Child Health

looking out for infants and children at this age.

Woman HealthCheck Program, 2018).

physical health, their overall health can be maintained at an optimal level.

Hispanics and Latinos

traditions, which is one of their main goals.

being of the tribe.

The Community's Political/Governmental Organization and Function

Government Structure and Function

Pima County's Government is structurally divided into departments which are

registered neighborhood associations and organizations (Pima County, 2018l).

legislative issues and intergovernmental needs (Pima County, 2018m).

The Tohono O’odham Nation is structurally composed of three branches of government,

Department of Natural Resources, The Department of Human Services, The Department of

Health and Safety Organizations

services and teen health services (Pima County, 2018).

The Pima County Sheriff's Department Mission is to work in collaboration with

as follows, child safety seat inspections, civil enforcement, fingerprinting services,