APPENDIX OR SUPPLEMENTAL DIGITAL CONTENT 1: VENTURA COUNTY DEMOGRAPHIC FEATURES Ventura County Ventura County (area, 2208 square miles) is the twelfth most populated of 58 counties in the State of California. Ventura County is bordered by Los Angeles County to the south, Santa Barbara County to the north, Kern County to the east, and the Pacific Ocean to the west. Most people reside in the Oxnard Plain and the Simi and Conejo valleys. The northern part of Ventura County is mountainous and mostly uninhabited and contains inaccessible Los Padres National Forest wilderness areas. Demographic Characteristics In September 2013, the population of Ventura County was 824 513 people. Although the United States Census reported that the population of Ventura County primarily included white and Asian people, the Ventura County Human Services Agency reported that 33.4% of the county population was Hispanic/Latino (Table SDC 1).1,2 Many immigrant, monolingual, Spanish- or Mixteco-speaking agricultural workers reside in the cities of Oxnard and Santa Paula and do not access Western medical and mental health services. Ventura County gang members are mostly Hispanic/Latino (Table SDC 2).3 Homelessness is an ongoing problem because transient people are attracted by the temperate local weather. Homeless youths frequently are gang members (16%) and gang-associated (32%).4 Most youths in the juvenile justice system (70%) have a diagnosable mental health disorder, most have a substance use disorder (60%), and many experience major functional impairment (27%).5 During 2 quarters in fiscal year 2008 to 2009, Ventura County facilities treated 4055 juveniles who had serious mental illness (disruptive, 34%; depression, 18%; psychosis, 3%).6 Economic factors and crime The average 2012 household income among Ventura County residents was $75 348, and frequency of poverty was 9.2% (Table SDC 3).7,8 The average home price was $440 050, and 64% residents could not afford to own a home.9 The frequency of unemployment in Ventura County in July 2013 was 8.0%. The leading employers in Ventura County were Amgen, Bankers Capital Financial, Baxter Healthcare, and Boskovich Farms. Gang activity was concentrated in county areas that had high racial/ethnic diversity and a high frequency of poverty (population below 200% Federal Poverty Level: Oxnard, 34%; Ventura, 31%; Santa Paula, 43%). In these areas, poverty and unemployment were associated with gang participation and violence (Table SDC 3).7,8 In 2012, the countywide overall crime frequency was 21.9 per 1000 population and violent crime frequency was 2.1 per 1000 population, but the violent crime frequency in the gang-affected areas was much higher (Table SDC 3). Although Ventura County was smaller in population than some neighboring counties, the presence of gangs had major economic, social, and health effects on residents. Oxnard and Ventura cities were listed in the “Trajectory 4” group of United States cities that had gang problems, which is the second most severe listing, with 40% homicides being gang related compared with ≤ 20% for other United States cities.10 Oxnard has focused efforts to control drug trafficking, human trafficking, and violent crime. In addition, Oxnard was an early adopter of civil gang injunctions to reduce the combined effects of poverty, high Hispanic proportion, high noncitizen proportion, and heavy gang activity. Gang involvement was prevalent in Ventura County schools, with approximately 10% students in grade 7 admitting gang involvement (Table SDC 4).11 Effect of crime on communities The confluence of poverty and gang involvement has produced an environment in which residents, especially youths, have a high incidence of violent trauma. Ventura County Medical Center has served a substantial part of the injured population and has had numerous admissions because of trauma (Table SDC 5 and 6). Most youths admitted to Ventura County Medical Center in 2010 and 2102 because of violent trauma were Hispanic (Table SDC 6). In addition, most trauma victims admitted were uninsured, adding medical cost burden to the human and law-enforcement costs of trauma.