CITY OF LAREDO

2022-2023
COMMUNITY HEALTH
NEEDS ASSESSMENT

PREPARED BY
ABOUT TEXAS HEALTH INSTITUTE
Texas Health Institute is a nonprofit, nonpartisan public health institute with the mission of
advancing the health of all. Since 1964, we have served as a trusted, leading voice on public
health and health care issues in Texas and the nation. Our expertise, strategies, and nimble
approach makes us an integral and essential partner in driving systems change. We work
across and within sectors to lead collaborative efforts and facilitate connections to foster
systems that provide the opportunity for everyone to lead a healthy life. For more information,
visit texashealthinstitute.org and follow us on Twitter, Facebook, and LinkedIn.

THI adopted an equity-centered, community-focused, and place-based approach to the City of

Laredo Community Health Needs Assessment development. This approach builds on THI’s
robust experience and core focus on health equity over the last 12 years. THI’s approach is
grounded in the belief that improving community health must be centered on advancing and
achieving health equity–ensuring that everyone has the opportunities they need, free from
preventable barriers, to pursue their best health. THI recognizes that doing so requires a deep
understanding of the importance of social determinants of health and systems factors that
shape a community’s health needs and drive health inequities.

ACKNOWLEDGEMENTS
City of Laredo Health Department
Richard A. Chamberlain, DrPH, MPH, CPHA, CPM, CHW, RS
Erika Martinez, MBA, SHRM-SCP, CHW, CTCM
Jaime Lara, BBA
Ryan P. Logan, BS, BA
Elizabeth Guerra, BA

Texas Health Institute

Rachelle Johnsson Chiang, DrPH, MPH
Susana M. Morales, MA
Blair Williams, MPA, MBA
Emily Peterson Johnson, LMSW
Cristal Romero, MPP
Cody Price, MPH
Afrida Faria, MPH
Jessica Cargill, MPH

A leader in public health through excellence and leadership, the City of Laredo Health
Department provides culturally competent quality services that promote optimal health, prevent
disease, and protects the safety of all to achieve health equity. The 2022-23 City of Laredo
Community Health Needs Assessment represents the commitment of many partners who have
contributed their expertise, resources, and time.

In addition to recognizing the City of Laredo Health Department, we recognize all our partners,
most importantly the many community members, organizations, agencies, and leaders, who
assisted with outreach and engagement and shared their time and experience. Texas Health
Institute acknowledges the following organizations’ contributions to this report:

COMMUNITY LEADERSHIP
COMMITTEE
 Julie Bazan, Executive Director, Area Health Education Center of the Mid Rio Grande
Border Area of Texas (AHEC)
 Javier Garcia, Shelter Coordinator, Bethany House of Laredo
 Maria Sanchez, Executive Director, Border Region Behavioral Health Center
 Emma Maria Montes-Ewing, Chief Executive Officer, Doctors Hospital of Laredo
 Eric Castillo, Child Find Coordinator, Early Childhood Intervention (ECI)
 Elmo Lopez, Chief Executive Officer, Gateway Community Health Center, Inc.
 Ubaldo Santana, Executive Director, Las Alturas Nursing & Transitional Care
 Dr. Minita Ramirez, President, Laredo College
 Reymundo Cruz, Community Outreach Specialists, Laredo Health Coalition
 Dr. Sylvia G. Rios, Superintendent, Laredo Independent School District
 Jorge Leal, Chief Executive Officer, Laredo Medical Center
 Hanna Lee Huang, Market Chief Executive Officer, Laredo Specialty Hospital
 Dr. John Kilburn, Associate Dean of Research and Professor of Sociology, Texas A&M
International University
 Dr. Cindy Salazar-Collier, Associate Professor of Public Health, Texas A&M International
University
 Dr. Pablo Arenaz, President, Texas A&M International University
 David Gonzalez, Superintendent, United Independent School District
TABLE OF CONTENTS
EXECUTIVE SUMMARY ........................................................................................................... 1
Process and Methods ............................................................................................................. 1
Findings.................................................................................................................................. 1
Key Themes........................................................................................................................ 1
Priority Health Needs .......................................................................................................... 3
Barriers to Care................................................................................................................... 5
Health Literacy .................................................................................................................... 6
Impact of COVID-19 ............................................................................................................ 7
Other Health Needs ............................................................................................................ 7
Community Assets.................................................................................................................. 7
Health Care Organizations .................................................................................................. 7
Nonprofits and Community Organizations ........................................................................... 8
Churches and Faith-Based Organizations ........................................................................... 8
Parks and Recreation Centers ............................................................................................ 8
Recommendations.................................................................................................................. 8
Improve Health Care Access and Affordability .................................................................... 8
Improve Access to Specialty Care ...................................................................................... 8
Increase Culturally Relevant Health Care............................................................................ 9
Build Trust and Encourage Partnerships to Strengthen the Community .............................. 9
Strengthen Community Engagement and Outreach ............................................................ 9
INTRODUCTION ......................................................................................................................10
Methods ................................................................................................................................10
Primary Data Collection and Analysis ................................................................................11
Secondary Data Sources and Analysis ..............................................................................13
CHNA Laredo Community Leadership Committee .............................................................15
Sensemaking Session........................................................................................................15
Data Considerations and Limitations .....................................................................................16
Community Survey.............................................................................................................16
Note About Categories of Race and Ethnicity ....................................................................16
Limitations..........................................................................................................................17
Landscape and Context .........................................................................................................18
DEMOGRAPHICS ....................................................................................................................20
Population .............................................................................................................................20
Age ........................................................................................................................................21
 Children and Youth ............................................................................................................22
Working-Age Population ....................................................................................................22
Older Adult Population .......................................................................................................25
Race and Ethnicity.................................................................................................................26
Nativity and Language ...........................................................................................................28
Native Born ........................................................................................................................28
U.S. Citizenship Status of Foreign-Born Residents ............................................................28
Language ...........................................................................................................................29
Disability ................................................................................................................................31
OVERVIEW OF COMMUNITY SURVEY ..................................................................................34
Demographics .......................................................................................................................34
Age ....................................................................................................................................35
Sex and Gender Identity ....................................................................................................35
Race and Ethnicity .............................................................................................................36
Education ...........................................................................................................................37
Language ...........................................................................................................................38
SOCIAL DETERMINANTS OF HEALTH ..................................................................................39
Social Vulnerability and Environmental Justice Index ............................................................39
Environmental Justice Index ..................................................................................................40
Child Opportunity Index .........................................................................................................41
Community Resilience Estimates ..........................................................................................42
Income ..................................................................................................................................43
Poverty and Asset Limited (ALICE)........................................................................................44
Community Input ................................................................................................................44
Poverty ..............................................................................................................................45
Asset Limited Income Constrained, Employed (ALICE)......................................................47
Unemployment ......................................................................................................................49
Secondary Data .................................................................................................................49
Housing .................................................................................................................................50
Community Input ................................................................................................................50
Community Survey.............................................................................................................51
Secondary Data .................................................................................................................53
Education ..............................................................................................................................57
Secondary Data .................................................................................................................57
Food Insecurity ......................................................................................................................58
Community Input ................................................................................................................58
 Community Survey.............................................................................................................59
Secondary Data .................................................................................................................60
Internet Access......................................................................................................................61
Secondary Data .................................................................................................................61
Crime.....................................................................................................................................62
Community Survey.............................................................................................................62
Secondary Data .................................................................................................................62
Transportation .......................................................................................................................63
Community Input ................................................................................................................63
COMMUNITY ASSETS AND STRENGTHS .............................................................................64
Health Care Organizations ....................................................................................................64
Nonprofits and Community Organizations..............................................................................65
Churches and Faith-Based Organizations .............................................................................65
Parks and Recreation Centers ...............................................................................................65
Community Input ................................................................................................................65
Community Survey.............................................................................................................66
PRIORITY HEALTH NEEDS ....................................................................................................68
Diabetes ................................................................................................................................68
Community Input ................................................................................................................68
Community Survey.............................................................................................................68
Secondary Data .................................................................................................................69
Obesity ..................................................................................................................................70
Community Input ................................................................................................................70
Community Survey.............................................................................................................71
Secondary Data .................................................................................................................71
Kidney Disease .....................................................................................................................73
Secondary Data .................................................................................................................73
Mental Health ........................................................................................................................75
Community Input ................................................................................................................75
Community Survey.............................................................................................................76
Secondary Data .................................................................................................................79
Overall Health and Wellbeing ................................................................................................84
Community Input ................................................................................................................84
Community Survey.............................................................................................................84
Secondary Data .................................................................................................................85
Substance Use ......................................................................................................................87
 Community Input ................................................................................................................87
Secondary Data .................................................................................................................88
Cancer...................................................................................................................................90
Community Input ................................................................................................................90
Community Survey.............................................................................................................90
Secondary Data .................................................................................................................90
Child Health ...........................................................................................................................91
Community Input ................................................................................................................91
Secondary Data .................................................................................................................93
Maternal Health .....................................................................................................................95
Community Survey.............................................................................................................95
Secondary Data .................................................................................................................96
Preventive Health Care..........................................................................................................98
Community Input ................................................................................................................98
Secondary Data .................................................................................................................99
Oral Health Care....................................................................................................................99
Community Survey.............................................................................................................99
Secondary Data .................................................................................................................99
Premature Death .................................................................................................................100
Health Insurance .................................................................................................................101
Community Input ..............................................................................................................101
Community Survey...........................................................................................................102
Secondary Data ...............................................................................................................103
Access to Primary and Specialty Care .................................................................................105
Community Input ..............................................................................................................105
Community Survey...........................................................................................................106
Secondary Data ...............................................................................................................111
Access to Mental Health Care .............................................................................................113
Community Input ..............................................................................................................113
Community Survey...........................................................................................................113
Secondary Data ...............................................................................................................114
Access to Affordable Care ...................................................................................................115
Community Input ..............................................................................................................115
Medically Underserved Areas and Populations ....................................................................116
Secondary Data ...............................................................................................................116
Emergency Room Visits and Preventable Hospital Stays ....................................................116
 Community Survey...........................................................................................................116
Secondary Data ...............................................................................................................118
Health Literacy ....................................................................................................................118
Community Input ..............................................................................................................118
Secondary Data ...............................................................................................................119
Community Awareness and Trust Related to Health............................................................120
Community Input ..............................................................................................................120
Community Survey...........................................................................................................121
OTHER HEALTH NEEDS .......................................................................................................123
Community Concerns ..........................................................................................................123
Community Input ..............................................................................................................123
Community Survey...........................................................................................................123
Asthma ................................................................................................................................124
Community Survey...........................................................................................................124
Neurodevelopmental Disability ............................................................................................124
Community Survey...........................................................................................................124
Impact of COVID-19 ............................................................................................................124
Community Input ..............................................................................................................124
Community Survey...........................................................................................................125
Secondary Data ...............................................................................................................126
CONCLUSION ........................................................................................................................127
Improve Health Care Access and Affordability .....................................................................127
Improve Access to Specialty Care .......................................................................................128
Increase Culturally Relevant Health Care ............................................................................128
Build Trust and Encourage Partnerships to Strengthen Community.....................................128
Strengthen Community Engagement and Outreach.............................................................129
APPENDIX A: INDICATORS ..................................................................................................130
APPENDIX B: LAREDO COMMUNITY SURVEY - ENGLISH ................................................142
APPENDIX C: LAREDO COMMUNITY SURVEY - SPANISH ................................................161
APPENDIX D: LAREDO COMMUNITY HEALTH SURVEY RESULTS ..................................182
APPENDIX E: COMMUNITY INPUT SUMMARY REPORT .................................................... 248
 EXECUTIVE SUMMARY
The City of Laredo Health Department is pleased to present the 2022-2023 Community Health
Needs Assessment (CHNA) for the City of Laredo. CHNAs provide a deeper understanding of
community health needs, particularly those faced by historically-underserved residents.

The City of Laredo Health Department takes great pride in being a leader in public health in
Laredo. The department is committed to proactive health care, preventing issues before they
arise to increase the likelihood of healthier and longer lives for community members. Staff
continuously improve community outreach, patient care efficiency, and the education and
expertise of the local public health workforce. The department seeks to advance health equity in
the Laredo community, ensuring that every person has access to their full health potential,
regardless of social position or other circumstances.

The City of Laredo Health Department contracted with Texas Health Institute (THI) to conduct
the 2022-2023 City of Laredo CHNA. This report provides an overview of the process, methods,
and findings of identifying health and social determinants of health needs in the city of Laredo,
community assets, as well as a summary of recommendations from residents to address the
identified needs.

PROCESS AND METHODS

THI adopted an equity-centered, community-focused, and place-based approach to the

development of the City of Laredo Community Health Needs Assessment. THI used a mix of
quantitative and qualitative methods, including the analysis of publicly available date sets, key
informant interviews, focus groups with community members, and a robust community survey.

For the focus groups, THI partnered with Area Health Education Center of the Mid Rio Grande
Border Area of Texas (AHEC) and Texas A&M International University (TAMIU). THI also
partnered with AHEC to do targeted survey outreach.

FINDINGS

KEY THEMES

Key themes emerged both from community input and review of quantitative data. The findings
center around five priority ZIP codes: 78040, 78041, 78043, 78045, and 78046.

1 City of Laredo 2022-23 Community Health Needs Assessment

Demographics

Over the past decade, the Laredo population has increased by 10.0%. A third of Laredo’s
residents are under 18 years of age.

 Laredo has a high dependent-age population (ages 0-14 and 65 and older) with an age
dependency ratio of 72.1, meaning that for every 100 working-age people there were 72
dependent-age people.
 According to the U.S. Census, 95.5% of Laredo’s population is Hispanic.
 Laredo has a high population of foreign-born residents and a large population of
residents who have limited English proficiency.

Poverty

Laredo’s median household incomes varies by household type; households of adults (age 65+)
and households with children have the lowest median household incomes. At the individual
level, nearly a quarter of residents (22.2%) in the city of Laredo live below the federal poverty
level. In addition, we considered residents who live above the poverty line but who earn less
than the basic cost of living for the city of Laredo, measured as Asset Limited, Income
Constrained, Employed (ALICE). This information is not available for Laredo specifically, but in
Webb County, 43.5% of total households are ALICE. Altogether, 59.0% of the population fall
below the ALICE threshold. Single female-headed families are most likely to fall below the
ALICE threshold in Webb County.

Housing

In Laredo, 33.3% of households experience severe housing cost burden (meaning 33.3% or
more of their household income is spent on housing). Key informants and focus group
participants described the complicated nature of people experiencing homelessness in and
around Laredo. In addition, when asked about the extent to which housing costs (such as rent,
mortgage, or utilities) are a financial burden each month, 20.1% of survey respondents reported
that housing costs are a large struggle, and 39.6% indicated that housing costs are somewhat
of a struggle.

Education

The 4-year longitudinal graduation rate for grades 9-12 in Laredo ISD is 96.2% and in United
ISD is 97.2%, indicating a high percentage of students are completing high school. In Laredo,
20.0% of adult residents have a bachelor’s degree or higher. However, Laredo has a high
percentage of adult population who have not completed high school (30.4%).

Food Insecurity

Focus group participants described how increasing inflation combined with financial strain from
the COVID-19 pandemic directly influenced their ability to purchase healthy foods. Among

2 City of Laredo 2022-23 Community Health Needs Assessment

community survey respondents, over one-third (37.2%) reported feeling worried about having
enough to eat due to a lack of financial resources at some point within the last year; 32.3%
reported they were unable to eat nutritious food due to a lack of money or resources. These
rates are higher than the most recently available rate of food insecurity for Webb County (16.2%
in 2020).

Crime

Over one quarter of the community survey respondents (28.5%) indicated that crime and
violence is a problem affecting their health or the health of those with whom they live.

Transportation

Focus group participants stated that with Laredo’s climate and infrastructure, driving is the
primary way to get around, but with the spiking prices of gas, transportation is yet another area
of concern, particularly to residents with lower incomes. Transportation becomes a barrier for
residents seeking specialty care and mental health services. Focus group members shared that
for health needs outside of routine care, they must travel to a major metropolitan area.

PRIORITY HEALTH NEEDS

Community members and leaders identified several priority health issues including chronic
conditions and behavioral health needs.

Diabetes

The most common health conditions mentioned by key informants and focus group participants
include diabetes, hypertension, obesity, heart disease, and cancer. As described by the
participants, diabetes is common in Hispanic families and in the community. Nearly one-fifth
(21.6%) of the community survey respondents reported a doctor or health care provider told
them they had diabetes. The estimated prevalence of diabetes in Laredo is 15.7%.

Obesity

Focus groups participants and key informants emphasized obesity as prominent in the Hispanic
community. They shared several contributing factors such as inability to afford healthy food
options, poor nutrition habits, and lack of nutrition education. Among community survey
respondents, 35.3% reported a doctor or health care provider told them they have obesity. The
estimated prevalence of obesity in Laredo is 45.2%.

Mental Health

Community members in Laredo feel there is a significant need for local mental health services.
The magnitude of the need has increased due to the impact of COVID-19. Nearly one-fifth
(19.8%) of community survey respondents indicated they had been told by a doctor or health

3 City of Laredo 2022-23 Community Health Needs Assessment

care provider that they have a mental health condition. The estimated prevalence of depression
in Laredo is 20.2%. The estimated prevalence of frequent mental distress in Laredo is 16.2%.

 Laredo residents face severe challenges with a lack of specialty care, especially
psychiatry. Many reported that people struggle to find continuity of care for mental health
after crisis management.
 Focus group participants shared that they often travel to other parts of the state to seek
mental health services, which can be expensive.
 Community members mentioned the need to increase access to mental health services
in Laredo.
 Participants also mentioned the negative stigma in the Hispanic culture associated with
mental health, which might prevent individuals and families from seeking treatment and
support.

Overall Health and Wellbeing

The majority (77.8%) of community survey respondents indicated that their health is generally
“good,” “very good,” or “excellent.” The estimated prevalence of frequent physical distress in
Laredo is 15.4%, and the estimated prevalence of “fair” or “poor” self-rated health status in
Webb County is 27.4%.

Focus group participants were asked what health meant to them. They shared:

 Health is at the root of wellbeing and being successful in life.

 Health is being active and a contributing member of the community.
 Key contributions to a healthy lifestyle, such as food access, physical activity, and
education.

Substance Use

Focus group participants and key informants reported concerns regarding increased substance
use and misuse in the community, particularly among young people. Presently, there are no
detox facilities and few halfway homes in Laredo. The estimated prevalence of smoking is
16.4% and heavy drinking, 16.5%. Notably, the overdose death rate has more than doubled in
Webb County over the past two decades, from 5.62 in 2003 to 19.38 in 2021.

Cancer

Focus group participants and key informant interviews listed cancer as a common condition in
the community. Among community survey respondents, 3.9% reported a doctor or health care
provider told them they have cancer. Over the past decade, the age-adjusted invasive cancer
incidence rate for Webb County has been declining (2019 rates per 100,000 are 309.4).

4 City of Laredo 2022-23 Community Health Needs Assessment

Child Health

Many community participants expressed concerns about childhood obesity in Laredo.

Participants also shared that many children in Laredo developed cancer in recent years.
Alongside this concern is the continued need for pediatricians and specialists in Laredo to
provide specialty care. The infant mortality rate (IMR) in Webb County is low, similar to Texas.
Webb County’s IMR was 3.7 in 2019, showing a decrease from 5.1 in 2011. In addition,
vaccination rates increased in Webb County kindergartners.

Maternal Health

A higher percentage of patients in Webb County receive prenatal care in the first trimester than
in Texas (71.7% vs 66.1%). The teen birth rate in Webb County has decreased over the past
decade. Despite this decrease, the teen birth rate in Webb County is higher than Texas and the
United States (39.0 vs 22.4 and 15.4, respectively). Webb County’s teen birth rate decreased
from 82.9 in 2010 to 39.0 in 2020.

Preventive Health Care

Focus group participants noted a pattern of avoidance of preventive care and seeking care at
the last minute, attributing it in part to the Hispanic culture. A lower percentage of adult residents
in Webb County (69.1%) received a preventive, primary checkup in the last year compared to
Texas (72.6%).

Oral Health Care

Over one-third (34.8%) of community survey respondents indicated that they have traveled
outside of Laredo within the past year to receive medical, dental, or mental health care for
themselves. Of these, nearly one half (46.2%) traveled outside of Laredo for dental care. A
much lower percentage of residents in Webb County received a preventive, dental checkup
(42.9%) compared to Texas (57.5%).

BARRIERS TO CARE

Community members and leaders identified lack of health insurance, access to primary and
specialty care, and access to affordable care as the key barriers to managing and treating
health conditions.

Health Insurance

Focus group participants indicated that uninsured and underinsured community members often
avoid preventive care due to cost. Over one-third (69.3%) of community survey respondents
reported having health insurance. Rates of public health insurance coverage (Medicaid,
Medicare) are higher among children and older adults over age 65. An estimated 82,077

5 City of Laredo 2022-23 Community Health Needs Assessment

residents of the city of Laredo have insurance coverage from a public source such as Medicare
or Medicaid/CHIP.

Access to Primary and Specialty Care

Focus group participants described regularly seeking health care outside of Laredo for a variety
of reasons such as better-quality care for more complex health conditions and increased
access. Participants often travelled outside of Laredo to other parts of Texas and to Nuevo
Laredo, Mexico. Webb County is designated as a Medically Underserved Area (MUA). MUAs
are geographic areas with a lack of access to primary care.

The root causes participants identified for the lack of access to primary and specialty care
included overburdened providers leaving Laredo for better opportunities with higher salaries and
a lack of medical residents to become future providers. Community members frequently
mentioned the increasing need for mental health services within the Laredo area. In addition,
they expressed the need for more comprehensive, coordinated care in one place.

 Among community survey respondents, 56.6% indicated they had at least one person
they think of as a personal doctor or health care provider.
o Younger populations (age 18-34) are significantly less likely to have a personal
provider whereas people over 55 years are significantly more likely.
 When asked if there was any time in the last year they needed care but did not get it,
nearly half (48.0%) of community survey respondents indicated they were able to
receive medical care when needed; almost one-third (31.6%) indicated they could not
afford the care.
 Over one-third (34.8%) of community survey respondents indicated they had traveled
outside of Laredo within the past year to receive medical, dental, or health care for
themselves.
o Nearly one-third (32.8%) of those who were parents, guardians, or caregivers
reported traveling outside of Laredo in the last 12 months to receive medical,
dental, or mental health care for children living in their home.

Access to Affordable Care

Community members reported affordability of care as another top barrier to health care access.
They indicated that low-income families living in poverty must make a choice between paying for
basic needs or insurance. Because many residents do not receive full benefits or health
insurance through their jobs, they seek care across the border for prescriptions and doctor’s
visits.

HEALTH LITERACY

According to the Health Resources and Services Administration (HRSA), health literacy means
people have the ability to find, understand, and use information regarding services that can
inform health-related decisions and actions. A large portion of the population in Webb County

6 City of Laredo 2022-23 Community Health Needs Assessment

has basic or below basic levels of health literacy. Community members reported that health
literacy and insurance literacy are still major barriers for many residents of Laredo, especially
those who are undocumented. Many people still feel there is a disconnect in understanding how
to access, seek, and receive care. Language on pamphlets, brochures, and official applications
is often confusing and hard to understand.

Impact of COVID-19

Focus group participants shared that financial strain from the COVID-19 pandemic combined
with inflation decreased their ability to purchase healthy foods. Participants also expressed a
shift in mental health due to COVID. At the same time, some participants noted that although
the pandemic left many negative impacts, the community managed to uplift itself in various
ways. For example, there was a lot of collaboration between different community organizations
to help provide resources and services to the community. Additionally, people became more
aware of their health. For example, several focus group participants said they became more
physically active.

Other Health Needs

Focus group participants wondered if the beautiful parks, resources, and assets could be more
fairly distributed in and around Laredo, including the Colonias. Community survey respondents
identified “stray dogs and or cats” (31.0%), “crime and violence” (28.5%), and the “lack of parks
or playgrounds” (26.0%) as the top three things negatively affecting their health or the health of
those with whom they live.

COMMUNITY ASSETS

The city of Laredo has many community assets and strengths. Participants noted the close-knit
border town and the community’s continual desire to improve. Community members noted key
players in providing health care services and resources to community members. Health and
community-based organizations, nonprofits, and churches are key players, regularly assisting
the community by providing health care services and resources to community members.
Services include housing assistance, workforce development, child abuse support, veteran
support, and food pantry services, among others. These community assets and strengths have
been instrumental in promoting health and wellness to the residents of Laredo.

HEALTH CARE ORGANIZATIONS

Laredo has several health care organizations serving the community, including one federally
qualified health center (FHQC), Gateway Community Clinic, which provides comprehensive
primary and specialty care. Focus groups participants also mentioned Border Region Behavioral
Health Center, City of Laredo Health Department, and Laredo Medical Center.

7 City of Laredo 2022-23 Community Health Needs Assessment

NONPROFITS AND COMMUNITY ORGANIZATIONS

Focus group participants shared that multiple nonprofit and community organizations play a vital
role in supporting and building a healthy community. The Holding Institute, Laredo Housing
Authority, and Serving Children and Adults in Need (SCAN) were specifically mentioned by
participants.

CHURCHES AND FAITH-BASED ORGANIZATIONS

Key informants expressed the impact of churches and faith-based organizations that participate
in community outreach, advocacy, and support those experiencing homelessness. Specifically,
they mentioned Bethany House, Casa de Misericordia, and Mercy Ministries.

PARKS AND RECREATION CENTERS

Focus group participants identified the city’s parks and recreation centers as essential sites for
the community. These sites are hubs of wellness and gathering for the residents of Laredo. But
over a quarter (26.0%) of community survey respondents indicated that a lack of parks and
playgrounds is a problem affecting their health or the health of those with whom they live.

RECOMMENDATIONS

Community members interviewed provided a number of recommendations about actions that

can support and address the health needs of the City of Laredo.

IMPROVE HEALTH CARE ACCESS AND AFFORDABILITY

 Establish mobile or satellite clinics with various health services and programs for primary
care and specialty care throughout Laredo.
 Focus on comprehensive, coordinated care to ensure patients are not lost to follow-up
and increase the time between the providers and patients.
 Offer lower-cost options for primary care and specialty health care.
 Strategize and build incentive programs and opportunities to attract and recruit more
providers.

IMPROVE ACCESS TO SPECIALTY CARE

 Increase availability of specialty care for more complex health conditions.

 Expand mental health services and facilities to meet the needs of the population of
Laredo.

8 City of Laredo 2022-23 Community Health Needs Assessment

INCREASE CULTURALLY RELEVANT HEALTH CARE

 Increase the availability and efficiency of Spanish translators and ensure translation of
all materials into Spanish.
 Encourage providers to involve patients in their treatment decisions and take ownership
of their health from their cultural perspective.

BUILD TRUST AND ENCOURAGE PARTNERSHIPS TO STRENGTHEN THE

COMMUNITY

 Engage community members and build trust through community champions and
community leaders.
 Increase cross-sector collaboration and coordination by building, nurturing, and
deepening partnerships.

STRENGTHEN COMMUNITY ENGAGEMENT AND OUTREACH

 Increase health literacy awareness, especially to community members who are

undocumented.
 Increase knowledge and awareness of how health systems and insurance work.
 Increase the availability of transportation by collaborating with public transportation
services and volunteers.
 Promote available programs and resources in the community through dissemination of
easy-to-understand information.
 Offer health care service opportunities on-site during community events. Promote health
and well-being at community events.

9 City of Laredo 2022-23 Community Health Needs Assessment

 INTRODUCTION
The City of Laredo Health Department is pleased to present the 2022-23 Community Health
Needs Assessment (CHNA) for the City of Laredo, Texas.

CHNAs provide deeper understanding of community health needs, in particular those faced by
historically-underserved community members, and are used to inform strategies and initiatives.
The purpose of this CHNA is to offer a comprehensive understanding of the health and social
determinant of health needs of Laredo residents.

This report provides an overview of the process and methods used to identify priority health and
social determinants of health needs of residents in the city of Laredo, along with community
assets and recommendations from community members to address the identified needs. The
report focuses special attention on the needs of underserved populations, unmet health or
social determinants of health needs, gaps in services, and input from community members and
leaders. This assessment recognizes the social and economic determinants that are the primary
drivers of health and well-being—as the contribution of medical care is only 10-20%—and
emphasizes the living conditions that are upstream of and surround personal behaviors,
disease, and death.

Texas Health Institute (THI) carried out this CHNA for the City of Laredo Health Department
between May 2022 and April 2023. THI used a mix of quantitative and qualitative methods to
identify community health needs, including the analysis of publicly available data sets (Appendix
A), a community-wide survey (Appendices B, C, and D), key informant interviews, and focus
groups (Appendix E) with community members. Content gathered though focus groups and
interviews is integrated into the relevant report sections. Quotes reflect the opinion of one or
more community members. The key findings from the community survey are also integrated into
the relevant report sections. Findings from this report will be used to identify and develop efforts
to improve the health and wellbeing of residents in the Laredo community.

METHODS

The 2022-2023 CHNA uses both primary and secondary data to identify the community's priority
health needs and strengths through a social determinants of health framework. Health is not
only affected by people’s genes and lifestyles but by upstream factors such as employment
status, housing quality, and policies. In addition, the influences of race, ethnicity, income, and
geography on health patterns are often intertwined. As a result, data was analyzed using an
equity lens when possible.

10 City of Laredo 2022-23 Community Health Needs Assessment

Primary data include qualitative and quantitative data collected for the purposes of the CHNA.
THI and collaborating partners collected qualitative data directly from the Laredo community
through focus groups and key informant interviews—referred to as “community input”
throughout the report. In addition, THI, in collaboration with the City of Laredo Health
Department, administered a robust quantitative community survey—referred as “community
survey” throughout the report.

Secondary data include quantitative data attained through publicly available federal and state
agency databases. Federal and state agencies collected these data through surveys or
electronic health records.

PRIMARY DATA COLLECTION AND ANALYSIS

Focus Groups and Key Informant Interviews

THI virtually conducted 11 key informant interviews and seven in-person community focus
groups in Laredo during August and September 2022. The goal of the focus groups and
interviews was to learn about local priority health needs and assets and how community
members think community health and well-being can be improved.

Adult focus group participants (Appendix E) were between 18-65+ years of age and all resided
in ZIP codes 78040, 78041, 78043, 78045, and 78046. The focus groups were conducted in
September 2022. All participants were given a $40 electronic gift card as a thank you for their
participation. Focus groups were facilitated by a faculty member of Texas A&M International
University, a local partner, and one focus group was facilitated by the City of Laredo Health
Department staff. Audio recordings of the focus groups were transcribed using TranscribeMe,
an online transcription service, and staff cleaned and verified transcripts for accuracy, paying
close attention to Spanish comments. Transcripts were coded and analyzed using Atlas.ti
qualitative software.

Key informants (Appendix E) included representatives from health care organizations,

community-based organizations, and the local government. The City of Laredo Health
Department provided a recommended list of key informants based on their leadership roles and
experience working with medically underserved, low-income, or minority communities. The key
informant interviews were conducted in August 2022. A THI staff member served as the
facilitator for all virtual interviews. Audio recordings of the key informant interviews were
transcribed by a transcription service, and staff cleaned and verified transcripts for accuracy,
paying close attention to local knowledge. Transcripts were coded and analyzed using Atlas.ti
qualitative software.

Community Survey

THI developed and—jointly with the City of Laredo Health Department—disseminated a

community survey in fall 2022. The survey was completed by 1,635 residents of the city of

11 City of Laredo 2022-23 Community Health Needs Assessment

Laredo living in ZIP codes 78040, 78041, 78043, 78045, and 78046 between November 18 and
December 9, 2022. All residents completing the survey were 18 or older. One-fifth of survey
respondents (20.4%) completed the survey in Spanish, and 79.6% in English. The process of
development and dissemination of the survey is detailed below.

THI developed a preliminary version of the community survey instrument by referencing other
validated state and national surveys. For example, the CHNA survey tool has questions adapted
from surveys such as the Behavior Risk Factor Surveillance System, American Community
Survey, the National Survey on Drug Use and Health, and the Census. In addition, THI created
community-specific questions that were of interest to the health department and translated the
final draft into Spanish. Team members from the City of Laredo Health Department reviewed,
pilot tested and refined the survey in English and Spanish. The refinement process was
particularly important as the community survey needed to reflect local language and knowledge.
The team from the City of Laredo Health Department spent numerous hours consulting with
local leaders to ensure the language used in the survey was aligned to the language used and
recognized in the community, both in English and Spanish. The final survey instrument reflects
the community of Laredo.

The community survey included 47 questions pertaining to health status and conditions, mental
health, health insurance, health-seeking behaviors and services, COVID-19, housing status,
neighborhood concerns, food access, and demographics (such as age, race, ethnicity, etc.).
The survey also had two screening questions to ensure responses were from residents 18 years
or older that resided within the identified ZIP codes in Laredo.

The survey was built and disseminated in Qualtrics, a web-based survey platform that allows
people to take surveys on a computer, laptop, or mobile device, including scenarios without
internet access.

The City of Laredo Health Department and THI tested the survey in Qualtrics in English and
Spanish, paying careful attention to functionality, clarity of language, and usability on different
device types (e.g., desktop, mobile, tablet).

The City of Laredo Health Department disseminated the community survey during November 18
to December 9, 2022. The health department sent an anonymous link to Qualtrics to community
partner organizations and the health department’s community outreach team. The City of
Laredo Health Department played a key role in the dissemination of the survey, meeting with
promotional specialists who in-turn went to multiple locations throughout the city to engage
community members to complete the survey. The promotional specialists worked during
daytime working hours as well as after-hours events. In addition, the staff of the City of Laredo
Health Department collaborated to promote the survey with:

 Promos on local television stations, including a morning show and on live online news
feeds
 Promos on local radio stations
 Posts on all of the health department’s social media platforms

12 City of Laredo 2022-23 Community Health Needs Assessment

  Survey link emailed to city employees
 Survey QR code and flyers on multiple digital billboards located at various City of Laredo
offices
 In-person visits to Laredo organizations to engage and provide flyers with survey QR
code to managers and service providers with direct customer interaction, including at
City of Laredo buildings, recreation centers, public libraries, nonprofit organizations, and
food banks
 In-person survey recruitment at local health care facilities, including the health
department, Gateway Community Clinics, and five WIC clinics across the city

While the survey was a convenience sample, THI and the City of Laredo Health Department
worked to ensure that it captured a representative sample of Laredo residents by monitoring
several key indicators:

 Age
 Educational level
 Insurance status
 Primary language
 Sex
 Type of insurance
 ZIP code distribution

THI staff provided regular updates to the City of Laredo Health Department, and health
department staff fine-tuned community outreach to achieve a representative sample. In addition,
THI worked with the Area Health Education Center of the Mid Rio Grande Border Area of Texas
to do targeted outreach in ZIP codes with lower initial responses rates and community members
who were uninsured, enrolled in Medicaid, or over 65 years of age.

SECONDARY DATA SOURCES AND ANALYSIS

The quantitative data used for this report is secondary data1 and include data on approximately
80 indicators, many broken down by geography or demographic characteristics when available.
Indicator sources are cited for figures, tables, and graphs in this CHNA. Publicly available data
sources used include:
 American Community Survey o COVID Data Tracker
 Argonne National Laboratory: o National Center for Health
Housing Stability Index Statistics
 Behavioral Risk Factor Surveillance o Social Vulnerability Index
System o U.S. Diabetes Surveillance
 Centers for Disease Control and System
Prevention  Centers for Medicare and Medicaid

1 Data that have already been collected for another purpose.

13 City of Laredo 2022-23 Community Health Needs Assessment

  Federal Bureau of Investigation  Texas Education Agency
Crime Data Explorer  United for ALICE
 Feeding America: Map the Meal Gap  U.S. Bureau of Labor Statistics
Study  U.S. Department of Agriculture:
 Health Resources and Services Food Access Research Atlas
Administration  U.S. Census Bureau
 Substance Abuse and Mental Health o Small Area Income and Poverty
Services Administration: National Estimates Program
Survey on Drug Use and Health o Small Area Health Insurance
 Texas Cancer Statistics Estimates Program
 Texas Department of State Health
Services

These sources collected data through surveys or electronic health record systems, and results
are often a snapshot in time. The data are self-reported unless otherwise indicated. Each
indicator used the most recent data point available for each data source. Multiple years of data
were used to calculate the estimates with a larger sample size and more precision. The
estimates were calculated by the original data source for all secondary data.

THI selected quantitative data for inclusion in this report based on the availability of confidence
intervals at the state and national levels, which allowed THI staff to determine statistical
significance (e.g., whether the county-level value was better or worse than the state or national
value). For some variables, such as “Adult Obesity,” the confidence intervals were not available
at the state or national levels. Consequently, statistical significance could not be calculated. If,
however, the county-level value was notably higher than the state and national average, the
value was included in this report.

Confidence intervals are included in graphs when data for an indicator has a small population
sample. The smaller the population sample, the less certainty about the actual number for the
total population, resulting in overlapping confidence intervals. It can be hard to determine any
significant change when confidence intervals overlap between categories, such as race and
ethnic groups. Some indicators are broken down by geography-based ZIP code tabulation areas
(ZCTAs), as ZIP code is a common variable across many local and state datasets. 2 A reference
map is included in the demographics section. The data analysis typically consisted of calculating
proportions and rates, with a 95% confidence interval where appropriate.

2 ZIP Code Tabulation Areas (ZCTAs) are generalized areal representations of United States Postal Service (USPS)
ZIP Code service areas. The USPS ZIP Codes identify the individual post office or metropolitan area delivery
station associated with mailing addresses. USPS ZIP Codes are not areal features but a collection of mail delivery
routes. The term ZCTA was created to differentiate between this entity and true USPS ZIP Codes.

14 City of Laredo 2022-23 Community Health Needs Assessment

CHNA LAREDO COMMUNITY LEADERSHIP COMMITTEE

The CHNA Laredo Community Leadership Committee (CLC) served as a sounding board and
thought partner throughout the duration of the project. The CLC met a total of four times at
different benchmarks of the CHNA and provided feedback on items such as the community
survey, secondary data indicators, and the utilization of the dashboard and final report. The CLC
was instrumental in disseminating the community survey. See the introduction of this report for a
list of committee members.

SENSEMAKING SESSION

THI facilitated one sensemaking session with the City of Laredo Health Department in March
2023. The sensemaking process provided a structured opportunity for the City of Laredo Health
Department staff and community leaders to begin to sort and make sense of the large amount of
information included in the CHNA and to develop a shared understanding of possible needs and
actions. It also provided an opportunity for feedback prior to finalization of the 2022-23 final
report.

15 City of Laredo 2022-23 Community Health Needs Assessment

DATA CONSIDERATIONS AND LIMITATIONS

The challenges of the past three years have highlighted the critical importance of approaching
all work through the lens of health equity. The co-occurrence of COVID-19, systemic racism,
and inflation (along with widening social and economic inequality) have long-term implications
for health, the systems that shape health, health equity, and regional capacity. As a result, even
the most recently available quantitative data is unlikely to capture fully the emerging health
needs of the diverse and isolated communities most heavily impacted by the pandemic and co-
occurring challenges. This makes incorporating the input of community residents even more
essential for understanding community needs and highlights the importance of capturing high-
quality qualitative data regarding the impact of these challenges on capacity, adaptation of
systems, and the prospects for meeting community needs.

COMMUNITY SURVEY

During analysis, THI weighted the community survey data in order to make the survey sample
more representative of population-level data. The survey data were weighted by age, education,
gender identity, sex, and ZIP code. Staff used Qualtrics to conduct univariate and bivariate
analyses on questions with single and multiple-choice answers. Questions that included an
open-ended answer option were analyzed using Excel, in order to identify the most common
themes among the responses.

The survey findings in this report were included if they were statistically significant, meaning
there is mathematical reason to believe the findings are not due to random chance and instead
there is a true difference between groups. In some cases, the analyses yielded a small or
medium effect size. Even with a small effect size, there were notable patterns among the
findings that emerged across variables. Additionally, the survey had a relatively large sample
(1,635). In combination, this suggests that the differences between groups are significant.

NOTE ABOUT CATEGORIES OF RACE AND ETHNICITY

Data, including census data, is commonly reported by race (e.g., White, Black, Asian).
Reporting outcomes by these groups can be helpful for identifying differences in outcomes
between groups. However, there are important considerations to keep in mind when interpreting
data that uses categories of race. Many factors may influence different health outcomes
between racial groups, including social, environmental, historical, and structural differences in
lived experiences.

When interpreting data in this report, the reader should use caution and remember to
contextualize these findings with the many factors that influence the way people experience
health.

16 City of Laredo 2022-23 Community Health Needs Assessment

LIMITATIONS

As with all data collection, several limitations apply to the data in this report. Different secondary
data sources use different ways of measuring similar variables. There may be a time lag for
many data sources from the time of data collection to data availability. Some data are not
available by specific groups or at a granular geographic level due to the small sample size.

There are limitations in the community survey as well. The survey was a convenience sample,
people that were easy to reach and willing to take a 47-question survey were the respondents.
There could also be potential misinterpretation of questions due to cultural and language
differences. In addition, community partners disseminated the survey, possibly increasingly the
likelihood of reaching already engaged community members.

The perspectives shared are of community members and community leaders who were willing
and able to participate in in-person focus groups and virtual interviews.

17 City of Laredo 2022-23 Community Health Needs Assessment

LANDSCAPE AND CONTEXT

The city of Laredo has a population of 258,014 (2021) people and is located in South Texas on
the border of the United States and Mexico. The city sits on the western edge of Webb County,
Texas (population 267,945 in 2021). Laredo’s economic strength is anchored in logistics and
transportation, with corporate services and life sciences rounding out the local business
landscape. Laredo is the 11th most populous city in Texas. Most notably, more than 95% of its
population identify as Hispanic.

The city of Laredo includes five ZIP Code Tabulation Areas within its boundaries: 78040, 78041,
78043, 78045, and 78046. Figure 1 shows the boundaries of these five ZCTAs. These ZCTAs
are the analyses throughout this report.

To provide further context:

ZIP code 78040 is entirely located within the city of Laredo and encompasses the Historic
downtown district. International Bridge 1 and International Bridge 2 connect it to downtown
Nuevo Laredo, Mexico. Various government buildings, including Laredo City Hall and Webb
County Courthouse, are situated in this ZIP code. Additionally, 78040 is home to the primary
campus of Laredo College, the City of Laredo Health Department, and the well-liked shopping
destination, the Outlet Shoppes. The iconic San Agustin Cathedral is also situated in the
downtown area.

The area known as Central Laredo is contained within the 78041 ZIP code. Its northern
boundary is Del Mar Boulevard, its southern boundary is Saunders St, and it extends to the
east, encompassing Lake Casa Blanca International State Park. In addition to popular
destinations such as Laredo International Airport, Mall Del Norte, and Texas A&M International
University, 78041 is home to numerous health care facilities, including Laredo Medical Center,
Laredo Specialty, and Laredo Rehabilitation Hospitals, and the central Gateway Community
Healthcare Clinic.

The eastern part of Laredo is encompassed by the 78043 ZIP code, which primarily consists of
residential areas. The region extends along U.S. Highway 59 and State Highway 359 and
includes several Colonias. These communities are often underdeveloped and may lack
fundamental infrastructure such as paved roads, running water, or electricity. The Bill Johnson
Student Activity Center is a significant athletic facility for United Independent School District in
78043, and the Utilities Department is located in the City of Laredo City Hall Annex. Additionally,
the Bob Bullock Loop houses the district headquarters of the Texas Department of Public Safety
and the Texas Department of Transportation in this region.

The ZIP code 78045, located in the northernmost part of Laredo, is bordered by Del Mar Blvd to
the south. It boasts the largest public park in Laredo, North Central Park, and is also home to
Laredo Country Club and Doctors Hospital of Laredo. The area extends to the north and west of
Laredo, running along the border with Mexico, and includes both the World Trade Bridge and

18 City of Laredo 2022-23 Community Health Needs Assessment

Columbia Solidarity International Bridge. Additionally, the Mines Road corridor houses a
significant amount of trade and logistics industry infrastructure.

Encompassing the southernmost area of Laredo, the 78046 ZIP code extends southward to
include the towns of El Cenizo and Rio Bravo, and is bordered on the west by the Rio Grande
River, which forms the international border with Mexico. The region is largely residential and is
home to Laredo College's South Campus, as well as a primary care clinic operated by Mercy
Ministries of Laredo. In addition, the area covers a significant amount of rural land, extending
beyond Laredo to the east.

Figure 1
Total Population of Residents by ZCTAs, City of Laredo

19 City of Laredo 2022-23 Community Health Needs Assessment

 DEMOGRAPHICS
Demographics of the community significantly affect its health profile as different race, ethnic,
age, and socioeconomic groups have unique needs and require different approaches to health
improvement efforts.

All demographic estimates included in this section are based on United States Census Bureau
American Community Surveys, unless otherwise indicated.

POPULATION

The population of Laredo is growing. Due to population growth over the past decade, over
258,000 people now live in the city of Laredo (2021). This growth represents a 10.0% increase
in population; during this time, population growth also occurred in the United States, Texas, and
Webb County (8.0%, 16.0%, and 9.0%, respectively).

Population size and growth varies by ZCTA. ZCTA 78045 experienced the greatest growth
(26.0%) and is the second most populous ZCTA with a total of 67,730 residents. ZCTA 78046
experienced an 11.0% population increase and now has the highest population with 68,418
residents. In contrast, ZCTA 78040 experienced an 11.0% population decrease and now has
the smallest population with 37,136 residents.

Figure 2
Laredo’s population has grown over the past decade with highest growth in ZIP codes 78045 and 78046.

300,000 266,963
254,697

250,000

200,000

150,000

100,000 67,730 68,418

46,751 45,703
37,136
50,000

0
78040 78041 78043 78045 78046 City of Laredo Webb County

2011 2016 2021

Source. U.S. Census Bureau, American Community Survey, 2007-2011, 2012-2016, and 2017-2021 (5-year estimates).

20 City of Laredo 2022-23 Community Health Needs Assessment

AGE

Laredo has a smaller percentage of adult population compared to the United States and
Texas. A third of Laredo’s population are under the age of 18 years; this portion is higher than
both the United States (22.5%) and Texas (25.8%). Laredo has a slightly smaller portion of
adults (ages 18-64) than in both Texas and the United States (58.1% vs. 61.7% and 61.5%,
respectively). It also has a slightly smaller population of older adults (over the age of 65 years)
than in both Texas and the United States (9.3% vs 12.5% and 16.0%, respectively).

Figure 3
Laredo has a smaller percentage of adult population compared to Texas and the United States.

100%
9.3% 9.4% 12.5%
90% 16.0%
80%
70%
60% 58.1% 57.9%
61.7%
61.5%
50%
40%
30%
20%
32.6% 32.7%
10% 25.8% 22.5%
0%
City of Laredo Webb County Texas United States

Children (ages 0-17) Adults (ages 18-64) Older Adults (ages 65 and over)

Source. United States Census Bureau Population Estimates, 2017-2020

Laredo’s location on the U.S.–Mexico border may have an impact on population and
demographic estimates. The United States Census Bureau Post-Enumeration Survey
estimates that Texas had a total undercount of 1.92% for the 2020 Census.3 In addition, the
Texas Census Institute has estimated the Webb County undercount to be 1.79% or 4,864
people.4 In the Laredo area, factors that contribute to an undercount may include reluctance to
participate in the Census, complex living arrangements, language barriers, fear of political
climate, and fear of scrutiny due to citizenship status.

3
U.S. Census Bureau. (2022, May 19). 2020 Census Undercounts in Six States, Overcounts in Eight.
https://www.census.gov/library/stories/2022/05/2020-census-undercount-overcount-rates-by-state.html
4
Castellanos-Sosa, F. (2022). Undercounting and Overcounting Population in Texas Counties: A Determinants-Side
Approach and its Application to Texas. Texas Census Institute. https://texascensus.org/wp-
content/uploads/2022/12/06-RRS22-001_221202full-report.pdf

21 City of Laredo 2022-23 Community Health Needs Assessment

CHILDREN AND YOUTH

Laredo’s population of children is growing with largest growth in ZCTA 78045. Over the
past decade, Laredo’s population of children (defined here as ages 0-17) grew slightly
compared to Texas (2.0% vs 10.0%). Over 83,000 children live in Laredo, with the highest
population of children in ZCTA 78046. In the city of Laredo, ZCTA 78045 experienced the
greatest child population growth (18.0%); however, ZCTAs 78040, 78041, 78046, and 78046
experienced a decrease in the child population (-12.0%, -4.0%, -1.0%, and -1.0%, respectively).
The portion of children in the Laredo population exceeds estimates for both Texas and the
United States (32.6% vs 25.8% and 22.5%, respectively).

Figure 4
Laredo has a larger percentage of child population than Texas, with the largest percentage in 78046.

40%
36.2%
35% Laredo 32.6% 33.0%
32.0% 32.1%

30% 29.0%
TX 25.8%
25%
US 22.5%
20%

15%

10%

5%

0%
78040 78041 78043 78045 78046

Source. United States Census Bureau, American Community Survey, 2017-2021.

WORKING-AGE POPULATION

Laredo’s population of working-age residents is increasing slightly with largest growth in

ZCTA 78043. Over the past decade in the United States, the growth of the working-age
population (ages 15 to 64) was outpaced by the rapid growth of the dependent-age population
(ages 0 to 14 and 65 and older). During the same period, Laredo’s working-age population
experienced slight growth with the greatest increase in ZCTA 78043 and decrease in ZCTA
78041. However, the portion of working-age population in most Laredo ZCTAs is lower than in
Texas (66.1%). The portion of working-age population is highest in ZCTA 78045 and lowest in
ZCTA 78040 (66.4% and 58.5%, respectively).

22 City of Laredo 2022-23 Community Health Needs Assessment

Figure 5
Laredo has a smaller percentage of working-age population (ages 15 to 64) with smallest percentage in
78040.

70%

TX 66.1%
65% US 65.4%
Laredo 63.5%
64.1% 66.4%
63.4% 62.6%
60%

58.5%

55%

50%
78040 78041 78043 78045 78046

Source. U.S. Census Bureau, American Community Survey, 2017-2021.

Laredo has a high dependent-age population compared to the working-age population.

Age dependency is higher in Laredo than in both Texas and the United States (72.1 vs 62.2 and
62.7, respectively). The relationship of working-age populations (ages 15-64) and dependent-
age populations (ages 0 to 14 and 65 and older) is measured with the age dependency ratio. In
Laredo, the age dependency ratio is 72.1, meaning that for every 100 working-age people there
were 72 dependent-age people. A high age dependency ratio has social and economic impacts
for residents of all ages.

23 City of Laredo 2022-23 Community Health Needs Assessment

Figure 6
Laredo Has a High Age Dependency Ratio with Highest Ratios in 78040 and 78046.

100
88.3
90

80 76.6
70.7 71.1
70 Laredo 72.1 63.8
60 US 62.7 TX 62.2
50

40

30

20

10

0
78040 78041 78043 78045 78046

Source. United States Census Bureau, American Community Survey, 2017-2021.

24 City of Laredo 2022-23 Community Health Needs Assessment

OLDER ADULT POPULATION

Laredo’s population of older adults is rapidly increasing. Over the past decade, Laredo’s
population of older adults is increasing, although the growth is slower than in Texas and the
United States (29.3% vs 41.9% and 33.7%, respectively). Nearly 24,000 older adults (ages 65
and over) live in the city of Laredo, with the highest population in ZCTA 78040 In the city of
Laredo, ZCTAs 78046, 78045, 78041, and 78043 experienced the greatest growth in older adult
population (83.5%, 62.1%, 40.3%, and 24.3% respectively); however, ZCTA 78040 experienced
a decrease (-10.0%). Despite this rapid growth, the portion of older adults in the Laredo
population is lower than in Texas and the United States (9.3% vs 12.5% and 16.0%,
respectively).

Figure 7
Laredo Has Highest Percentage of Older Adult Population in 78040 and 78041.

18%
US 16.0%
16%
13.9%
14%
TX 12.5% 12.4%
12%

10%
Laredo 9.3% 9.6%

8% 6.8% 7.1%

6%

4%

2%

0%
78040 78041 78043 78045 78046

Source. United States Census Bureau, American Community Survey, 2017-2021.

Laredo’s dependent population of older adults is growing faster than the working-age
population. The relationship of working-age populations (ages 15-64) and old-age dependent
populations (ages 65 and older) is measured with the old-age dependency ratio. In Laredo, the
old-age dependency ratio is 16, meaning that for every 100 working-age people there were 16
old-age dependent-age people. Old-age dependency is lower in Laredo than in both Texas and
the United States (16 vs 20.3 and 26.1, respectively); however, Laredo’s ratio has rapidly
increased over the past decade. A high old-age dependency ratio has social and economic
impacts for residents of all ages. Growth is highest in ZCTAs 78046 and 78041.

25 City of Laredo 2022-23 Community Health Needs Assessment

Figure 8
Laredo’s old-age dependency ratio increased over the past decade, with largest ratios in 78040.

30

25
US 2021 26.14
26.2 26.2
23.8
20 TX 2021 20.3 20.8 21.2

15Laredo 2021 16
16.2 16.3
15.2 15.2

12.6
10 11.1
10.1
8.9 9.2
7.8
5

0
78040 78041 78043 78045 78046

2011 2016 2021

Source. United States Census Bureau, American Community Survey, 2007-2011, 2012-2016, and 2017-2021.

RACE AND ETHNICITY

Most of Laredo’s population identifies as “Hispanic,” followed by “Non-Hispanic White.”

The race and ethnicity of Laredo’s residents remains similar to 2011 estimates.

Figure 9
Population in Laredo is majority Hispanic

Black, 0.3%
Asian, 0.5%
AI/AN, 0.0%
White, 3.2%

Hispanic,
95.5%

Source. United States Census Bureau, American Community Survey, 2017-2021

26 City of Laredo 2022-23 Community Health Needs Assessment

Table 1
Laredo is majority Hispanic, stable over the past decade.

Race/Ethnicity 2011 2021

Hispanic 95.4% 95.5% ▲

White, Non-Hispanic 3.6% 3.2% ▼

Asian, Non-Hispanic 0.6% 0.5% ▼

Black, Non-Hispanic 0.3% 0.3% ▬

American Indian, Alaska Native, NH 0.0% 0.0% ▬

Source. United States Census Bureau, American Community Survey, 2007-2011 and 2017-2021

27 City of Laredo 2022-23 Community Health Needs Assessment

NATIVITY AND LANGUAGE

NATIVE BORN

Laredo has a high population of foreign-born residents compared to Texas and the
United States. The native-born population includes anyone who is a U.S. citizen at birth,
whereas the foreign-born population includes anyone who is not a U.S. citizen at birth or
becomes a U.S. citizen through naturalization. Over the past decade, Laredo’s estimates for
foreign-born residents have decreased while Texas’s and the United States’ estimates have
increased (-15.0% vs 5.0% and 6.0%, respectively).

Figure 10
Laredo has a higher population of foreign-born residents compared to Texas and the United States.

100%
90%
80%
70%
71.5% 74.3% 71.7% 76.7%
60% 77.0%

50%
40%
30%
Laredo 25.2%
20%
TX 17.0%
10% US 13.6%
28.5% 25.7% 28.3% 23.3% 23.0%
0%
78040 78041 78043 78045 78046

Foreign-Born Native-Born

Source. United States Census Bureau, American Community Survey, 2017-2021

U.S. CITIZENSHIP STATUS OF FOREIGN-BORN RESIDENTS

Laredo’s estimated population of foreign-born residents has decreased; however, the

percentage that are naturalized as U.S. citizens has increased. The foreign-born population
includes anyone who is not a U.S. citizen at birth, including those who become U.S. citizens
through naturalization. Laredo’s estimates for foreign-born residents (non-citizen) are higher
than Texas’s and the United States’ estimates (67.9% vs 60.2% and 48.4%, respectively).

28 City of Laredo 2022-23 Community Health Needs Assessment

Figure 11
Laredo has higher populations of foreign-born residents who do not have U.S. citizenship.

100%
90% 23.0% 28.3% 26.7%
80% 34.2%
43.9%
70% Laredo 67.9%
60% TX 60.2%
50%
US 48.4%
40%
30%
20%
10%
77.0% 65.8% 71.7% 56.1% 73.3%
0%
78040 78041 78043 78045 78046

Foreign-born, not US Citizen Foreign-born, US Citizen

Source. United States Census Bureau, American Community Survey, 2017-2021

LANGUAGE

Laredo has a large population of residents who have limited English proficiency. Of the
estimated 232,041 Laredo residents ages 5 and over, nearly 90.0% speak a language other
than English. Of this population, an estimated 77,428 (37.0%) have limited English proficiency.
Populations with limited English proficiency are highest in Laredo ZCTAs 78040 and 78046.
Laredo estimates of limited English proficiency are higher than in Texas and the United States
(37.2% vs 13.1% and 8.2%, respectively).

29 City of Laredo 2022-23 Community Health Needs Assessment

Figure 12
Laredo has a higher percentage of residents who speak a foreign language and have limited English
proficiency.

100%
90%
80% 41.3%
70% 62.8% 61.2%
65.6%
73.4%
60%
50% 58.7%
40%
Laredo 37.3%
30% 37.2% 38.8%
34.4%
20% 26.6%
10% TX 13.1%
0% US 8.2%
78040 78041 78043 78045 78046

Foreign Language-Speaking, Proficient English

Foreign Language-Speaking, Limited English Proficiency

Source. United States Census Bureau, American Community Survey, 2017-2021

Figure 13
South Laredo has the highest percentage of residents who are limited English proficient.

30 City of Laredo 2022-23 Community Health Needs Assessment

DISABILITY

Laredo ZCTA 78040 has the highest estimates of children, adults, and older adults with a
disability. Disabled people are at greater risk for poor general health, wellbeing, and access to
health care services. According to recent estimates, 12.3% of Laredo residents have a disability.
This rate is higher than Texas, but lower than United States averages (11.5% and 12.6%).
ZCTA 78040 has the highest estimates of disability status for older adults (over 65 years of
age), adults (ages 18-64), and children (ages 0-17).

Figure 14
Laredo ZIP codes 78040 and 78046 have the highest percentages of children, adults and older adults
with a disability

a. Children with a disability

12%
10.8%

10%

8%

Laredo 5.7% 6.0%

6% 5.6%

TX 4.4% 4.1%
4% US 4.4% 2.9%

2%

0%
78040 78041 78043 78045 78046

31 City of Laredo 2022-23 Community Health Needs Assessment

 b. Adults with a disability

18%
16.6%
16%

14%

12% 11.0%
Laredo 10.4% 8.8% 9.7% 8.4%
10%
US 10.3%
8%

6%
TX 9.5%

4%

2%

0%
78040 78041 78043 78045 78046

c. Older adults with a disability

70%
65.0%

60%
52.6%
50.1%
50% Laredo 48.5%

39.6%
40%
TX 35.7% 35.2%

30% US 33.4%

20%

10%

0%
78040 78041 78043 78045 78046

Source. United States Census Bureau, American Community Survey, 2017-2021

32 City of Laredo 2022-23 Community Health Needs Assessment

Figure 15
People with Disability by Census Tract, Webb County

33 City of Laredo 2022-23 Community Health Needs Assessment

 OVERVIEW OF COMMUNITY
SURVEY
THI developed and—jointly with the City of Laredo Health Department and with the support of
the Area Health Education Center of the Mid Rio Grande Border Area of Texas (AHEC)—
disseminated a community survey in fall 2022. A total of 1,683 people completed the survey
screening questions. Of these, 1,635 people met the inclusion criteria (at least 18 years old and
residing in ZIP codes 78040, 78041, 78043, 78045 or 78046) and completed the full survey. The
City of Laredo Health Department and community partners distributed the survey between
November 18 and December 9, 2022. The survey was a convenience sample.

DEMOGRAPHICS

Survey participants reported living in the following ZIP codes: 78040 (10.6%), 78041 (16.5%),
78043 (18.8%), 78045 (26.0%), and 78046 (27.9%).

Figure 16
Community Survey Respondents by ZIP code (n=1,631)

30% 27.9%
26.0%
25%

20% 18.8%
16.5%
15%
10.6%
10%

5%

0%
78040 78041 78043 78045 78046

Source. Laredo CHNA Community Survey, 2022

34 City of Laredo 2022-23 Community Health Needs Assessment

AGE

Respondents had to be over 18 years old to participate in the survey. The following chart
displays the breakdown of age ranges among respondents. The majority of people surveyed
were between ages 25 and 54 (68.0%).

Figure 17
Community Survey Respondents by Age (n=1,348)

30%
26.0%
25%
21.7%
20.3%
20%

15% 13.5%
10.0%
10% 8.5%

5%

0%
18-24 25-34 35-44 45-54 55-64 65+

Source. Laredo CHNA Community Survey, 2022

SEX AND GENDER IDENTITY

The survey asked respondents “How do you identify?” with multiple choice options. The majority
(71.6%) identified as “female,” and 27.8% identified as “male.”

Figure 18
Sex of Community Survey Respondents (n=1,345)

Male, 27.8%

Female,
71.6%

Source. Laredo CHNA Community Survey, 2022. Survey respondents were also able to report identifying as “Binary” or “Prefer not
to say” however these were suppressed and excluded from the figure due to data suppression rules.

35 City of Laredo 2022-23 Community Health Needs Assessment

Among survey respondents (1,309), 75.9% identified as “straight” and 14.7% identified as “gay
or lesbian” (one category).

Figure 19
Gender Identity Among Survey Respondents (n=1,309)

I don't know the Prefer not to

Bisexual, 1.6% answer, 1.8% answer, 5.7%

Gay or
lesbian,
14.7%

Straight, 75.9%

Source. Laredo CHNA Community Survey, 2022

RACE AND ETHNICITY

The majority of survey respondents identified their ethnicity as “Hispanic” (96.3%). Additionally,
most respondents identified their race as “White” (86.3%). The second most common racial
category reported was “other” (11.7%). It is important to note that the racialized category of
“White” may include people who have ethnic origins from Latin America, Europe, or even the
Middle East. This category may also include people who identify ethnically as “Hispanic or
Latino.” See note in “Limitations” section about the considerations and limitations of racialized
categories.

36 City of Laredo 2022-23 Community Health Needs Assessment

Figure 20
The majority of community survey respondents were Hispanic or Latino(a) (n=1,334).

Hispanic
or
Latino(a),
96.3%

Not
Hispanic
or
Latino(a),
3.7%

Source. Laredo CHNA Community Survey, 2022

EDUCATION
Nearly two-fifths (38.5%) of people who took the community survey (1,339) reported having a
college degree. As described in the methods section, THI weighted the community survey data
in order to make the survey sample more representative of population-level data. In this case,
the community survey respondents reported having higher educational attainment levels
compared to the overall population of Laredo. Statistical weights were added to the survey data
to make it more representative of educational attainment among the overall population.

Figure 21
A majority of survey respondents had at least some college or technical training (n=1,339).

College Graduate 38.5%

Some College or Technical Training 25.2%

Grades 12 or GED 22.6%

Grades 9-11 8.7%

Grades 1-8 4.6%

0% 10% 20% 30% 40% 50%

Source. Laredo CHNA Community Survey, 2022

Note. Survey respondents were also able to report “never attended.” However these responses were suppressed and excluded from
the figure due to data suppression rules.

37 City of Laredo 2022-23 Community Health Needs Assessment

LANGUAGE

Among people surveyed (1,329), 54.7% reported that they primarily speak English at home and
43.0% primarily speak Spanish. Most people reported speaking English very well (63.5%).

Figure 22
Primary language survey respondents spoke at home was English, followed by Spanish (n=1,329).

English 54.7%

Spanish 43.0%

Other (please specify): 2.3%

0% 10% 20% 30% 40% 50% 60%

Source. Laredo CHNA Community Survey, 2022

Figure 23
Most survey respondents reported speaking English “very well” or “well” (n=1,344).

70% 63.5%
60%

50%

40%

30%
21.7%
20%
7.1% 7.7%
10%

0%
Very well Well Not well Not at all

Source: Laredo CHNA Community Survey, 2022

38 City of Laredo 2022-23 Community Health Needs Assessment

 SOCIAL DETERMINANTS
OF HEALTH
Social determinants of health are the conditions in which people are born, grow, work, live, and
age, and the wider set of forces and systems shaping the conditions of daily life. These
conditions affect the communities and residents of the city of Laredo in many ways.

SOCIAL VULNERABILITY AND ENVIRONMENTAL JUSTICE INDEX

CDC developed the Social Vulnerability Index

(SVI) to measure the potential negative effect
of external stresses—such as disease
outbreaks or human-caused disasters—on
communities. A number of factors, such as
poverty, lack of access to transportation, and
crowded housing may weaken a community’s
ability to prevent human suffering and
financial loss during a disaster. These factors
are known as measures of social
vulnerability.

CDC uses 15 U.S. census variables to help

local leaders identify communities that may
need support before, during, and after a
natural or human-caused disaster or disease
outbreak. These 15 variables are grouped
into four separate vulnerability indices across
(a) housing and transportation measures, (b)
minority status and language measures, (c) household composition measures, and (d)
socioeconomic measures. The four indices are also combined to create an overall index. The
index ranges from 0 to 1, with 0 indicating the lowest vulnerability and 1 the highest
vulnerability.

The city of Laredo’s SVI of 0.7459 indicates a moderate- to high- level of vulnerability.
However, there is some variability within the county, ranging from a very high vulnerability of
0.9360 in the northeast part of the county, to a lower vulnerability of 0.3756 in the eastern part
of the county.

39 City of Laredo 2022-23 Community Health Needs Assessment

Figure 24
Social Vulnerability Index, Webb County

Source. Centers for Disease Control and Prevention, 2020

ENVIRONMENTAL JUSTICE INDEX

The Environmental Justice Index scores census tracts using a percentile ranking which
represents the proportion of tracts that experience cumulative impacts of environmental burden
and injustice equal to or lower than a tract of interest. A percentile ranking represents the
proportion of tracts (or counties) that are equal to or lower than a tract of interest in
environmental burden.

40 City of Laredo 2022-23 Community Health Needs Assessment

Figure 25
Environmental Justice Index, Webb County

CHILD OPPORTUNITY INDEX

Three ZIP codes in the city of Laredo have lower opportunities for children, according to
the Child Opportunity Index (78040, 78043, 78046). The Child Opportunity Index (COI)
measures and maps 29 neighborhood conditions children need to grow and thrive, like access
to healthy food, quality education, safe housing, and clean air. Higher opportunity means
children are more likely to have each of these elements needed to thrive. The COI reveals
disparities in education, health, environment, and socioeconomic indicators. Nationally-normed,
state-normed, and metro-normed COI modeling shows ZIP codes and Census Tracts where
children have very low, low, moderate, high, and very high opportunity.

41 City of Laredo 2022-23 Community Health Needs Assessment

Figure 26
Nationally-Normed Overall Child Opportunity Index by ZCTAs, City of Laredo

When compared to
other ZIP codes
across the nation,
children living in light
color areas have a
‘very high’ Child
Opportunity Index.
Children living in
darker color areas
have a ‘very low’
Child Opportunity
Index.

ZIP Codes with

Lower COI:

 78040
 78043
 78046

ZIP Codes with

Higher COI:

 78045

Source. Diversity Data Kids, Child Opportunity Index 2.0 Database, 2015

COMMUNITY RESILIENCE ESTIMATES

The Community Resilience Estimates, highlighted in Figure 27, measures the capacity of
populations to endure and recover from the health, social, and economic impacts of a disaster
such as a pandemic. Some populations are less likely to have the capacity and resources to
overcome the obstacles due to multiple socioeconomic risk factors. Higher percentages of
population with multiple risk factors indicate that the areas have lower capacity and resources to
overcome the obstacles presented during a hazardous event.

Resilience estimates are modeled from demographics and indicators from the 2019 American
Community Survey (ACS). Examples include: poverty, communication barriers, disability, single
or zero caregiver households, crowded housing, uninsured, older adult over age of 65, limited
transportation, and limited broadband internet.

42 City of Laredo 2022-23 Community Health Needs Assessment

Figure 27
Estimated populations with risk factors for low resilience by census tract, Webb County.

When compared to other census tracts across

the nation, dark orange areas have three or
more risk factors and green areas have no
risk factors.

Source. United States Census Bureau, Community Resilience Estimates, 2019

INCOME

In Laredo, the median household income is $55,603; this is lower than in Texas and the
United States ($67,321 and $69,021, respectively). The median household income reflects
the relative affluence and prosperity of an area. Areas with higher median incomes are likely to
have a greater share of educated residents and lower unemployment rates. Laredo’s median
household income varies by household type. The lowest median household incomes are found
with householders of older adults (ages 65+) and family households with children.

43 City of Laredo 2022-23 Community Health Needs Assessment

Figure 28
Median household income of households in Laredo is lower than Texas and United States.

$90,000
$82,767
$80,000 $76,239
$69,021
$70,000 $67,321

$60,000 $55,603 $54,669

$50,523
$49,599
$50,000

$40,000 $36,275

$30,000

$20,000

$10,000

$0
All Households Householder Age 65+ Family Household with Children

Laredo City Texas United States

Source. United States Census Bureau, American Community Survey, 2017-2021

POVERTY AND ASSET LIMITED (ALICE)

COMMUNITY INPUT
The price of living has increased over the last several years, from housing to food at the grocery
store and to gasoline in particular. Participants from the focus groups and key informant
interviews expressed how this increase in the cost of everyday products and services has
affected not only themselves but also those with the tightest budgets in the community.

“Poverty goes right up at the top … the risk factors and chronic
issues and insurance that kind of tie into poverty. That would be
one, and lack of providers would be two for me. I don’t think you
can really separate them.”
– Key Informant

Both the key informants and focus group participants understand that poverty—and more
generally, any struggle to purchase basic needs—lies at the core of almost all health issues in
Laredo residents’ experience. Health care and health insurance often take a backseat to more
pressing and immediate needs such as food and housing. Focus group participants also felt that
poverty stems from low rates of high school completion and attainment of post-secondary
education among Laredo residents in the current educational system.

44 City of Laredo 2022-23 Community Health Needs Assessment

POVERTY

At the individual level, nearly a quarter of residents in the city of Laredo (22.2%) live
below the federal poverty level. This percentage is higher than Texas (14.0%) and the United
States (12.6%). A high poverty rate is both a cause and consequence of poor economic
conditions. The Census Bureau sets federal poverty thresholds every year, which varies by size
of family and ages of family members. A high poverty rate indicates that local employment
opportunities are not sufficient to provide for the local community. Through decreased buying
power and decreased tax revenue to the county, poverty correlates with lower quality schools
and decreased business survival.

Within the city of Laredo, the ZCTAs with the highest proportion of people living in poverty
include: 78040 (37.1%), 78046 (28.1%), 78043 (27.5%), and 78041 (21.1%). As displayed in
Figure 29, the percentage of children and older adults living in poverty is higher.

Figure 29
Laredo has a higher percentage of children, adults and older adults living in poverty compared to Texas.

a. Children living in poverty in

50%
47.0%

45%

40% 37.5%
36.6%
35% 32.9%
Laredo 30.2%
30%

25%
TX 19.6%
20%

15% US 17.0%
9.6%
10%

5%

0%
78040 78041 78043 78045 78046

45 City of Laredo 2022-23 Community Health Needs Assessment

b. Adults living in poverty in

35%
31.3%
30%

25%
22.3%
21.5%

20%
Laredo 17.5%
16.7%

15%
TX 12.3%

10% US 11.8%
6.5%

5%

0%
78040 78041 78043 78045 78046

Source. United States Census Bureau, American Community Survey, 2017-2021

c. Older adults living in poverty in

40%

35.3%
35%
31.5%

30% 28.9%

25%
Laredo 23.9%

20%
15.9%
15% 13.7%
TX 11.0%
10%
US 9.6%
5%

0%
78040 78041 78043 78045 78046

Source. United States Census Bureau, American Community Survey, 2017-2021

46 City of Laredo 2022-23 Community Health Needs Assessment

Figure 30
Webb County population below the poverty level by census tract

ASSET LIMITED INCOME CONSTRAINED, EMPLOYED (ALICE)

In addition to poverty, it is also important to understand the portion of residents who live above
the poverty line but who earn less than the basic cost of living for the city of Laredo, measured
as ALICE.5

ALICE is an important indicator of economic insecurity because it identifies the prevalence of

households who struggle to afford essentials like food, housing, or health care, and yet do not
meet income qualifications for public assistance programs, such as Supplemental Nutrition
Assistance Plan (SNAP). Basic costs of living are defined as the bare-minimum costs for
housing, child care, food, transportation, health care, and a smartphone plan. ALICE figures are
not available for the city of Laredo specifically, but are available for Webb County.

5 Asset limited, income constrained, employed. For more information on the ALICE methodology and
data, visit https://unitedforalice.org.

47 City of Laredo 2022-23 Community Health Needs Assessment

Laredo ZCTAs 78040 and 78046 have the highest percentage of households below
ALICE. Overall, ZCTA level distribution of ALICE households mirrors the county-level ALICE
data as shown in Table 2 below.

Table 2
ALICE Threshold for Webb County, Texas, 2018 ZCTAs
Laredo ZCTA Total Households % Below ALICE

78040 11,731 79%

78041 14,111 56%

78043 12,402 66%

78045 18,703 43%

78046 16,145 73%

Source. United for ALICE, 2018.

 In 2018—the most recent year ALICE figures are available—26.0% of the households
fell below the poverty line while another 33.0% were ALICE.
 In Texas, single female-headed families are most likely to fall below the ALICE threshold
in Texas due to either living in poverty or being ALICE (79.0%).
 In Texas, households headed by residents ages 45-64 are most likely to fall above the
ALICE category (38.5%) whereas households headed by residents under age 25 are
more likely to fall below the ALICE threshold (74.7%).
 In Webb County, family with children and householders above age 65 are more likely to
live in poverty or below the ALICE threshold.

48 City of Laredo 2022-23 Community Health Needs Assessment

Figure 31
Nearly two-thirds of total households in Webb County are living below the poverty level or ALICE
threshold

100%

90%

80% 38.1% 38.8% 41.0%

46.4%
70%

60%

50% 25.1%
28.6%
40% 33.0%

41.7%
30%

20% 36.2%
33.3%
26.0%
10%
11.8%
0%
Single or Cohabitating Families with Children 65 and Over Total Households
(No Children Under 18)

Poverty ALICE Threshold Above ALICE Threshold

Source. United for ALICE, 2018.

Note. ALICE Threshold households earn more than the Federal Poverty Level, but less than the basic cost of living for the county.

UNEMPLOYMENT

SECONDARY DATA

As with most of the state, the city of Laredo’s unemployment rate was higher than the
United States throughout 2022. The rate of unemployment is an indicator of economic
insecurity experienced by a community. Unemployment can affect an individual’s physical and
mental health, as well as their ability to access and engage with health care services. In fall of
2022, the city of Laredo’s and Webb County’s unemployment rates fell below the rate in Texas.
In 2022, the city of Laredo’s unemployment rate started with 5.4% in January and fell to 3.7% in
December. In 2022, the Texas unemployment rate started with 4.8% in January and fell to 3.9%
in December.

49 City of Laredo 2022-23 Community Health Needs Assessment

Figure 32
Unemployment, Jan 2022-Dec 2022: City of Laredo, Webb County, Texas and United States

0
Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22

City of Laredo Webb County Texas United States

Source. United States Bureau of Labor Statistics

HOUSING

COMMUNITY INPUT

Key informants and focus group participants referenced the complicated nature of
homelessness in and around Laredo. Participants expressed that homelessness is often tied to
mental health and substance abuse, but they were unsure which ultimately led to the other.
Mental health, cost of living increases, and poverty are issues for many residents, but it is a
unique challenge to support people experiencing homelessness.

There is a perception among some focus group participants and key informants that those
experiencing homelessness in Laredo tend to decline support services. However, according to
our key informants, it is also common (roughly two-fifths of the population) for those same
people to be unable to progress in their treatment due to a lack of required documentation.

Laredo residents and leaders seem to be aligned on the need to address housing insecurity. Far
more frequently, key informants and focus group members referred to the difficult commutes of
residents from the Colonias (particularly those on the south side of Laredo towards State
Highway 59, State Highway 359, and U.S. Highway 83).

50 City of Laredo 2022-23 Community Health Needs Assessment

 “I believe that the issue of homelessness is out there. It's been
brought to our community's attention. It's been brought to the mayor
and city council of Webb County. And so now more than ever, I
believe that we're all on the same page.”
– Key Informant

COMMUNITY SURVEY

Survey respondents were asked to report the number of people living in their home (including
themselves). Among respondents (1,320), the most common household size was four people
(21.4%) followed by five people (19.3%).

Survey respondents were asked to indicate what concerns they had, if any, regarding their
current living situation. Of those who responded to this question (1,315), around 18% of survey
respondents indicated they were concerned about feeling safe, and 11.0% reported being
concerned by the condition of their current housing. Finally, about 5% of survey respondents
reported being concerned that their housing is temporary.

Figure 33
Concerns Related to Housing Among Survey Respondents (n=1,315)

Ability to pay for housing or utilities 30.2%

Feeling safe 17.8%

Condition of housing 11.0%

Housing is temporary and I do not have permanent

4.6%
housing

Other (please specify): 3.1%

I do not have any of these concerns about my current

44.2%
living situation

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Source. Laredo CHNA Community Survey, 2022

Survey respondents were asked about the extent to which housing costs (such as rent,
mortgage, or utilities) are a financial burden each month. Of people who answered this question
(1,355), 20.1% reported that housing costs are a large struggle. About 40.0% indicated that
housing costs are somewhat of a struggle.

51 City of Laredo 2022-23 Community Health Needs Assessment

People living in ZIP code 78040 were slightly more likely to report that housing costs were a
large struggle, compared to other areas. Conversely, people living in ZIP codes 78045 and
78043 were most likely to indicate that housing costs were not a struggle at all, compared to
other ZIP codes.

Figure 34
A majority of respondents identified housing costs as a struggle (n=1,355)

20.1% 39.6% 32.4% 7.9%

A large struggle Somewhat of a Not a struggle at all, Don't
struggle know /
not sure

0% 20% 40% 60% 80% 100%

Source. Laredo CHNA Community Survey, 2022

In addition, most survey respondents (86.5%) indicated that they have permanent housing, but
6.6% reported that they have temporary housing with family or friends.

52 City of Laredo 2022-23 Community Health Needs Assessment

Figure 35
Most survey respondents have permanent housing (n=1,345)

I have temporary
housing with family or
friends, 6.6%

I have permanent I do not have housing

housing (living in a (living outside, on the
house alone or with street, in a car, or in a
others, an apartment or park), 1.6%
mobile home), 86.5%

Other, 4.7%

Source. Laredo CHNA Community Survey, 2022

SECONDARY DATA

Housing Burden

In the Laredo, 33.3% of households experience severe housing cost burden; this
estimate is higher than Texas and the United States (29.9% and 30.3%, respectively).
ZCTA 78040 has the highest percentage of severe housing burden for renter-occupied housing
units (53.6%) whereas ZCTA 78046 has highest percentage of severe housing burden for
owner-occupied housing units (32.2%). Severe Housing Cost Burden is the percentage of
households that spend 30% or more of their household income on housing.

53 City of Laredo 2022-23 Community Health Needs Assessment

Figure 36
ZCTAs in Laredo with higher housing cost burden compared to Texas

a. All occupied housing

45%
42.0%

40%

Laredo 33.3% 31.1% 34.9%

35% 32.8%
US 30.3%
30%
27.2%
TX 29.9%
25%

20%

15%

10%

5%

0%
78040 78041 78043 78045 78046

b. Owner-occupied housing

35%
32.2%

30%
26.8%
Laredo 25.4% 24.4%
25%
22.7%
US 21.8%
20%
TX 20.5% 17.2%

15%

10%

5%

0%
78040 78041 78043 78045 78046

54 City of Laredo 2022-23 Community Health Needs Assessment

c. Renter-occupied units

60%
53.6%

50% US 46.0% 43.3% 47.0% 43.6%

Laredo 45.7%
40% 36.3%
TX 45.4%
30%

20%

10%

0%
78040 78041 78043 78045 78046

Source. United States Census Bureau, American Community Survey, 2017-2021

55 City of Laredo 2022-23 Community Health Needs Assessment

Figure 37
ZIP codes 78040, 78046, and 78041 have the highest severe housing cost burden

Source. United States Census Bureau, American Community Survey, 2021

56 City of Laredo 2022-23 Community Health Needs Assessment

EDUCATION

SECONDARY DATA

Attrition and College Readiness

According to Texas Education Agency data for the 2020-2021 school year, the graduation
rate for Laredo ISD is 96.0% and United ISD is 97.2%. This is higher than the average for
Texas’ schools (90.0%), indicating that a higher percentage of students are completing
high school. The four-year graduation rate is a four-year longitudinal rate. This measures the
status of a group of students, or cohort, after four years in high school.

According to Texas Education Agency data for the 2020-2021 school year, the college
readiness rate for Laredo ISD is 92.0% and United ISD is 69.5%, higher than the average
among all Texas’ schools (53.0%). The college readiness rate reflects the percent of students
prepared to take English language and mathematics courses in order to enroll and succeed,
without remediation, in an entry-level general education course for a baccalaureate or associate
degree program.

Educational Attainment

In Laredo, 20.0% of adult residents have a bachelor’s degree or higher; this estimate is
lower than Texas and United States estimates (31.5% and 33.7%, respectively). Laredo
ZCTAs with low educational attainment in ascending order: 78040, 78046, 78043, 78041, 78045
(7.4%, 10.3%, 12.2%, 25.8%, and 34.8%, respectively).

57 City of Laredo 2022-23 Community Health Needs Assessment

Figure 38
Laredo has a higher percent of adult population who have not completed high school.

100%
7.4% 10.3%
12.2%
90% 6.6% 25.8% 6.0%
6.3% 34.8%
80% 16.1%
17.5%
70% 7.7% 20.6%

60% 20.0% 17.3% 10.3%

50% 28.7%
25.7%
49.9% 19.1%
40% 22.1%
Laredo 30.4%
30% 37.5%

27.2% 35.2% 20.0%

20%
TX 15.1%
10%
US 11% 15.8%
0%
78040 78041 78043 78045 78046
Less than 12th Grade High School Graduate (or equivalent)
Some College, No Degree Associate's Degree
Bachelor's Degree or Higher

Source. United States Census Bureau, American Community Survey, 2017-2021

FOOD INSECURITY

COMMUNITY INPUT

“But even if we go to, say, your HEBs, you know, good food, your
vegetables … even for those folks who like organic stuff. And I mean,
it’s expensive to eat healthy. And it’s cheap not to.”
– Focus Group Participant

Focus group participants described how increasing rates of inflation combined with financial
strain from the COVID pandemic directly influenced their ability to purchase healthy foods. Not
only is fast food significantly cheaper in Laredo than a home-cooked meal, but picking up food
saves valuable time that could be spent with family or working another job. As a result, eating
anything takes priority over eating healthy foods.

The food banks serving Laredo strive to nudge their clients toward healthier eating. For
example, they will intentionally accept and offer fewer sugar-sweetened beverages. However,

58 City of Laredo 2022-23 Community Health Needs Assessment

the food banks are often at the mercy of the requirements set by various food suppliers,
including the United States government.

Key informants relayed an unusually large uptick in residents struggling to make ends meet
during COVID, specifically those who would not have needed support before the pandemic.
Residents expressed intense frustration for facing food insecurity while working full-time jobs.

“We had educators in line [at the food bank] during COVID and we had
to ask specific questions [about income] … and [the educators] are
yelling in Spanish, and they’re using really ugly language…. It’s a lot to
ask for help. I think COVID really brought out a lot. It just took things to
another level for a lot [of] people and everything that it brought with it.”
– Key Informant

Finally, residents frequently stated that Laredo’s culture and heritage makes it difficult to eat
healthy. There is an abundance of and a predisposition for greasy, fatty foods.

COMMUNITY SURVEY

Over one-third of respondents in the community survey (37.2%) reported feeling worried
about having enough food to eat due to a lack of financial resources at some point within
the last year. Additionally, 32.3% of respondents indicated that they were unable to eat
nutritious food (such as fruit or vegetables) due to a lack of money or resources.

Specific insights from the community survey:

 Among survey respondents, people who are ages 25-34 were the most likely to
report experiencing food insecurity. People ages 55-64 were less likely to report
experiencing food insecurity.
 People who reported being out of work for one year or more were more likely to
indicate that they did not have enough food to eat due to lack of financial
resources.
 People who reported being unable to work or reported being a homemaker were more
likely to report not having enough food to eat. Alternatively, people who indicated they
are employed for wages were least likely to report not having enough food to eat.
 People living in ZIP codes 78040 and 78043 may be more likely to worry about not
having enough food to eat due to a lack of financial resources. In contrast, people living
in ZIP code 78045 were least likely to worry about having enough food to eat.

Survey respondents were asked to identify any community or government organizations that
provided assistance with food during the last year. SNAP and the South Texas Food Bank were
the most frequent responses. This is notable given the ending of emergency allotments for
SNAP that temporarily increased benefits during the pandemic, helping low-income individuals
and families deal with hardships. Per the United States Department of Agriculture: “The

59 City of Laredo 2022-23 Community Health Needs Assessment

Consolidated Appropriations Act of 2023 passed by Congress ended emergency allotments
after the February 2023 issuance.”

Figure 39
Food Assistance Providers among Survey Respondents (n=1,254)

SNAP (Supplemental Nutrition Assistance 21.4%

Program, Food Stamps)

14.7%
South Texas Food Bank

11.3%
WIC

4.5%
Other

4.5%
Laredo Regional Food Bank
0% 5% 10% 15% 20% 25%

Source. Laredo CHNA Community Survey, 2022

SECONDARY DATA

Prior to the COVID pandemic, food insecurity in Webb County households was higher than in
Texas households and Untied States households (16.2% vs 13.0% and 11.8%, respectively).

60 City of Laredo 2022-23 Community Health Needs Assessment

INTERNET ACCESS

SECONDARY DATA

It is estimated that 78.1% of Laredo residents have broadband internet access; this is
lower than Texas and the United States (86.9% and 87.0%, respectively). Broadband
internet access is lowest in Laredo ZCTA 78040 and highest in 78045 (59.7% and 92.8%,
respectively).

Figure 40
Internet Access by ZCTAs, City of Laredo

Source. United States Census Bureau, American Community Survey, 2017-2021

61 City of Laredo 2022-23 Community Health Needs Assessment

CRIME

COMMUNITY SURVEY

Over one quarter of respondents in the community survey (28.5%) indicated that crime and
violence is a problem affecting their health or the health of those with whom they live. This was
the second highest reported issue.

Figure 41
Survey respondents identified stray dogs or cats and crime and violence as the top concerns affecting
their health (n=1,387).

Stray dogs or cats 31.0%

Crime and violence 28.5%

Not enough parks or playgrounds 26.0%

Not enough sidewalks 17.7%

Air pollution such as fumes, smells, and smoke 16.6%

Abandoned homes and lots 13.2%

Not enough grocery stores 12.8%

Lack of accessible public transportation 10.6%

Too many liquor stores 2.2%

None of these 33.9%

0% 10% 20% 30% 40%

Source. Laredo CHNA Community Survey, 2022

SECONDARY DATA

Violent Crime

The reported violent crime rate (offences per 100,000 population) was lower in Laredo
compared to Texas and the United States in 2021 (310.4 vs. 446.5 and 398.5,
respectively).6 Violent crime includes murder, manslaughter, rape (revised definition), robbery,
and aggravated assault.

6 Federal Bureau of Investigation. (2022). Crime Data Explorer. https://cde.ucr.cjis.gov/

62 City of Laredo 2022-23 Community Health Needs Assessment

Property Crime

The reported property crime rate (offenses per 100,000 population) was lower in Laredo
compared to Texas and the United States in 2020 (1227 vs. 2245 and 1958, respectively).
Property crime includes burglary, larceny-theft, and motor vehicle theft.

TRANSPORTATION

COMMUNITY INPUT

“We drive everywhere. Nobody wants to walk. I don't want to walk to the
health department from the food bank. I'll get run over. You have people visit
from London, and they think they can just walk to a spot. You're not walking
there. It's too hot. You’ll get burnt here. You’re not going to make it. This is
just the inactivity of things.”
– Key Informant

Participants stated that with Laredo’s climate and infrastructure, driving is a necessity for
everyday life—walking and biking are simply untenable. However, with the cost of gas spiking
significantly from 2020 through mid-2022, transportation was yet another area that became an
issue for residents of Laredo, particularly for residents with lower incomes.

Transportation becomes even more of a barrier for residents seeking specialty care and mental
health services. Focus group members shared that for health needs outside of routine care,
they must travel to a major metropolitan area, most frequently San Antonio or Corpus Christi.
For example, people undergoing surgery required other family members to take time off from
work to travel with them.

63 City of Laredo 2022-23 Community Health Needs Assessment

 COMMUNITY ASSETS AND
STRENGTHS
Participants noted the close-knit border town and the community’s continual desire to improve.
The city of Laredo has many community assets and strengths that support the needs of the
community and improve quality of life. Health and community-based organizations, nonprofits,
and churches are key players, regularly assisting the community by providing health care
services and resources to community members. In addition, participants also mentioned the
City’s beautiful parks and modern recreational centers.

Key informants praised collaborative efforts from nonprofit organizations and community-based
organizations, as they constantly improve the quality of services and make it possible to reach
those most in need. Services provided by the nonprofits and community-based organizations
range from housing assistance, to workforce development, child abuse support, veteran
support, and food pantry services, among others. These community assets and strengths have
been instrumental in promoting health and wellness to the residents of Laredo.

Participants identified four categories of organizations as valuable resources in community:

health care organizations; nonprofits and community organizations; churches and faith-based
organizations; and parks and recreation centers.

HEALTH CARE ORGANIZATIONS

Laredo is home to one federally qualified health center (FQHC), Gateway Community Clinic,
which provides comprehensive primary care and specialty care.

The city is also home to clinics that provide primary and specialty care. Focus group participants
mentioned:
 Border Region Behavioral Health Center
 City of Laredo Health Department
 Laredo Medical Center

In addition, the Doctors Hospital of Laredo is also a community asset. The City of Laredo has
five National Health Service Corps (NHSC) sites. This designation is given by the Health
Resources and Services Administration for a clinical site, typically an FQHC, which is located
within a designated Health Professional Shortage Area and can provide services to people
without regard for their ability to pay. Of the five NHSC sites in the City of Laredo, all five are
open to the public: Gateway Community Health Center, which has four locations, and Border
Region Community Center.

64 City of Laredo 2022-23 Community Health Needs Assessment

NONPROFITS AND COMMUNITY ORGANIZATIONS

Nonprofits and community-based organizations in the city of Laredo play a vital role in building
healthy communities by providing educational, health, and social services to community
members. Focus group participants shared that these organizations in the area are essential to
providing residents with basic needs and other important services. Participants specifically
mentioned:
 Children’s Advocacy Center—Laredo
 Holding Institute
 Laredo Economic Development Corporation
 Operation Border Health Preparedness
 Laredo Housing Authority
 NeighborWorks Laredo
 Serving Children and Adults in Need
 South Texas Food Bank
 Laredo Webb County Food Bank
 Webb County Veterans Services

CHURCHES AND FAITH-BASED ORGANIZATIONS

Key informants also expressed the impact of churches and faith-based organizations that
participate in community outreach, advocacy, and support for those experiencing
homelessness. Participants mentioned the following churches and faith-based organizations as
valuable resources for the community:
 Bethany House of Laredo  Mercy Ministries of Laredo
 Casa De Misericordia

PARKS AND RECREATION CENTERS

COMMUNITY INPUT

Focus group participants identified the city’s parks and recreation centers as essential sites for
the community. These spaces provide natural space, opportunities for physical activity, time in
nature, and places to hold community events. These sites remain hubs of wellness and
gathering for the residents of Laredo.

“Well, I think like the parks, I mean, they're getting better. I

think before like in the 90s, early 2000s there was a lack of
parks, and I think in the last 10-15 years, the parks have
been helping us, like—that's my gym, you know? I do not go
to any gym. That is my gym.”
– Focus Group Participant

65 City of Laredo 2022-23 Community Health Needs Assessment

COMMUNITY SURVEY

Over one quarter of respondents in the community survey (26.0%) indicated that a lack of
parks or playgrounds is a problem affecting their health or the health of those with whom
they live. Additionally, 17.7% indicated that a lack of sidewalks was a concern (see Figure 41).

The City of Laredo has many parks available for residents to use:

 Albert Ochoa/Nixon Park  Indian Sunset/Robert Muller Park

 Aldo Tatangelo Walkway  Inner City Park
 Andres “Andy” Ramos Jr. (East  Jarvis Plaza
Central Park)  Juan Ramirez (El Cuatro) Park
 Andrew Circle Park  John Valls Park WWII Veteran at
 Andrew Trautmann Park North Central
 Arturo N. Benavides Sr. Memorial  John Peter & Consuelo Montalvo
Park  Johnny Rendon Park
 Azteca Park  Jose & Alica Garza Park (Cielito
 Blas Castañeda Park Lindo)
 Bruni Plaza  Jose Ortiz-Elida Valdez Park
 Canizales Park  Jovita Idar’s El Progreso Park
 Chacon Bat Park  Lafayette Street Park
 Chaparral Park  Las Brisas Park
 Cheyenne Park  Loma Alta Park
 Circle Drive Park  Mario Tijerina Park
 Corner Park  Noon Lions Park
 Cynthia Collazo Park  Parque España (Santa Rita) Park
 Dr. Cecilia May Moreno Park  Roberto De Llano Track
 Dr. Martha E. Villarreal (Ochoa  San Agustin Plaza
Sanchez) Park  Santa Fe Park
 Divine Mercy Park  Santo Niño Park
 Dryden Memorial Park  Seven Flags Park
 El Mercado  Shiloh Crossing
 Father McNaboe Park  St. Peter’s Plaza
 First Responder Park  Slaughter Splash Park
 Freddie Benavides Sports Complex  Three Points Park
 George Washington Park  Uni-Trade Stadium
 Geraldine Agredano (Century City)  Vietnam Veterans Memorial at North
Park Central Park
 Houston Park  Villa Del Sol Park
 Independence Hills Park  Vista Nueva Park

66 City of Laredo 2022-23 Community Health Needs Assessment

The City of Laredo has twelve recreation centers available:

 Barbara Fasken Recreation Center

 Canizales Boxing Gym
 Cigarroa Recreation Center
 East Hachar Recreation Center
 El Eden Recreation Center
 Fasken Senior Center
 Haynes Recreation Center
 La Ladrillera Adult Recreation Center
 Marcos J. Aranda Recreation & Boxing Gym
 Margarito Benavides, Jr. Recreation Center
 NE Hillside Recreation Center
 North Central Fitness Center

67 City of Laredo 2022-23 Community Health Needs Assessment

 PRIORITY HEALTH NEEDS
The priority health issues and barriers to healthy lifestyles experienced by the residents of
Laredo can be influenced through policy and system-level changes and collaboration with
community partners.

DIABETES

COMMUNITY INPUT

The most common health conditions mentioned among key informants and focus group
participants include diabetes, hypertension, obesity, heart disease, and cancer. Participants
emphasized that each of these conditions are prominent in the Hispanic and Latino communities
in Laredo.

Diabetes came up multiple times as something that runs in families, mostly Hispanic families.
Participants indicated that diabetes is very common in their community. Several participants
said there were robust educational resources available in the community but people did not
access them for multiple reasons, from not knowing they exist to not understanding how these
resources help people navigate the disease.

“But at least in in my family—I think a lot of Hispanic families

are like this—diabetes and heart disease is very prevalent.”
– Focus Group Participant

COMMUNITY SURVEY

Nearly one-fifth of survey participants (21.6%) reported a doctor or health care provider
told them they have diabetes, and almost 19.0% reported a doctor or health care provider
told them they have prediabetes. In addition, nearly 30.0% of the 305 survey participants
indicated they had gestational diabetes during a previous pregnancy.

68 City of Laredo 2022-23 Community Health Needs Assessment

Figure 42
Laredo residents report high rates of health conditions, including chronic disease and mental health (as
told by a doctor or health care provider) (n=951).

High blood pressure 41.1%

Obesity 35.3%
High cholesterol 29.9%
Diabetes 21.6%
Mental health condition 19.8%
Prediabetes 18.8%
Asthma 14.4%
Heart disease 4.5%
Neurodevelopmental disability 4.2%
Any physical disability 4.1%
Cancer 3.9%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Source. Laredo CHNA Community Survey, 2022

Note. Results for substance use were omitted due to low numbers.

SECONDARY DATA

The estimated prevalence of diabetes in Laredo is higher than in Texas and the United
States (15.7% vs 12.6% and 11.1%, respectively). Laredo ZCTAs 78040 and 78043 have the
highest estimates (22.5% and 16.6%, respectively). Laredo ZCTA 78045 has the lowest
estimates (10.6%).

Figure 43
Estimated prevalence of diabetes among adults is higher in Laredo with highest estimates in 78040.
25%
22.5%

20% 16.6%
15.8% 15.2%
15%Laredo 15.7%
TX 12.6% 10.6%

10% US 11.1%

5%

0%
78040 78041 78043 78045 78046

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, ZCTA 2022 Release (2020 Data)

69 City of Laredo 2022-23 Community Health Needs Assessment

Figure 44
Estimated Prevalence of Diabetes Among Adults Aged 18 Years and Older by Census Tract, Webb
County

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, Census Tract 2022 Release

OBESITY

COMMUNITY INPUT

Participants from focus groups and key informant interviews emphasized obesity as prominent
in the Hispanic community. They shared several contributing factors such as inability to afford
healthy food options, poor nutrition habits, and lack of nutrition education possibility linked to the
Hispanic culture.

70 City of Laredo 2022-23 Community Health Needs Assessment

 “Well, we're just talking about earlier: the tamales come in. That's part
of our race and ethnicity, right? It starts getting chilly and like… We
need these tamales, we need that hot cocoa, champurrado, and we
eat like 3000 calories in one meal. We don't care, like, but it's part of
our race and ethnicity. We like to have that bonding with our family,
and that's where it goes back to, like, the older generations. They
have that, and they taught us that.”
– Focus Group Participant

COMMUNITY SURVEY

Among survey respondents (951), 35.3% reported a doctor or health care provider told
them they have obesity (Figure 42).

SECONDARY DATA

The estimated prevalence of obesity in Laredo is higher than in Texas and the United
States (45.2% vs 35.8% and 31.9%, respectively). Laredo ZCTAs 78040 and 78046 have the
highest estimates (48.9% and 46.9%, respectively). Laredo ZCTA 78045 has the lowest
estimates (39.8%).

Figure 45
Estimated prevalence of obesity among adults is higher in Laredo with highest estimates in 78040 and
78046.

60%

48.9%
50% 42.9% 45.7% 46.9%
Laredo 45.2%
39.8%
40%
TX 35.8%
30% US 31.9%

20%

10%

0%
78040 78041 78043 78045 78046

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, ZCTA 2022 Release (2020 data)

71 City of Laredo 2022-23 Community Health Needs Assessment

Figure 46
Estimated Prevalence of Obesity Among Adults Aged 18 Years and Older by Census Tract, Webb County

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, Census Tract 2022 Release

72 City of Laredo 2022-23 Community Health Needs Assessment

KIDNEY DISEASE

SECONDARY DATA

The estimated prevalence of chronic kidney disease among adults aged 18 years and
older in Laredo is higher than in Texas and the United States (4.0% vs 2.7% and 2.9%,
respectively). Laredo ZCTAs 78040 and 78043 have the highest estimates (5.3% and 3.7%,
respectively). Laredo ZCTA 78045 has the lowest estimates (2.2%).

Figure 47
The estimated prevalence of chronic kidney disease among adults is higher in Laredo and ZIP code
78040.

6%
5.3%

5%

3.7%
4% Laredo 4.0% 3.5%
3.3%

3% US 2.9%
TX 2.7% 2.2%
2%

1%

0%
78040 78041 78043 78045 78046

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, ZCTA 2022 Release (2020 data)

73 City of Laredo 2022-23 Community Health Needs Assessment

Figure 48
Estimated Prevalence of Chronic Kidney Disease Among Adults Aged 18 Years and Older by Census
Tract, Webb County

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, Census Tract 2022 Release

74 City of Laredo 2022-23 Community Health Needs Assessment

MENTAL HEALTH

COMMUNITY INPUT
Residents of Laredo feel there is a significant need for local mental health services. The
prevalence of mental illness in Laredo has increased due to the impact of the COVID-19
pandemic, and so far, service providers have not been able to keep up.
Laredo residents face severe challenges with a lack of access to specialty care, especially
psychiatry. Key informants and focus group participants stated that many residents struggle to
find continuity of care for mental health after going through crisis management.

“We don't have a lot of mental health services here. We don't have a lot of
psychiatrists here. There's not a lot of continuity of care. The private sector
doctors are overwhelmed with private practice.”
– Key Informant

The costs associated with traveling to other parts of the state to seek mental health services can
make it expensive for residents to maintain treatment. Patients who do not travel outside of
Laredo for mental health services only rely on their prescribed medication, which at times is only
half of the required treatment for specific illnesses.

“Mental health issues. We have a lot of untreated mental health issues. And
when they do try to seek help, there are so many barriers. So access to
mental health resources in Laredo is nearly impossible to get.”
– Focus Group Participant

Community members frequently mentioned the increasing need for mental health services
within the Laredo. Common mental health concerns discussed include a lack of psychiatrists
and psychologists, an increase in substance abuse in youth and people experiencing
homelessness, and having very little access to mental health services in general.

“One of the things that we definitely do not have enough access to is mental
health, because there's a lot of patients that are under-treated and lack
access to mental health professionals.”
– Key Informant

Community members also mentioned a negative stigma in the Hispanic and Latino cultures
associated with mental illness, which prevents individuals and families in these communities
from seeking treatment and support.

75 City of Laredo 2022-23 Community Health Needs Assessment

 “The issue here in Laredo is that because our population is majority
Mexican American and is of Mexican descent, there is a stigma about
mental health. So, people wait ‘til the last minute, after maybe a crisis
situation arises, and they have to hospitalize a family member….
Sometimes the closest place is either San Antonio or Corpus Christi. And
again, that's only because of the fact that the facility that we have here for
treatment services has a very low amount of availability for beds.”
– Key Informant

COMMUNITY SURVEY

Nearly one-fifth of respondents (19.8%) indicated that they had been told by a doctor or
health care provider that they have a mental health condition, such as anxiety,
schizophrenia, or other major emotional problem.

In addition, people indicated how many days within the last month their mental health was not
good. The average number of days reported was 5.5, and the median number of days was
three.

Figure 49
Number of Poor Mental Health Days During the Last 30 Days (n=1,371)

45%

40% 38.4%

35% 33.0%

30%

25%

20%

15% 13.6%

10%
4.7% 4.2% 4.2%
5% 2.0%
0%
0 1-5 days 6-10 days 11-15 days 16 to 20 21 to 25 26 to 30
days days days

Source. Laredo CHNA Community Survey, 2022

76 City of Laredo 2022-23 Community Health Needs Assessment

Figure 50
Average and Median Number of Poor Mental Health Days Over the Last 30 Days by Age (n=1,149)

8
7.1
Days Per Month with Poor Mental Health

7 Average Overall, 5.5

5.7 5.8
6 5.5
5
4.0 3.9
4 3.5 3.6

3
2.0 2.0 2.0
2 Median
Overall, 3.0
1
0
0
18-24 25-34 35-44 45-54 55-64 65+
Age Group

Median Days by Age Group Average Days by Age Group

Median Overall Average Overall

Source. Laredo CHNA Community Survey, 2022

According to the community survey, people living in ZIP code 78040 were slightly more likely to
report having more poor mental health days, compared to other areas.

Figure 51
Median Number of Poor Mental Health Days by ZIP Code (n=1,323)

8
7.2 Average Overall, 5.5
Number of Poor Mental Health Days per

6 5.1 5.6 5.7

5 4.5
4.0 Median
Month

4
Median Overall, 3.0 Average
3.0
3 Median Overall
2.0 2.0 2.0 Average Overall
2

0
78040 78041 78043 78045 78046
ZIP Code

Source. Laredo CHNA Community Survey, 2022

77 City of Laredo 2022-23 Community Health Needs Assessment

Figure 52
Females reported a higher number of poor mental health days than males (n=1,139)

7
Number of Poor Mental Health Days per Month

6
6.0 Average
Days
5

4.5
4 Average
Days
3
3.0
Median Days
2

1 1.0
Median
Days
0
Male Female
Sex

Source. Laredo CHNA Community Survey, 2022

Figure 53
Number of Poor Mental Health Days by Employment Type (n=1,138)

Median Days Average Days

12 10.9
Number of Poor Mental Health Days per

10
7.5
8
6.1 5.6 5.0 5.9
5.4 5.4
6 4.4 4.7
4 2.5 3.0 3.0
2.0 2.0
Month

2
0
0

Source. Laredo CHNA Community Survey, 2022

78 City of Laredo 2022-23 Community Health Needs Assessment

SECONDARY DATA

The estimated prevalence of depression in Laredo is higher than in Texas and the United
States (20.2% vs 17.7% and 19.2%, respectively). Laredo ZCTAs 78040 and 78046 have the
highest estimates (22.4% and 22.4%, respectively). ZCTA 78045 has the lowest estimates
(18.5%).

Figure 54
The estimated prevalence of depression among adults is higher in Laredo and ZIP 78040 and 78046.

25%
22.4% 22.4%
21.3%
19.9% 18.5%
20% Laredo 20.2%
US 19.2%
15% TX 17.7%

10%

5%

0%
78040 78041 78043 78045 78046

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, ZCTA 2022 Release (2020 data)

79 City of Laredo 2022-23 Community Health Needs Assessment

Figure 55
Estimated Prevalence of Depression Among Adults Aged 18 Years and Older by Census Tract, Webb
County

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, Census Tract 2022 Release

80 City of Laredo 2022-23 Community Health Needs Assessment

The estimated prevalence of frequent mental health distress in Laredo is higher than in
Texas and the United States (16.2% vs 13.2% and 13.5%, respectively). Laredo ZCTAs
78046 and 78040 have the highest estimates (19.0% and 18.6%, respectively). Laredo ZCTA
78045 has the lowest estimates (14.3%). Frequent mental health distress refers to residents
who report mental health as “not good” for 14 days or more.

Figure 56
Estimated prevalence of frequent mental distress among adults is higher in Laredo and 78046.

20% 18.6% 19.0%

17.5%
18%
15.9%
16% Laredo 16.2%
14.3%
14% US 13.5%
12% TX 13.2%
10%

8%

6%

4%

2%

0%
78040 78041 78043 78045 78046

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, ZCTA 2022 Release (2020 data)

81 City of Laredo 2022-23 Community Health Needs Assessment

Figure 57
Estimated Prevalence of Frequent Mental Distress Among Adults Aged 18 Years and Older by Census
Tract, Webb County

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, Census Tract 2022 Release

Webb County has higher depression compared to Texas (19.7% vs 17.7%) and higher
frequent mental distress (16.1% vs 13.2%). Data for suicidal thoughts, serious mental illness,
and mental health services received in the past year are available from the National Survey of
Drug Use and Health (NSDUH) for Region 11abd, which includes Webb County and 17 other
counties in south Texas.7 However, county-level data is not available due to recent updates in
NSDUH’s methodology. The estimates for suicidal thoughts and serious mental illness are

7 NSDUH Region 11abd counties include Aransas, Bee, Brooks, Cameron, Duval, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak,
McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, and Zapata.

82 City of Laredo 2022-23 Community Health Needs Assessment

slightly lower in Region 11abd than Texas. The Region 11abd estimate for receiving mental
health services in the past year is lower than Texas (8.6% vs 12.9%).

Figure 58
Mental Health Estimates for Adults Aged 18 Years and Older in Webb County, Public Health Region
11abd and Texas

25%

19.7%
20%
17.7%
16.1%
15% 13.2% 12.9%

10% 8.6%

5% 3.3% 3.6% 3.2% 3.7%

0%
Ever told they Frequent mental Suicidal thoughts Serious mental Received mental
have depression distresss in the past year illness in the past health services
year

Webb County Region 11abd Texas

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, ZCTA 2022 Release; Substance
Abuse and Mental Health Services Administration (SAMHSA) National Survey of Drug Use and Health 2016-18.

83 City of Laredo 2022-23 Community Health Needs Assessment

OVERALL HEALTH AND WELLBEING

COMMUNITY INPUT

Focus groups participants were asked about what health meant to them and why it was
important to them. Many expressed that health was at the root of wellbeing and being
successful in life.

“In the community, you can be wealthy, you can be poor, but if you have
no health, it doesn’t matter.”
– Focus Group Participant

Several participants connected health to being an active and contributing member of the
community.

“I think health is more than the lack of or the lack of illness, it’s more about
being able to enjoy life and contribute, participate actively in the
community and to—I think for me, it’s about being able to enjoy life and
not be preoccupied with this condition and that condition.”
– Focus Group Participant

Health was also defined broadly by participants. They spoke about the different aspects of
health and also some of the key contributors to healthy lifestyles such environment, food
access, physical activity, and education.

“We've got physical health, mental health, emotional health, spiritual

health, social health, financial health. So the moment you mentioned
that’s what came to mind in mind. So there's many aspects to that word.
It's not just the physical health itself.”
– Focus Group Participant

COMMUNITY SURVEY

A majority of survey respondents indicated that their health is generally “good,” “very good,” or
“excellent,” 18.3% indicated their health was in “fair” condition, and only 12.9% indicated their
health was in “excellent” condition.

Based on the survey responses, people living in ZIP code 78040 were more likely to report
having poor health, whereas those living in ZIP code 78041 may be more likely to report having
very good health. In addition, women were more likely to report fair health than men. Similarly,
respondents who did not speak English were significantly more likely to report “fair” health
(35.9%) (Appendix D).

84 City of Laredo 2022-23 Community Health Needs Assessment

Figure 59
The majority of survey respondents indicated that their general health was good, very good, or excellent.
(n=1,579)

50%
38.9%
40%

30% 26.0%

18.3%
20%
12.9%
10%
2.8% 1.1%
0%
Excellent Very good Good Fair Poor Don't
know/not
sure

Source. Laredo CHNA Community Survey, 2022

SECONDARY DATA

Physical Distress

The estimated prevalence of frequent physical distress in Laredo is higher than in Texas
and the United States (14.4% vs 9.4% and 9.9%, respectively). Laredo ZCTAs 78040 and
78046 have the highest estimates of people reporting frequent physical distress (20.4% and
15.6%, respectively). ZCTA 78045 has the lowest estimates (9.3%). Frequent physical distress
refers to residents who report physical health as “not good” for 14 days or more.

Figure 60
The estimated prevalence of frequent physical distress is higher in Laredo and highest in 78040
25%
20.4%
20%
13.6% 15.3% 15.6%
15% Laredo
14.4%
US 9.9% 9.3%
10%
TX 9.4%
5%

0%
78040 78041 78043 78045 78046
Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, ZCTA 2022 Release (2020 data)

85 City of Laredo 2022-23 Community Health Needs Assessment

Figure 61
Estimated Prevalence of Frequent Physical Distress among Adults Aged 18 Years and Older by Census
Tract, Webb County

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, Census Tract 2022 Release

Overall Health Status

The estimated prevalence of “fair” or “poor” self-rated health status in Webb County
(27.4%) is higher than in Texas and the United States (17.7% and 17.8%, respectively).
When self-rating health, the difference between Laredo’s highest ZCTAs (78040 and 78046) is
substantial. ZCTAs 78040 and 78046 have the highest estimates (40.2% and 31.1%,
respectively), and ZCTA 78045 has the lowest estimates (16.7%).

86 City of Laredo 2022-23 Community Health Needs Assessment

Physical Inactivity

The estimated prevalence of physical inactivity is lower in Laredo (39.5%) than in Texas
(48.1%) and the United States (50.6%). This indicates that overall, residents of Laredo are more
physically active. However, there is significant variability between ZIP codes. Laredo ZCTAs
78040 and 78046 have the highest estimates of physical inactivity (49.0% and 42.0%,
respectively) while ZCTA 78045 has the lowest estimates (27.1%). This indicates that residents
of 78045 are the most physically active.

Figure 62
Rates of Physical Inactivity in Laredo and by ZIP Code

60%

US 50.6% 49.0%
50%
TX 48.1%
40.6% 42.0%
36.1%
40% Laredo 39.5%

30% 27.1%

20%

10%

0%
78040 78041 78043 78045 78046

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, ZCTA 2022 Release (2020 Data)

SUBSTANCE USE

COMMUNITY INPUT

Focus group participants and key informants reported concern regarding an increase in
substance use and misuse in the community, particularly among young people.
Residents expressed a dire need for local substance use care centers because currently people
have to go outside of Laredo to receive treatment.

“And anybody that I needed to send for treatment [or] I needed to send them
for detox, I would have to send them [out] of Laredo.”
– Key Informant

87 City of Laredo 2022-23 Community Health Needs Assessment

Participants indicated that people experiencing homelessness continue to face ongoing
challenges, especially mental illness and substance use disorders. Presently, there are no
detox facilities and few halfway homes in Laredo, which heavily contributes to this ongoing issue
of homelessness.

SECONDARY DATA

Smoking

The estimated prevalence of smoking in Laredo is higher than in Texas and the United
States (18.2% vs 13.2% and 15.5%, respectively) (Figure 63). Laredo ZCTAs 78040 and
78046 have the highest estimates (23.2% and 21.8%, respectively). ZCTA 78045 has the lowest
estimates (12.4%).

Heavy Drinking

The estimated prevalence of heavy drinking in Laredo is lower than in Texas and the
United States (15.6% vs 16.4% and 15.7%, respectively) (Figure 63). Laredo ZCTAs 78045
and 78046 have the highest estimates (19.1% and 17.2%, respectively). ZCTA 78040 has the
lowest estimates (13.8%).

Figure 63
Estimated Prevalence of Smoking and Heavy Drinking Among Adults

Laredo, 18.2%

Smoking Texas, 13.2%

United States,
15.5%

Laredo, 15.6%

Heavy drinking Texas, 16.4%

United States,
15.7%

0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%

Source. CDC Behavioral Risk Factor Surveillance System (BRFSS), Local Data for Better Health, ZCTA 2022 Release (2020 data)

88 City of Laredo 2022-23 Community Health Needs Assessment

Illicit Substance Use and Overdose

The overdose death rate has more than doubled in Webb County over the last two
decades. Webb County’s overdose death rate was 19.38 in 2021, an increase from 5.63 in
2003. Overdose deaths in Texas and the United States have also been increasing during this
same period, with 2020 estimates of 14.1 and 28.3, respectively.

The estimated prevalence of recent illicit substance use in the past month8 for the Webb County
area (Region 11abd) is lower than in Texas and the United States (5.3% vs 7.8% and 11.2%,
respectively).

Figure 64
Illicit Drug Use in Past Month, Ages 12 and Over
14.00% 12.7%

12.00% 11.2%
9.6%
10.00%
8.9%
8.00%
7.4% 7.8%
6.00%
5.3%
5.7%
4.00%

2.00%

0.00%
2012-2014 2016-2018 2018-2019

Region 11abd Texas US

Source. Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey of Drug Use and Health, 2020
Note. Region 11abd counties include Aransas, Bee, Brooks, Cameron, Duval, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak,
McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata

8 Illicit substance use includes the misuse of prescription psychotherapeutics or the use of marijuana, cocaine
(including crack), heroin, hallucinogens, inhalants, or methamphetamine. Misuse of prescription
psychotherapeutics is defined as use in any way not directed by a doctor, including use without a prescription of
one’s own; use in greater amounts, more often, or longer than told; or use in any other way not directed by a
doctor. Prescription psychotherapeutics do not include over-the-counter drugs.

89 City of Laredo 2022-23 Community Health Needs Assessment

Figure 65
Crude Death Rates for Drug Overdose, All Ages

35
32.4
30

25
19.38
20

15
14.10
8.9
10
8.00
5
5.63
0

Webb County TX US

Source. CDC National Center for Health Statistics, county-level drug overdose mortality in the United States, 2003-2021, and drug
poisoning mortality by state: United States, 1999-2016

CANCER

COMMUNITY INPUT

Focus group and key informants listed cancer as a common condition in the community.
Specifically, childhood cancer was mentioned, which is addressed in a separate section.

COMMUNITY SURVEY

Among people surveyed (951), 3.9% reported a doctor or health care provider telling them they
have cancer.

SECONDARY DATA

Over the past decade, the age-adjusted invasive cancer incidence rate for Webb County has
been lower than Texas, with a slight decline (2019 rates per 100,000 are 309.7 vs 412.4,
respectively).

90 City of Laredo 2022-23 Community Health Needs Assessment

Figure 66
Age-Adjusted Invasive Cancer Incidence Rates in Webb County and Texas, 2009-2019

500

450
449.9
400 412.4

350 376.1

300 309.7

250

200

150

100

50

0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Webb County Texas

Source. Texas Cancer Registry

CHILD HEALTH

COMMUNITY INPUT

Many community participants expressed their concerns about childhood obesity in

Laredo. They commented that it is best to start health education on food early in life to be able
to change cultural beliefs and limitations of food consumption.

“And if we start them off young understanding how nutrition works,

understanding how their bodies works, showing them that, ‘Hey,
when you're eating fruits and vegetables, your body can work better
and you can run faster, you can do all these things’— it leads to
better choices in the kids and the kids will tell the parents. They'll
start changing the parents’ minds little by little, and it helps any little
change from little ones to big ones.”
– Focus Group Participant

91 City of Laredo 2022-23 Community Health Needs Assessment

 “I do not know, everyone has to be on the same page and it's very difficult to
have children being taught something and then going home and then them
just falling back on those bad behaviors.”
– Focus Group Participant

Participants stated that the lack of medical providers and specialists in Laredo affects youth and
adults equally. Parents voiced the effects that children face when their parents are not in good
socioeconomic standing; many families face food insecurity, need better access to health care,
and lack specific community amenities and resources.

Participants also expressed a concern that many children in Laredo developed cancer in
recent years. One participant suggested the cause might be environmental factors, specifically
the release of harmful toxins into the air.

“Everyone knows a child who has cancer."

– Focus Group Participant

One participant spoke of a specific factory and how this issue has been brought to the Laredo
City Council. Residents formed the Clean Air Laredo Coalition to tackle the issue and find
solutions. In general, participants observed that many children with cancer live within that area.
They also mentioned a news article discussing this issue.9

“There was a news article of families expressing: ‘I live in this area. Is this
the reason why my child had cancer from this time to this time?’ So there's
now all these people that are vocalizing their family health because of this
whole report, because I think it was a report that kind of spurred up all this
stuff, and that's when families started to say, ‘Hey. So is this the reason why
I got sick? Is this the reason why my child got sick?’ It's a big thing.”
– Focus Group Participant

Alongside this concern is the continued need for pediatricians and specialists in Laredo
to provide specialty service. There is also a need to promote and offer preventive care early
on. The lack of pediatricians in the area proves to be a barrier for children to receive yearly
checkups and maintain a culture of prevention. Many low-income families find themselves
farther away from services and resources.

9 Collier, K., Flynn, K. (2021, December 27). A Plant That Sterilizes Medical Equipment Spews Cancer-Causing
Pollution on Tens of Thousands of Schoolchildren. ProPublica. https://www.propublica.org/article/a-plant-that-
sterilizes-medical-equipment-spews-cancer-causing-pollution-on-tens-of-thousands-of-schoolchildren

92 City of Laredo 2022-23 Community Health Needs Assessment

 “I feel parents should be more knowledgeable about what's important for
their health and their kid’s health as well for mental health, diet, nutrition,
and just the ability to enhance developmentally. If they have these three
core fundamentals of knowledge, they can be very proactive instead of
waiting until the reactive mode. More costs are incurred because of the
lack of tackling these problems at a young age.”
– Focus Group Participant

SECONDARY DATA

Infant Mortality Rate

The infant mortality rate (IMR) in Webb County is similar to the rate in Texas. In 2020, the
Texas infant mortality rate reached a historic low of 5.3, slightly above the Healthy People 2030
target of 5.0 deaths per 1,000 live births. Webb County’s IMR was 3.7 in 2019, showing a
decrease from 5.1 in 2011. Leading causes of infant deaths in Webb County include congenital
anomalies, complications of pregnancy, and sudden infant death syndrome.

Figure 67
The crude rate of infant deaths to live infant births in Webb County is lower than Texas and the United
States

40
36
35 33

30 28 28
25
25
21 20 19
20 17
15

10

5
5.1 3.7
0
2011 2012 2013 2014 2015 2016 2017 2018 2019

Number of Webb County Infant Deaths

Crude Rate per 1,000 Live Births (Webb County)
Crude Rate per 1,000 Live Births (Texas)
Crude Rate per 1,000 Live Births (US)

Source. Texas Department of State Health Services, 2011-2019

93 City of Laredo 2022-23 Community Health Needs Assessment

Childhood Immunization

Texas requires public school districts and accredited private schools to annually submit a report
of students’ immunization status (Title 25 Health Services, Texas Administrative Code, §§97.61-
97.72). The Annual Report of Immunization Status is a self-reported survey created by the
Texas Department of State Health Services to measure immunization coverage among
kindergarten and seventh grade students.

Similar to Texas’s rates, vaccination coverage rates for Webb County kindergarteners
improved from school year 2020-21 to 2021-22. Most schools in Webb County showed
improvement (▲) in rates when compared to the previous school year; however, Laredo ISD
reported a decline (▼) in vaccination coverage rates for kindergarteners over the same time
period.

Table 3
Vaccination Coverage Rates among Kindergarteners in Webb County by School, 2021-2022

DTP/DTaP/
Hepatitis A Hepatitis B MMR Polio Varicella
DT/Td
Texas 95.07%▲ 95.33%▲ 96.71%▲ 95.43%▲ 95.48%▲ 94.85%▲

Webb County 99.09%▲ 98.79%▲ 99.53%▲ 99.31%▲ 99.31%▲ 98.73%▲

Laredo ISD 98.75%▼ 98.05%▼ 99.69%▼ 99.61%▼ 99.37%▼ 99.06%▼

United ISD 99.37%▲ 99.14%▲ 99.41%▲ 99.28%▲ 99.37%▲ 99.19%▲

Blessed Sacrament
School
100% 100% 100% 100% 100% 100%
Mary Help of
Christians
100% 100% 100% 100% 100% 100%
St Augustine
Elementary School
100% 100% 100% 100% 100% 100%

United Day School 100% 100% 100% 100% 100% 100%

Source. Texas Department of State Health Services, Vaccination Coverage Levels in Texas Schools, 2020-2021 and 2021-2022,
Annual Report of Immunization Status
Note: List does not include schools with less than 5 students in kindergarten.

Vaccination coverage rates for Webb County seventh graders improved for TDaP/Td and
meningococcal vaccines, a trend opposite of Texas’s. However, vaccination coverage rates
decreased for hepatitis A, hepatitis B, MMR, polio, and varicella. Most schools in Webb County
showed improvement (▲) in rates when compared to the previous school year; however, Laredo
ISD and United Day School reported a decline ( ▼) in vaccination coverage rates for seventh
graders.

94 City of Laredo 2022-23 Community Health Needs Assessment

Table 4
Vaccination Coverage Rates among Seventh Grade Students in Webb County by School, 2021-2022

Meningococc
Tdap/Td Hepatitis A Hepatitis B MMR Polio Varicella
al
Texas 95.41%▼ 95.31%▼ 98.42%▲ 98.66%▲ 98.58%▲ 98.51%▲ 97.79%▲

Webb County 99.47%▲ 99.55%▲ 99.44%▼ 99.89%▼ 99.91%▼ 99.87%▼ 97.18%▼

Laredo ISD 99.64%▼ 99.78%▼ 98.84%▼ 99.93%▼ 100% 99.71%▼ 99.85%▼

United ISD 99.56%▲ 99.62%▲ 99.68%▼ 99.87%▲ 99.87%▲ 99.94%▲ 99.94%▲

Blessed
Sacrament School
100% 100% 100% 100% 100% 100% 100%
Mary Help of
Christians
100% 100% 100% 100% 100% 100% 100%
St Augustine
Elementary 100% 100% 100% 100% 100% 100% 100%
School
United Day
School
99.56%▼ 99.62%▼ 99.68%▼ 99.87%▼ 99.87%▼ 99.94%▼ 99.94%▼

Source. Texas Department of State Health Services, Vaccination Coverage Levels in Texas Schools, 2020-2021 and 2021-2022
Annual Report of Immunization Status
Note. List does not include schools with less than 5 students in seventh grade.

MATERNAL HEALTH

COMMUNITY SURVEY

In the community survey, 51.0% of respondents indicated having ever been pregnant (724
people). Of these, 304 respondents reported on health conditions during their most recent
pregnancy. Respondents most frequently mentioned pre-eclampsia (31.8%), followed by
gestational diabetes (28.5%), depression (26.6%), miscarriage (22.6%), and preterm labor
(13.8%).

95 City of Laredo 2022-23 Community Health Needs Assessment

Figure 68
Self-Reported Health Conditions of Respondents During Most Recent Pregnancy (n=304)

50%

40%

31.8%
30% 28.5%
26.6%
22.6%
20%
13.8%

10%

0%
Pre-eclampsia Gestational diabetes Depression Miscarriage Preterm labor

SECONDARY DATA

A higher percentage of patients in Webb County received prenatal care in the first
trimester than in Texas (71.7% vs 66.1%). However, the percentage receiving prenatal care
varies by ZIP code. Percentages are lower than Texas estimates in Laredo ZCTA 78040
(62.0%), while they are higher than Texas in all other ZCTAs: 78043 (69.1%), 78046 (70.0%),
78041 (72.8%), and 78045 (84.4%).

96 City of Laredo 2022-23 Community Health Needs Assessment

Figure 69
Pre-Pregnancy or Gestational Diabetes, Hypertension, and Obesity in Webb County

Diabetes:
Pregnancy or
Gestational

Webb County
rate is 2.8
(lower than
nearby
counties).

Hypertension:
Pre-
pregnancy or
Gestational

Webb County
rate is 2.5
(lower than
nearby
counties).

Obesity:
Pre-
pregnancy

Webb County
rate is 33.0
(slightly lower
than nearby
counties,
however higher
than other
areas in
Texas).

Source. HRSA Maternal & Child Health, Maternal and Infant Health Mapping Tool, 2017-2019

97 City of Laredo 2022-23 Community Health Needs Assessment

The teen birth rate in Webb County has decreased over the past decade, in line with
similar trends in Texas and the United States. Despite this decrease, the teen birth rate in
Webb County is higher than in Texas and the United States (39.0 vs 22.4 and 15.4 per 1,000
females, respectively). Webb County’s teen birth rate decreased from 82.9 in 2010 to 39.0 in
2020. The rate is highest in 78040 (23.3) and lowest in 78045 (4.5).

Figure 70
The teen birth rate has declined over the past decade in Webb County, Texas, and United States (per
1,000 females between Ages 15-19).

90
82.9
80

70

60
52.20
50

40 39.0
34.2
30
22.4
20
15.4
10

0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

United States Texas Webb County

Source. CDC National Center for Health Statistics, Teen Birth Rates for Age Group 15-19 in the United States by County, 2010-
2020

PREVENTIVE HEALTH CARE

COMMUNITY INPUT

Focus group participants noted a pattern of avoidance of preventive care and seeking care at
the last minute, attributing it in part to Hispanic or Latino culture. Participants also recognized
that oftentimes, some cultural practices and values are not supportive of healthy lifestyles and
become a generational problem.

“I'd say it's not just in the machismo, but it's also like—for example, in
Mexico, preventive care is barely on the rise because we were always born
with a mentality that to go to the doctor, you have to be sick.”
– Focus Group Participant

98 City of Laredo 2022-23 Community Health Needs Assessment

SECONDARY DATA

A lower percentage of adult residents in Webb County received a preventive, primary

checkup in the last year (69.1%) than in Texas (72.6%) and the United States (75.7%).
Rates of preventive, primary checkup for adults in Laredo ZCTAs are, in descending order:
78040 (70.2%), 78041 (69.4%), 78043 (68.5%), 78045 (67.3%), and 78046 (66.4%).

ORAL HEALTH CARE

COMMUNITY SURVEY

Over one-third (34.8%) of survey participants indicated that they have traveled outside of
Laredo within the past year to receive medical, dental, or health care for themselves. Of
these, nearly one-half (46.2%) traveled outside of Laredo for dental care.

Figure 71
Type of Care Sought Outside Laredo (n=506)

80% Medical Care,

72.9%
70%

60%
Dental Care,
50% 46.2%

40%

30%

20%
Mental Health Care,
10% 7.9%

0%

SECONDARY DATA

A much lower percentage of residents in Webb County receive a preventive, dental

checkup (42.9%) than in Texas (57.5%) and the United States (66.3%). Rates of preventive,
dental checkup in Laredo ZCTAs are, in descending order: 78045 (55.0%), 78041 (45.0%),
78043 (38.2%), 78046 (34.8%), and 78040 (30.5%).

99 City of Laredo 2022-23 Community Health Needs Assessment

PREMATURE DEATH

Estimates for premature death in Webb County are lower than in Texas and the United
States (6,800 vs 7,000 and 7,300, respectively). In Webb County, 6,800 years of life were
prematurely lost to deaths of people under age 75 (per 100,000 people). Leading causes of
death include malignant neoplasms, diseases of the heart, COVID, accidents, and
diabetes mellitus.

Life expectancy in Webb County is 78.4, similar to life expectancy in Texas and the United
States (78.4 and 78.5 respectively). Webb County’s life expectancy is lower for Hispanic
residents compared to White residents (78.2 vs 84.8 years, respectively).

In Webb County, there were 360 deaths per 100,000 people age 75 and younger. The
premature age-adjusted mortality rate in Webb County is the same as in Texas and the United
States (360 in both). Webb County’s premature age-adjusted mortality rate is higher for
Hispanic residents compared to White residents (370 vs 210, respectively).

100 City of Laredo 2022-23 Community Health Needs Assessment

 BARRIERS TO CARE
The affordability and availability of needed health care and mental health services and providers
have a direct impact on access to health care. The following section discusses the use of health
care and other services, barriers to accessing these services, and the current health
professional landscape in the county.

HEALTH INSURANCE

COMMUNITY INPUT
Participants indicated that uninsured or underinsured community members often avoid
preventive care due to cost, resulting in high emergency department utilization, as well as high
utilization of services across the border.
Participants discussed contributing factors for chronic diseases, including diabetes,
hypertension, heart conditions, and obesity, such as foregoing health care visits due to lack of
insurance and not qualifying for any additional government assistance.

“Let's say they have a condition like diabetes,

hypertension, heart disease, and they don't have the
means to buy the medication. They're not going to care for
themselves. So, they're dying younger when they should
have an opportunity to last longer. But since there's no
insurance for them, they don't qualify. Even for a penny,
some people don't qualify, which is sad. There should be
something that you can work with.”
– Key Informant

101 City of Laredo 2022-23 Community Health Needs Assessment

COMMUNITY SURVEY

About 69.0% of survey respondents reported having health insurance.

Figure 72
Insurance Status Among Survey Respondents (n=1,568)

Don't know/Not
sure, 2.8%

No insurance,
27.9% Yes have
insurance,
69.3%

Source. Laredo CHNA Community Survey, 2022

Among those who have at least one child under 18 living in their home (799), 83.0%
reported that all the children have health insurance, and 5.1% reported that some (but not
all) of the children have insurance. Around 10% reported that none of the children have
health insurance.

People living in ZIP codes 78040 and 78043 are less likely to have insurance, while those living
in 78045 are more likely to have insurance.

102 City of Laredo 2022-23 Community Health Needs Assessment

Figure 73
Survey Respondents Without Health Insurance by ZIP Code (n=1,568)

50%

40% Uninsured, all

survey
37.3% 36.9%
respondents
30% 27.9%

28.1%
26.4%
20%
18.5%

10%

0%
78040 78041 78043 78045 78046

Source. Laredo CHNA Community Survey, 2022

Figure 74
Reported Insurance Status of Children Under 18 (n=799)

No, children do
not have health
insurance,
10.4%
Yes, all
children have
health
insurance,
Yes, some, but 83.0%
not all have
health
insurance, 5.1%

Source. Laredo CHNA Community Survey, 2022

SECONDARY DATA

Rates of public health insurance coverage (Medicaid, Medicare) are highest among
children and older adults over age 65. Insurance coverage improves access to care and care

103 City of Laredo 2022-23 Community Health Needs Assessment

seeking by lowering out-of-pocket costs. Coverage also improves rates of preventive care (e.g.,
screenings and vaccinations). An estimated 82,077 residents of the city of Laredo have
insurance coverage from a public source such as Medicare or Medicaid/CHIP. Estimates of
public health insurance coverage are higher for children in Laredo (52.5%) than in Texas
(37.6%) and lower for older adults in Laredo (91.9%) than in Texas (94.2%).

Most of the Laredo ZCTAs have higher percentages of children with public health insurance
coverage compared to Texas and the United States (37.6% and 38.3%, respectively). Most
ZCTAs have slightly lower percentages of older adults with public health insurance coverage
compared to Texas and the United States (94.2% and 95.8%, respectively).

Figure 75
Public Health Insurance in Laredo by ZCTA Compared to City of Laredo and Texas 2021

a. Children

100%

90%

80%
71.6%
70% 63.0% 64.4%
60% Laredo 52.5%
50.4%
50%

40%
US 38.3%
TX 37.6% 27.0%
30%

20%

10%

0%
78040 78041 78043 78045 78046

104 City of Laredo 2022-23 Community Health Needs Assessment

b. Older adults

100%

95%
US 95.8% 93.9% 93.6%
TX 94.2% 92.3% 92.9%
Laredo 91.9%
90%
86.9%

85%

80%

75%
78040 78041 78043 78045 78046

Source. United States Census Bureau, American Community Survey, 2017-2021

ACCESS TO PRIMARY AND SPECIALTY CARE

COMMUNITY INPUT
Participants described regularly seeking health care outside of Laredo for a variety of
reasons, including needing better quality care for more complex health conditions, such as
obstetrics and gynecology, pediatrics, cardiology, and psychiatry. Residents must regularly
travel to San Antonio, Dallas, Austin, Corpus Christi, Houston, and Nuevo Laredo in Mexico to
seek these health services.
Participants identified root causes of inadequate access to primary and specialty care,
including overburdened providers leaving Laredo or taking better opportunities where they are
paid higher salaries (often at private systems) and a lack of residency programs in the Laredo
area, meaning the area lacks a pool of residents to become future providers.
In addition, they expressed the need for more comprehensive care under one roof rather
than fragmented and uncoordinated care. Fragmented care leads to fewer patients with
continuous care. The lack of patient–provider relationships is due to the high cost of office visits
and limited time with providers.

“We don’t have insurance. And so what happens is you fall under a plateau,
that you're not too poor, and you don't have enough resources to have
insurance. So, you don't have the means to pay. A lot of the people go to
Nuevo Laredo to receive services.”
– Key Informant

105 City of Laredo 2022-23 Community Health Needs Assessment

COMMUNITY SURVEY

Access to Health Care Providers

Among survey respondents, 56.6% indicated they had at least one person they think of as a
personal doctor or health care provider (for example, primary care provider). Younger
populations (age 18-34) are significantly less likely to have a personal health provider whereas
people over 55 years are significantly more likely.

Figure 76
Over one-third of survey respondents do not have someone they think of as a personal doctor or health
care provider (n=1,497).

No personal
health care
provider,
37.3%

Yes,
personal
health care
provider
56.6%
Don't
know/not
sure, 6.1%

Source. Laredo CHNA Community Survey, 2022

Survey respondents were asked if there was any time in the last year when they needed
medical care but did not get it. While nearly half (47.5%) indicated they were able to receive
medical care when they needed it, almost one-third (31.6%) indicated they could not afford the
care.

Other barriers to care included: the doctor’s office or clinic was not open at the time they could
go (14.4%), in-person appointments were not available (10.4%), they did not trust doctors or
health care providers (5.4%), they lacked transportation (3.3%), or they were unable to access
virtual visits (1.9%).

106 City of Laredo 2022-23 Community Health Needs Assessment

Figure 77
Reasons for Not Receiving Medical Care During Last 12 Months, Among Survey Respondents (n=1,328)

I was able to receive medical care when I needed it 47.5%

I could not afford it 31.6%

Doctor's office or clinic was not open at a time I

14.4%
could go

I could not get an in-person appointment 10.4%

I did not trust doctors or other healthcare providers 5.4%

I did not have transportation 3.3%

I did not have a way to access virtual visits (also

1.9%
called telehealth)

0% 10% 20% 30% 40% 50%

Source. Laredo CHNA Community Survey, 2022

When asked to indicate where they seek health care for physical, dental, or mental health,
54.1% of survey respondents reported going to a doctor’s or dentist’s office. Of 1,475 survey
respondents, the second most common place of care was a clinic or health center, such as
Gateway Community Health Center (21.7%).

Figure 78
Where Adult Survey Respondents Seek Health Care (n=1,475)

Doctor's or dentist's office 54.1%

Clinic or health center 21.7%

Urgent care 19.0%

Other 11.0%

Emergency room 11.0%

City of Laredo Health Department 8.6%

0% 10% 20% 30% 40% 50% 60%

Source. Laredo CHNA Community Survey, 2022

107 City of Laredo 2022-23 Community Health Needs Assessment

Access to Health Care for Children

The majority (81.9%) of survey respondents who are the parent, guardian, or primary
caregiver of at least one child under 18 living with them reported that their child(ren) all
have a personal health care provider. Only 10.2% of respondents indicated that the child(ren)
do not have a personal health care provider. In addition, nearly two-thirds (61.2%) reported that
they go to a doctor’s or dentist’s office when their children need care. The second most common
place of care reported was urgent care clinics (26.1%). Almost 10% of survey respondents who
care for children reported taking the children to the emergency room when physical, dental, or
mental health care is needed.

Figure 79
Where Parents, Guardians and Primary Caregivers of Children Under 18 Seek Health Care (n=783)

Doctor's or dentist's office 61.2%

Urgent care 26.1%

Clinic or health care 18.9%

Other 10.5%

Emergency room 9.8%

City of Laredo Health Department 8.2%

0% 10% 20% 30% 40% 50% 60% 70%

Source. Laredo CHNA Community Survey, 2022

Travel outside of Laredo among Adults

Over one-third (34.8%) of survey participants indicated that they have traveled outside of
Laredo within the past year to receive medical, dental, or health care for themselves.
Almost one-quarter (22.4%) reported going to Nuevo Laredo, Mexico, 13.0% reported going to
another city in Texas, and 2.3% reported going to another city in Mexico besides Nuevo Laredo.

108 City of Laredo 2022-23 Community Health Needs Assessment

Figure 80
Percent of Survey Respondents Seeking Care Outside Laredo (n=1,512)

A city in Mexico other than Nuevo Laredo 2.3%

Another city in Texas 13.0%

Nuevo Laredo 22.4%

Did not go outside of Laredo for care 65.2%

0% 10% 20% 30% 40% 50% 60% 70%

Source. Laredo CHNA Community Survey, 2022

Among those survey respondents who reported seeking care outside Laredo (506), 72.9%
reported seeking medical care, 46.2% reported seeking dental care, and 7.9% reported seeking
mental health care.

Travel outside Laredo for Children

Over one-third (32.8%) of survey respondents who were parents, guardians, or

caregivers reported traveling outside of Laredo in the last 12 months to receive medical,
dental, or mental health care for children living in their home. Of these, 59.4% went to
Nuevo Laredo, Mexico, and 40.6% went to another city in Texas.

109 City of Laredo 2022-23 Community Health Needs Assessment

Figure 81
Adult Caregivers Seeking Medical, Dental or Mental Health Care for Children Outside of Laredo

Nearly one-third of caregivers of Many adult caregivers of children

children seek care outside of Laredo who seek care outside of Laredo
(n=816) go to Nuevo Laredo and other
cities in Texas (n=276)
Yes, I went to another
13.9%
city in Texas

Another
Yes, I went to Nuevo Nuevo city in
20.4% Texas,
Laredo Laredo,
59.4% 40.6%

No, I did not go outside

67.2%
of Laredo for care

0% 20% 40% 60% 80%

Source. Laredo CHNA Community Survey, 2022

The majority of people who sought care for children outside of Laredo (260) were seeking
medical care (80.0%). The other types of care sought were dental care (36.9%) and mental
health care (15.0%).

Figure 82
Type of Care Sought Outside Laredo for Children and Adolescents Under 18 (n=260)

90%
Medical care,
80.0%
80%

70%

60%

50%
Dental care,
40% 36.9%

30%
Mental health care,
20% 15.0%

10%

0%

Source. Laredo CHNA Community Survey, 2022

110 City of Laredo 2022-23 Community Health Needs Assessment

SECONDARY DATA

Health Professional Shortage Area (HPSA) scores are used to determine priorities for the
assignment of clinicians (scores range from 1-25 for primary care and mental health; 1 to 26 for
dental health). The higher the score, the greater the priority.

Table 5
Health Professional Shortage Area Score
Webb County HPSA Score Score Range
Primary Care 14 1-25
Dental Care 19 1-26

Source. Health Resources and Services Administration, 2022

111 City of Laredo 2022-23 Community Health Needs Assessment

Figure 83
HPSA Scores by County in Surrounding Areas

Primary
Care
HPSA
Scores

Dental
Care
HPSA
Scores

Source. Health Resources and Services Administration, 2021

112 City of Laredo 2022-23 Community Health Needs Assessment

ACCESS TO MENTAL HEALTH CARE

COMMUNITY INPUT

Community members frequently mentioned the increasing need for mental health
services within the Laredo area. Common mental health concerns discussed include a lack of
psychiatrists and psychologists, an increase in substance abuse in youth and people
experiencing homelessness, and having very little access to mental health services in general.

“We don’t have a mental [health] facility. We have agencies that have
received funding, but we don’t have specialists. My daughter suffers from
mental health, and during COVID, it was really hard for her. And then there
wasn’t a specialist…. There’s nobody locally. Very limited. So they were
Zoomed with specialists. It’s not the same. They need a connection.”
– Focus Group Participant

“The people were not getting the care that they required [during COVID]….
What do we do? Because we don’t have the facility. Even if we will talk about
getting resources to do the brick and mortar, how are we going to attract the
psychologists [and] psychiatrists?”
– Focus Group Participant

COMMUNITY SURVEY

Over one-fifth (21.9%) of survey respondents indicated that there was any time during the
last 12 months that they needed mental health treatment or counseling for themselves
but did not get it. The top reason provided was being unable to afford the cost (44.0%)
followed by not knowing where to go to get mental health treatment (34.5%).

113 City of Laredo 2022-23 Community Health Needs Assessment

Figure 84
Survey respondents identified affordability and not knowing where to go for services as the top reasons
for not receiving mental health treatment (n=325).

Couldn't afford the cost 44.0%

Did not know where to go to get services 34.5%

Concerned about negative effect on my job 12.9%

Concerned about confidentiality with counselor 12.6%

Concerned that neighbors or community to have a

12.6%
negative opinion of you

Health insurance does not pay enough for mental health

12.3%
treatment

Health insurance does not cover any mental health

10.5%
treatment

Concerned that you might be committed to a psychiatric

6.5%
hospital or might have to take medicine

Some other reason(s) 28.9%

0% 10% 20% 30% 40% 50%

Source. Laredo CHNA Community Survey, 2022

Among survey respondents, people aged 25-34 were slightly more likely to report that they
needed mental health treatment at some point in the last year, but did not get it. Conversely,
people 55 and older were slightly less likely to report needing care but not getting it.

SECONDARY DATA

HPSA scores are used to determine priorities for the assignment of clinicians (scores range
from 1-25 for primary care and mental health; 1 to 26 for dental health.) The higher the score,
the greater the need. Webb County’s HPSA Score is 18 for mental health care in 2021. In
addition, Figure 86 highlights unmet need for addiction treatment in Webb County and the
surrounding areas.

114 City of Laredo 2022-23 Community Health Needs Assessment

Figure 85
Access to addiction treatment in Webb County

In Webb
County, 95%
of those 12
and over
reporting illicit
drug use in the
past year
indicate
needing but
not receiving
treatment

Source. Health Resources and Services Administration, 2014

ACCESS TO AFFORDABLE CARE

COMMUNITY INPUT

Participants reported affordability of care as another top barrier to health care access.
Key informants and focus group participants indicated that low-income families living in poverty,
predominantly Hispanic and Latino community members, must make a choice between paying
for basic necessities or insurance. As many residents do not receive full benefits or health
insurance through their jobs, they seek care across the border for prescriptions and doctor’s
visits.

“And you know, when families are receiving lower levels of income,
sometimes they have to kind of prioritize where they are going to spend their
money. I believe that insurance, unfortunately, is not one of the priorities for
many of the lower-income families.”
– Key Informant

Key informants reported that about 40% of residents travel across the border to Nuevo Laredo,
Mexico, to seek health services as it is less expensive.

115 City of Laredo 2022-23 Community Health Needs Assessment

MEDICALLY UNDERSERVED AREAS AND POPULATIONS

SECONDARY DATA

Webb County is designated as a Medically Underserved Area, with a score of 54.3 for
primary care. Medically Underserved Areas (MUAs) and Medically Underserved Populations
(MUPs) identify geographic areas and populations with a lack of access to primary care
services, too few primary care providers, high infant mortality, high poverty, and/or high elderly
populations. Each MUA and MUP is assigned a Medical Underservice Score from zero to 100,
with the lowest scores indicating the highest need. To qualify for designation, this score must be
less than or equal to 62, except for a governor designation, which does not receive a score.
These designations also help officials establish additional support or community health centers
where needed.

EMERGENCY ROOM VISITS AND PREVENTABLE HOSPITAL STAYS

COMMUNITY SURVEY

While the majority of survey respondents reported seeking care in a doctor’s or dentist’s office
(54.1%), clinic or health center (21.7%), or urgent care center (19.0%), 11.0% reported that
they seek care in the emergency room when they are sick.

Figure 86
Where Survey Respondents Seek Health Care When They Are Sick (n=1,475)

Doctor's or dentist's office 54.1%

Clinic or health center 21.7%

Urgent care 19.0%

Other 11.0%

Emergency room 11.0%

City of Laredo Health Department 8.6%

0% 10% 20% 30% 40% 50% 60%

Source. Laredo CHNA Community Survey, 2022

116 City of Laredo 2022-23 Community Health Needs Assessment

Survey respondents were asked whether they visited an emergency room for themselves or a
child at any time during the last year. While the majority (67.1%) said they had not visited the
emergency room, 8.0% said they visited an emergency room because they did not have health
insurance, and 16.5% reported that they visited an emergency room due to a mild injury or
illness that could have been treated in a doctor’s office or clinic.

Figure 87
Reasons for Emergency Room Use Among Survey Respondents (n=1,378)

Could not afford health care anywhere else 3.6%

Other 4.9%

Did not know where else to go for care 5.8%

Did not have health insurance 8.0%

A mild injury or illness that could have been treated in

16.5%
a doctor's office or clinic

No, I have never visited the emergency room for any

67.1%
of these reasons

0% 10% 20% 30% 40% 50% 60% 70% 80%

Source. Laredo CHNA Community Survey, 2022

In addition, while the majority of parents, caregivers, and guardians of children under 18
indicated that they go to a doctor’s or dentist’s office, urgent care, or clinic when children in their
care are sick, 9.8% of the same reported taking the children to the emergency room when
physical, dental, or mental health care is needed.

117 City of Laredo 2022-23 Community Health Needs Assessment

Figure 88
Where Parents, Guardians and Caregivers of Children Seek Care When Sick, Among Survey
Respondents (n=783)

Doctor's or Dentist's Office 61.2%

Urgent Care 26.1%

Clinic or Health Care 18.9%

Other 10.5%

Emergency Room 9.8%

City of Laredo Health Department 8.2%

0% 10% 20% 30% 40% 50% 60% 70%

Source. Laredo CHNA Community Survey, 2022

SECONDARY DATA

Figure 89
Preventable Hospital Stays per 100,000 Medicare Enrollees Webb County, Texas, and United States

Webb County 4,850

Texas 4,255

US 3,767

Source. Centers for Medicare and Medicaid Services, 2019

HEALTH LITERACY

COMMUNITY INPUT

Health literacy and insurance literacy are still major barriers for many residents of Laredo,
especially for those who are undocumented. Participants indicated that as Laredo is

118 City of Laredo 2022-23 Community Health Needs Assessment

predominantly Hispanic or Latino, many people still feel there is a disconnect in understanding
how to access, seek, and receive care. For example, having documents in English creates
difficulties, as it takes longer for translation services, depleting time from the actual appointment.

More so, participants described how language on pamphlets, brochures, and official
applications is often confusing and hard to understand. Participants agree that the health
system should work to increase cultural competency and educate residents on health services
and insurance to equip them to take control of their health.

“The impact of health literacy on their families and their lives is huge,
because people are dying. They are dying just because they don't have
the information that can help them get to the resources. I think it's so
important that people become aware of how to take care of themselves
and these types of illnesses.”
– Key Informant

Patients continue to face challenges in understanding insurance and health materials on

pamphlets, brochures, and applications, as the medical terminology language is still difficult to
follow. In addition, the frequency and accessibility of culturally and linguistically appropriate
services is still a need in Laredo, as processes for translation and education are not
streamlined.

SECONDARY DATA

As noted in Figure 91, a large portion of the population of Webb County has basic or
below basic levels of health literacy. Specifically, the majority of ZCTAs 78041, 78042,
78043, and 78046 have between 50%-65% of the population that have basic or below basic
levels of health literacy.10

10 National Health Literacy Mapping to Inform Health Care Policy (2014). Health Literacy Data Map. University of
North Carolina at Chapel Hill. Retrieved June 1, 2015, from http://healthliteracymap.unc.edu/#.

119 City of Laredo 2022-23 Community Health Needs Assessment

 Figure 90
Levels of Basic Health Literacy in Webb County Census tracts in red
have basic or below basic levels of health literacy, based on the National
Assessment of Adult Literacy (NAAL) health literacy results. Areas in
green have above basic levels of health literacy.

Source. The University of North Carolina at Chapel Hill, Health Literacy Data Map, 2015

COMMUNITY AWARENESS AND TRUST RELATED TO HEALTH

COMMUNITY INPUT

“I think there's a lot of programs that the city offers that are excellent.
However, there's a lot of disconnect as far as how information goes out
there. I know the City tries to do as much as possible. But, a lot of people do
not know about these programs, for whatever reason. And I think that's
common throughout communities.”
– Focus Group Participant

While the City of Laredo Health Department offers a variety of health and screening programs,
many residents forgo services due to a lack of awareness of available resources. This is
especially true for undocumented residents who are unwilling to seek care or information due to
the fear of deportation. Participants indicated that the City of Laredo should work to bring
resources and programs to the community and raise awareness through advocacy and public
service announcements.

120 City of Laredo 2022-23 Community Health Needs Assessment

Participants particularly described a lack of knowledge regarding the diagnosis, treatment, and
management of chronic conditions such as diabetes and high blood pressure among residents
of Laredo. For example, one focus group participant explained that the predominantly Hispanic
community follows the advice of family and friends for disease management rather than seeking
professional care. Community members agreed there is a lack of knowledge about chronic
condition management and treatment among residents in Laredo. Many defer to their family and
friends when seeking health advice rather than going to health care providers.

Many residents choose to self-medicate with antibiotics accessed across the border. This
antibiotic use can become detrimental to the management of serious health conditions, leading
to hospitalization or even death.

Residents who are undocumented commonly distrust the health care system due to fear of
deportation. As a result, they often do not seek out health information.

Stigma in Hispanic and Latino culture keeps many from seeking preventative care; instead they
wait until the last minute to seek medical attention, and many children in Laredo do not grow up
seeing preventative care and best practices of wellness, which becomes a generational problem
of avoiding care.

“When we talk about influence, we see children and young adults going
into adulthood not knowing about their yearly checkup. That all starts
with maternal health…. And now we are in the position of where there's a
delay, and then it causes this ripple effect of health services. So it's just
also, again, the influence of where these caregivers are coming from,
and then their children having these same upbringings, and then them
missing out. It's a ripple effect.”
– Focus Group Participant

COMMUNITY SURVEY

Community members responding to the survey indicated that health care providers
(64.1%) and the City of Laredo Health Department (51.8%) were the sources they trusted
most to provide information on health, followed by the Texas Department of State Health
Services (40.8%), and friends and family (36.0%).

121 City of Laredo 2022-23 Community Health Needs Assessment

Figure 91
Laredo residents indicate high levels of trust in health care providers and the City of Laredo Health
Department for health information (n=1,411).

Health care provider such as doctor or nurse 64.1%

City of Laredo Health Department 51.8%
Texas Department of State Health Services 40.8%
Friends or family 36.4%
National US government agencies such as the CDC 34.6%
National news in English (Radio, TV, or newspaper) 13.2%
Local news in English (Radio, TV, or newspaper) 11.7%
Employers 10.2%
Neighborhood or community organizations 9.1%
Local news in Spanish (Radio, TV, or newspaper) 8.8%
National news in Spanish (Radio, TV, or newspaper) 6.6%
Other 6.4%
Faith organizations/faith leaders 6.4%

0% 10% 20% 30% 40% 50% 60% 70%

Source. Laredo CHNA Community Survey, 2022

122 City of Laredo 2022-23 Community Health Needs Assessment

 OTHER HEALTH NEEDS
The following additional significant health needs emerged from a review of the publicly available
quantitative data for the city of Laredo. While these topics did not specifically emerge as priority
areas in the focus groups and key informant interviews, they are worth noting.

COMMUNITY CONCERNS

COMMUNITY INPUT

Focus group participants noted that the Laredo community has many assets and resources
such as beautiful parks and ongoing community health classes to learn from, but they wonder if
these resources could be more fairly distributed in and around Laredo, including the Colonias.

COMMUNITY SURVEY

Respondents identified “stray dogs or cats” (31.0%), “crime and violence” (28.5%), and
“the lack of parks or playgrounds” (26.0%) as the top three things negatively affecting their
health or the health of those with whom they live.

Figure 92
Top Community Concerns among Survey Respondents, as Related to Health (n=1,387)

Stray dogs or cats 31.0%

Crime and violence 28.5%

Not enough parks or playgrounds 26.0%

Not enough sidewalks 17.7%

Air pollution such as fumes, smells, and smoke 16.6%

Abandoned homes and lots 13.2%

Not enough grocery stores 12.8%

Lack of accessible public transportation 10.6%

Too many liquor stores 2.2%

None of these 33.9%

0% 10% 20% 30% 40%

123 City of Laredo 2022-23 Community Health Needs Assessment

ASTHMA

COMMUNITY SURVEY

Among survey respondents (951), 14.4% reported being told by a doctor that they have asthma.

NEURODEVELOPMENTAL DISABILITY

COMMUNITY SURVEY

Among survey respondents (951), 4.2% reported being told by a doctor that they have a
neurodevelopmental disability (such as dyslexia, autism spectrum disorder, or another
developmental diagnosis).

IMPACT OF COVID-19

COMMUNITY INPUT

Participants described how increasing rates of inflation combined with financial strain from the
COVID-19 pandemic directly influenced their ability to purchase healthy foods. Key informants
relayed an unusually large uptick in clientele struggling to make ends meet during COVID,
specifically those who would not have needed support before the pandemic. Residents
expressed intense frustration for facing food insecurity while working full-time jobs.

I think COVID really brought out a lot. It just took things to another level
for a lot [of] people and everything that it brought with it.”
– Key Informant

Participants also expressed a shift in mental health due to COVID.

I feel like post COVID, during COVID, a lot of them were

going through lot of mental health issues.
– Focus Group Participant

At the same time, some participants noted that although the pandemic left many negative
impacts, the community managed to uplift itself in various ways. For example, there was a lot of
collaboration between different community organizations to help provide resources and services
to the community. Additionally, people became more aware of their health and how it affects
their everyday life; for example, the community was more physically active. There was also
more inclusivity during the pandemic since it was imperative to disseminate information to
everyone.

124 City of Laredo 2022-23 Community Health Needs Assessment

 “During COVID, we saw a lot of people going on walks way more than
before in our neighborhood. We live in the Mines Road area, so during
COVID, you would see tons of people on the sidewalk going for walks with
their dog, with the kids, and we saw—it kind of trickled down a little bit, but
people are still doing it more now than they were before.”
– Focus Group Participant

COMMUNITY SURVEY

Nearly two-thirds of participants in the community survey (62.3%) reported that they have
had COVID at least once since January 2020 (1,433 responses). About 40% of those
reported testing positive using a PCR test (from a laboratory) and 18.6% reported testing
positive with a home test. The remaining 3.3% reported that they believe they had COVID but
did not take a test.

Of survey respondents, people aged 65 and older were less likely to report having COVID
compared to other age groups. In addition, according to survey analyses, there was no
significant relationship between ZIP code and self-reported COVID since January 2020.

When asked to describe the level of health care received while having COVID, over half
(51.8%) of respondents reported that they did not seek care. Those who did seek care while
having COVID largely sought care at a doctor’s office, urgent care, or clinic (44.9%), followed by
an emergency room (4.1%), with 2.1% reporting being hospitalized.

Figure 93
Care Seeking Among Participants Who Indicated Having COVID Since January 2020 (n=871)

I did not seek medical care from a health

51.8%
care provider

I received medical care at a doctor's office,

44.9%
urgent care, or clinic

I received medical care at an emergency

4.1%
room

I was hospitalized 2.1%

0% 10% 20% 30% 40% 50% 60%

Source. Laredo CHNA Community Survey, 2022

The community survey also asked participants to indicate whether their mental health is better
or worse than before the COVID pandemic. Of 1,406 responses, the largest group (41.5%)

125 City of Laredo 2022-23 Community Health Needs Assessment

indicated that their mental health was “neither better nor worse.” About one-quarter of
respondents indicated that their mental health is “much better.” Only about 15% indicated that
their mental health is either “somewhat worse” or “much worse” than prior to the pandemic.

Figure 94
Mental Health Compared to Pre-Pandemic Status (n=1,406)

Much worse 3.6%

Somewhat worse 12.2%

Neither better nor worse 41.5%

Somewhat better 18.3%

Much better 24.3%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Source. Laredo CHNA Community Survey, 2022

SECONDARY DATA
Table 6
COVID-19 statistics, March 1, 2020 through December 7, 2022

Webb County Texas United States

COVID-19 cases weekly case rate

117.48 105.7 29,892
(rate per 100,000 population)

COVID-19 deaths weekly death rate

0 0.3 325
(rate per 100,000 population)
Completed primary series of
COVID-19 vaccinations 95.0% 67.5% 72.9%
(percent of population ages 5 and up)
Received updated booster dose of
COVID-19 vaccination 8.8% 8.4% 13.5%
(percent of population ages 5 and up)

Source. CDC COVID Tracker, dates March 1, 2020, through December 7, 2022

126 City of Laredo 2022-23 Community Health Needs Assessment

 CONCLUSION
The City of Laredo Health Department contracted with THI to compile and analyze quantitative
data for the city of Laredo for the 2022-2023 CHNA process. Additionally, THI conducted and
analyzed 11 virtual key informant interviews, analyzed seven in-person focus groups facilitated
by a local partner, and administered a robust community survey to understand the health
priorities of the residents of the city of Laredo.

Both quantitative and qualitative data indicate Laredo has many significant assets and
strengths, including a strong sense of community, a diverse network of local organizations
championing for the health and wellbeing of all, and a strong community-based public health
leader (City of Laredo Health Department).

Laredo is a border city and is the 11th most populous city in Texas. The city is growing,
demonstrated by an increase in population of around 10% in the past decade. Most notably, the
city is about 95% Hispanic and with this, the city has a unique context. For example, the city has
a high population of foreign-born residents compared to the United States and Texas and a
large population of residents who have limited English proficiency. In addition, many residents
regularly seek health care outside of Laredo, including in Nuevo Laredo, other cities in Mexico,
and other cities in Texas.

It is evident that many community members experience barriers to health care and healthy
lifestyles. In addition, linguistically appropriate care, lack of disease and health awareness, and
a shortage of specialty care are key drivers of health for Laredo residents.

It is possible to reduce many of these barriers through policy and system change, or via
collaboration with community partners. Focus groups participants and key informants provided a
number of recommendations about actions the community and community partners could take
to address the concerns identified in Laredo. The recommendations focused on five primary
outcomes: (a) improve health care access and affordability, (b) improve access to specialty
care, (c) increase culturally relevant health care, (d) build trust and encourage partnerships to
strengthen community, and (e) strengthen community engagement and outreach.

The recommendations below come directly from the community input gathered in this CHNA:

IMPROVE HEALTH CARE ACCESS AND AFFORDABILITY

Access to services: Establish mobile or satellite clinics with various health services and
programs for primary care and specialty care throughout Laredo (North and South).

127 City of Laredo 2022-23 Community Health Needs Assessment

Quality health care: Focus on holistic, comprehensive care with a coordinated system of
referral (both within Laredo and outside) to decrease the number of patients lost to follow-up.
Increase the length of time patients spend with providers. Establish a centralized database
system with easy access to patient information to allow for continuity of care.

Affordable health care: Offer lower-cost options for primary care and specialty health care,
ideally at a level comparable to costs in Mexico.

Provider incentives: Strategize and build incentive programs and opportunities to attract and
recruit more doctors, nurses, and clinical staff for publicly available programs in Laredo to
increase the number of qualified providers in the area.

IMPROVE ACCESS TO SPECIALTY CARE

Specialty care: Increase availability of care for more complex health conditions, including
obstetrics and gynecology, pediatrics, cardiology, and psychiatry.

Mental health services: Expand mental health facilities and services to meet the needs of the
population in Laredo, especially for youth. Bring in more licensed clinical counselors to provide
continuity of care.

INCREASE CULTURALLY RELEVANT HEALTH CARE

Language and translation services: Increase the availability and efficiency of Spanish
translators during appointments and ensure translation of all materials into Spanish.

Culturally relevant treatment: Encourage providers to involve patients in their treatment

decisions and take ownership of their health from their cultural perspective. Train hospital and
clinic staff on culturally appropriate treatment and methods (e.g., nutrition, medicine).

BUILD TRUST AND ENCOURAGE PARTNERSHIPS TO STRENGTHEN

COMMUNITY

Trust: Work through community champions and church leaders to engage community members
to build trust. Hold more public events in the community to keep an open channel of
communication with residents and be more visible in the community.

Partnership: Increase cross-sector collaboration and coordination by partnering with

community-based organizations in Laredo. Bring together vital agencies to encourage system-
wide change and to develop strategies for revenue income from health services and programs.

128 City of Laredo 2022-23 Community Health Needs Assessment

STRENGTHEN COMMUNITY ENGAGEMENT AND OUTREACH

Health literacy: Increase health literacy and awareness about health issues, especially for
residents who are undocumented.

Education on health care and insurance: Increase knowledge and awareness of how health
systems and insurance work. Provide education on navigating these systems, being mindful of
culture and language.

Transportation: Increase the availability of transportation to health care appointments by

collaborating with public transportation services and volunteers.

Knowledge and awareness: Promote available programs and resources in the community
through dissemination of easy-to-understand information through pamphlets, booklets, and
other culturally and linguistically appropriate materials at community events, schools, and other
public places. Provide community education and classes on nutrition, behavior change, physical
activity, disease management, cooking demonstrations, and healthy grocery shopping on a
budget. Provide health and nutrition education in schools to help build healthy lifestyles.

A culture of health at community events: Offer health care and social service opportunities
onsite during community events (e.g., community celebrations, health fairs, church events,
school events). Provide healthier food options and activities at community events to encourage
health and well-being.

129 City of Laredo 2022-23 Community Health Needs Assessment

 APPENDIX A

130 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Webb County, Texas and US
Measurement
Indicator Webb County TX US Source Definitions
Period
Total Population 266,963 28,862,581 329,725,481 CENSUS ACS 2017-2021
Pop by Sex CENSUS ACS 2017-2021
Female 50.6% 50.1% 50.5% CENSUS ACS 2017-2021
Male 49.4% 49.9% 49.5% CENSUS ACS 2017-2021
Pop by Age CENSUS ACS 2017-2021
Pop Under 18 32.7% 25.8% 22.5% CENSUS ACS 2017-2021
Pop 18-64 57.9% 61.7% 61.5% CENSUS ACS 2017-2021
Pop 65+ 9.4% 12.5% 16.0% CENSUS ACS 2017-2021
Pop by Race/Ethnicity CENSUS ACS 2017-2021
Hispanic 95.5% 39.8% 18.4% CENSUS ACS 2017-2021
White, NH 3.3% 40.7% 59.4% CENSUS ACS 2017-2021
Demographics Black, NH 0.3% 11.8% 12.2% CENSUS ACS 2017-2021
Asian, NH 0.5% 5.0% 5.6% CENSUS ACS 2017-2021
AI/AN, NH 0.0% 0.2% 0.6% CENSUS ACS 2017-2021
Age Dependency Ratio 72.7 62.2 62.7 CENSUS ACS 2017-2021
Number of children age 0-17 per
Child Dependency Ratio 56.4 41.8 36.6 CENSUS ACS 2017-2021
100 adults age 18-64
Old-Age Dependency Number of older people age 65+
16.2 20.3 26.1 CENSUS ACS 2017-2021
Ratio per 100 adults age 18-64
Portion of Population
12.4% 11.4% 12.6% CENSUS ACS 2017-2021
Disabled
Not Proficient in English,
Population 5 Years and 37.3% 13.1% 8.2% CENSUS ACS 2017-2021
Up
Medicaid Coverage 26.2% 16.4% 20.2% CENSUS ACS 2017-2021

Dentists to Population
3,120:1 1,660:1 1,400:1 CHR 2020
Ratio
Mental Health Providers
11 Needed 702 Needed 7,871 Needed HRSA 2022
Needed
Dental Health Providers
30 Needed 475 Needed 11,896 Needed HRSA 2022
Needed
Delayed Care Due to Cost 15.9% 8.8% CDC BRFSS 2021

131 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Webb County, Texas and US
Measurement
Indicator Webb County TX US Source Definitions
Period
Rate of hospital stays for
Preventable Hospital ambulatory-care sensitive
4,850 4,255 3,767 CMS /CHR 2019
Stays conditions per 100,000 Medicare
enrollees
Uninsured CENSUS ACS 2017-2021
Percentage of Children
Access
Under Age 19 w/o 15.0% 11.5% 5.3% CENSUS ACS 2017-2021
Health Insurance
Percentage of Adults
Ages 19-64 w/o Health 40.9% 23.7% 12.3% CENSUS ACS 2017-2021
Insurance
Percentage of the
Population Under Age 5.4% 1.8% 0.8% CENSUS ACS 2017-2021
65 w/o Health Insurance

Health Literacy 217 254 264 UNC 2003

Drug/Alcohol Facility 9 509 16,066 SAMHSA 2020
Received Mental Health Note: Region 11abd includes total
(Region 11abd)
Services in Past Year, 11.5% 14.7% NSDUH 2016--2018 of 18 counties; includes Webb
8.7%
Ages 18+ County

No physical activity in past month

(exercises such as running,
calisthenics, golf, gardening, or
Health Behaviors Physical Inactivity 37.2% 48.1% 50.6% CDC BRFSS 2020
walking for exercise, outside of
regular job) among adults aged
≥18 years

Infant & Child Health

Infant Mortality 3.7 5.5 5.6 TX DSHS 2019
CDC
Low Birthweight 8% 8% 8% 2014-2020
WONDER/CHR
CDC
Child Mortality 54.4 48.9 48.4 2014-2020
WONDER/CHR
General Health
Life Expectancy 78.5 78.4 78.5 CDC/CHR 2018-2020
Premature Mortality 360 360 360 CDC/CHR 2018-2020
Premature Death 6,800 7,000 7,300 CDC/CHR 2018-2020

132 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Webb County, Texas and US
Measurement
Indicator Webb County TX US Source Definitions
Period
Chronic Disease
Adult Obesity 43.9% 35.8% 31.9% CDC BRFSS 2020
Diabetes Prevalance 16.0% 12.6% 11.1% CDC BRFSS 2020
Frequent Physical 14+ days in past 30 that physical
13.8% 9.4% 9.9% CDC BRFSS 2020
Distress health was "not good"
High Blood Pressure
31.4% 30.8% 38.7% CDC BRFSS 2019
Awareness
Poor or Fair Health 27.4% 17.7% 17.8% CDC BRFSS 2020
TX Cancer
New Cancer Cases 309.7 412.4 N/A 2019
Statistics
Ever Told Have Kidney
3.5% 2.7% 2.9% CDC BRFSS 2020
Disease
Mental / Behavioral Health
Depression Ever Told 19.7% 17.7% 19.2% CDC BRFSS 2020
Frequent Mental 14+ days in past 30 that mental
16.1% 13.2% 13.5% CDC BRFSS 2020
Distress health was "not good"
Health Outcomes
Drug poisoning deaths per
Drug Overdose Deaths 19.38 14.1 32.4 NCHS 2021
100,000 population
Had serious thoughts of suicide in
Suicidal Thoughts, Ages (Region 11abd)
3.6% 4.2% NSDUH 2016--2018 the past year among adults aged
18+ 3.3%
18 or older
Serious mental illness in the past
Serious Mental Illness, (Region 11abd)
3.7% 4.5% NSDUH 2016--2018 year among adults aged 18 or
Ages 18+ 3.2%
older
Illicit Drug Use in Past Illicit drug use in the past month
(Region 11abd)
Month, Ages 12 and 7.8% 11.2% NSDUH 2016--2018 among individuals aged 12 or
5.3%
Older older
Substance Use
Heavy Drinking 16.5% 16.4% 15.7% CDC BRFSS 2020 Binge drinking among adults 18+
Smoking 16.4% 13.2% 15.5% CDC BRFSS 2020
Opioid Prescription 16.233 37.9 43.3 CDC RX RATE 2020
COVID-19
Weekly case rate per 100k as of
CDC COVID
COVID-19 Cases 117.5 105.7 29,892 2020-2022 data 01Mar2020 through
TRACKER
07Dec2022
Weekly death rate per 100k as of
CDC COVID
COVID-19 Deaths 0.0 0.3 325 2020-2022 data 01Mar2020 through
TRACKER
07Dec2022

133 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Webb County, Texas and US
Measurement
Indicator Webb County TX US Source Definitions
Period
Percent of pop ages 5+ with
CDC COVID
COVID-19 Vaccinations 95.0% 67.5% 72.9% 2020-2022 completed primary series as of
TRACKER
data through 07Dec2022
Percent of pop ages 5+ with
CDC COVID
COVID-19 Vaccinations 8.8% 8.4% 13.5% 2020-2022 updated booster dose as of data
TRACKER
through 07Dec2022

Percentage of households that

Severe Housing Cost
32.8% 29.9% 30.3% CENSUS ACS 2017-2021 spend 30% or more of their
Burden
household income on housing
Broadband Access 77.0% 86.9% 87.0% CENSUS ACS 2017-2021
Housing Stability score of 0.96 indicates
4% fewer households in that
ARGONNE
Housing Stability 97% N/A N/A 2022 jurisdiction are stable (i.e., not at
NAT'L LIBRARY
risk of eviction or foreclosure) than
baseline period (Jan,2020)

FEEDING
Infrastructure Food Insecurity 16.2% 13.0% 11.8% 2020
AMERICA

Education Attainment (BS

19.4% 31.5% 33.7% CENSUS ACS 2017-2021
or Higher)
Unemployment 3.5% 3.9% 3.7% BLS Dec-22
Percent Below Poverty
22.9% 14.0% 12.6% CENSUS ACS 2017-2021
Level
Prevalence of households who
struggle to afford essentials like
Socioeconomic food, housing, or health care, and
Households Below ALICE 59.0% 44.0% 28.0% UNITED WAY 2018
yet do not meet income
qualifications for public assistance
programs
Score of 5.0 represents a ZIP with
Community Needs Index CNI 2021 the most need compared to
national average (score of 3.0)
Median Household
$ 54,618 $ 67,321 $ 69,021 CENSUS ACS 2017-2021
Income

LISD: 96.2%;
Graduation Rate 90.3% TEA TAPR 2020-2021
UISD 97.2%

134 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Webb County, Texas and US
Measurement
Indicator Webb County TX US Source Definitions
Period
LISD: 93.5%;
College Ready 53.4% TEA TAPR 2020-2021
UISD 69.5%
Violent crime includes the
offenses of murder and
Social Conditions 2021 Violent Crime
(Laredo) 310.4 446.5 398.5 FBI CDE 2020 nonnegligent manslaughter, rape
Offenses Per 100k Pop
(revised definition), robbery, and
aggravated assault
Property crime includes the
2021 Property Crime Per
(Laredo) 1227 2,245 1,958 FBI CDE 2020 offenses of burglary, larceny-theft,
100k Pop
and motor vehicle theft.

Teen Birth Rate, Ages 15- TDSHS / CDC

38.85 22.37 15.39 2020
19 NCHS
Percent of births to mothers
Sexual Health Prenatal Care in First
71.7% 66.1% TDSHS 2019 receiving prenatal care in first
Trimester
trimester
HIV - New Cases 6.1 14.5 11.1 TDSHS 2020

Preventive Care
Primary Check, Ages 18
69.1% 72.6% 75.7% CDC BRFSS 2020
and Up
Dental Check, Ages 18
42.9% 57.5% 66.3% CDC BRFSS 2020
and Up
HIV Test 39.6% 35.1% CDC BRFSS 2021
Immunizations
Pneumonia 69.0% 70.9% CDC BRFSS 2020
Flu Shot 66.0% 67.1% CDC BRFSS 2020
HPV Up to Date, Ages 9-
54.9% 58.6% TX HHS 2020
17
DTP/DTaP/DT/Td
2021-2022
Vaccination Coverage 99.1% 95.1% Tx DSHS
School Year
Among Kindergarteners
MMR Vaccination
2021-2022
Coverage Among 99.3% 95.4% Tx DSHS
School Year
Kindergarteners
Tdap/Td Vaccination
Coverage Among 2021-2022
99.5% 95.4% Tx DSHS
Seventh Grade School Year
Students

135 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Webb County, Texas and US
Measurement
Indicator Webb County TX US Source Definitions
Period
MMR Vaccination
Coverage Among 2021-2022
99.9% 98.6% Tx DSHS
Seventh Grade School Year
Preventive Students
Preventive Cancer
Colorectal Screening,
56.9% 54.0% 64.3% CDC BRFSS 2020
Ages 50-75
Cervical Cancer
74.3% 75.0% 77.7% CDC BRFSS 2020
Screening, Ages 21-65
Mammogram, Ages 50-
69.5% 77.7% 78.3% CDC BRFSS 2020
74
Diabetes
Diabetics, adults 18 years and up,
Diabetic Feet Check
54.3% TX BRFSS 2021 feet checked daily for any sores or
Daily
irritations
Diabetics, adults 18 years and up,
Hemoglobin A1C 83.9% TX BRFSS 2021
had A1C test in past 12 months
Diabetics, adults 18 years and up,
seen a doctor/nurse/or other
Seeing Doctor 86.9% TX BRFSS 2021
healthcare professional in past 12
months for diabetes
Diabetics, adults 18 years and up,
Check Daily Blood
58.2% TX BRFSS 2021 blood checked daily for glucose or
Sugar
sugar
Diabetics, adults 18 years and up,
Self-Management
46.4% TX BRFSS 2021 taken a course in how to manage
Course
your diabetes yourself

136 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Texas, Laredo and Laredo ZIP Codes
Measurement
Indicator TX Laredo 78040 78041 78043 78045 78046 Source Definitions
Period

Total Population 28,862,581 254,697 37,136 46,751 45,703 67,730 68,418 CENSUS ACS 2017-2021

Pop by Sex CENSUS ACS 2017-2021

Female 50.1% 50.7% 51.9% 51.6% 50.7% 49.7% 50.3% CENSUS ACS 2017-2021
Male 49.9% 49.3% 48.1% 48.4% 49.3% 50.3% 49.7% CENSUS ACS 2017-2021
Pop by Age CENSUS ACS 2017-2021
Pop Under 18 25.8% 32.6% 33.0% 29.0% 32.0% 32.1% 36.2% CENSUS ACS 2017-2021
Pop 18-64 61.7% 58.1% 53.1% 58.6% 58.4% 61.1% 56.7% CENSUS ACS 2017-2021
Pop 65+ 12.5% 9.3% 13.9% 12.4% 9.6% 6.8% 7.1% CENSUS ACS 2017-2021
Pop by Race/Ethnicity CENSUS ACS 2017-2021
Hispanic 39.8% 95.5% 97.8% 93.9% 96.9% 93.2% 96.8% CENSUS ACS 2017-2021
White, NH 40.7% 3.2% 1.6% 4.2% 2.1% 5.2% 2.4% CENSUS ACS 2017-2021
Demographics Black, NH 11.8% 0.3% 0.4% 0.6% 0.3% 0.5% 0.0% CENSUS ACS 2017-2021
Asian, NH 5.0% 0.5% 0.1% 0.7% 0.5% 0.8% 0.2% CENSUS ACS 2017-2021
AI/AN, NH 0.2% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% CENSUS ACS 2017-2021
Age Dependency Ratio 62.2 72.1 88.3 70.7 71.1 63.8 76.6 CENSUS ACS 2017-2021
Number of children age 0-17 per
Child Dependency Ratio 41.8 56.1 62.1 49.5 54.8 52.6 64.0 CENSUS ACS 2017-2021
100 adults age 18-64
Old-Age Dependency Number of older people age 65+
20.3 16.0 26.2 21.2 16.3 11.1 12.6 CENSUS ACS 2017-2021
Ratio per 100 adults age 18-64
Portion of Population
11.5% 12.3% 21.3% 11.7% 11.4% 8.8% 12.2% CENSUS ACS 2017-2021
Disabled
Not Proficient in English,
Population 5 Years and 13.1% 37.2% 58.7% 34.4% 37.2% 26.6% 38.8% CENSUS ACS 2017-2021
Up
Medicaid Coverage 16.4% 25.6% 37.2% 23.3% 29.7% 12.8% 33.4% CENSUS ACS 2017-2021

Dentists to Population
1,660:1 CHR 2020
Ratio
Mental Health Providers
702 Needed HRSA 2022
Needed
Dental Health Providers
475 Needed HRSA 2022
Needed

Delayed Care Due to Cost 15.9% CDC BRFSS 2021

Rate of hospital stays for

Preventable Hospital ambulatory-care sensitive
4,255 CMS /CHR 2019
Stays conditions per 100,000 Medicare
enrollees
Uninsured CENSUS ACS 2017-2021
Access Percentage of Children
Under Age 19 w/o 11.5% 15.1% 19.1% 13.0% 13.0% 15.6% 14.6% CENSUS ACS 2017-2021
Health Insurance

137 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Texas, Laredo and Laredo ZIP Codes
Measurement
Indicator TX Laredo 78040 78041 78043 78045 78046 Source Definitions
Period
Percentage of Adults
Ages 19-64 w/o Health 23.7% 40.5% 57.2% 38.2% 45.3% 25.2% 48.7% CENSUS ACS 2017-2021
Insurance
Percentage of the
Population Under Age 1.8% 5.4% 6.0% 3.8% 4.5% 3.4% 9.6% CENSUS ACS 2017-2021
65 w/o Health Insurance

Health Literacy 254 UNC 2003

Drug/Alcohol Facility 509 SAMHSA 2020
Received Mental Health Note: Region 11abd includes total
Services in Past Year, 11.5% NSDUH 2016--2018 of 18 counties; includes Webb
Ages 18+ County

No physical activity in past month

(exercises such as running,
calisthenics, golf, gardening, or
Health Behaviors Physical Inactivity 48.1% 39.5% 49.0% 36.1% 40.6% 27.1% 42.0% CDC BRFSS 2020
walking for exercise, outside of
regular job) among adults aged
≥18 years

Infant & Child Health

Infant Mortality 5.5 TX DSHS 2019

CDC
Low Birthweight 8% 2014-2020
WONDER/CHR
CDC
Child Mortality 48.9 2014-2020
WONDER/CHR
General Health
Life Expectancy 78.4 CDC/CHR 2018-2020
Premature Mortality 360 CDC/CHR 2018-2020
Premature Death 7,000 CDC/CHR 2018-2020
Chronic Disease
Adult Obesity 35.8% 45.2% 48.9% 42.9% 45.7% 39.8% 46.9% CDC BRFSS 2020
Diabetes Prevalance 12.6% 15.7% 22.5% 15.8% 16.6% 10.6% 15.2% CDC BRFSS 2020
Frequent Physical 14+ days in past 30 that physical
9.4% 14.4% 20.4% 13.6% 15.3% 9.3% 15.6% CDC BRFSS 2020
Distress health was "not good"
High Blood Pressure
30.8% 30.4% 38.7% 30.9% 31.6% 24.0% 29.3% CDC BRFSS 2019
Awareness
Poor or Fair Health 17.7% 27.9% 40.2% 25.9% 30.0% 16.7% 31.1% CDC BRFSS 2020
TX Cancer
New Cancer Cases 412.40 2019
Statistics
Ever Told Have Kidney
2.7% 4.0% 5.3% 3.5% 3.7% 2.2% 3.3% CDC BRFSS 2020
Disease
Mental / Behavioral Health
Depression Ever Told 17.7% 20.2% 22.4% 19.9% 21.3% 18.5% 22.4% CDC BRFSS 2020

138 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Texas, Laredo and Laredo ZIP Codes
Measurement
Indicator TX Laredo 78040 78041 78043 78045 78046 Source Definitions
Period
Frequent Mental 14+ days in past 30 that mental
13.2% 16.2% 18.6% 15.9% 17.5% 14.3% 19.0% CDC BRFSS 2020
Health Outcomes Distress health was "not good"
Drug poisoning deaths per
Drug Overdose Deaths 14.1 NCHS 2021
100,000 population
Had serious thoughts of suicide in
Suicidal Thoughts, Ages
3.6% NSDUH 2016--2018 the past year among adults aged
18+
18 or older
Serious mental illness in the past
Serious Mental Illness,
3.7% NSDUH 2016--2018 year among adults aged 18 or
Ages 18+
older
Illicit Drug Use in Past Illicit drug use in the past month
Month, Ages 12 and 7.8% NSDUH 2016--2018 among Individuals aged 12 or
Older older
Substance Use
Heavy Drinking 16.4% 15.6% 13.8% 16.4% 16.1% 19.1% 17.2% CDC BRFSS 2020 Binge drinking among adults 18+
Smoking 13.2% 18.2% 23.2% 16.2% 19.1% 12.4% 21.8% CDC BRFSS 2020
Opioid Prescription 37.9 CDC RX RATE 2020
COVID-19
Weekly case rate per 100k as of
CDC COVID
COVID-19 Cases 105.7 2020-2022 data 01Mar2020 through
TRACKER
07Dec2022
Weekly death rate per 100k as of
CDC COVID
COVID-19 Deaths 0.3 2020-2022 data 01Mar2020 through
TRACKER
07Dec2022
Percent of pop ages 5+ with
CDC COVID
COVID-19 Vaccinations 67.5% 2020-2022 completed primary series as of
TRACKER
data through 07Dec2022
Percent of pop ages 5+ with
CDC COVID
COVID-19 Vaccinations 8.4% 2020-2022 updated booster dose as of data
TRACKER
through 07Dec2022

Percentage of households that

Severe Housing Cost
29.9% 33.3% 42.0% 33.8% 31.1% 27.2% 34.9% CENSUS ACS 2017-2021 spend 30% or more of their
Burden
household income on housing
Broadband Access 86.9% 78.1% 59.7% 78.0% 72.0% 92.8% 73.0% CENSUS ACS 2017-2021
Housing Stability score of 0.96 indicates
4% fewer households in that
ARGONNE
Housing Stability N/A 2022 jurisdiction are stable (i.e., not at
NAT'L LIBRARY
risk of eviction or foreclosure) than
baseline period (Jan,2020)

FEEDING
Infrastructure Food Insecurity 13.0% 2020
AMERICA

Education Attainment (BS

31.5% 20.0% 7.4% 25.8% 12.2% 34.8% 10.3% CENSUS ACS 2017-2021
or Higher)
Unemployment 3.9% 3.7% BLS Dec-22
Percent Below Poverty
14.0% 22.2% 37.1% 21.1% 27.5% 8.1% 28.1% CENSUS ACS 2017-2021
Level

139 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Texas, Laredo and Laredo ZIP Codes
Measurement
Indicator TX Laredo 78040 78041 78043 78045 78046 Source Definitions
Period
Prevalence of households who
struggle to afford essentials like
Socioeconomic food, housing, or health care, and
Households Below ALICE 44.0% 79.0% 56.0% 66.0% 43.0% 73.0% UNITED WAY 2018
yet do not meet income
qualifications for public assistance
programs
Score of 5.0 represents a ZIP with
Community Needs Index 5 4.8 5 4 4.6 CNI 2021 the most need compared to
national average (score of 3.0)
Median Household
$ 67,321 $ 55,603 $ 29,836 $ 55,311 $ 50,190 $ 78,478 $ 46,845 CENSUS ACS 2017-2021
Income

Graduation Rate 90.3% TEA TAPR 2020-2021

College Ready 53.4% TEA TAPR 2020-2021

Violent crime includes the
offenses of murder and
Social Conditions 2021 Violent Crime
446.5 231.3 FBI CDE 2020 nonnegligent manslaughter, rape
Offenses Per 100k Pop
(revised definition), robbery, and
aggravated assault
Property crime includes the
2021 Property Crime
2,245 1227 FBI CDE 2020 offenses of burglary, larceny-theft,
Offenses Per 100k Pop
and motor vehicle theft.

Teen Birth Rate, Ages 15- TDSHS / CDC

22.37 23.27 12.08 18.15 4.45 20.92 2020
19 NCHS
Percent of births to mothers
Sexual Health Prenatal Care in First
66.1% 62.0% 72.8% 69.1% 84.4% 70.0% TDSHS 2019 receiving prenatal care in first
Trimester
trimester
HIV - New Cases 14.5 TDSHS 2020

Preventive Care
Primary Check, Ages 18
72.6% 70.2% 69.4% 68.5% 67.3% 66.4% CDC BRFSS 2020
and Up
Dental Check, Ages 18
57.5% 30.5% 45.0% 38.2% 55.0% 34.8% CDC BRFSS 2020
and Up
HIV Test 39.6% CDC BRFSS 2021
Immunizations
Pneumonia 69.0% CDC BRFSS 2020
Flu Shot 66.0% CDC BRFSS 2020
HPV Up to Date, Ages 9-
54.9% TX HHS 2020
17

DTP/DTaP/DT/Td
2021-2022 School
Vaccination Coverage 95.1% Tx DSHS
Year
Among Kindergarteners

140 City of Laredo 2022-23 Community Health Needs Assessment

 Indicators for Texas, Laredo and Laredo ZIP Codes
Measurement
Indicator TX Laredo 78040 78041 78043 78045 78046 Source Definitions
Period
MMR Vaccination
2021-2022 School
Coverage Among 95.4% Tx DSHS
Year
Kindergarteners
Tdap/Td Vaccination
Coverage Among 2021-2022 School
95.4% Tx DSHS
Seventh Grade Year
Students
MMR Vaccination
Coverage Among 2021-2022 School
Preventive 98.6% Tx DSHS
Seventh Grade Year
Students
Preventive Cancer
Colorectal Screening,
54.0% 54.8% 50.9% 57.4% 53.7% 60.2% 49.7% CDC BRFSS 2020
Ages 50-75
Cervical Cancer
75.0% 74.3% 68.7% 74.9% 72.7% 80.7% 71.7% CDC BRFSS 2020
Screening, Ages 21-65
Mammogram, Ages 50-
77.7% 74.3% 72.4% 74.9% 74.1% 76.6% 73.6% CDC BRFSS 2020
74

Diabetes
Diabetics, adults 18 years and up,
Diabetic Feet Check
54.3% TX BRFSS 2021 feet checked daily for any sores or
Daily
irritations
Diabetics, adults 18 years and up,
Hemoglobin A1C 83.9% TX BRFSS 2021
had A1C test in past 12 months
Diabetics, adults 18 years and up,
seen a doctor/nurse/or other
Seeing Doctor 86.9% TX BRFSS 2021
healthcare professional in past 12
months for diabetes
Diabetics, adults 18 years and up,
Check Daily Blood
58.2% TX BRFSS 2021 blood checked daily for glucose or
Sugar
sugar
Diabetics, adults 18 years and up,
Self-Management
46.4% TX BRFSS 2021 taken a course in how to manage
Course
your diabetes yourself

141 City of Laredo 2022-23 Community Health Needs Assessment

 APPENDIX B

Laredo Community Survey - English

Start of Block: Default Question Block

Introduction

The City of Laredo Health Department has partnered with Texas Health Institute to conduct a survey to
learn more about what helps or prevents people in Laredo from achieving good health. The results of this
survey will help the City of Laredo Health Department and other organizations in Laredo to better plan for
and provide services that meet the health needs of our community. Your participation is voluntary. Your
identity and your answers will remain anonymous and confidential. It will not affect your ability to access
services in any way. We will not ask your name, where you live (aside from ZIP code), or about your
citizenship. We are only interested in what you think affects your health and what helps and may help you
lead a healthy life in the community. We are only surveying people living in the City of Laredo. If you meet
this criteria, then we will ask you to complete the full survey which will take roughly 10-15 minutes.

Q1 Are you willing to participate in this survey?

 Yes (1)

 No (2)

Skip To: End of Survey If 1. Are you willing to participate in this survey? = No

Q2 Are you 18 years of age or older?

 Yes (1)

 No (2)

Skip To: End of Block If 2. Are you 18 years of age or older? = No

142 City of Laredo 2022-23 Community Health Needs Assessment

Q57 Do you live in one of the following zip codes in Laredo?
78040
78041
78043
78045
78046

 Yes (1)

 No (2)

Skip To: End of Block If Do you live in one of the following zip codes in Laredo? 78040 78041 78043
78045 78046 = No

Q4 In which of the following zip codes do you live in Laredo? If you live in more than one home, what zip
code do you regularly spend most nights?

 78040 (1)

 78041 (2)

 78043 (3)

 78045 (4)

 78046 (5)

 Other/None of these (6)

Skip To: End of Block If In which of the following zip codes do you live in Laredo? If you live in more than
one home, wha... = Other/None of these

143 City of Laredo 2022-23 Community Health Needs Assessment

Q5 In general, would you say your health is...

 Excellent (1)

 Very good (2)

 Good (3)

 Fair (4)

 Poor (5)

 Don't know/not sure (6)

Q6 Now thinking about your mental health, which includes stress, depression, and problems with
emotions, for how many days during the past 30 days was your mental health not good?

▼ 0 (1) ... 30 (31)

Q7 During the last 12 months, was there any time when you needed mental health treatment or
counseling for yourself but didn't get it?

 Yes (1)

 No (2)

 Don't know/Not sure (3)

Skip To: Q8 If During the last 12 months, was there any time when you needed mental health treatment
or counseli... = Yes
Skip To: Q9 If During the last 12 months, was there any time when you needed mental health treatment
or counseli... = No
Skip To: Q9 If During the last 12 months, was there any time when you needed mental health treatment
or counseli... = Don't know/Not sure

144 City of Laredo 2022-23 Community Health Needs Assessment

Q8 Which of these statements explain why you did not get the mental health treatment or counseling you
needed? [Select all that apply]
 You couldn't afford the cost. (1)
 You did not know where to go to get services. (2)
 You were concerned that getting mental health treatment or counseling might cause your neighbors
or community to have a negative opinion of you. (3)
 You were concerned that getting mental health treatment or counseling might have a negative effect
on your job. (4)
 Your health insurance does not cover any mental health treatment or counseling. (5)
 Your health insurance does not pay enough for mental health treatment or counseling. (6)
 You were concerned that the information you gave the counselor might not be kept confidential. (7)
 You were concerned that you might be committed to a psychiatric hospital or might have to take
medicine. (8)
 Some other reason or reasons. (9)

Q9 Do you currently have any kind of health insurance?

 Yes (1)

 No (2)

 Don't know/Not sure (3)

Skip To: Q10 If Do you currently have any kind of health insurance? = Yes
Skip To: Q11 If Do you currently have any kind of health insurance? = No
Skip To: Q11 If Do you currently have any kind of health insurance? = Don't know/Not sure

145 City of Laredo 2022-23 Community Health Needs Assessment

Q10 What kind of health insurance do you have? [Select all that apply]
 Insurance through my job or my family member's job (1)
 Insurance through the Marketplace (www.healthcare.gov) (2)
 A private insurance that I, or a family member, buys directly from an insurance company (3)
 Medicaid (4)
 Medicare (5)
 Military related insurance (TRICARE, CHAMPUS, CHAMP-VA) (6)
 Other government program for health insurance from the state, county or city (7)
 Health insurance based in Mexico (8)
 Indian Health Service (9)
 Not sure (10)

Q11 Are you a parent, guardian, or primary caregiver of one or more children under 18 that live in Laredo
on a regular basis?

 Yes (1)

 No (2)

Skip To: Q17 If Are you a parent, guardian, or primary caregiver of one or more children under 18 that live
in La... = No
Skip To: Q12 If Are you a parent, guardian, or primary caregiver of one or more children under 18 that live
in La... = Yes

Q12 Do the children under 18 living in your home have health insurance?

 Yes, all have health insurance (1)

 Yes, some, but not all have health insurance (2)

 No, they do not have health insurance (3)

 Don't know/not sure (4)

146 City of Laredo 2022-23 Community Health Needs Assessment

Q13 Do the children under 18 living in your home have one or more people you think of as their personal
doctor or health care provider (for example, primary care provider, pediatrician)?

 Yes, all have a personal doctor (1)

 Yes, some, but not all have a personal doctor (2)

 No, they do not have a personal doctor (3)

 Don’t know/not sure (4)

Q14 When the children under 18 living in your home are sick and need health care, including dental care
or mental health care, where do you take them for care in Laredo? [Select all that apply]
 Clinic or Health Care (for example Gateway Community Health Center) (1)
 City of Laredo Health Department (2)
 Border Region Behavioral Health (3)
 Doctor's or Dentist Office (4)
 Urgent Care (for example Doc-Aid or VitalMed) (5)
 Emergency Room (6)
 Spiritual Healer (7)
 Other (please specify): (8) __________________________________________________

Q15 In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care for the
children living in your home? [Select all that apply]
 Yes, I went to Nuevo Laredo (1)
 Yes, I went to a city in Mexico other than Nuevo Laredo (2)
 Yes, I went to another city in Texas (3)
 No, I did not go outside of Laredo for care (4)

Page Break

147 City of Laredo 2022-23 Community Health Needs Assessment

Display This Question:
If In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care fo...
= Yes, I went to Nuevo Laredo
Or In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care fo...
= Yes, I went to a city in Mexico other than Nuevo Laredo
Or In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care fo...
= Yes, I went to another city in Texas

Q16 Please indicate the type of health care you sought for the children in your home outside of Laredo.
[Select all that apply]
 Medical care (1)
 Mental Health (2)
 Dental care (3)

Q17 Do you have one or more people you think of as your personal doctor or health care provider (for
example primary care provider)?

 Yes (1)

 No (2)

 Don't know/not sure (3)

148 City of Laredo 2022-23 Community Health Needs Assessment

Q18 When you are sick and need health care, including dental care or mental health care, where do you
go in Laredo? [Select all that apply]
 Clinic or Health Center (for example Gateway Community Health Center) (1)
 City of Laredo Health Department (2)
 Border Region Behavioral Health (3)
 Doctor's or Dentist's Office (4)
 Urgent Care (for example Doc-Aid or VitalMed) (5)
 Emergency Room (6)
 Spiritual Healer (7)
 Other (please specify): (8) __________________________________________________

Q19 In the past 12 months, did you go outside of Laredo for medical, dental or mental health care for
yourself? [Select all that apply]
 Yes, I went to Nuevo Laredo (1)
 Yes, I went to a city in Mexico other than Nuevo Laredo (2)
 Yes, I went to another city in Texas (3)
 No, I did not go outside of Laredo for care (4)

Page Break

Display This Question:

If In the past 12 months, did you go outside of Laredo for medical, dental or mental health care for...
= Yes, I went to Nuevo Laredo
Or In the past 12 months, did you go outside of Laredo for medical, dental or mental health care for...
= Yes, I went to a city in Mexico other than Nuevo Laredo
Or In the past 12 months, did you go outside of Laredo for medical, dental or mental health care for...
= Yes, I went to another city in Texas

149 City of Laredo 2022-23 Community Health Needs Assessment

Q20 Please indicate the type of health care you sought in Nuevo Laredo, another city in Mexico, or
another city in Texas. [Select all that apply]
 Medical care (1)
 Mental Health (2)
 Dental care (3)

Q21 During the last 12 months, did you ever need medical care but not get it because of any of these
reasons? [Select all that apply]
 I could not afford it (1)
 I did not have transportation (2)
 I could not get an in-person appointment (3)
 Doctor's office or clinic was not open at a time I could go (4)
 I did not have a way to access virtual visits (also called telehealth) (5)
 I did not trust doctors or other healthcare providers (6)
 There was not an instance where I needed medical care and could not get it in the last 12 months (7)

Q22 In the past 12 months, have you ever visited the emergency room for yourself or your child due to
any of the following reasons? [Select all that apply]
 A mild injury or illness that could have been treated in a doctor's office or clinic (1)
 Did not have health insurance (2)
 Could not afford health care anywhere else (3)
 Did not know where else to go for care (4)
 Did not have transportation to go elsewhere (5)
 Needed a safe place to stay or spend the night (6)
 Needed access to food (7)
 No, I have never visited the emergency room for any of these reasons (8)
 Other (please specify): (9) __________________________________________________

150 City of Laredo 2022-23 Community Health Needs Assessment

Q23 Whom do you trust the most to provide information on health? [Select top 3]
 Friends or family (1)
 Healthcare provider such as doctor or nurse (2)
 Neighborhood or community organizations (3)
 Faith organizations/faith leaders (4)
 Employers (5)
 City of Laredo Health Department (6)
 Texas Department of State Health Services (7)
 National US government agencies such as the CDC (8)
 Local news in Spanish (Radio, TV or newspaper) (9)
 Local news in English (Radio, TV or newspaper) (10)
 National news in Spanish (Radio, TV or newspaper) (11)
 National news in English (Radio, TV or newspaper) (12)
 Other (13) __________________________________________________

Page Break

Q24 To your knowledge, have you had COVID-19 since January 2020?

 Yes, I tested positive with a PCR (1)

 Yes, I tested positive with a home test (2)

 Yes, I think so but did not take a PCR test or home test (3)

 No, I have not had COVID-19 (4)

Skip To: Q25 If To your knowledge, have you had COVID-19 since January 2020? = Yes, I tested positive
with a PCR
Skip To: Q25 If To your knowledge, have you had COVID-19 since January 2020? = Yes, I tested positive
with a home test
Skip To: Q25 If To your knowledge, have you had COVID-19 since January 2020? = Yes, I think so but
did not take a PCR test or home test
Skip To: Q26 If To your knowledge, have you had COVID-19 since January 2020? = No, I have not had
COVID-19

151 City of Laredo 2022-23 Community Health Needs Assessment

Q25 Describe the level of health care you received when you had COVID-19. If you have had COVID-19
more than once, describe the level of health care during the first time you had COVID-19. [Select all that
apply]
 I did not seek medical care from a health care provider (1)
 I received medical care at a doctor's office, urgent care or clinic (2)
 I received medical care at an emergency room (3)
 I was hospitalized (4)

Q26 Compared to before the COVID-19 pandemic, how would you describe your mental health now?

 Much better (1)

 Somewhat better (2)

 Neither better nor worse (3)

 Somewhat worse (4)

 Much worse (5)

152 City of Laredo 2022-23 Community Health Needs Assessment

Q27 Please indicate below if a doctor or health care provider has ever told you that you have the
following medical conditions. [Select all that apply]
 Asthma (1)
 Cancer (2)
 Mental health condition (for example depression, anxiety, schizophrenia, or other major emotional
problem) (3)
 Prediabetes (4)
 Diabetes (5)
 Heart Disease (6)
 High blood pressure (7)
 High cholesterol (8)
 Obesity (9)
 Substance use disorder (alcohol or drugs) (10)
 Any physical disability (11)
 Neurodevelopmental disability (for example Dyslexia, Autism Spectrum Disorder, ADHD,
developmental disability) (12)

Q28 Have you ever been pregnant?

 Yes (1)

 No (2)

Skip To: Q29 If Have you ever been pregnant? = Yes

Skip To: Q32 If Have you ever been pregnant? = No

Q29 During your most recent pregnancy, did you have any of the following health conditions? [Select all
that apply]
 High blood pressure (that started during this pregnancy), pre-eclampsia or eclampsia (1)
 Miscarriage (2)
 Gestational diabetes (diabetes that started during the pregnancy) (3)
 Depression (4)
 Preterm labor (5)

153 City of Laredo 2022-23 Community Health Needs Assessment

Page Break

Q32 Now I would like to ask you more specific questions about issues that may affect your health.

Q30 Including yourself, how many individuals currently live in your home?

▼ 1 (1) ... More than 15 (16)

Q31 What is your housing situation today?

 I have permanent housing (living in a house alone or with others, an apartment or mobile home) (1)

 I have temporary housing with family or friends (2)

 I have temporary housing in a hotel or shelter (3)

 I do not have housing (living outside, on the street, in a car, or in a park) (4)

 Other (please specify): (5) __________________________________________________

154 City of Laredo 2022-23 Community Health Needs Assessment

Q32 To what extent is it a financial burden or struggle for you or those you live with to pay for housing
costs every month? This includes monthly rent or mortgage, and utilities such as electricity, water and
gas.

 A large struggle (1)

 Somewhat of a struggle (2)

 Not a struggle at all (3)

 Don't know/not sure (4)

Q33 Do you have any of the following concerns about your current living situation, like housing
conditions, safety, or costs? [Select all that apply]
 Condition of housing (1)
 Housing is temporary and I do not have permanent housing (2)
 Ability to pay for housing or utilities (3)
 Feeling safe (4)
 Other (please specify): (5) __________________________________________________
 I do not have any of these concerns about my current living situation (6)

155 City of Laredo 2022-23 Community Health Needs Assessment

Q34 Below is a list of problems that can affect health and mental health. Thinking about your
neighborhood, please indicate which of these are currently negatively affecting your health or the health
of those that live with you. Pick up to 3 choices.
 Abandoned homes and lots (1)
 Air pollution such as fumes, smells, and smoke (2)
 Crime and violence (3)
 Too many liquor stores (4)
 Not enough grocery stores (5)
 Not enough sidewalks (6)
 Not enough parks or playgrounds (7)
 Stray dogs or cats (8)
 Lack of accessible public transportation (9)
 None of these (10)

Page Break

Q35 During the past 12 months, was there a time when, because of lack of money or other resources,
you were worried you would not have enough food to eat?

 Yes (1)

 No (2)

 Don't know/not sure (3)

Q36 During the last 12 months, was there a time when, because of a lack of money or other resources,
that you were unable to eat healthy or nutritious food such a fruit or vegetables?

 Yes (1)

 No (2)

 Don't know/not sure (3)

156 City of Laredo 2022-23 Community Health Needs Assessment

Q37 During the past 12 months, have any of the following community organizations assisted you with
food? Select all that apply.
 South Texas Food Bank (1)
 Laredo Regional Food Bank (2)
 Bethany House of Laredo (3)
 WIC (4)
 SNAP (Supplemental Nutrition Assistance Program, Food Stamps) (5)
 Salvation Army (6)
 Other (please specify): (7) __________________________________________________
 None of these organizations have assisted me with food. (8)

Page Break

Q38 What is your age?

 18-24 (1)

 25-34 (2)

 35-44 (3)

 45-54 (4)

 55-64 (5)

 65+ (6)

Q39 What is your ethnicity? Are you Hispanic, Latino/a, or Spanish origin?

 Hispanic or Latino(a) (1)

 Not Hispanic or Latino(a) (2)

157 City of Laredo 2022-23 Community Health Needs Assessment

Q40 What is your race? [Select all that apply]
 American Indian or Alaska Native (1)
 Asian (examples: Chinese, Japanese, Korean, South Asian, Filipino, etc) (2)
 Black or African American (3)
 Native Hawaiian or Pacific Islander (4)
 White (5)
 Other (6)

Q41 How do you identify? Are you...

 Male (1)

 Female (2)

 Non-binary (3)

 Other (4)

 Prefer not to answer (5)

Q42 Which of the following best represents how you think of yourself?

 Gay or Lesbian (1)

 Straight (2)

 Bisexual (3)

 Something else (4)

 I don't know the answer (5)

 Prefer not to answer (6)

158 City of Laredo 2022-23 Community Health Needs Assessment

Q43 Do you consider yourself transgender?

 No (1)

 Yes, transgender, male-to-female (2)

 Yes, transgender, female-to-male (3)

 Yes, transgender, gender non-conforming (4)

Q44 What language do you primarily speak at home?

 English (1)

 Spanish (2)

 Other (please specify): (3) __________________________________________________

Q45 How well would you say you speak English?

 Very well (1)

 Well (2)

 Not well (3)

 Not at all (4)

159 City of Laredo 2022-23 Community Health Needs Assessment

Q46 What is the highest grade or year of school you completed?

 Never attended school or only attended kindergarten (1)

 Grades 1-8 (Elementary) (2)

 Grades 9-11 (Some high school) (3)

 Grades 12 or GED (High school graduate/finished high school) (4)

 College or technical training - 1 year to 3 years (5)

 College graduate - 4 years or more (6)

Q47 What is your current work situation?

 Employed for wages (1)

 Self-employed (2)

 Out of work for less than 1 year (3)

 Out of work for 1 year or more (4)

 A homemaker (5)

 A student (6)

 Retired (7)

 Unable to work (8)

End of Block: Default Question Block

160 City of Laredo 2022-23 Community Health Needs Assessment

 APPENDIX C

Laredo Community Survey - Spanish

Start of Block: Default Question Block

Introducción
El Departamento de Salud de la Ciudad de Laredo se ha asociado con el Instituto de Salud de
Texas para realizar una encuesta para obtener más información sobre lo que ayuda o impide
que las personas en Laredo alcancen una buena salud. Los resultados de esta encuesta
ayudarán al Departamento de Salud de la Ciudad de Laredo y otras organizaciones en Laredo
a planificar mejor y brindar servicios que satisfagan las necesidades de salud de nuestra
comunidad. Su participación es voluntaria. Su identidad y sus respuestas permanecerán
anónimas y confidenciales. No afectará su capacidad para obtener a los servicios de ninguna
manera. No le preguntaremos su nombre, dónde vive (aparte del código postal) o su
ciudadanía. Solo nos interesa lo que usted cree que afecta su salud y lo que le ayuda y puede
ayudarle a llevar una vida saludable en la comunidad. Solo estamos encuestando a personas
que viven en la Ciudad de Laredo. Si cumple con este requisito, le pediremos que complete la
encuesta completa, lo que le llevará aproximadamente entre 10 y 12 minutos.

Q1 1. ¿Está dispuesto a participar en esta encuesta?

o Sí (1)
o No (2)

Skip To: End of Survey If 1. Are you willing to participate in this survey? = No

161 City of Laredo 2022-23 Community Health Needs Assessment

Q2 2. ¿Tiene 18 años o más?
o Sí (1)
o No (2)

Skip To: End of Block If 2. Are you 18 years of age or older? = No

Q57 ¿Vive en uno de los siguientes códigos postales en Laredo?

78040
78041
78043
78045
78046

o Sí (1)
o No (2)

Skip To: End of Block If Do you live in one of the following zip codes in Laredo? 78040 78041 78043
78045 78046 = No

Q4 ¿En cuál de los siguientes códigos postales vive en Laredo? Si vive en más de una casa,
¿en qué código postal pasa regularmente la mayoría de las noches?
o 78040 (1)
o 78041 (2)
o 78043 (3)
o 78045 (4)
o 78046 (5)
o Otro/Ninguno de estos (6)

Skip To: End of Block If In which of the following zip codes do you live in Laredo? If you live in more than
one home, wha... = Other/None of these

162 City of Laredo 2022-23 Community Health Needs Assessment

Q5 En general, diría que su salud es...
 Excelente (1)
 Muy buena (2)
 Buena (3)
 Regular (4)
 Mala (5)
 No sé/no estoy seguro(a) (6)

Q6 Con respeto a su estado de salud mental, lo que incluye estrés, depresión, y problemas
emocionales, en los ultimos 30 días ¿durante cuántos días su estado de salud mental no fue
bueno?

▼ 0 (1) ... 30 (31)

Q7 Durante los últimos 12 meses, ¿hubo algún momento en que necesitó tratamiento de salud
mental o terapia para usted pero no lo recibió?
 Sí (1)
 No (2)
 No sé/No estoy seguro(a) (3)

Skip To: Q8 If During the last 12 months, was there any time when you needed mental health treatment
or counseli... = Yes
Skip To: Q9 If During the last 12 months, was there any time when you needed mental health treatment
or counseli... = No

163 City of Laredo 2022-23 Community Health Needs Assessment

Skip To: Q9 If During the last 12 months, was there any time when you needed mental health treatment
or counseli... = Don't know/Not sure

Q8 ¿Cuál de estas declaraciones explica por qué no recibió el tratamiento o la terapia de salud
mental que necesitaba? [Seleccione todas las opciones que correspondan]

 No podía pagar el costo. (1)

 No sabía a dónde ir para obtener servicios. (2)

 Le preocupaba que recibir tratamiento o consejería de salud mental pudiera causar que sus
vecinos o la comunidad tuvieran una opinión negativa de usted. (3)

 Le preocupaba que recibir tratamiento o asesoramiento de salud mental pudiera tener un

efecto negativo en su trabajo. (4)

 Su seguro de salud no cubre ningún tratamiento o asesoramiento de salud mental. (5)

 Su seguro de salud no paga lo suficiente por el tratamiento o la consejería de salud mental.

(6)

 Le preocupaba que la información que le dio al consejero no se mantuviera confidencial.

(7)

 Le preocupaba que lo internaran en un hospital psiquiátrico o que tuviera que tomar

medicamentos. (8)

 Alguna otra razón o razones. (9)

Q9 ¿Cuenta actualmente con algún tipo de seguro médico?

 Sí (1)
 No (2)
 No sé/No estoy seguro(a) (3)

Skip To: Q10 If Do you currently have any kind of health insurance? = Yes
Skip To: Q11 If Do you currently have any kind of health insurance? = No
Skip To: Q11 If Do you currently have any kind of health insurance? = Don't know/Not sure

164 City of Laredo 2022-23 Community Health Needs Assessment

Q10 ¿Qué tipo de seguro médico tiene? [Seleccione todas las opciones que correspondan]

 Seguro a través de mi trabajo o el trabajo de mi familiar (1)

 Seguro a través del Mercado Libre (como Obamacare) (www.healthcare.gov) (2)

 Un seguro privado que yo, o un miembro de mi familia, compramos directamente de una

compañía de seguros (3)

 Medicaid (4)

 Medicare (5)

 Seguro relacionado con el ejército (TRICARE, CHAMPUS, CHAMP-VA) (6)

 Otro programa gubernamental para seguro médico del estado, condado o ciudad (7)

 Seguro de salud con sede en México (8)

 Servicio de salud indio (Indian Health Service) (9)

 No estoy seguro(a) (10)

Q11 ¿Es usted padre, guardián o cuidador principal de uno o más niños menores de 18 años
que viven en Laredo regularmente?
 Sí (1)
 No (2)

Skip To: Q17 If Are you a parent, guardian, or primary caregiver of one or more children under 18 that live
in La... = No
Skip To: Q12 If Are you a parent, guardian, or primary caregiver of one or more children under 18 that live
in La... = Yes

165 City of Laredo 2022-23 Community Health Needs Assessment

Q12 ¿Los niños menores de 18 años que viven en su hogar tienen seguro médico?
 Sí, todos tienen seguro médico. (1)
 Sí, algunos, pero no todos tienen seguro médico (2)
 No, no tienen seguro médico. (3)
 No sé/no estoy seguro(a) (4)

Q13 ¿Los niños menores de 18 años que viven en su hogar tienen una o más personas a las
que considera su médico personal o proveedor de atención médica (por ejemplo, proveedor de
atención primaria, pediatra)?
 Sí, todos tienen un médico personal. (1)
 Sí, algunos, pero no todos tienen un médico personal. (2)
 No, no tienen médico personal. (3)
 No sé/no estoy seguro(a) (4)

166 City of Laredo 2022-23 Community Health Needs Assessment

Q14 Cuando los niños menores de 18 años que viven en su hogar están enfermos y necesitan
atención médica, incluyendo atención dental o atención de salud mental, ¿a dónde los lleva
para recibir atención en Laredo? [Seleccione todas las opciones que correspondan]

 Clínica o atención médica (por ejemplo, Gateway Community Health Center) (1)

 Departamento de Salud de la Ciudad de Laredo (2)

 Salud conductual de la región fronteriza (Border Region Behavioral Health) (3)

 Consultorio médico o dentista (4)

 Atención de urgencia (por ejemplo, Doc-Aid o VitalMed) (5)

 Sala de emergencias (6)

 Sanador espiritual (7)

 Otros (especificar): (8) __________________________________________________

Q15 En los últimos 12 meses, ¿salió de Laredo para recibir atención médica, dental o de salud
mental para los niños que viven en su hogar? [Seleccione todas las que correspondan]

 Sí, fui a Nuevo Laredo (1)

 Sí, fui a una ciudad en México que no es Nuevo Laredo (2)

 Sí, fui a otra ciudad en Texas (3)

 No, no salí de Laredo para recibir atención. (4)

Page Break

167 City of Laredo 2022-23 Community Health Needs Assessment

Display This Question:
If In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care fo...
= Yes, I went to Nuevo Laredo
Or In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care fo...
= Yes, I went to a city in Mexico other than Nuevo Laredo
Or In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care fo...
= Yes, I went to another city in Texas

Q16 Indique el tipo de atención médica que buscó para los niños en su hogar fuera de Laredo.
[Seleccione todas las opciones que correspondan]

 Atención médica (1)

 Salud mental (2)

 Cuidado dental (3)

Q17 ¿Tiene una o más personas a las que considera su médico personal o proveedor de
atención médica (por ejemplo, proveedor de atención primaria)?
 Sí (1)
 No (2)
 No sé/no estoy seguro(a) (3)

168 City of Laredo 2022-23 Community Health Needs Assessment

Q18 Cuando usted está enfermo y necesita atención médica, incluyendo atención dental o
atención de salud mental, ¿a dónde va en Laredo? [Seleccione todas las opciones que
correspondan]

 Clínica o centro de salud (por ejemplo, Gateway Community Health Center) (1)

 Departamento de Salud de la Ciudad de Laredo (2)

 Salud conductual de la región fronteriza (Border Region Behavioral Health) (3)

 Consultorio médico o dentista (4)

 Atención de urgencia (por ejemplo, Doc-Aid o VitalMed) (5)

 Sala de emergencias (6)

 Sanador espiritual (7)

 Otros (especificar): (8) __________________________________________________

Q19 En los últimos 12 meses, ¿salió de Laredo para recibir atención médica, dental o de salud
mental ? [Seleccione todas las opciones que correspondan]

 Sí, fui a Nuevo Laredo (1)

 Sí, fui a una ciudad en México que no es Nuevo Laredo (2)

 Sí, fui a otra ciudad en Texas (3)

 No, no salí de Laredo para recibir atención (4)

Page Break

169 City of Laredo 2022-23 Community Health Needs Assessment

Display This Question:
If In the past 12 months, did you go outside of Laredo for medical, dental or mental health care for...
= Yes, I went to Nuevo Laredo
Or In the past 12 months, did you go outside of Laredo for medical, dental or mental health care for...
= Yes, I went to a city in Mexico other than Nuevo Laredo
Or In the past 12 months, did you go outside of Laredo for medical, dental or mental health care for...
= Yes, I went to another city in Texas

Q20 Indique el tipo de atención médica que buscó en Nuevo Laredo, otra ciudad de México u
otra ciudad de Texas. [Seleccione todas las opciones que correspondan]

 Atención médica (1)

 Salud mental (2)

 Cuidado dental (3)

Q21 Durante los últimos 12 meses, ¿alguna vez necesitó atención médica pero no la obtuvo
por alguna de estas razones? [Seleccione todas las opciones que correspondan]

 No podía pagar el costo. (1)

 No tenia transporte (2)

 No pude conseguir una cita en persona (3)

 El consultorio médico o la clínica no estaban abiertos a la hora a la que podía ir (4)

 No tenía forma de atender a las visitas virtuales (también llamadas telesalud) (5)

 No confiaba en los médicos u otros proveedores de atención médica. (6)

 No hubo un caso en el que necesitara atención médica y no pudiera obtenerla en los

últimos 12 meses (7)

170 City of Laredo 2022-23 Community Health Needs Assessment

Q22 En los últimos 12 meses, ¿alguna vez visitó la sala de emergencias para usted o su hijo
debido a alguna de las siguientes razones? [Seleccione todas las opciones que correspondan]

 Una lesión o enfermedad leve que podría haberse tratado en el consultorio de un médico o
en una clínica (1)

 No tenia seguro medico (2)

 No podía pagar la atención médica en ningún otro lugar. (3)

 No sabía a dónde más ir para recibir atención. (4)

 No tenía transporte para ir a otro lado. (5)

 Necesitaba un lugar seguro para quedarse o pasar la noche (6)

 Acceso necesario a los alimentos (7)

 No, nunca he visitado la sala de emergencias por ninguna de estas razones (8)

 Otros (especificar): (9) __________________________________________________

171 City of Laredo 2022-23 Community Health Needs Assessment

Q23 ¿En quién confía más para brindar información sobre salud? [Seleccione las 3 opciones
más importantes para usted]

 Amigos o familia (1)

 Proveedor de atención médica, como un médico o una enfermera (2)

 Organizaciones vecinales o comunitarias (3)

 Organizaciones religiosas/líderes religiosos (4)

 Empleadores (5)

 Departamento de Salud de la Ciudad de Laredo (6)

 Departamento Estatal de Servicios de Salud de Texas (7)

 Agencias gubernamentales nacionales de EE. UU., como la CDC (8)

 Noticias locales en español (Radio, TV o periódico) (9)

 Noticias locales en inglés (Radio, TV o periódico) (10)

 Noticias nacionales en español (Radio, TV o periódico) (11)

 Noticias nacionales en inglés (Radio, TV o periódico) (12)

 Otro (especificar) (13) __________________________________________________

Page Break

172 City of Laredo 2022-23 Community Health Needs Assessment

Q24 Que usted sepa, ¿ha tenido COVID-19 desde enero de 2020?
 Sí, di positivo con una PCR (una prueba de laboratorio) (1)
 Sí, di positivo con una prueba casera. (2)
 Sí, creo que sí, pero no hice una prueba de PCR o una prueba casera. (3)
 No, no he tenido COVID-19 (4)

Skip To: Q25 If To your knowledge, have you had COVID-19 since January 2020? = Yes, I tested positive
with a PCR
Skip To: Q25 If To your knowledge, have you had COVID-19 since January 2020? = Yes, I tested positive
with a home test
Skip To: Q25 If To your knowledge, have you had COVID-19 since January 2020? = Yes, I think so but
did not take a PCR test or home test
Skip To: Q26 If To your knowledge, have you had COVID-19 since January 2020? = No, I have not had
COVID-19

Q25 Describa el nivel de atención médica que recibió cuando tuvo COVID-19. Si ha tenido
COVID-19 más de una vez, describa el nivel de atención médica durante la primera vez que
tuvo COVID-19. [Seleccione todas las opciones que correspondan]

 No busqué atención médica de un proveedor de salud (1)

 Recibí atención médica en el consultorio de un médico, atención de urgencia o clínica (2)

 Recibí atención médica en una sala de emergencia (3)

 Yo estaba hospitalizado(a) (4)

173 City of Laredo 2022-23 Community Health Needs Assessment

Q26 En comparación con antes de la pandemia de COVID-19, ¿cómo describiría su salud
mental ahora?
 Mucho mejor (1)
 Un poco mejor (2)
 Ni mejor ni peor (3)
 Algo peor (4)
 Mucho peor (5)

Q27 Indique si un médico o proveedor de atención médica le ha dicho alguna vez que tiene
alguna de las siguientes afecciones médicas. [Seleccione todas las opciones que
correspondan]

 Asma (1)

 Cáncer (2)

 Condición de salud mental (por ejemplo, depresión, ansiedad, esquizofrenia u otro

problema emocional importante) (3)

 Prediabetes (4)

 Diabetes (5)

 Enfermedad del corazón (6)

 Alta presión sanguínea (7)

 Colesterol alto (8)

 Obesidad (9)

 Trastorno por uso de sustancias (alcohol o drogas) (10)

 Cualquier discapacidad física (11)

 Discapacidad del desarrollo neurológico (por ejemplo, dislexia, trastorno del espectro
autista, TDAH, discapacidad del desarrollo) (12)

174 City of Laredo 2022-23 Community Health Needs Assessment

Q28 ¿Alguna vez has estado embarazada?
 Sí (1)
 No (2)

Skip To: Q29 If Have you ever been pregnant? = Yes

Skip To: Q32 If Have you ever been pregnant? = No

Q29 Durante su embarazo más reciente, ¿tuvo alguna de las siguientes condiciones de salud?
[Seleccione todas las opciones que correspondan]

 Presión arterial alta (que comenzó durante este embarazo), preeclampsia o eclampsia (1)

 Aborto espontáneo (2)

 Diabetes gestacional (diabetes que comenzó durante el embarazo) (3)

 Depresión (4)

 Trabajo prematuro (5)

Page Break

Q32 Ahora me gustaría hacerle preguntas más específicas sobre temas que pueden afectar su
salud.

Q30 Incluido usted mismo, ¿cuántas personas viven actualmente en su hogar?

▼ 1 (1) ... más de 15 (16)

175 City of Laredo 2022-23 Community Health Needs Assessment

Q31 ¿Cuál es su situación de vivienda hoy?
 Tengo vivienda permanente (vivo en una casa solo o con otros, un apartamento o casa
móvil) (1)
 Tengo vivienda temporal con familiares o amigos (2)
 Tengo vivienda temporal en un hotel o albergue (3)
 No tengo vivienda (vivo afuera, en la calle, en un auto o en un parque) (4)
 Otro (especificar): (5) __________________________________________________

Q32 ¿Hasta qué punto es una carga financiera o le causa dificultad para usted o para las
personas con las que vive pagar los costos de vivienda todos los meses? Esto incluye alquiler
mensual o hipoteca, y servicios públicos como electricidad, agua y gas.
 Una gran lucha (1)
 Algo de una lucha (2)
 No es una lucha en absoluto (3)
 No sé/no estoy seguro(a) (4)

Q33 ¿Tiene alguna de las siguientes preocupaciones sobre su situación de vivienda actual,
como las condiciones de vivienda, la seguridad o los costos? [Seleccione todas las opciones
que correspondan]

 Estado de la vivienda (1)

 La vivienda es temporal y no tengo vivienda permanente (2)

 Capacidad para pagar la vivienda o los servicios públicos (3)

 Sentirse a salvo (4)

 Otro (especificar): (5) __________________________________________________

 No tengo ninguna de estas preocupaciones sobre mi situación de vivienda actual (6)

176 City of Laredo 2022-23 Community Health Needs Assessment

Q34 A continuación se muestra una lista de problemas que pueden afectar la salud y la salud
mental. Pensando en su colonia, indique cuáles de estos están afectando negativamente su
salud o la salud de quienes viven con usted. Elija hasta 3 opciones.

 Casas y lotes abandonados (1)

 Contaminación del aire como vapores, olores y humo. (2)

 Crimen y violencia (3)

 Demasiadas tiendas de licores (4)

 No hay suficientes tiendas de comestibles (5)

 No hay suficientes banquetas (6)

 No hay suficientes parques o áreas de juego (7)

 Perros o gatos callejeros (8)

 Falta de transporte público accesible. (9)

 Ninguno de esos (10)

Page Break

Q35 Durante los últimos 12 meses, ¿hubo algún momento en que, debido a la falta de dinero u
otros recursos, le preocupaba no tener suficientes alimentos para comer?
 Sí (1)
 No (2)
 No sé/no estoy seguro(a) (3)

177 City of Laredo 2022-23 Community Health Needs Assessment

Q36 Durante los últimos 12 meses, ¿hubo algún momento en que, debido a la falta de dinero u
otros recursos, no pudo comer alimentos saludables o nutritivos, como frutas o verduras?
 Sí (1)
 No (2)
 No sé/no estoy seguro(a) (3)

Q37 Durante los últimos 12 meses, ¿alguna de las siguientes organizaciones comunitarias le
han ayudado con alimentos? Seleccione todas las opciones que correspondan.

 Banco de alimentos del sur de Texas (South Texas Food Bank) (1)

 Banco Regional de Alimentos de Laredo (Laredo Regional Food Bank) (2)

 Casa Betania de Laredo (Bethany House of Laredo) (3)

 WIC (4)

 SNAP (Programa de Asistencia Nutricional Suplementaria, Cupones, estampillas para

Alimentos) (5)

 Ejército de Salvación (6)

 Otro (especificar): (7) __________________________________________________

 Ninguna de estas organizaciones me ha ayudado con comida. (8)

Page Break

Q38 ¿Cual es su edad?

 18-24 (1)
 25-34 (2)
 35-44 (3)
 45-54 (4)
 55-64 (5)
 65+ (6)

178 City of Laredo 2022-23 Community Health Needs Assessment

Q39 ¿Cuál es su grupo étnico? ¿Eres Hispano, Latino/a o de origen español?
 Hispano o Latino(a) (1)
 No Hispano o latino(a) (2)

Q40 ¿Cuál es su raza? [Seleccione todas las opciones que correspondan]

 Indio americano o nativo de Alaska (1)

 Asiático (ejemplos: chino, japonés, coreano, sudasiático, filipino, etc.) (2)

 Negro o afroamericano (3)

 Nativo de Hawái o de las islas del Pacífico (4)

 Blanco (5)

 Otro (6)

Q41 ¿Cómo se identifica? Es...

 Masculino (1)
 Femenino (2)
 No binario (3)
 Otro (4)
 Prefiero no responder (5)

179 City of Laredo 2022-23 Community Health Needs Assessment

Q42 ¿Cuál de las siguentes opciones representa mejor lo que piensa de usted?
 Heterosexual (ni gay, ni lesbiana) (1)
 Gay o lesbiana (Homosexual) (2)
 Bisexual (3)
 Algo distinto (4)
 No se la respuesta (5)
 Prefiero no responder (6)

Q43 ¿Se considera transgénero?

 No (1)
 Sí, transgénero, de hombre a mujer (2)
 Sí, transgénero, de mujer a hombre (3)
 Sí, transgénero, género no conforme (4)

Q44 ¿Qué idioma habla principalmente en casa?

 Inglés (1)
 Español (2)
 Otros (especificar): (3) __________________________________________________

180 City of Laredo 2022-23 Community Health Needs Assessment

Q45 ¿Qué tan bien diría que habla inglés?
 Muy bien (1)
 Bien (2)
 Mal (3)
 No lo hablo (4)

Q46 ¿Cuál es el nivel de educación o grado escolar más alto que ha completado?
 Nunca asistió a la escuela o solo asistió al jardín de ninós (1)
 Grados 1-8 (Primaria) (2)
 Grados 9-11 (algunos de la escuela secundaria) (3)
 Grados 12 o GED (graduado de escuela secundaria/escuela secundaria terminada) (4)
 Formación universitaria o técnica - 1 año a 3 años (5)
 Graduado universitario - 4 años o más (6)

Q47 ¿Cual es tu situación laboral actual?

 Empleado (1)
 Trabajadores por cuenta propia (2)
 Sin trabajo por menos de 1 año (3)
 Sin trabajo por 1 año o más (4)
 Un ama de casa (5)
 Un estudiante (6)
 Jubilado (7)
 Incapaz de trabajar (8)

End of Block: Default Question Block

181 City of Laredo 2022-23 Community Health Needs Assessment

 APPENDIX D

182 City of Laredo 2022-23 Community Health Needs Assessment

LAREDO COMMUNITY HEALTH SURVEY
RESULTS

BACKGROUND

Texas Health Institute (THI) developed and—jointly with the City of Laredo Health Department—
disseminated a community survey in fall 2022. The survey was completed by 1,635 residents of
the city of Laredo living in ZIP codes 78040, 784041, 78043, 78045, and 78046 between
November 18 and December 9, 2022. All residents completing the survey were 18 or older.
One-fifth of survey respondents (20.4%) completed the survey in Spanish, and 79.6% in
English. The process of development and dissemination of the survey is detailed below.

THI developed a preliminary version of the community survey instrument by referencing other
validated state and national surveys. For example, the CHNA survey tool has questions adapted
from surveys such as the Behavior Risk Factor Surveillance System, American Community
Survey, the National Survey on Drug Use and Health, and the Census. In addition, THI created
community-specific questions that were of interest to the health department and translated the
final draft into Spanish. Team members from the City of Laredo Health Department reviewed,
pilot tested, and refined the survey in English and Spanish. The refinement process was
particularly important as the community survey needed to reflect local language and knowledge.
The team from the City of Laredo Health Department spent numerous hours consulting with
local leaders to ensure the language used in the survey was aligned to the language used and
recognized in the community, both in English and Spanish. The final survey instrument reflects
the community of Laredo.

The community survey included 47 questions pertaining to health status and conditions, mental
health, health insurance, health-seeking behaviors and services, COVID-19, housing status,
neighborhood concerns, food access, and demographics (e.g., age, race, ethnicity). The survey
also had two screening questions to ensure responses were from residents 18 years or older
that resided within the identified ZIP codes in Laredo. The majority of questions did not require a
response from the survey participant, allowing respondents to skip some questions. As a result,
the number of responses varies by question.

183 City of Laredo 2022-23 Community Health Needs Assessment

The survey was built and disseminated in Qualtrics, a web-based survey platform that allows
people to take the survey on a computer, laptop, or mobile device, including situations without
internet access.

The City of Laredo Health Department and THI tested the survey in Qualtrics in English and
Spanish, paying careful attention to functionality, clarity of language, and usability on different
device types (e.g., desktop, mobile, tablet).

The City of Laredo Health Department disseminated the community survey from November 18
to December 9, 2022. The health department sent an anonymous link to Qualtrics to community
partner organizations and the health department’s community outreach team. The City of
Laredo Health Department played a key role in the dissemination of the survey, meeting with
promotional specialists who then went to multiple locations throughout the city to engage
community members to complete the survey. The promotional specialists worked during
daytime working hours as well as after-hours events. In addition, the staff of the City of Laredo
Health Department collaborated to promote the survey with:

 Promos on local television stations, including a morning show and on live online news
feeds
 Promos on local radio stations
 Posts on all of the health department’s social media platforms
 Survey link emailed to city employees
 Survey QR code and flyers on multiple digital billboards located at various City of Laredo
offices
 In-person visits to Laredo organizations to engage and provide flyers with survey QR
code to managers and service providers with direct customer interaction, including at
City of Laredo buildings, recreation centers, public libraries, nonprofit organizations, and
food banks
 In-person survey recruitment at local health care facilities, including the health
department, Gateway Community Clinics, and five WIC clinics across the city

While the survey was a convenience sample, THI and the City of Laredo Health Department
worked to ensure that it captured a representative sample of Laredo residents by monitoring
several key indicators:

 Age
 Educational level
 Insurance status
 Primary language

184 City of Laredo 2022-23 Community Health Needs Assessment

  Sex
 Type of Insurance
 ZIP code distribution

THI provided regular updates to the City of Laredo Health Department, and the health
department staff fine-tuned community outreach to achieve a representative sample. In addition,
THI worked with the Area Health Education Center of the Mid Rio Grande Border Area of Texas
to do targeted outreach in ZIP codes with lower initial responses rates and community members
who were uninsured, enrolled in Medicaid or over 65 years of age.

ANALYSIS

During analysis, THI weighted the community survey data in order to make the survey sample
more representative of population-level data. The survey data were weighted by age, education,
gender identity, sex, and ZIP code. Staff used Qualtrics to conduct univariate and bivariate
analyses on questions with single and multiple-choice answers. Questions that included an
open-ended answer option were analyzed using Excel, in order to identify the most common
themes among the responses.

The survey findings in this report were included if they were statistically significant, meaning
there is mathematical reason to believe the findings are not due to random chance and there is
a true difference between groups. In some cases, the analyses yielded a small or medium effect
size. Even with a small effect size, there were notable patterns among the findings that emerged
across variables. Additionally, the survey had a relatively large sample (1,635). In combination,
this suggests that the differences between groups are significant. Finally, results with less than
20 responses were suppressed to safeguard confidentiality.

ACKNOWLEDGEMENTS

City of Laredo Health Department

Richard A. Chamberlain, DrPH, MPH, CPHA, CPM, CHW, RS
Erika Martinez, MBA, SHRM-SCP, CHW, CTCM
Jaime Lara, BBA
Ryan P. Logan, BS, BA
Elizabeth Guerra, BA

185 City of Laredo 2022-23 Community Health Needs Assessment

Texas Health Institute
Rachelle Johnsson Chiang, DrPH, MPH
Susana M. Morales, MA
Blair Williams, MPA, MBA
Emily Peterson Johnson, LMSW
Cristal Romero, MPP
Cody Price, MPH
Afrida Faria, MPH
Jessica Cargill, MPH

SURVEY RESULTS

Introduction to Survey in Qualtrics:

The City of Laredo Health Department has partnered with Texas Health Institute to conduct a survey to
learn more about what helps or prevents people in Laredo from achieving good health. The results of this
survey will help the City of Laredo Health Department and other organizations in Laredo to better plan for
and provide services that meet the health needs of our community. Your participation is voluntary. Your
identity and your answers will remain anonymous and confidential. It will not affect your ability to access
services in any way. We will not ask your name, where you live (aside from ZIP code), or about your
citizenship. We are only interested in what you think affects your health and what helps and may help you
lead a healthy life in the community. We are only surveying people living in the City of Laredo. If you meet
this criteria, then we will ask you to complete the full survey which will take roughly 10-15 minutes.

Q1 Are you willing to participate in this survey?

 Yes (1,683)
 No (12)

Skip To: End of Survey if “Are you willing to participate in this survey?” = No

Q2 Are you 18 years of age or older?

 Yes (1,667)
 No (14)

Skip To: End of Block “Are you 18 years of age or older?” = No

186 City of Laredo 2022-23 Community Health Needs Assessment

Q57 Do you live in one of the following zip codes in Laredo?

 78040
 78041
 78043
 78045
 78046
 Yes (1,635)
 No (28)

Skip To: End of Block If Do you live in one of the following zip codes in Laredo? 78040 78041 78043
78045 78046 = No

187 City of Laredo 2022-23 Community Health Needs Assessment

Q4 In which of the following zip codes do you live in Laredo? If you live in more than one home, what zip
code do you regularly spend most nights?

 78040
 78041
 78043
 78045
 78046
 Other/None of these

Figure 1
ZIP Code of Survey Respondents (n=1,631, unweighted)

30% 27.9%
26.0%
25%

20% 18.8%
16.5%
15%
10.6%
10%

5%

0%
78040 78041 78043 78045 78046

Note: “Other/None of these” included 6 responses but is omitted from the graph as the survey ended if survey participants lived in
ZIP codes other than those listed.

Skip To: End of Block If In which of the following zip codes do you live in Laredo? If you live in more than
one home, wha... = Other/None of these

188 City of Laredo 2022-23 Community Health Needs Assessment

Q5 In general, would you say your health is...

 Excellent
 Very good
 Good
 Fair
 Poor
 Don't know/not sure

Figure 2
General Health Among Survey Respondents (n=1,579)

50%
38.9%
40%

30% 26.0%

18.3%
20%
12.9%
10%
2.8% 1.1%
0%
Excellent Very good Good Fair Poor Don't
know/not
sure

189 City of Laredo 2022-23 Community Health Needs Assessment

Q6 Now thinking about your mental health, which includes stress, depression, and problems with
emotions, for how many days during the past 30 days was your mental health not good? (Dropdown with
selection of 0-30)

Figure 3
Average Number of Poor Mental Health Days During the Last 30 Days (n=1,371)

45%

40% 38.4%

35% 33.0%

30%

25%

20%

15% 13.6%

10%
4.7% 4.2% 4.2%
5% 2.0%
0%
0 1-5 days 6-10 days 11-15 days 16 to 20 21 to 25 26 to 30
days days days

Q7 During the last 12 months, was there any time when you needed mental health treatment or
counseling for yourself but didn't get it?

 Yes
 No
 Don't know/Not sure

Figure 4
Needed, but Did Not Get Mental Health Treatment or Counseling During Last 12 Months (n=1,582)

80% 69.0%
70%
60%
50%
40%
30% 21.9%
20% 9.0%
10%
0%
Yes, needed care No, didn't need care Don't know/Not sure
but didn't get it

190 City of Laredo 2022-23 Community Health Needs Assessment

Skip To: Q8 If During the last 12 months, was there any time when you needed mental health treatment
or counseli... = Yes

Skip To: Q9 If During the last 12 months, was there any time when you needed mental health treatment
or counseli... = No

Skip To: Q9 If During the last 12 months, was there any time when you needed mental health treatment
or counseli... = Don't know/Not sure

Q8 Which of these statements explain why you did not get the mental health treatment or counseling you
needed? [Select all that apply]

 You couldn't afford the cost.

 You did not know where to go to get services.
 You were concerned that getting mental health treatment or counseling might cause your neighbors
or community to have a negative opinion of you.
 You were concerned that getting mental health treatment or counseling might have a negative effect
on your job.
 Your health insurance does not cover any mental health treatment or counseling.
 Your health insurance does not pay enough for mental health treatment or counseling.
 You were concerned that the information you gave the counselor might not be kept confidential.
 You were concerned that you might be committed to a psychiatric hospital or might have to take
medicine.
 Some other reason or reasons.

191 City of Laredo 2022-23 Community Health Needs Assessment

Figure 5
Reasons for Not Getting Needed Mental Health Treatment or Counseling (n=325)

Couldn't afford the cost 44.0%

Did not know where to go to get services 34.5%

Concerned about negative effect on my job 12.9%

Concerned about confidentiality with
12.6%
counselor
Concerned that neighbors or community to
12.6%
have a negative opinion of you
Health insurance does not pay enough for
12.3%
mental health treatment
Health insurance does not cover any mental
10.5%
health treatment
Concerned that you might be committed to a
6.5%
psychiatric hospital or might have to take…

Some other reason(s) 28.9%

0% 10% 20% 30% 40% 50%

192 City of Laredo 2022-23 Community Health Needs Assessment

Q9 Do you currently have any kind of health insurance?

 Yes
 No
 Don't know/Not sure (3)

Figure 6
Insurance Status Among Survey Respondents (n=1,568)

Don't know/Not
sure, 2.8%

No insurance,
27.9% Yes have
insurance,
69.3%

Skip To: Q10 If Do you currently have any kind of health insurance? = Yes
Skip To: Q11 If Do you currently have any kind of health insurance? = No
Skip To: Q11 If Do you currently have any kind of health insurance? = Don't know/Not sure

Q10 What kind of health insurance do you have? [Select all that apply]

 Insurance through my job or my family member's job

 Insurance through the Marketplace (www.healthcare.gov)
 A private insurance that I, or a family member, buys directly from an insurance company
 Medicaid
 Medicare
 Military related insurance (TRICARE, CHAMPUS, CHAMP-VA)
 Other government program for health insurance from the state, county or city
 Health insurance based in Mexico
 Indian Health Service
 Not sure

193 City of Laredo 2022-23 Community Health Needs Assessment

Figure 7
Type of Health Insurance Among Survey Respondents (n=1,078)

Insurance through Employer 70.3%

Medicaid 10.4%

Medicare 9.6%

Marketplace 6.9%

Private insurance, directly from an insurance

3.7%
company

Not sure 2.0%

Other government program 1.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Note: Some results have been suppressed due to having fewer than 20 responses.

194 City of Laredo 2022-23 Community Health Needs Assessment

Q11 Are you a parent, guardian, or primary caregiver of one or more children under 18 that live in Laredo
on a regular basis?

 Yes
 No

Figure 8
Survey Respondents Who Are a Parent, Guardian, or Primary Caregiver of Child(ren) Regularly Living in
Laredo (n=1,563)

No, not a
primary Yes, I am a
caregiver of primary
child(ren), caregiver of
47.6% child(ren),
53.4%

Skip To: Q17 If Are you a parent, guardian, or primary caregiver of one or more children under 18 that live
in La... = No

Skip To: Q12 If Are you a parent, guardian, or primary caregiver of one or more children under 18 that live
in La... = Yes

Q12 Do the children under 18 living in your home have health insurance?

 Yes, all have health insurance

 Yes, some, but not all have health insurance
 No, they do not have health insurance
 Don't know/not sure

195 City of Laredo 2022-23 Community Health Needs Assessment

Figure 9
Insurance Status of Children <18 Among Survey Respondents (n=799)

No, children do
not have health
insurance,
10.4%
Yes, all
children have
health
insurance,
Yes, some, but 83.0%
not all have
health
insurance, 5.1%

Note: Results for “Don’t know/Not sure” have been suppressed due to having fewer than 20 responses.

196 City of Laredo 2022-23 Community Health Needs Assessment

Q13 Do the children under 18 living in your home have one or more people you think of as their personal
doctor or health care provider (for example, primary care provider, pediatrician)?

 Yes, all have a personal doctor

 Yes, some, but not all have a personal doctor
 No, they do not have a personal doctor
 Don’t know/not sure

Figure 10
Children Under 18 Living in Home with Personal Health Care Provider (n=791)

Yes, all have a personal doctor 81.9%

No, they do not have a personal doctor 10.2%

Yes, some, but not all have a personal doctor 5.3%

Don’t know/not sure 2.5%

0% 20% 40% 60% 80% 100%

197 City of Laredo 2022-23 Community Health Needs Assessment

Q14 When the children under 18 living in your home are sick and need health care, including dental care
or mental health care, where do you take them for care in Laredo? [Select all that apply]

 Clinic or health care (for example Gateway Community Health Center) (1)
 City of Laredo Health Department
 Border Region Behavioral Health
 Doctor's or dentist office
 Urgent care (for example Doc-Aid or VitalMed)
 Emergency room
 Spiritual healer
 Other (please specify):

Figure 11
Where Parents, Guardians’ and Primary Caregivers of Children under 18 Seek Health Care (n=783)

Doctor's or dentist's office 61.2%

Urgent care 26.1%

Clinic or health care 18.9%

Other 10.5%

Emergency room 9.8%

City of Laredo Health Department 8.2%

0% 10% 20% 30% 40% 50% 60% 70%

Note: “Spiritual healer” results were suppressed due to low numbers. 60 respondents indicated “Other” and provided
additional details. The top three responses were Nuevo Laredo or Mexico (40%), doctor or dentist office (25%), and
clinic or health care (13%). Additional locations mentioned include the pharmacy, TAMIU Counseling, employee
health and wellness, telehealth, out of town, and another country other than Mexico.

198 City of Laredo 2022-23 Community Health Needs Assessment

Q15 In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care for the
children living in your home? [Select all that apply]

 Yes, I went to Nuevo Laredo

 Yes, I went to a city in Mexico other than Nuevo Laredo
 Yes, I went to another city in Texas
 No, I did not go outside of Laredo for care

Figure 12
Adult Caregivers Seeking Medical, Dental, or Mental Health Care for Children Outside of Laredo (n=816)

Nearly one-third of caregivers of

children seek care outside of Laredo Many adult caregivers of children
(n=816) who seek care outside of Laredo
go to Nuevo Laredo and other
cities in Texas (n=276)
Yes, I went to another
13.9%
city in Texas

Yes, I went to Nuevo Another

20.4% city in
Laredo Nuevo
Laredo, Texas,
59.4% 40.6%
No, I did not go outside
67.2%
of Laredo for care

0% 20% 40% 60% 80%

Note: Some results were supressed due to low numbers.

Display This Question:

If In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care fo... =
Yes, I went to Nuevo Laredo

Or In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care fo... =
Yes, I went to a city in Mexico other than Nuevo Laredo

Or In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care fo... =
Yes, I went to another city in Texas

199 City of Laredo 2022-23 Community Health Needs Assessment

Q16 Please indicate the type of health care you sought for the children in your home outside of Laredo.
[Select all that apply]

 Medical care
 Mental health
 Dental care

Figure 13
Type of Care Sought Outside Laredo for Children and Adolescents Under 18 (n=260)

90%
Medical care,
80.0%
80%

70%

60%

50%
Dental care,
40% 36.9%

30%
Mental health,
20% 15.0%

10%

0%

200 City of Laredo 2022-23 Community Health Needs Assessment

Q17 Do you have one or more people you think of as your personal doctor or health care provider (for
example primary care provider)?

 Yes
 No
 Don't know/not sure

Figure 14
Adults with personal doctor or health care provider (n=1,497)

No personal
health care
provider,
37.3%

Yes, personal
health care
provider 56.6%

Don't know/not
sure, 6.1%

Q18 When you are sick and need health care, including dental care or mental health care, where do you
go in Laredo? [Select all that apply]

 Clinic or health center (for example Gateway Community Health Center)

 City of Laredo Health Department
 Border Region Behavioral Health
 Doctor's or dentist's office
 Urgent care (for example Doc-Aid or VitalMed)
 Emergency room
 Spiritual healer
 Other (please specify): __________________________________________________

201 City of Laredo 2022-23 Community Health Needs Assessment

Figure 15
Where Survey Respondents Seek Health Care When They Are Sick (n=1,475)

Doctor's or dentist's office 54.1%

Clinic or health center 21.7%

Urgent care 19.0%

Other 11.0%

Emergency room 11.0%

City of Laredo Health Department 8.6%

0% 10% 20% 30% 40% 50% 60%

Note: Some results have been suppressed due to having fewer than 20 responses. 134 respondents selected “Other”
and provided additional details. The top three responses were Nuevo Laredo or Mexico (43%), doctor or dentist’s
office (11%), and employee health and wellness (7%). Other locations mentioned included the City Health Clinic, La
Familia Health Clinic, Laredo Medical Center, Laredo Premier Care, Laredo VA Clinic, Nuestra Salud Family Health
Clinic, Pharmacy, Pillar Strong, TAMIU Counseling, Webb County Clinic, Mercy Clinic Laredo, and Valley Day Clinic.

Q19 In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care for
yourself? [Select all that apply]

 Yes, I went to Nuevo Laredo

 Yes, I went to a city in Mexico other than Nuevo Laredo
 Yes, I went to another city in Texas
 No, I did not go outside of Laredo for care

202 City of Laredo 2022-23 Community Health Needs Assessment

Figure 16
Percent of Survey Respondents Seeking Care Outside of Laredo (n=1,512)

A city in Mexico other than Nuevo Laredo 2.3%

Another city in Texas 13.0%

Nuevo Laredo 22.4%

Did not go outside of Laredo for care 65.2%

0% 10% 20% 30% 40% 50% 60% 70%

Display This Question:

If In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care for... =
Yes, I went to Nuevo Laredo

Or In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care for... =
Yes, I went to a city in Mexico other than Nuevo Laredo

Or In the past 12 months, did you go outside of Laredo for medical, dental, or mental health care for... =
Yes, I went to another city in Texas

203 City of Laredo 2022-23 Community Health Needs Assessment

Q20 Please indicate the type of health care you sought in Nuevo Laredo, another city in Mexico, or
another city in Texas. [Select all that apply]

 Medical care (1)

 Mental health (2)
 Dental care (3)

Figure 17
Type of Care Sought Outside Laredo (n=506)
80% Medical care,
72.9%
70%

60%
Dental care,
50% 46.2%

40%

30%

20%
Mental health,
10% 7.9%

0%

Q21 During the last 12 months, did you ever need medical care but not get it because of any of these
reasons? [Select all that apply]

 I could not afford it

 I did not have transportation
 I could not get an in-person appointment
 Doctor's office or clinic was not open at a time I could go
 I did not have a way to access virtual visits (also called telehealth)
 I did not trust doctors or other healthcare providers
 There was not an instance where I needed medical care and could not get it in the last 12 months

204 City of Laredo 2022-23 Community Health Needs Assessment

Figure 18
Reasons for Not Receiving Medical Care during Last 12 Months, Among Survey Participants (n=1,328)

I was able to receive medical care when I

47.5%
needed it

I could not afford it 31.6%

Doctor's office or clinic was not open at a time I

14.4%
could go

I could not get an in-person appointment 10.4%

I did not trust doctors or other healthcare

5.4%
providers

I did not have transportation 3.3%

I did not have a way to access virtual visits

1.9%
(also called telehealth)

0% 10% 20% 30% 40% 50%

Q22 In the past 12 months, have you ever visited the emergency room for yourself or your child due to
any of the following reasons? [Select all that apply]

 A mild injury or illness that could have been treated in a doctor's office or clinic
 Did not have health insurance
 Could not afford health care anywhere else
 Did not know where else to go for care
 Did not have transportation to go elsewhere
 Needed a safe place to stay or spend the night
 Needed access to food
 No, I have never visited the emergency room for any of these reasons
 Other (please specify): __________________________________________________

205 City of Laredo 2022-23 Community Health Needs Assessment

Figure 19
Reasons for Emergency Room Use Among Survey Respondents (n=1,378)

Could not afford health care anywhere else 3.6%

Other 4.9%

Did not know where else to go for care 5.8%

Did not have health insurance 8.0%

A mild injury or illness that could have been treated in

16.5%
a doctor's office or clinic
No, I have never visited the emergency room for any
67.1%
of these reasons

0% 10% 20% 30% 40% 50% 60% 70% 80%

Note: Some results have been suppressed due to having fewer than 20 responses. 54 respondents indicated “Other”
and provided additional details. The top four responses were N/A (30%), “accident or injury” (13%), and “other health
care facilities not open” (13%).

Q23 Whom do you trust the most to provide information on health? [Select top 3]

 Friends or family (1)

 Healthcare provider such as doctor or nurse (2)
 Neighborhood or community organizations (3)
 Faith organizations/faith leaders (4)
 Employers (5)
 City of Laredo Health Department (6)
 Texas Department of State Health Services (7)
 National US government agencies such as the CDC (8)
 Local news in Spanish (Radio, TV or newspaper) (9)
 Local news in English (Radio, TV or newspaper) (10)
 National news in Spanish (Radio, TV or newspaper) (11)
 National news in English (Radio, TV or newspaper) (12)
 Other (13) __________________________________________________

206 City of Laredo 2022-23 Community Health Needs Assessment

Figure 20
Sources of Trust for Health Information (n=1,411)

Health care provider such as doctor or nurse 64.1%

City of Laredo Health Department 51.8%
Texas Department of State Health Services 40.8%
Friends or family 36.4%
National US government agencies such as the CDC 34.6%
National news in English (Radio, TV, or newspaper) 13.2%
Local news in English (Radio, TV, or newspaper) 11.7%
Employers 10.2%
Neighborhood or community organizations 9.1%
Local news in Spanish (Radio, TV, or newspaper) 8.8%
National news in Spanish (Radio, TV, or newspaper) 6.6%
Other 6.4%
Faith organizations/faith leaders 6.4%

0% 10% 20% 30% 40% 50% 60% 70%

Note: 55 respondents indicated “Other” and provided additional details. The top two responses were “online
resources” (18%) and “medical professional” (18%). The remainder included “myself,” “none,” “do not see outside
information,” “family/friend,” and “scientific research,” along with specific mentions of research from governmental
institutions and clinics based in Laredo.

Q24 To your knowledge, have you had COVID-19 since January 2020?

 Yes, I tested positive with a PCR

 Yes, I tested positive with a home test
 Yes, I think so but did not take a PCR test or home test
 No, I have not had COVID-19

207 City of Laredo 2022-23 Community Health Needs Assessment

Figure 21
Survey Respondents who have had COVID-19 since January 2020 (n=1,433)

Yes, I tested positive with a PCR 40.6%

No, I have not had COVID-19 37.6%

Yes, I tested positive with a home test 18.4%

Yes, I think so but did not take a PCR test or

3.3%
home test

0% 10% 20% 30% 40% 50%

Skip To: Q25 If To your knowledge, have you had COVID-19 since January 2020? = Yes, I tested positive
with a PCR
Skip To: Q25 If To your knowledge, have you had COVID-19 since January 2020? = Yes, I tested positive
with a home test
Skip To: Q25 If To your knowledge, have you had COVID-19 since January 2020? = Yes, I think so but
did not take a PCR test or home test
Skip To: Q26 If To your knowledge, have you had COVID-19 since January 2020? = No, I have not had
COVID-19

Q25 Describe the level of health care you received when you had COVID-19. If you have had COVID-19
more than once, describe the level of health care during the first time you had COVID-19. [Select all that
apply]

 I did not seek medical care from a health care provider (1)
 I received medical care at a doctor's office, urgent care or clinic (2)
 I received medical care at an emergency room (3)
 I was hospitalized (4)

208 City of Laredo 2022-23 Community Health Needs Assessment

Figure 22
Care Seeking Among Participants Who Indicated Having COVID Since January 2020 (n=871)

I did not seek medical care from a health

51.8%
care provider

I received medical care at a doctor's office,

44.9%
urgent care, or clinic

I received medical care at an emergency

4.1%
room

I was hospitalized 2.1%

0% 10% 20% 30% 40% 50% 60%

Note: Results for “I was hospitalized” were suppressed due to having fewer than 20 responses.

Q26 Compared to before the COVID-19 pandemic, how would you describe your mental health now?

 Much better
 Somewhat better
 Neither better nor worse
 Somewhat worse
 Much worse

209 City of Laredo 2022-23 Community Health Needs Assessment

Figure 23
Mental Health Compared to Pre-Pandemic Status (n=1,406)

Much worse 3.6%

Somewhat worse 12.2%

Neither better nor worse 41.5%

Somewhat better 18.3%

Much better 24.3%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Q27 Please indicate below if a doctor or health care provider has ever told you that you have the
following medical conditions. [Select all that apply]

 Asthma
 Cancer
 Mental health condition (for example depression, anxiety, schizophrenia, or other major emotional
problem)
 Prediabetes
 Diabetes
 Heart disease
 High blood pressure
 High cholesterol
 Obesity
 Substance use disorder (alcohol or drugs)
 Any physical disability
 Neurodevelopmental disability (for example Dyslexia, Autism Spectrum Disorder, ADHD,
developmental disability)

210 City of Laredo 2022-23 Community Health Needs Assessment

Figure 24
Self-reported health conditions (as told by a doctor or health care provider) (n=951)

High blood pressure 41.1%

Obesity 35.3%
High cholesterol 29.9%
Diabetes 21.6%
Mental health condition 19.8%
Prediabetes 18.8%
Asthma 14.4%
Heart disease 4.5%
Neurodevelopmental disability 4.2%
Any physical disability 4.1%
Cancer 3.9%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Note: Results for substance use were supressed due to low numbers.

211 City of Laredo 2022-23 Community Health Needs Assessment

Q28 Have you ever been pregnant?

 Yes
 No

Figure 25
Prevalence of Pregnancy Among Female Survey Respondents (n=963)

No, I have
never been
pregnant,
29.9%

Yes, I have
been pregnant,
70.1%

212 City of Laredo 2022-23 Community Health Needs Assessment

Skip To: Q29 If Have you ever been pregnant? = Yes

Skip To: Q32 If Have you ever been pregnant? = No

Q29 During your most recent pregnancy, did you have any of the following health conditions? [Select all
that apply]

 High blood pressure (that started during this pregnancy), pre-eclampsia or eclampsia
 Miscarriage
 Gestational diabetes (diabetes that started during the pregnancy)
 Depression
 Preterm labor

Figure 26
Self-Reported Health Conditions of Respondents During Most Recent Pregnancy (n=305)

50%

40%

31.8%
30% 28.5%
26.6%
22.6%

20%
13.8%

10%

0%
Pre-eclampsia Gestational diabetes Depression Miscarriage Preterm labor

213 City of Laredo 2022-23 Community Health Needs Assessment

Q32 Now I would like to ask you more specific questions about issues that may affect your health.

Q30 Including yourself, how many individuals currently live in your home?

▼ 1 (1) ... More than 15 (16)

Figure 27
Individuals Living in Home, Including Respondent (n=1,320)

7 3.3%

6 9.4%

5 19.3%

4 21.4%

3 17.7%

2 18.5%

1 8.3%

0% 5% 10% 15% 20% 25%

214 City of Laredo 2022-23 Community Health Needs Assessment

Q31 What is your housing situation today?

 I have permanent housing (living in a house alone or with others, an apartment or mobile home)
 I have temporary housing with family or friends
 I have temporary housing in a hotel or shelter
 I do not have housing (living outside, on the street, in a car, or in a park)
 Other (please specify):

Figure 28
Housing Status of Survey Respondents (n=1,345)

I have temporary
housing with family or
friends, 6.6%

I have permanent I do not have housing

housing (living in a (living outside, on the
house alone or with street, in a car, or in a
others, an apartment park), 1.6%
or mobile home),
86.5%
Other, 4.7%

Note: Fifty (50) respondents indicated “Other” and provided additional details. The top two responses were “home
owner” (38%) and “rent property” (32%).

215 City of Laredo 2022-23 Community Health Needs Assessment

Figure 29
Respondents Indicating that They Have Permanent Housing, by Age (n=1,345)

100%
88.4% 89.4% 90.6% 88.4%
85.2%

80% 73.9%

60%

40%

20%

0%
18-24 25-34 35-44 45-54 55-64 65+

216 City of Laredo 2022-23 Community Health Needs Assessment

Q32 To what extent is it a financial burden or struggle for you or those you live with to pay for housing
costs every month? This includes monthly rent or mortgage, and utilities such as electricity, water and
gas.

 A large struggle
 Somewhat of a struggle
 Not a struggle at all (3)
 Don't know/not sure (4)

Figure 30
A majority of respondents identified housing costs as a struggle (n=1,355)

20.1% 39.6% 32.4% 7.9%

Somewhat of a Not a struggle at
A large struggle Don't
struggle all,
know…

0% 20% 40% 60% 80% 100%

217 City of Laredo 2022-23 Community Health Needs Assessment

Q33 Do you have any of the following concerns about your current living situation, like housing
conditions, safety, or costs? [Select all that apply]

 Condition of housing
 Housing is temporary and I do not have permanent housing
 Ability to pay for housing or utilities
 Feeling safe
 Other (please specify): __________________________________________________
 I do not have any of these concerns about my current living situation

Figure 31
Concerns Related to Housing (n=1,315)

Ability to pay for housing or utilities 30.2%

Feeling safe 17.8%

Condition of housing 11.0%

Housing is temporary and I do not have permanent

4.6%
housing

Other (please specify): 3.1%

I do not have any of these concerns about my current

44.2%
living situation

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Note: 36 respondents indicated “Other” and provided additional details. The top three responses were general high
cost of living (28%), food cost (14%), and no concerns (14%).

218 City of Laredo 2022-23 Community Health Needs Assessment

Q34 Below is a list of problems that can affect health and mental health. Thinking about your
neighborhood, please indicate which of these are currently negatively affecting your health or the health
of those that live with you. Pick up to 3 choices.

 Abandoned homes and lots

 Air pollution such as fumes, smells, and smoke
 Crime and violence
 Too many liquor stores
 Not enough grocery stores
 Not enough sidewalks
 Not enough parks or playgrounds
 Stray dogs or cats
 Lack of accessible public transportation
 None of these

Figure 32
Top Community Concerns among Survey Respondents, as Related to Health (n=1,387)

Stray dogs or cats 31.0%

Crime and violence 28.5%

Not enough parks or playgrounds 26.0%

Not enough sidewalks 17.7%

Air pollution such as fumes, smells, and smoke 16.6%

Abandoned homes and lots 13.2%

Not enough grocery stores 12.8%

Lack of accessible public transportation 10.6%

Too many liquor stores 2.2%

None of these 33.9%

0% 10% 20% 30% 40%

219 City of Laredo 2022-23 Community Health Needs Assessment

Q35 During the past 12 months, was there a time when, because of lack of money or other resources,
you were worried you would not have enough food to eat?

 Yes (1)
 No (2)
 Don't know/not sure (3)

Figure 33
Food Insecurity in Last 12 Months Among Survey Respondents (n=1,349)

70%
61.0%
60%
50%
40% 32.7%
30%
20%
10% 6.3%

0%
Yes No Don't know/not
sure

Q36 During the last 12 months, was there a time when, because of a lack of money or other resources,
that you were unable to eat healthy or nutritious food such a fruit or vegetables?

 Yes
 No
 Don't know/not sure

220 City of Laredo 2022-23 Community Health Needs Assessment

Figure 34
Food Insecurity for Healthy or Nutritious Food (n=1,348)

Don't
know/not
sure, 5.3%

Yes, 32.3%
No, 62.4%

Q37 During the past 12 months, have any of the following community organizations assisted you with
food? Select all that apply.

 South Texas Food Bank

 Laredo Regional Food Bank
 Bethany House of Laredo
 WIC
 SNAP (Supplemental Nutrition Assistance Program, Food Stamps)
 Salvation Army
 Other (please specify): __________________________________________________
 None of these organizations have assisted me with food.

221 City of Laredo 2022-23 Community Health Needs Assessment

Figure 35
Food Assistance Providers among Survey Respondents (n=1,254)

SNAP (Supplemental Nutrition Assistance

21.4%
Program, Food Stamps)

South Texas Food Bank 14.7%

WIC 11.3%

Other 4.5%

Laredo Regional Food Bank 4.5%

0% 5% 10% 15% 20% 25%

222 City of Laredo 2022-23 Community Health Needs Assessment

Note: All demographic questions are displayed as unweighted results from survey.

Q38 What is your age?

 18-24
 25-34
 35-44
 45-54
 55-64
 65+

Figure 36
Community Survey Respondents by Age (n=1,348)

30%
26.0%
25%
21.7%
20.3%
20%

15% 13.5%
10.0%
10% 8.5%

5%

0%
18-24 25-34 35-44 45-54 55-64 65+

223 City of Laredo 2022-23 Community Health Needs Assessment

Q39 What is your ethnicity? Are you Hispanic, Latino/a, or Spanish origin?

 Hispanic or Latino(a)
 Not Hispanic or Latino(a)

Figure 37
Ethnicity of Survey Respondents (Hispanic or Latino(a) (n=1,334)

Hispanic or
Latino(a),
96.3%

Not
Hispanic or
Latino(a),
3.7%

Q40 What is your race? [Select all that apply]

 American Indian or Alaska Native

 Asian (examples: Chinese, Japanese, Korean, South Asian, Filipino, etc.)
 Black or African American
 Native Hawaiian or Pacific Islander
 White
 Other

224 City of Laredo 2022-23 Community Health Needs Assessment

Figure 38
Race of Survey Respondents (n=1,257)

100%
86.3%
80%

60%

40%

20% 11.7%
2.1% 0.6% 0.6% 0.2%
0%
American Asian Black or Native Other White
Indian or (examples: African Hawaiian or
Alaska Chinese, American Pacific
Native Japanese, Islander
Korean,
South Asian,
Filipino, etc)

Q41 How do you identify? Are you...

 Male
 Female
 Non-binary
 Other
 Prefer not to answer

Figure 39
Sex of Survey Respondents (n=1,345)

Male,
27.8%

Female,
71.6%

Note: Survey respondents were also able to report identifying as “Binary” or “Prefer not to say” however these
were suppressed and excluded from the figure due to data suppression rules.

225 City of Laredo 2022-23 Community Health Needs Assessment

Q42 Which of the following best represents how you think of yourself?

 Gay or Lesbian
 Straight
 Bisexual
 Something else
 I don't know the answer
 Prefer not to answer

Figure 40
Gender Identity Among Survey Respondents (n=1,309)

I don't know the Prefer not to

answer, 1.8% answer, 5.7%
Bisexual, 1.6%
Gay or
lesbian,
14.7%

Straight, 75.9%

Q43 Do you consider yourself transgender?

 No
 Yes, transgender, male-to-female
 Yes, transgender, female-to-male
 Yes, transgender, gender non-conforming

Responses omitted due to low numbers.

226 City of Laredo 2022-23 Community Health Needs Assessment

Q44 What language do you primarily speak at home?

 English
 Spanish
 Other (please specify):

Figure 41
Primary Language Spoken at Home of Survey Respondents (n=1,329)

English 54.7%

Spanish 43.0%

Other (please specify): 2.3%

0% 10% 20% 30% 40% 50% 60%

Q45 How well would you say you speak English?

 Very well
 Well
 Not well
 Not at all

227 City of Laredo 2022-23 Community Health Needs Assessment

Figure 42
Most survey respondents reported speaking English “very well” or “well” (n=1,344)

70% 63.5%
60%

50%

40%

30%
21.7%
20%
7.1% 7.7%
10%

0%
Very well Well Not well Not at all

Q46 What is the highest grade or year of school you completed?

 Never attended school or only attended kindergarten

 Grades 1-8 (Elementary)
 Grades 9-11 (Some high school)
 Grades 12 or GED (High school graduate/finished high school)
 College or technical training - 1 year to 3 years
 College graduate - 4 years or more

228 City of Laredo 2022-23 Community Health Needs Assessment

Figure 43
Educational Level of Survey Respondents (n=1,339)

College Graduate 38.5%

Some College or Technical Training 25.2%

Grades 12 or GED 22.6%

Grades 9-11 8.7%

Grades 1-8 4.6%

0% 10% 20% 30% 40% 50%

Q47 What is your current work situation?

 Employed for wages

 Self-employed
 Out of work for less than 1 year
 Out of work for 1 year or more
 A homemaker
 A student
 Retired
 Unable to work

229 City of Laredo 2022-23 Community Health Needs Assessment

Figure 44
Employment Status of Survey Respondents (n=1,329)

Employed for wages 63.4%

Homemaker 10.8%

Retired 6.5%

Self-employed 6.4%

Student 4.9%

Unable to work 2.9%

Out of work 1 year or more 2.8%

Out of work < 1 year 2.3%

0% 10% 20% 30% 40% 50% 60% 70%

End of Block: Default Question Block

230 City of Laredo 2022-23 Community Health Needs Assessment

ADDITIONAL ANALYSES

GENERAL HEALTH
Figure 45
General Health Among Survey Respondents by ZIP Code (n= 1,579)

Excellent Very good Good Fair Poor

78046 12.4% 24.0% 41.2% 19.2% 2.3%

78045 13.3% 29.4% 39.0% 15.9% 1.9%

78043 13.4% 20.8% 41.9% 19.5% 2.0%

78041 12.8% 32.6% 36.0% 16.7% 1.2%

78040 12.0% 21.7% 31.9% 22.3% 10.2%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0%

231 City of Laredo 2022-23 Community Health Needs Assessment

Figure 46
General Health Among Survey Respondents by Sex (n=1,334)

45%
41.1%
40%
35.1%
35% 33.0%

30%

25% 23.6%
21.2%
Male
20%
Female
15% 13.7% 13.1%
11.0%
10%
4.0%
5% 2.2% 1.1% 0.8%
0%
Excellent Very good Good Fair Poor Don't know/not
sure

Figure 47
General Health among Survey Respondents by Age (n=1,345)

Excellent Very good Good Fair Poor

65+ 4.4% 20.2% 45.6% 21.9% 7.0%

55-64 9.4% 29.8% 32.0% 23.8% 4.4%

45-54 10.2% 23.4% 38.7% 21.2% 4.0%

35-44 12.6% 24.0% 41.4% 20.0% 1.7%

25-34 11.7% 29.9% 39.2% 17.2% 1.0%

18-24 23.7% 29.6% 40.0% 5.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

232 City of Laredo 2022-23 Community Health Needs Assessment

MENTAL HEALTH

Figure 48
Average and Median Number of Poor Mental Health Days by Sex (n=1,139)

7
Number of Poor Mental Health Days per

5 6.0
Average
4.5 Days
4 Average
Month

Days
3
3.0
2 Median Days

1
1.0
Median Days
0
Male Female
Sex

Figure 49
Number of Poor Mental Health Days by Employment Type (n=1,138)

Median Days Average Days

12 10.9
Number of Poor Mental Health Days per

10
7.5
8
6.1 5.6 5.0 5.9
6 5.4 5.4
4.4 4.7
4 2.5 3.0 3.0
2.0 2.0
Month

2
0
0

233 City of Laredo 2022-23 Community Health Needs Assessment

Figure 50
Average and Median Number of Poor Mental Health Days Over the Last 30 Days by Age (n=1,149)

8
7.1
Days Per Month with Poor Mental Health

7 Average Overall, 5.5

5.7 5.8
6 5.5
5
4.0 3.9
4 3.5 3.6

3
2.0 2.0 2.0
2 Median
Overall, 3.0
1
0
0
18-24 25-34 35-44 45-54 55-64 65+
Age Group

Median Days by Age Group Average Days by Age Group

Median Overall Average Overall

234 City of Laredo 2022-23 Community Health Needs Assessment

Figure 51
Median Number of Poor Mental Health Days by ZIP Code (n=1,323)

8
7.2 Average Overall, 5.5
Number of Poor Mental Health Days per

6 5.1 5.6 5.7

5 4.5
4.0 Median
Month

4
Median Overall, 3.0 Average
3.0
3 Median Overall
2.0 2.0 2.0 Average Overall
2

0
78040 78041 78043 78045 78046
ZIP Code

Figure 52
Needed but Did Not Get Mental Health Treatment or Counseling During Last 12 Months by Age (n=1,348)

100% 1.7%
7.7% 7.3% 7.7%
15.6% 13.7%

80%

60% 53.4% 68.6% 72.6% 86.1%

63.7% 81.9%

40%

20%
32.9%
20.7% 23.7% 20.1%
10.4% 12.2%
0%
18-24 25-34 35-44 45-54 55-64 65+

Yes No Don't know/Not sure

235 City of Laredo 2022-23 Community Health Needs Assessment

Figure 53
Needed but Did Not Get Mental Health Treatment or Counseling During Last 12 Months, by Gender
Identity (n=1,208)

Don't know/Not sure 8.3% 91.7%

No 19.4% 80.6% LGBT

Straight

Yes 16.2% 83.8%

0% 20% 40% 60% 80% 100%

HEALTH CARE ACCESS

Figure 54
Reported Health Insurance Status of Uninsured, Respondents by ZIP code (n=1,568)

100%

80%

60%
Uninsured, all
survey
40% respondents
37.3% 36.9% 27.9%
26.4% 28.1%
20%
18.5%

0%
78040 78041 78043 78045 78046

236 City of Laredo 2022-23 Community Health Needs Assessment

Figure 55
Percent of People with Personal Health Care Provider by ZIP Code (n=1,497)

100%

80%

56.6%
60%
Yes, has provider (by ZIP code)
Has provider (all surveyed)
40%
65%
56% 55% 54%
51%
20%

0%
78040 78041 78043 78045 78046

Figure 56
Personal Health Care Provider, by Language Spoken (n=1,318)

100%

80%
60.4%
60% 53.5% Yes, has a provider
39.7%
40% 34.5% No, doesn't have a
provider
20%

0%
English Spanish

237 City of Laredo 2022-23 Community Health Needs Assessment

Figure 57
Health Insurance Status Among Survey Respondents by ZIP code (n=1,568)

Yes No Don't know/Not sure

78046 68.8% 28.1% 3.2%

78045 79.6% 18.5% 1.9%

78043 58.6% 36.9% 4.4%

78041 72.0% 26.4% 1.6%

78040 59.6% 37.3% 3.0%

0% 20% 40% 60% 80% 100%

Figure 58
Respondents with a Personal Doctor or Health Care Provider by Age (n=1,336)

Yes No Don't know/not sure

65+ 81.6% 17.5% 0.9%

55-64 70.0% 25.6% 4.4%

45-54 64.6% 31.4% 4.1%

35-44 51.3% 43.2% 5.5%

25-34 46.2% 47.2% 6.6%

18-24 41.8% 41.0% 17.2%

0% 20% 40% 60% 80% 100%

238 City of Laredo 2022-23 Community Health Needs Assessment

Figure 59
Respondents with a Personal Doctor or Health Care Provider by Primary Language (n= 1,318)

100%
5.1% 6.7%
16.7%

80%
34.5%
39.7%

60% 46.7%
Don't know/not sure
No, doesn't have a provider
40% Yes, has a provider
60.4%
53.5%
20% 36.7%

0%
English Spanish Other Language

Figure 60
Respondents with a Personal Doctor or Health Care Provider by ZIP code (n=1,497)

Yes No Don't know/not sure

78046 53.6% 39.8% 6.6%

78045 65.0% 29.8% 5.1%

78043 51.0% 42.0% 7.0%

78041 54.9% 39.3% 5.7%

78040 56.4% 37.2% 6.4%

0% 20% 40% 60% 80% 100%

239 City of Laredo 2022-23 Community Health Needs Assessment

CHILD AND ADOLESCENT HEALTH

Figure 61
Parents, Guardians, and Caretakers Reporting that Children Under 18 in Their Care and Residing in
Laredo Have a Personal Health Care Provider, by Language (n=676)

100%
87%
77%
80%

60% Yes, all have a

personal doctor
40% No, they do not have
a personal doctor
20% 15%
6%
0%
English Spanish

Figure 62
Insurance Status of Children <18 Among Survey Respondents by ZIP code (n=799)

100%

80%

60%

40%

20%

0%
78040 78041 78043 78045 78046

Yes, all have health insurance Yes, some, but not all have health insurance
No, they do not have health insurance Don't know/not sure

240 City of Laredo 2022-23 Community Health Needs Assessment

FOOD INSECURITY

Question from survey: During the past 12 months, was there a time when, because of lack of money or
other resources, you were worried you would not have enough food to eat?

Figure 63
Survey Respondents Worried about Not Having Enough Food to Eat, by ZIP code (n= 1,349)

Yes No Don't know/not sure

80% 72.2%
70% 65.6%
58.1%
60% 53.1%
50.3%
50% 44.1%
40.8%
40% 33.8%
28.5%
30% 23.1%
20%
5.6% 5.9% 6.2% 8.2%
10% 4.8%
0%
78040 78041 78043 78045 78046

Figure 64
Survey Respondents Worried about Not Having Enough Food to Eat, by Current Work Status (n=1,317)

Out of work for 1 year or more 62.2%

Unable to work 57.9%

A homemaker 48.3%

Out of work for less than 1 year 44.8%

A student 30.8%

Self-employed 28.6%

Employed for wages 28.4%

Retired 23.3%

0% 10% 20% 30% 40% 50% 60% 70%

241 City of Laredo 2022-23 Community Health Needs Assessment

Figure 65
Worried about Not Having Enough Food to Eat, by Age (n=1,337)

Yes No Don't know/not sure

80%
70.3% 69.6%
70%
62.0%
59.7%
60% 56.3% 55.0%

50%
39.1%
40% 35.1%
33.9%

30% 26.7% 27.0%

23.6%
20% 17.0%

10% 5.9% 6.4% 6.0%

3.0% 3.5%
0%
18-24 25-34 35-44 45-54 55-64 65+

Question: During the last 12 months, was there a time when, because of a lack of money or other
resources, that you were unable to eat healthy or nutritious food such a fruit or vegetables?

Figure 66
Ability to Eat Healthy or Nutritious Food, by ZIP Code (n=1,348)

78046 33.2% 59.6% 7.2%

78045 24.0% 72.7% 3.3%

Yes
78043 36.7% 56.4% 6.9%
No
Don't know/not sure
78041 33.2% 63.7% 3.1%

78040 40.3% 54.9% 4.9%

0% 20% 40% 60% 80% 100%

242 City of Laredo 2022-23 Community Health Needs Assessment

HOUSING

Figure 67
Survey Respondents Indicating Having Permanent Housing, by ZIP code (n=1,345)

I have permanent housing (living in a house alone or with others, an apartment or mobile home)
I have temporary housing with family or friends
Other (please specify):
I do not have housing (living outside, on the street, in a car, or in a park)
I have temporary housing in a hotel or shelter

78046 87.3% 5.7%

78045 91.2% 5.3%

78043 87.2% 5.2%

78041 83.8% 8.8%

78040 76.1% 11.6%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

243 City of Laredo 2022-23 Community Health Needs Assessment

Figure 68
Survey Respondents Indicating Monthly Housing Costs Are a Struggle (n=1,355)

A large struggle Somewhat of a struggle Not a struggle at all Don't know/not sure

78046 29.8% 27.4% 30.1% 29.9%

78045 19.1% 24.6% 29.2% 26.2%

78043 19.9% 22.2% 14.8% 15.9%

78041 17.3% 14.0% 20.0% 13.1%

78040 14.0% 11.9% 5.9% 15.0%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

DEMOGRAPHICS

Figure 69
ZIP Code Where Respondents Spend Each Night, by Primary Language Spoken at Home (n=1,329)

English Spanish Other (please specify):

70%
62.3%
59.4%
60%
50.7% 52.4%
49.7%
50% 47.1% 46.8% 46.4%
39.2%
40% 35.6%

30%

20%

10% 3.9%
2.2% 1.4% 0.8% 2.1%
0%
78040 78041 78043 78045 78046

244 City of Laredo 2022-23 Community Health Needs Assessment

Figure 70
Respondents Indicating Housing Costs as Struggle, by ZIP Code (n=1,355)

A large struggle Somewhat of a struggle Not a struggle at all Don't know/not sure

78046 29.8% 27.4% 30.1% 29.9%

78045 19.1% 24.6% 29.2% 26.2%

78043 19.9% 22.2% 14.8% 15.9%

78041 17.3% 14.0% 20.0% 13.1%

78040 14.0% 11.9% 5.9% 15.0%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

245 City of Laredo 2022-23 Community Health Needs Assessment

COVID-19

Figure 71
Survey Respondents Who Have Had COVID-19 Since January 2020 by Age (n=1,348)

65+ 27.8% 7.8% 4.3% 60.0%

55-64 35.2% 17.0% 1.1% 46.7%

45-54 43.8% 16.1% 2.9% 37.2%

35-44 44.9% 21.1% 3.7% 30.3%

25-34 48.3% 19.2% 3.1% 29.5%

18-24 29.6% 22.2% 5.9% 42.2%

0% 20% 40% 60% 80% 100%

Yes, I tested positive with a PCR Yes, I tested positive with a home test
Yes, I think so but did not take a PCR test or home test No, I have not had COVID-19

246 City of Laredo 2022-23 Community Health Needs Assessment

Figure 72
Survey Respondent’s COVID-19 Status Since January 2020 by How ‘Well’ or “Not Well’ They Speak
English (n= 1,344)

No, I have not had COVID-19

Yes, I think so but did not take a PCR test or home test
Yes, I tested positive with a home test
Yes, I tested positive with a PCR
100%
90%
33.6%
80% 39.9%
49.5% 48.1%
70%
2.9%
60% 2.7%
19.6%
50% 15.1% 6.3% 4.8%
40% 12.6% 23.1%
30%
20% 43.9% 42.3%
31.6%
10% 24.0%

0%
Very well Well Not well Not at all

247 City of Laredo 2022-23 Community Health Needs Assessment

 APPENDIX E

248 City of Laredo 2022-23 Community Health Needs Assessment

 COMMUNITY INPUT
SUMMARY REPORT
For the
City of Laredo Health Department

In support of the 2022-2023 City of Laredo

Community Health Needs Assessment

249 City of Laredo 2022-23 Community Health Needs Assessment

ABOUT TEXAS HEALTH INSTITUTE
Texas Health Institute is a nonprofit, nonpartisan public health institute with the mission of
advancing the health of all. Since 1964, we have served as a trusted, leading voice on public
health and health care issues in Texas and the nation. Our expertise, strategies, and nimble
approach makes us an integral and essential partner in driving systems change. We work
across and within sectors to lead collaborative efforts and facilitate connections to foster
systems that provide the opportunity for everyone to lead a healthy life. For more information,
visit texashealthinstitute.org and follow us on Twitter, Facebook, and LinkedIn.

ACKNOWLEDGEMENTS
Rachelle Johnsson Chiang, DrPH, MPH

Susana Morales, MA

Afrida Faria, MPH

Cody Price, MPH

Cristal Romero, MPP

250 City of Laredo 2022-23 Community Health Needs Assessment

TABLE OF CONTENTS
About Texas Health Institute ...................................................................................................250

Background and Methods .......................................................................................................253

Methods ..............................................................................................................................253

Key Informant Interviews .................................................................................................253

Focus Groups..................................................................................................................253

Health Equity .......................................................................................................................254

Themes ...................................................................................................................................255

Access to Health Care .........................................................................................................255

Primary and Specialty Care Provider Accessibility...........................................................255

Affordability of Health Care..............................................................................................257

Disease and Resource Awareness ..................................................................................258

Health and Insurance Literacy .........................................................................................259

Social and Structural Determinants of Health ......................................................................260

Poverty ............................................................................................................................260

Housing and Homelessness ............................................................................................261

Food Insecurity................................................................................................................261

Transportation .................................................................................................................262

Priority Health Needs...........................................................................................................263

Chronic Diseases ............................................................................................................263

Mental Health and Substance Use ..................................................................................264

Child Health.....................................................................................................................265

Impact of COVID-19 ........................................................................................................266

Community Assets and Strengths ...........................................................................................267

251 City of Laredo 2022-23 Community Health Needs Assessment

 Health Care Organizations ..............................................................................................267

Churches & Faith-Based Organizations...........................................................................268

Nonprofits & Community-Based Organizations................................................................268

Proposed Solutions and Actions for City of Laredo .................................................................269

Improve Health Care Access and Affordability .....................................................................269

Increase Culturally Relevant Health Care ............................................................................270

Build Trust and Encourage Partnerships to strengthen community ......................................270

Limitations...............................................................................................................................271

Conclusion ..............................................................................................................................271

Tables .....................................................................................................................................273

Appendix A: Key Informant Interview Guide ............................................................................277

Appendix B: Focus Group Guide .............................................................................................280

THI Texas Health Institute

CHNA Community Health Needs Assessments
CBO Community-Based Organizations
AHEC Area Health Education Center
PSA Public Service Announcement

252 City of Laredo 2022-23 Community Health Needs Assessment

BACKGROUND AND METHODS
The City of Laredo Health Department contracted with Texas Health Institute (THI) to conduct
the 2022-2023 Community Health Needs Assessment (CHNA). As part of the CHNA, THI staff
used key informant interviews and focus groups to explore critical health issues in Laredo and
how these issues are affected by COVID-19, structural factors, underlying causes, and
community assets.

METHODS

Between August and September of 2022, THI virtually conducted eleven key informant
interviews and seven in-person community focus groups in the City of Laredo. THI staff
members conducted all of the virtual interviews. THI collaborated with two local organizations to
conduct the focus groups: Area Health Education Center (AHEC) of the Mid Rio Grande Border
and Texas A&M International University (TAMIU). AHEC managed the logistics of the focus
groups including recruitment of participants, location, and scheduling. TAMIU facilitated the six
focus groups. The City of Laredo Public Health Department facilitated one focus group.

All focus groups and key informant interviews were recorded, and audio recordings of the key
informant interviews were automatically transcribed using Otter.ai. Focus group recordings were
transcribed using a transcription service. THI staff verified and cleaned transcripts for accuracy.
Transcripts were coded and analyzed using Atlas.ti qualitative software.

Key Informant Interviews

The City of Laredo Health Department helped identify potential key informants based on their
leadership roles and experience working with medically underserved and low-income
populations in the Laredo area. THI contacted and recruited key informants via email with an
explanation of the project. The key informants for this project (Table 1) included representatives
from health care organizations, community-based organizations (CBOs), and local government.

The key informant interview guide for organizational leaders covered critical health issues in the
city, the impact of COVID-19 on these issues, structural factors that contribute to the critical
health issues, assets and strengths of the community, and possible solutions (Appendix A).
Each key informant interview was conducted virtually via Zoom and lasted one hour.

Focus Groups

For the focus groups, THI collaborated with the Area Health Education Center (AHEC) of the
Mid Rio Grande Border to identify and recruit residents that reflect Laredo’s population,
including variety in:

253 City of Laredo 2022-23 Community Health Needs Assessment

  Age groups (parents of children aged 5-11 years and people over the age of 65
years)
 Socioeconomic status
 Other factors (geographic representation, gender, race/ethnicity, and language)

Focus groups included up to 10 people and were offered in both English and Spanish. After
community members expressed an interest in participating, AHEC coordinated with the
participants to arrange meeting details. Upon the conclusion of each focus group, THI honored
attendees’ time through a $40 electronic gift card. A faculty member from TAMIU facilitated and
recorded the focus groups for reference purposes (with participant consent with records being
maintained confidentially). The City of Laredo Health Department conducted the focus group
consisting of city employees.

The focus group guide included questions about participants’ health concerns, underlying root
causes of health issues they see in their communities, community assets, proposed solutions,
and specific strategies for addressing critical health needs (Appendix B). Each focus group was
approximately 75-90 minutes.

HEALTH EQUITY

THI applied a health equity lens to the focus groups and key informant interviews by
incorporating specific questions into the interview guides, including the following:

Key informant interview guide:

 Who do the top most critical health issues affect the most? (e.g., age groups, racial
and ethnic groups, socioeconomic groups, geographic subsets, etc.)
 What factors contribute to the critical health issues?
 How does the critical health issue identified specifically impact low-income,
underserved, or uninsured populations?
 What are some of the community’s greatest strengths and assets? How could
these be leveraged to address the health issues identified?
 What are your suggestions for ways to engage and build trust with community
members, particularly low-income, underserved populations, ethnic and racial
minorities, and limited English proficient residents to address the critical health
issues of the city?

Focus group guide:

 How does your race or ethnicity impact your ability to be healthy, if at all?
 Are there health services that you need but do not receive currently?
 What are some resources in the community that seem to be working to address
health-related issues?

Additionally, THI used the following reflective questions to frame the analysis of the transcripts
in order to draw out considerations of health equity:

254 City of Laredo 2022-23 Community Health Needs Assessment

  Who is disproportionately affected and impacted by critical health issues and by
potential solutions?
 Who is included, and who is excluded?
 What are the root causes and causal factors contributing to the community health
needs?
 Are there assumptions taking place? If so, what are they?
 Who is potentially benefiting, and who is being harmed?
 What are the interviews and focus groups telling us about what data might be
missing? About who is and is not at the decision-making table?
 What changes are needed in the community, and what could be done differently?

THEMES
Among the focus groups and key informant interviews, three primary thematic categories
emerged. The order presented below does not indicate priority or frequency of needs.

 Access to health care

 Structural and social determinants of health
 Priority health needs

In all interview contexts, participants identified barriers within the health care system that inhibit
their ability to receive accessible and affordable care including specialty services and care for
more complex health conditions. The participants also identified various social and structural
barriers community members face that impact their wellness. Finally, critical health needs
emerged as participants described the most commonly occurring chronic conditions present in
the City of Laredo. Several sub-themes are explored under each main theme.

ACCESS TO HEALTH CARE

Key informants and focus group participants indicated several key factors that create barriers to
health care access in Laredo, including provider shortage, affordability of health care, residents’
knowledge and awareness of disease and resources, and health and insurance literacy.

Primary and Specialty Care Provider Accessibility

“We are really short if you look at our providers for population and the
severity of our illnesses. We don't have enough pediatricians, internal
medicine doctors, family medicine doctors, or OBGYN[s], which in
Texas is considered a primary care service.”
– Key Informant

255 City of Laredo 2022-23 Community Health Needs Assessment

The top barrier identified in the focus groups and key informant interviews is the lack of access
to primary care and specialty care providers in the area. With a growing population, Laredo
faces challenges with provider capacity to meet the needs of the increasing rates of chronic
conditions among residents. The provider shortage worsened with the onset of the pandemic.

As the vast majority of residents do not have a regular primary care provider, the emergency
room tends to be the first point of care for many, leading to high rates of emergency department
utilization. Participants reported that even individuals with primary care providers do not receive
the proper time and attention needed due to the overwhelming patient volume.

Laredo residents face severe challenges with a lack of access to specialty care, especially
psychiatry and pediatrics. Key informants and focus group participants stated that many
residents struggle to find continuity of care for mental health after going through crisis
management. The costs associated with traveling to other parts of the state to seek mental
health services can become expensive for individuals to maintain treatment. With most specialty
care and complex conditions such as cancer, heart disease, mental health, and pediatric care,
people must regularly travel to San Antonio, Houston, Austin, Dallas, Corpus Christi, or Nuevo
Laredo in Mexico to receive care.

“We don't have a lot of mental health services here. We don't have a
lot of psychiatrists here. There's not a lot of continuity of care. The
private sector doctors are overwhelmed with private practice.”
– Key Informant

Sub-themes:

 With a growing population, Laredo faces a shortage of primary care and specialty
care providers to meet residents’ needs due to increasing rates of chronic
conditions.
 Participants indicated a need to focus on a culture of prevention. Due to the lack of
patient–provider relationships, many residents wait until symptoms worsen to seek
care, which is usually at the ER.
 Participants described needing better quality care for more complex health
conditions, including obstetrics and gynecology, pediatrics, cardiology, and
psychiatry. Residents must regularly travel to San Antonio, Dallas, Austin, Corpus
Christi, Houston, and Nuevo Laredo in Mexico to seek these health services.
 Key informants indicated that overburdened providers often leave Laredo or take
better opportunities where they are paid higher salaries (often at private systems).
 A lack of residency programs in the Laredo area is also a barrier as there is not a
pool of residents to become future providers.

256 City of Laredo 2022-23 Community Health Needs Assessment

 “It seems like getting a doctor's appointment is a challenge when you
get in. There is a whole line of people, your doctor comes in, and it's
like a drive-through. The easy patch is sometimes to prescribe
medication. Rather than working with a patient, whether you are
looking for the road to a better or a healthier lifestyle (which is
sometimes the root of all problems), they just give you an easy fix.”
– Key Informant

Affordability of Health Care

Participants reported affordability of care as another top barrier to health care access. Key
informants and focus group participants indicated that low-income families living in poverty,
predominantly Hispanic/Latino community members, must make a choice between affording
their basic necessities and insurance. As many residents do not receive full benefits or health
insurance through their jobs, they seek care across the border for prescriptions and doctor’s
visits.

“And you know, when families are receiving lower levels of income,
sometimes they have to kind of prioritize where they are going to
spend their money. I believe that insurance, unfortunately, is not one
of the priorities for many of the lower-income families.”
– Key Informant

Sub-themes:

 Uninsured or underinsured community members often avoid preventive care due to

cost, resulting in high emergency department utilization.
 Key informants reported that about 40% of residents travel across the border to
Nuevo Laredo, Mexico, to seek health services, as it is less expensive.
 Participants indicated the need for more comprehensive care under one roof rather
than fragmented and uncoordinated care. Fragmented care leads to higher
patients being lost to care.
 The lack of patient–provider relationships is due to the high cost of office visits and
quick turnaround time.

“We don’t have insurance. And so, what happens is you fall under a
plateau, that you're not too poor, and you don't have enough
resources to have insurance. So, you don't have the means to pay. A
lot of the people go to Nuevo Laredo to receive services.”
– Key Informant

257 City of Laredo 2022-23 Community Health Needs Assessment

Disease and Resource Awareness

“I think there's a lot of programs that the city offers that are excellent.
However, there's a lot of disconnect as far as how information goes
out there. I know the City tries to do as much as possible. But, a lot of
people do not know about these programs, for whatever reason. And I
think that's common throughout communities.”
– Focus Group Participant

While the City of Laredo and the Health Department offer a variety of health and screening
programs, many residents forgo services due to a lack of awareness of available resources.
This is especially true for undocumented residents who are unwilling to seek care or information
due to the fear of deportation. Participants indicated that the City of Laredo should work to bring
resources and programs to the community and raise awareness through advocacy and public
service announcements (PSA).

Participants particularly described a lack of knowledge regarding the diagnosis, treatment, and
management of chronic conditions such as diabetes and high blood pressure among residents
of Laredo. For example, one focus group participant explained that the predominantly Hispanic
community follows the advice of family and friends for disease management rather than seeking
professional care. Many tend to self-medicate with antibiotics accessed across the border. This
can become detrimental to the management of serious health conditions leading to
hospitalization or even death. Furthermore, focus group participants attributed the avoidance of
preventative care and waiting to seek care at the last minute to Hispanic/Latino culture.
Participants recognized that oftentimes, some cultural practices and values are not supportive of
healthy lifestyles and become a generational problem.

“I'd say it's not just in the machismo, but it's also like—for example, in
Mexico, preventive care is barely on the rise because we were always
born with a mentality that to go to the doctor, you have to be sick.”
– Focus Group Participant

Sub-themes:

 Many programs, screenings, and health resources are available through the City of
Laredo and the health department, but many residents are unaware.
 Undocumented residents commonly distrust the health care system due to fear of
deportation. As a result, they often do not seek out health information.
 Community members agreed there is a lack of knowledge about chronic condition
management and treatment among residents in Laredo. Many defer to their family
and friends when seeking health advice rather than going to health care providers.
 Stigma in Hispanic/Latino culture keeps many from seeking preventative care;
instead they wait until the last minute to seek medical attention.

258 City of Laredo 2022-23 Community Health Needs Assessment

  Many children in Laredo do not grow up seeing preventative care and best
practices of wellness, which becomes a generational problem of avoiding care.

“When we talk about influence, we see children and young adults

going into adulthood not knowing about their yearly checkup. That all
starts with maternal health…. And now we are in the position of where
there's a delay, and then it causes this ripple effect of health services.
So it's just also, again, the influence of where these caregivers are
coming from, and then their children having these same upbringings,
and then them missing out. It's a ripple effect.”
– Focus Group Participant

Health and Insurance Literacy

Health literacy and insurance literacy are still major barriers for many residents of Laredo,
especially for those who are undocumented. Participants indicated that as Laredo is
predominantly Hispanic/Latino, many people still feel there is a disconnect in understanding how
to access, seek, and receive care. For example, having documents in English creates
difficulties, as it takes longer for translation services, depleting time from the actual appointment.

More so, participants described how language on pamphlets, brochures, and official
applications is often confusing and hard to understand. Participants agree that the health
system should work to increase cultural competency and educate residents on health services
and insurance to equip them to take control of their health.

“The impact of health literacy on their families and their lives is

huge, because people are dying. They are dying just because they
don't have the information that can help them get to the resources.
I think it's so important that people become aware of how to take
care of themselves and these types of illnesses.”
– Key Informant

Sub-themes:

 The frequency and accessibility of culturally and linguistically appropriate services

is still a need in Laredo, as processes for translation and education are not
streamlined.
 Patients still face challenges in understanding insurance and health materials on
pamphlets, brochures, and applications, as the medical terminology language is
still difficult to follow.

259 City of Laredo 2022-23 Community Health Needs Assessment

SOCIAL AND STRUCTURAL DETERMINANTS OF HEALTH

Multiple compounding social and structural determinants of health cause poor health outcomes
for Laredo residents. Key informants and focus group participants noted several factors that
affect health outcomes including poverty, homelessness, food insecurity, and transportation.

Poverty

“Poverty goes right up at the top … the risk factors and chronic
issues and insurance that kind of tie into poverty. That would be
one, and lack of providers would be two for me. I don't think you
can really separate them.”
– Key Informant

The price of living has increased over the last several years—housing, food at the grocery store,
and gasoline in particular. Participants expressed how this increase in the cost of everyday
products and services has affected not only themselves but also those with the tightest budgets
in the community.

Both key informants and focus group participants understand that poverty—and more generally,
any struggle to purchase basic needs—lies at the core of almost all health issues Laredo
residents experience. Health care and health insurance often take a backseat to more pressing
and immediate needs such as food and housing.

Finally, focus group participants feel that the current education system leads many Laredo
residents into precarious financial situations. They expressed that this cycle of poverty stems
from the low rates of high school completion and attainment of post-secondary education
among Laredo residents.

Sub-themes:

 The majority of the population works in “blue-collar” positions. Community

members expressed that this blue-collar work is undercompensated in income and
benefits (such as health insurance).
 Poverty directly leads to a lack of health insurance. As residents make tough
choices between maintaining critical needs like housing or paying in advance for
health care, many choose the former.
 Lower rates of high school completion and attainment of post-secondary education
in Laredo has created a cycle of poverty.

“I think a lack of resources all around. I think if rich or poor …anyone

who has a catastrophic health incident should be able to get care in
our country. That doesn't happen. And it's not the hospital's fault. It's
not the doctors or providers. It's just that the resources are different.”
– Focus Group Participant

260 City of Laredo 2022-23 Community Health Needs Assessment

Housing and Homelessness

Key informants and focus group participants referenced the complicated nature of
homelessness in and around Laredo. Participants expressed that homelessness is often tied to
mental health and substance abuse, but they were unsure which ultimately led to the other.
Mental health, cost of living increases, and poverty are issues for many residents, but it is a
unique challenge to support people experiencing homelessness.

There is a perception among some focus group participants and key informants that those
experiencing homeless in Laredo tend to decline support services. However, also according to
our key informants, it is common (roughly 40% of the population) for those same individuals to
be unable to progress in their treatment due to a lack of required documentation.

Laredo residents and leaders seem to be aligned on the need to address housing insecurity. Far
more frequently, key informants and focus group members referred to the difficulty residents
from the Colonias (particularly those on the south side of Laredo towards highways 59, 359, and
83) face in commuting to and from their homes.

“I believe that the issue of homelessness is out there. It's been

brought to our community's attention. It's been brought to the
mayor and city council of Webb County. And so now more than
ever, I believe that we're all on the same page.”
– Key Informant

Food Insecurity

“But even if we go to, say, your HEBs you know, good food, your
vegetables…even for those folks who like organic stuff. And I mean,
it’s expensive to eat healthy. And it’s cheap not to.”
– Focus Group Participant

Participants described how increasing rates of inflation combined with financial strain from the
COVID-19 pandemic directly influenced their ability to purchase healthy foods. Not only is fast
food significantly cheaper in Laredo than a home-cooked meal, but picking up food saves
valuable time that could be spent with family or working another job. As a result, eating anything
takes priority over eating healthy foods.

The food banks serving Laredo strives to nudge their clients toward healthier eating. For
example, they will intentionally accept and offer fewer sugar-sweetened beverages. However,
the food banks are often at the mercy of the requirements set by various food suppliers,
including the U.S. government.

261 City of Laredo 2022-23 Community Health Needs Assessment

Key informants relayed an unusually large uptick in clientele struggling to make ends meet
during COVID-19, specifically those who would not have needed support before the pandemic.
Residents expressed intense frustration for facing food insecurity while working full-time jobs.

“We had educators in line [at the food bank] during COVID and we
had to ask specific questions [about income] … and [the
educators] are yelling in Spanish, and they’re using really ugly
language…. It’s a lot to ask for help. I think COVID really brought
out a lot. It just took things to another level for a lot [of] people and
everything that it brought with it.”
– Key Informant

Finally, residents frequently stated that Laredo’s culture and heritage makes it difficult to eat
healthy. There is an abundance of and a predisposition for greasy, fatty foods.

Sub-themes:

 Fast food is cheaper and easier to access than home-cooked meals. The high cost
of healthy foods discourages residents from purchasing them, as the quantity of
food is prioritized over the quality of food in order to survive.
 Culturally sensitive food can be difficult to obtain from food banks. However, food
banks do their best to match local preferences, even going so far as to swap goods
like broccoli for eggplant with food banks in the Rio Grande Valley.
 More affordable, nutritious food options are necessary in many areas, but there is
also a need for better awareness of food preparation.
 Transportation is a barrier to accessing healthy and affordable food.

Transportation

“We drive everywhere. Nobody wants to walk. I don't want to walk to

the health department from the food bank. I'll get run over. You have
people visit from London, and they think they can just walk to a spot.
You're not walking there. It's too hot. You’ll get burnt here. You’re not
going to make it. This is just the inactivity of things.”
– Key Informant

Participants stated that with Laredo’s climate and infrastructure, driving is a necessity for
everyday life—walking and biking are simply untenable. However, with the cost of gas spiking
significantly from 2020 through mid-2022, transportation was yet another area that became an
issue for residents of Laredo, particularly for those residents with lower incomes.

Transportation becomes even more of a barrier for residents seeking specialty care and mental
health services. Focus group members shared that for health needs outside of routine care,
they must travel to a major metropolitan area, most frequently San Antonio or Corpus Christi.

262 City of Laredo 2022-23 Community Health Needs Assessment

For example, people undergoing surgery required other family members to take time off from
work to travel with them.

Sub-themes:

 Laredo’s climate and infrastructure requires vehicles for everyday life.

 The lack of access to specialty health care in the Laredo area creates
transportation burdens on family members to travel to San Antonio, across the
border, or another large metropolitan area.
 Key Informants from El Metro Transit expressed enthusiasm for using available
tools to communicate with the public through displays and flyers at high-traffic
areas.
 Residents support mobile health vans to provide care to those living further out
from services and resources.

PRIORITY HEALTH NEEDS

Key informants and focus group participants acknowledged several top health priorities to
address within the City of Laredo, including treatment for chronic health conditions, behavioral
health needs—including assistance with mental health and substance use—and child health.

Chronic Diseases

The most common health conditions mentioned among key informants and focus group
participants include diabetes, hypertension, obesity, heart disease, and cancer. Participants
emphasized diabetes, hypertension, heart disease, and obesity as most prominent in the
Hispanic/Latino communities. In addition, cancer was noticeably prevalent in children.

They cited the following as contributing factors for diabetes, hypertension, heart conditions, and
obesity: (a) inability to afford healthy food options or medications due to poor socioeconomic
status, (b) poor nutrition habits and lack of nutrition education possibly stemming from their
Hispanic/Latino culture, and (c) foregoing doctor visits due to lack of insurance and not
qualifying for any additional government assistance.

“Let's say they have a condition like diabetes, hypertension, heart

disease, and they don't have the means to buy the medication.
They're not going to care for themselves. So they're dying
younger when they should have an opportunity to last longer. But
since there's no insurance for them, they don't qualify. Even for a
penny, some people don't qualify, which is sad. There should be
something that you can work with.”
– Key Informant

263 City of Laredo 2022-23 Community Health Needs Assessment

Sub-themes:

 Hispanic/Latino populations have higher rates of diabetes, hypertension, heart

disease, and obesity possibly due to the lack of physical activity and poor nutrition,
which may be a cause of culturally learned behaviors.
 There is an overall lack of education on how to prevent, treat, and maintain chronic
conditions.
 An additional barrier to ongoing care is the cost of medications to treat chronic
diseases such as diabetes, as they tend to be very expensive.
 Families in Laredo who live in multi-generational households are more affected
when dealing with infectious and chronic diseases.
 Although established health programs exist in Laredo for uninsured residents,
some remain without access to services because they do not meet program
requirements. As a result, their condition(s) worsen.

Mental Health and Substance Use

Community members frequently mentioned the increasing need for mental health services
within the City of Laredo. Common mental health concerns discussed include a lack of
psychiatrists and psychologists, an increase in substance abuse in youth and people
experiencing homelessness, and having very little access to mental health services in general.

“One of the things that we definitely do not have enough access to is

mental health, because there's a lot of patients that are under-treated
and lack access to mental health professionals.”
– Focus Group Participant

Community participants also discussed the need for an inpatient psychiatric facility in Laredo.
They explained that Laredo lacks the resources necessary to treat mental health patients. This
issue worsened during COVID-19 when the community saw more mental illness in the
community, straining existing mental health services even more. Despite it being a burden for
those seeking care, the main alternative for the community has been to travel elsewhere to
obtain mental health services.

Participants also highlighted the current telehealth system provided for mental health services in
Laredo. Community participants explained that telehealth is insufficient for mental health
services and that there is a disconnect in telehealth between patients and providers.

“We don't have a mental facility. We have agencies that have received
funding, but we don't have specialists. My daughter suffers from
mental health, and during COVID, it was really hard for her. There
wasn't a specialist. There's nobody locally so they were Zoomed with
specialists. It's not the same. “
– Focus Group Participant

264 City of Laredo 2022-23 Community Health Needs Assessment

Sub-themes:

 The prevalence of mental illness in Laredo has increased due to the impact of the
COVID-19 pandemic.
 There is a significant negative stigma in the Hispanic/Latino culture associated with
mental illness, which prevents individuals and families in these communities from
seeking treatment and support.
 There has been an increase in mental health conditions and substance abuse in
Laredo’s youth population.
 People experiencing homelessness continue to face ongoing challenges,
especially mental illness and substance use disorders. Presently, there are no
detox facilities and few halfway homes in Laredo, which heavily contributes to this
ongoing issue.
 Those patients who do not travel outside of Laredo for mental health services only
rely on their prescribed medication, which at times is only half of the required
treatment for specific illnesses.

“The issue here in Laredo is that because our population is majority

Mexican American and is of Mexican descent, there is a stigma
about mental health. So people wait ‘til the last minute after maybe
a crisis situation arises, and they have to hospitalize a family
member…. Sometimes the closest place is either San Antonio or
Corpus Christi. And again, that's only because of the fact that the
facility that we have here for treatment services, has a very low
amount of availability for beds.”
– Key Informant

Child Health

Many community participants expressed their concerns about childhood obesity and child health
care needs in general. They stated that the lack of providers and specialists in Laredo equally
affects youth as much as adults. Parents voiced the effects that children face when their parents
are not in good socioeconomic standing; many families face food insecurity, need better access
to health care, and lack specific community amenities and resources.

Another concern among participants was the common observation that many children in Laredo
developed cancer in recent years. One participant suggested the cause might be environmental
factors, specifically the release of harmful toxins into the air. Alongside this concern is the
continued need for pediatricians and specialists in Laredo to provide specialty services for those
with chronic illnesses.

“Everyone knows a child who has cancer."

– Focus Group Participant

265 City of Laredo 2022-23 Community Health Needs Assessment

Sub-themes:

 The lack of pediatricians in the area proves to be a barrier for children to receive
yearly checkups and maintain a culture of prevention.
 Many low-income families find themselves further away from services and
resources.

“I feel parents should be more knowledgeable about what's

important for their health and their kid’s health as well for mental
health, diet, nutrition, and just the ability to enhance
developmentally. If they have these three core fundamentals of
knowledge, they can be very proactive instead of waiting until
the reactive mode. More costs are incurred because of the lack
of tackling these problems at a young age.”
-Focus Group Participant

Impact of COVID-19

The COVID-19 pandemic exacerbated the existing issues that Laredo was facing and added
unforeseen situations that resonated throughout the entire community. Laredo quickly felt the
shortage of providers and the lack of resources due to the “tremendous need that the pandemic
brought.” Additionally, higher rates of chronic conditions significantly affected low-income, multi-
generational households. There was also a rise in mental illness and substance use rates
throughout the community, which greatly affected the youth due to the social isolation, anxiety,
depression, and stress that became present with COVID-19.

Key informants and focus group participants noted that it was extremely difficult to obtain health
care services in person, which was detrimental to those suffering from chronic conditions and
mental health illness. This lack of in-person health care services even trickled down to Laredo’s
children, who would miss checkups, leading to childhood vaccination delays and undiagnosed
conditions. Getting vaccinated and tested for COVID-19 was also a challenge because of the
lack of transportation, especially in the elderly population who were more isolated at the time.
There was also an increase in domestic abuse throughout the community.

“The scarcity and the lack of resources, I think COVID really

brought that to the forefront. It really exaggerated what our needs
really have been, and made it a lot more obvious. Because we lost
so many of our hospitals, support staff, our professional staff, the
nurses, the hospitals just really got beat up.”
– Focus Group Participant

At the same time, some participants noted that although the pandemic left many negative
impacts, the community managed to uplift itself in various ways. For example, there was a lot of
collaboration between different community organizations to help provide resources and services
to the community. Additionally, people became more aware of their health and how it affects

266 City of Laredo 2022-23 Community Health Needs Assessment

their everyday life; for example, the community was more physically active. There was also
more inclusivity during the pandemic since it was imperative to disseminate information to
everyone.

“During COVID, we saw a lot of people going on walks way more than
before in our neighborhood. We live in the Mines Road area, so during
COVID, you would see tons of people on the sidewalk going for walks
with their dog, with the kids, and we saw—it kind of trickled down a
little bit, but people are still doing it more now than they were before.”
– Focus Group Participant

COMMUNITY ASSETS AND STRENGTHS

When asked to describe the assets and strengths of the City of Laredo, participants frequently
mentioned that the community is close-knit and has a strong sense of pride in being a border
town. The predominately Hispanic/Latino culture cultivates a connection and passion for
improving the community. This pride becomes apparent in community leaders and community-
based organizations that take initiative in collaborating and coordinating to achieve better
systems that provide care to residents throughout the community.

Participants also highlighted the existing amenities and recreational centers that the City of
Laredo has around town. Other assets and strengths that the focus group participants and key
informants mentioned were safe neighborhoods, community programs, and health fairs that
provide different screenings that people do not regularly have access to in Laredo.

“I think that can be an asset that we do know each other--

we're willing to all find the people that are in the roles. They are
usually in the roles because they enjoy what they're doing, and
they really have a passion for it. I feel that's our biggest assets,
that the people that we have feel like they have a purpose, and
they're trying to work toward that purpose.”
– Key Informant

Participants named the following organizations as valuable resources for the community:

Health Care Organizations

Gateway Community Health Center
Border Region Behavioral Health Center

City of Laredo Health Department

Laredo Medical Center

267 City of Laredo 2022-23 Community Health Needs Assessment

Mercy Ministries

PILLAR

Serving Children and Adults in Need

(SCAN)

Churches & Faith-Based Organizations

Bethany House

Casa de Misericordia

Nonprofits & Community-Based Organizations

Children’s Advocacy Center NeighborWorks Laredo

Holding Community Center Operation Border Health Preparedness

Laredo Economic Development Corporation South Texas Food Bank

Laredo Housing Authority Webb County Veterans Services

Laredo Regional Food Bank

“We're starting to see that as we're all collaborating with each other,
we’re also coming together to improve this community. I feel one of
the best assets that we have is … a family type of environment where
we all collaborate with each other. I feel like the people in the
community are responding to that. The people are hungry to learn and
become a part of the community. They're learning about things that
can help them and their families. The people that we have are wanting
to be more knowledgeable be more empowered in general.”
– Key Informant

268 City of Laredo 2022-23 Community Health Needs Assessment

PROPOSED SOLUTIONS AND ACTIONS FOR
CITY OF LAREDO
Participants were asked to identify potential solutions for the challenges discussed during the
interviews and focus groups.

IMPROVE HEALTH CARE ACCESS AND AFFORDABILITY

Provider incentives: Strategize and build incentive programs and opportunities to attract and
recruit more doctors, nurses, and clinical staff for publicly available programs in Laredo.

Access to services: Establish mobile or satellite clinics with various health services and
programs for primary care and specialty care throughout Laredo (North and South).

Mental health services: Expand mental health facilities and services to meet the needs of the
population in Laredo, especially for youth. Participants recommended more licensed clinical
counselors to provide continuity of care.

Quality health care: Increase the length of time patients spend with providers. Focus on
holistic, comprehensive care with a coordinated system of referral (both within Laredo and
outside) to decrease the number of patients lost to follow-up. Participants recommended
establishing a centralized database system to provide easy access to patient information to
allow for continuity of care.

Affordable health care: Offer low-cost, affordable options for primary care and specialty health
care; comparable expenses to Mexico.

Transportation: Increase the availability of transportation to health care appointments by

collaborating with public transportation services and volunteers.

Knowledge and awareness: Promote available programs and resources in the community
through dissemination of easy-to-understand information through pamphlets, booklets, and
other culturally and linguistically appropriate materials at community events, schools, and other
public places. Utilize social media platforms and community champions to advocate various
programs and resources through PSA.

Provide community education and classes on nutrition, behavior change, physical activity,
disease management, cooking demonstrations, and healthy grocery shopping on a budget.
Participants also recommended providing health and nutrition education in schools to help build
healthy lifestyles.

Encourage a culture of health at community events: Offer health care and social service
opportunities on-site during community events (e.g., community celebrations, health fairs,

269 City of Laredo 2022-23 Community Health Needs Assessment

church events, school events, etc.). Participants also recommended providing healthier food
options and activities at community events to encourage health and well-being.

INCREASE CULTURALLY RELEVANT HEALTH CARE

Language and translation services: Increase the availability and efficiency of Spanish
translators during appointments and ensure all materials are translated.

Culturally relevant treatment: Encourage providers to involve patients in their treatment

decisions and take ownership of their health from their cultural perspective. This also means
training hospital and clinic staff on culturally appropriate treatment and methods (nutrition,
medicine, etc.).

Education on health care and insurance: To increase knowledge and awareness of how
health systems and insurance works, the City of Laredo and City of Laredo Health Department
should provide education on navigating through these systems, being mindful of culture and
language.

“The patients should voice their opinion about the treatment, because
I think that has a lot to do with getting better. But then again, it has to
do with how the caregiver approaches that situation."
– Focus Group Participant

BUILD TRUST AND ENCOURAGE PARTNERSHIPS TO

STRENGTHEN COMMUNITY
Trust: Key informants recommended working through community champions and church
leaders to engage community members to build trust. Participants also recommended holding
more public events in the community to keep an open channel of communication with residents
and to be more visible in the community.

Partnership: Increase cross-sector collaboration and coordination by partnering with

community-based organizations in Laredo. Key informants recommended bringing together vital
agencies to encourage system-wide change and to develop strategies for revenue income from
health services and programs.

“I think building trust means we need to be out in the community a little

bit more. For example, like this mobile unit that we have purchased, I
think that was a great way to build that trust.... So I think we need to
find more, more creative ways to go out to the community, and
engage with them and educate them.”
– Key Informant

270 City of Laredo 2022-23 Community Health Needs Assessment

LIMITATIONS
Data collection limitations for this 2022-2023 Laredo CHNA are relatively mild compared to
similar assessments completed during 2020 and 2021. Although COVID-19 still lingers in
numerous variants, much of Laredo and Texas have moved on from concerns over the direct
transmission of the virus. All focus groups were conducted in-person. Key informant interviews
were conducted virtually due to convenience of scheduling.

Focus groups were all conducted during September. It is important to note how political
advertisements and discourse in the run-up to the November 2022 mid-term elections might
have altered what was top of mind for our interviewees and focus group participants. In addition,
attending an in-person focus groups may have been a barrier for some residents, including
those with concerns about possible exposure to COVID-19 and other viruses, people with
disabilities, people without readily available transportation, and others.

Finally, in our data collection it was apparent that the mental health ramifications of the past
several years will be with the Laredo community for years if not decades to come. We expect
the broad impact of COVID-19 to far outlive the virus itself.

CONCLUSION
Between August and September of 2022, Texas Health Institute conducted ten key informant
interviews and seven focus groups with the residents of Laredo. Community members
collectively identified the following categories as top health priorities:

 Chronic diseases
 Mental health and substance abuse
 Child health

Whether it was diabetes, hypertension, or heart disease, there was a deep understanding that
Laredo struggles with these chronic conditions and obesity, unhealthy eating habits, and the
lack of exercise that contributes to them.

Second, residents of Laredo feel there is a massive need for local mental health and substance
abuse care centers. COVID-19 dramatically increased this need, and so far, service providers
have not been able to keep up.

Third, the residents of Laredo are deeply concerned about the health of their youth. The lack of
pediatricians and specialists prevents families from receiving the care that they need, leaving
people at a disadvantage and with no other choice than to go elsewhere to access health
services.

271 City of Laredo 2022-23 Community Health Needs Assessment

Finally, residents frequently brought all of these issues back to the social and structural
determinants of health. Poverty makes it difficult to put healthy food on the table or to afford
adequate health insurance. It can lead to eating more fast food because it is quick, convenient,
and cheap, which may increase rates of chronic disease and cancer. Additionally, not being
able to afford your own personal vehicle makes transportation and everyday living nearly
impossible.

Laredo residents are proud of how they came together through and beyond the COVID-19
pandemic. They feel the Laredo community has many assets and resources such as beautiful
parks and ongoing community health classes to learn from, but they wonder if these resources
could be more fairly distributed in and around Laredo, including the Colonias.

To address Laredo’s top health priorities, our key informants and focus group participants
routinely referenced the need for (a) greater cross-sector collaboration and (b) the influential
players in the area to incentivize health care and mental health providers to visit and ultimately
call Laredo their home.

272 City of Laredo 2022-23 Community Health Needs Assessment

TABLES

Table 1
Description of Key Informants

Key Informant Community Input Sector

Person with special knowledge or expertise in public

health
Jaime Arizpe Leader, representative, or member of medically
Board Chairman underserved, low income, and minority populations and
Texas Holding Institute populations with chronic disease needs

Person with special knowledge or expertise in public

Eric Castillo health
Child Find Coordinator Leader, representative, or member of medically
ECI Project Niños underserved, low income, and minority populations and
populations with chronic disease needs

Dr. Maurice Click, MD Person with special knowledge or expertise in public

Health Authority health
City of Laredo Health Leader, representative, or member of medically
Department underserved, low income, and minority populations and
populations with chronic disease needs

DeAnne Economedes Leader, representative, or member of medically

Director of Compliance underserved, low income, and minority populations and
South Texas Food Bank populations with chronic disease needs

Javier Garcia Leader, representative, or member of medically

Executive Director underserved, low income, and minority populations and
Bethany House populations with chronic disease needs

Robert Garza Leader, representative, or member of medically

General Manager underserved, low income, and minority populations and
Hendrix and Transportation populations with chronic disease needs
Group- Laredo Transit
Management

273 City of Laredo 2022-23 Community Health Needs Assessment

Key Informant Community Input Sector

Paul C. Giasi, MD Person with special knowledge or expertise in public

Chairman and System health
Medical Director Leader, representative, or member of medically
Emergency Departments at underserved, low income, and minority populations and
Doctors Hospital Laredo populations with chronic disease needs

Person with special knowledge or expertise in public

Elmo Lopez, MBA, CHW health
Chief Executive Officer Leader, representative, or member of medically
Gateway Community Health underserved, low income, and minority populations and
Center, Inc. populations with chronic disease needs

Maria Tina Martinez Federal, tribal, regional, state, or local health or other
Community Development department or agency, with current data or other
Director information relevant to the health needs of the community
City of Laredo

Leader, representative, or member of medically

Irene Rosales underserved, low income, and minority populations and
Director of Health Services populations with chronic disease needs
United Independent School Federal, tribal, regional, state, or local health or other
District department or agency, with current data or other
information relevant to the health needs

Leader, representative, or member of medically

Rogelio Trevino underserved, low income, and minority populations and
Executive Director populations with chronic disease needs
Workforce Solutions for
South Texas

274 City of Laredo 2022-23 Community Health Needs Assessment

Table 2
Description of Focus Group Participants

Focus
Community Input Sector Description Number Language
Group

Participants included female

and male residents of ZIP
codes 78040, 78041,
78043, 78045, and 78046.
Ages 65+ old. Nine
1 Older adults (65+) 10 English
Participants self-identified
as Mexican, Mexican-
American or Chicano/a and
one participant identified as
other Hispanic white.

Participants included female

and male residents of ZIP
codes 78040, 78041,
78043, 78045, and 78046
2 Young parents 6 English
with ages 18-50.
Participants self-identified
as Mexican, Mexican-
American or Chicano/a.

Participants included female

and male residents of ZIP
codes 78040, 78041,
78045, and 78046 with ages
3 Various group 10 English
18-65. Participants self-
identified as Mexican,
Mexican-American or
Chicano/a.

Participants included female

and male residents of ZIP
4 Various Groups codes 78040, 78041, 8 English
78043, 78045, and 78046
with ages 18-50.

275 City of Laredo 2022-23 Community Health Needs Assessment

 Participants self-identified
as Mexican, Mexican-
American or Chicano/a.

Participants included female

and male residents of ZIP
codes 78041, 78043,
78045, and 78046 with ages
5 Young Adults 18-30 and one participant 6 English
age 30-40. Participants self-
identified as Mexican,
Mexican-American or
Chicano/a.

Participants included female

and male residents of ZIP
codes 78041, 78045, and
78046 with ages 30-65.
City of Laredo Health Eight participants self-
6 9 English
Department Employees identified as Mexican,
Mexican-American or
Chicano/a and one
identified as another
Hispanic.

Participants included female

and male residents of ZIP
codes 78040, 78041, 78043
and 78045 with ages 30-65
7 City of Laredo Employees and one participant age 18- 8 English
30. Participants self-
identified as Mexican,
Mexican-American or
Chicano/a.

276 City of Laredo 2022-23 Community Health Needs Assessment

APPENDIX A: KEY INFORMANT INTERVIEW
GUIDE
City of Laredo Key Informant Interview Guide

1. Please briefly describe your role in [organization] and who [organization] serves in
Laredo.
2. Please describe how you are connected to the City of Laredo Health Department. If you
are not connected, just indicate that.
3. What do you think are Laredo’s three most critical health issues? (Examples if needed:
heart disease, diabetes, substance use, mental health, cancer, asthma, STIs, HIV, etc.)
a. PROBE: Why are these the top priorities?
b. PROBE: Who do these health issues affect the most? (e.g., age groups,
racial/ethnic groups, socioeconomic groups, geographic subsets, etc.)
4. The top health issues identified in the [2011 or 2018] Community Health Needs
Assessment were insurance status, poverty level, chronic disease risk factors, and lack
of providers. How important are these issues today? Please rank them.
5. How has COVID-19 impacted the three critical health issues you identified?
a. PROBE: Are there some groups that have been more affected by COVID-19 than
others in your community?
b. PROBE: Especially children under 12 years and adults over 65 years?
6. Now I am going to ask you about the factors that contribute to each of the top priority
health issues you identified and how the issue impacts specific populations. (Prompt:
Note that a “factor” could be a health behavior like physical activity, SDOH such as food
insecurity, insurance status, physical environment, etc.)
a. Starting with [Name #1 critical health issue identified by interviewee]
i. What are the factors that contribute to making this a critical health issue?
ii. Which populations does the issue impact the most?
iii. How does this critical health issue specifically impact low-income,
underserved/uninsured populations in Laredo?
iv. Are there organizations already addressing these issues in the city? If so,
which ones? How do they address it?
b. Now thinking about [Name #2 critical health issue identified by interviewee]
i. What are the factors that contribute to making this a critical health issue?
ii. How does this critical health issue specifically impact low-income,
underserved or uninsured populations in Laredo?
iii. Which populations does the issue impact the most?
iv. Are there organizations already addressing these issues in the city? If so,
which ones?

277 City of Laredo 2022-23 Community Health Needs Assessment

 c. Now thinking about [Name #3 critical health issue identified by interviewee]
i. What are the factors that contribute to making this a critical health issue?
ii. How does this critical health issue specifically impact low-income,
underserved or uninsured populations in Laredo?
iii. Which populations does the issue impact the most?
iv. Are there organizations already addressing these issues in the city? If so,
which organizations?
7. Based on your knowledge and expertise, what are the most effective strategies to
address the top three health issues that you identified?
a. PROBE: What are some specific strategies that could help to address disparities
between different populations for these health issues?
8. Beyond the top three health issues you’ve identified, what are the other critical health
issues that are important to address?
9. How could the City of Laredo Health Department possibly partner with or enhance the
efforts of organizations that are working to address the issues that you identified?
10. What are some of your community’s greatest assets and strengths? (Prompt: These
often include social and human service agencies, community-based organizations,
nonprofit organizations, churches, but can also be cultural qualities).
a. How do you think these strengths could be leveraged to address the top health
issues in Laredo?
11. What are your suggestions for ways to engage and build trust with community members,
particularly low-income, underserved populations, and limited English proficient
residents of Laredo to address these critical health issues?
12. Is there anything else you would like to share about the top health issues in Laredo?
13. Now I want you to think a little about a broader range of factors that could affect health.
What do you think are the social and economic concerns facing your community?
(Prompt: affordable housing, unemployment, access to quality daycare, poverty)
a. Who do these health needs or concerns affect the most (e.g., age groups,
racial/ethnic groups, socioeconomic groups, geographic subsets, etc.)?
b. PROBE: Are there organizations or available resources already addressing these
needs? If so, which ones? How do they address the needs?
c. PROBE: How important do you think it is that hospitals and health care systems
work to connect patients with resources to support these factors affecting health?
Why?
14. How could the City of Laredo Health Department possibly partner with or enhance the
efforts of these organizations to support factors affecting health?
15. Where do members of your community go to access primary health care?
a. What about specialty care?
b. What about access to emergency rooms or urgent care centers?
c. And mental and behavioral health care?

PROBE: What are the barriers to seeking and receiving mental and behavioral care?

a. Where do children go to receive the above resources?

16. What challenges/barriers do low-income, underserved, and uninsured populations in
your community face in access to health care?
a. What are two things that the City of Laredo Health Department could do to address
these challenges?

278 City of Laredo 2022-23 Community Health Needs Assessment

 b. Are there other populations in your community that experience health disparities?
17. To what extent do you think health literacy is a barrier to community members seeking
and receiving care?
a. How do you propose reducing this barrier?
18. If you are involved with an organization that provides services, how often do you believe
your clients have undocumented status?

Those are all of the questions I have for you today. Is there anything else you would like to add
before I turn off the recorder? [Allow time for comments]

279 City of Laredo 2022-23 Community Health Needs Assessment

APPENDIX B: FOCUS GROUP GUIDE
City of Laredo Focus Group Guide (English)

1. When you think about your community, what is the first thing that comes to mind?
2. What does health mean to you?
3. What do you do to stay healthy?
4. What are the things that help you to be healthy in your community? (e.g., places to buy
healthy food, safe places to walk and to exercise, community services and events,
access to health care, affordable housing)
5. What are the strengths of the health services available in your community?
6. What makes it difficult to be healthy in your community? (e.g., lack of access to
affordable health care, few grocery stores with fresh fruits and vegetables, affordable
food, lack of transportation, language barriers, substance use, etc.)
7. How does your race or ethnicity impact your ability to be healthy, if at all?
8. What challenges do you face, if any, about understanding your own health needs and
how to be healthy?
9. Thinking about people you may know who have a chronic health condition such as
diabetes or heart disease, (this could be you, friends, or family members), what
challenges do you or they face regarding getting support for the health condition?

PROBE: In your own words, describe how well you or your family members feel when
doctors or nurses talk about how to manage the health condition.

10. What do you think are the two most important health issues facing your community?
Why? (e.g., diabetes or cancer, unhealthy food or drug abuse, mental health, violence,
or access to care)
11. What are the top two things that could be done to fix these issues? (Alternate
phrasing: What would it look like to fix the issues?)
a. Who should be involved in fixing these issues? (e.g., people or organizations)
12. What could the City of Laredo Health Department do to improve health and quality of life
in the community?
13. Are there health services that you need but do not receive currently? [If yes] Which
services?
14. Where do you, your family, or friends go for help when you need health services and
cannot find them?

PROBE: Do you, your family, or friends ever go to Mexico to receive health services or
purchase medications?
[If yes, PROBE]
Why do people go to Mexico to receive health services?
What types of health services do community members go for?

15. Where do community members in Laredo go when they need mental health support?
Clinical services such as counseling?

280 City of Laredo 2022-23 Community Health Needs Assessment

 PROBE: What are some of the challenges of finding support for mental health in the
community?

16. What resources do you have in the community that seem to be working to address the
health-related issues that we talked about?

[Ask COVID-19 question (#17) and probes only if they have not already been addressed.]

17. What impact has the COVID-19 pandemic had in your life and in the community?
a. How has it affected your health, including your mental health?
b. How did COVID-19 impact the health challenges that we discussed earlier?
c. Are there community resources or agencies that have helped to support you during
the pandemic? If so, which organizations have been helpful?
18. Are there any other issues that impact your physical or mental health that you would like
to discuss?

281 City of Laredo 2022-23 Community Health Needs Assessment

City of Laredo Focus Group Guide (Spanish)

1. Cuando piensan en la palabra “comunidad,” ¿qué es lo primero que les viene a la

mente?
2. ¿Qué significa la salud para Uds.?
3. ¿Qué hacen para estar sano?
4. ¿Cuáles son las cosas que les ayudan a vivir una vida saludable en su comunidad?
(Avisar si es necesario: lugares para comprar alimentos saludables, lugares seguros
para caminar y hacer ejercicio, servicios y eventos comunitarios, acceso a atención
médica, viviendas asequibles).
5. ¿Cuáles son las fortalezas de los servicios de salud disponibles en su comunidad?
6. ¿Cuáles son las cosas que les hace más difícil vivir una vida saludable en su
comunidad? (Avisar si es necesario: falta de acceso a atención médica, pocas tiendas
con frutas y verduras frescas y comida saludable, falta de transporte para llegar a los
supermercados, falta de espacios seguros para estar activo, falta de servicios dentales,
falta de servicios médicos con médicos que hablan español, el consumo de drogas en la
comunidad, etc.)
7. ¿Cómo afecta, si lo es, su raza y etnicidad su habilidad para estar saludable?
8. ¿Cuáles son sus desafíos, si los tiene, al entender sus propias necesidades de salud y
como estar saludable?
9. ¿Si piensa en gente que tienen una condición médica crónica tal como diabetes o
enfermedades del corazón (puede ser usted, sus amigos, o sus familiares), qué
desafíos cree usted que tienen al recibir apoyo para su condición médica? (Avisar si es
necesario: en sus propias palabras, describa como se sienten Ud. o sus familiares
cuando los doctores o enfermeras les hablan de cómo manejar la condición médica)
10. ¿Cuáles creen que son los dos problemas de salud más importantes que enfrenta su
comunidad? (ejemplo diabetes o cáncer, comida no saludable o uso de drogas, salud
mental, violencia, o acceso al cuidado)
11. Pensando en los problemas de salud y otros factores de apoyo que hemos discutido,
¿cuáles son las dos cosas principales que se podrían hacer para solucionar estos
problemas?
a. ¿Cuáles son los grupos, organizaciones o personas que deberían ser parte de la
solución en su comunidad?
12. ¿Qué puede hacer el departamento de salud de la ciudad de Laredo para mejorar la
salud y calidad de vida en la comunidad?
13. ¿Actualmente, hay servicios de salud que necesita, pero no recibe? [si sí, cuales
servicios]
14. ¿A dónde va usted y sus amigos para encontrar ayuda cuando necesitan servicios de
salud y no los puede encontrar?
a. Avisar si es necesario: ¿Alguna vez va usted, su familia o sus amigos a México
para recibir servicios de salud o para comprar medicamentos? [si sí, ¿por qué va
la gente a México a recibir servicios de salud? ¿Para qué tipo de servicios de
salud van los miembros de la comunidad?
15. ¿Dónde van los miembros de la comunidad en Laredo para cuando necesitan apoyo
con la salud mental? ¿Servicios clínicos tal como consejería?
a. Avisar si es necesario: ¿Cuáles son algunos de los desafíos para encontrar
apoyo para la salud mental en la comunidad?

282 City of Laredo 2022-23 Community Health Needs Assessment

 16. ¿Qué recursos tiene su comunidad que parecen estar funcionando para mejorar los
problemas de salud que hablamos?

[Pregunta sobre COVID-19, si todavía no se ha comentado]

17. ¿Qué impacto ha tenido la pandemia de COVID-19 en su vida y en la comunidad?

a. ¿Cómo ha afectado su salud, incluyendo su salud mental?
b. ¿Cómo COVID-19 impacto los problemas de salud que discutimos aquí?
c. ¿Hay algunos recursos en la comunidad o agencias las cuales le ayudaron y
apoyaron durante la pandemia? Si sí, ¿Cuáles organizaciones le ayudaron?
18. ¿Ay algún otro problema que impacta su salud física o mental que le gustaría
compartir?

283 City of Laredo 2022-23 Community Health Needs Assessment