San Joaquin Valley children are more likely than anyone else in the state to suffer from chronic asthma.

Moreover, smoking cigarettes and heavy drinking are more prevalent in the Central Valley than in other regions.

Young adults in the valley are at higher risk of contracting chlamydia, the state's fastest-growing sexually transmitted disease.

And poor families in the valley are not tapping low-cost immunizations, dental care and health insurance because they are uninformed about the programs.

Those are just some of the findings of a Great Valley Center study that focuses on health in the Central Valley.

Richard Cummings, a spokesman for the Modesto-based center, said the study provides a comprehensive look at health problems in the region from Redding to Bakersfield, an area where more than one in four children live in poverty.

Data was gleaned from typical sources such as the Census Bureau and the state Department of Health Services, and also from a 2001 University of California at Los Angeles survey that quizzed 55,428 Californians about their health.

The latter survey allowed researchers to provide a regional and county breakdown of problems such as asthma, the uninsured and alcohol abuse.

According to the study asthma strikes 12 percent of children and 10 percent of adults in the San Joaquin Valley. Here are some other findings:

At 30.5 percent, the San Joaquin Valley has the state's highest rate of children living in poverty and those children are more likely to be uninsured or underinsured. Sixteen percent of valley residents from birth to age 64 are uninsured.

The valley has the highest percentage of children who are eligible, but not enrolled, in the state's Medi-Cal or Healthy Families programs for the poor.

Stanislaus, San Joaquin and Merced counties have shortages of primary-care physicians.

In Merced County, 35 percent of women who gave birth from 1996-2000 did not receive care in the first three months of pregnancy.

Twenty percent of Central Valley adults smoke cigarettes, and 30 percent reported drinking heavily in the month before the UCLA survey. Those rates are slightly higher than in other regions in the state.

The Great Valley Center is a nonprofit research and policy institute with a mission a improve life in the Central Valley. The study is the fourth in its series on the state of the valley.

A drain on public resources

Center President Carol Whiteside said the topic was chosen because poor health ruins people's lives and drains public resources.

"It just points to the fact that this region is underserved, and it creates a huge public liability down the road if we don't solve the problem."

With the state poised to cut funding for health services, it's even more important to spend wisely on prevention, she said.

The report urges local agencies to pay closer attention to land use and transportation projects that threaten to pollute the air, and it calls for building coalitions to improve the environment.

"I think people are generally concerned about the air," Whiteside said. "Now that the Bay Area can't be the bogeyman anymore, we have to look elsewhere for solutions."

Last year, Gov. Davis signed a bill that will tighten vehicle-exhaust testing in the Bay Area and keep pollutants from blowing into the valley.

Health officials have tracked the valley's asthma phenomenon for several years, variously linking it to smog and agricultural dust.

But local agencies and interest groups have disagreed on what to do about it.

Although asthma is more prevalent in Merced and Fresno counties, its occurrence in Stanislaus and San Joaquin counties is above the state average.

Vito Chiesa, board member and acting executive manager of the Stanislaus County Farm Bureau, said he is concerned, too, but cautioned against knee-jerk reactions.

"My kids have to live here and I want what's best for them," he said. "But unfortunately we live in a dust bowl. Too often people forget that agriculture contributes a lot to air quality.

"For example, irrigation keeps the dust down. We could fallow all this ground, and I guarantee you that when the wind blows, it won't be pretty."

Uninsured linked to rural life

The large numbers of uninsured also are a symptom of the valley's agriculture economy and rural setting, said Dr. Patrick Fox of the Institute for Health and Aging at the University of California at San Francisco, which oversaw the study.

Seasonal farmworkers earn low wages and usually don't have health benefits.

"So many of the health disparities we see across regions and across people living in those regions has to do with the socioeconomic status," Fox said. "I think economic development is the important thing -- to try to raise everybody's boat if we can."

About 750,000 people in the Central Valley need to be insured to meet a federal objective for 2010.

Stanislaus County has made progress enrolling people in Healthy Families insurance since the state reduced the application to four pages, said David Jones, spokesman for the county Health Services Agency.

When the program was unveiled three years ago, people were daunted by the 40-page application.

Another challenge is to convince doctors to set up practices in rural communities.

"In Stanislaus County, it's difficult to recruit physicians to serve a population where the payment is so low," Jones said. "California is ranked 49th among the 50 states in the payments to providers who serve patients" on state-funded insurance programs.

The county continues outreach efforts to get people insured, he said, even though the state cut funding for outreach in October. Another county service takes a medical bus into neighborhoods.

In 1995, the bus was dubbed the Maternity Outreach Mobile, or MOMobile, for its focus on expectant mothers; it's now called the Medical Outreach Mobile because 70 percent of the clients are children.

"For some, it's the only health care they are getting," said Lina Ruppel, a nurse manager for the program. "Some of the neighborhood people see us as their medical clinic."

Prenatal care a Merced problem

Early prenatal care, which reduces the risks for still births, premature births or low birth weights, is a concern in Merced County. The county did a survey a couple of years ago to learn why pregnant women are not getting care.

"One of the main reasons was they didn't know they were pregnant," said Betty Wetters, maternal and child health program manager for the county. "The other reason was they did not have a way to pay for it. Not everyone has Medi-Cal at the point they find out they are pregnant."

Illegal immigrants are entitled to Medi-Cal coverage only in emergencies or after they are pregnant. The county was doing outreach to enroll people in Medi-Cal and Healthy Families, but lost the funding in October. "I wish I could say we had more resources to work on this," Wetters said.

Fox said he hopes the study will raise awareness of chlamydia, a disease most prevalent in young adults and a leading cause of infertility. According to the study, San Joaquin County has above the state average of 240 cases per 100,000 people.

"It is a disease that people are not aware of and there are serious health effects if it's not treated," Fox said.

Bee staff writer Ken Carlson can be reached at 578-2321 or kcarlson@modbee.com.

Reprinted by permission of Modesto Bee.