First 5 Los Angeles is a

nonprofit A nonprofit organization (NPO), also known as a nonbusiness entity, nonprofit institution, not-for-profit organization, or simply a nonprofit, is a non-governmental (private) legal entity organized and operated for a collective, public, or so ...

child-advocacy organization that is part of the First 5 California Children and Families Act.

History

First 5 California was created in November 1998 when

California California () is a U.S. state, state in the Western United States that lies on the West Coast of the United States, Pacific Coast. It borders Oregon to the north, Nevada and Arizona to the east, and shares Mexico–United States border, an ...

voters passed Proposition 10 to invest tobacco tax revenues in programs that would help improve the lives of children in California. Spearheaded by Hollywood producer and political activist

Rob Reiner Robert Reiner (born March 6, 1947) is an American film director, producer, screenwriter, actor, and liberal activist. As an actor, Reiner first came to national prominence with the role of Michael Stivic, Mike "Meathead" Stivic on the CBS sitc ...

, who acted as the commission's first chairman in 1999 under former Governor Gray Davis, First 5 California was created to use tobacco tax revenues to fund health, safety and early education programs for children age prenatal to 5 years old in California.Bowers, T. (2013, November 1). Guest Commentary: Proposition 10 and First 5 Kings County. Retrieved February 1, 2014, from The Sentinel: http://first5association.org/wp-content/uploads/2013/11/Kings-County-Guest-Commentary-by-Commission-Chair-Tim-Bowers.pdf In the 12 years subsequent to its creation, First 5 LA had invested more than one billion dollars from tobacco tax revenues into grants and programs that benefit the children of

Los Angeles County Los Angeles County, officially the County of Los Angeles and sometimes abbreviated as LA County, is the most populous county in the United States, with 9,663,345 residents estimated in 2023. Its population is greater than that of 40 individua ...

Mission

First 5 LA aims to create programs and services for children age prenatal to five. The mission is to increase the number of Los Angeles County children ages 0 to 5 who are physically and emotionally healthy, ready to learn, and safe from harm.About Us. (2012). Retrieved February 1, 2014, from First 5 LA: http://www.first5la.org/About-Us

Programs

Programs are centered around child, parent/caretaker, and teacher to improve early childhood outcomes in the areas of

health Health has a variety of definitions, which have been used for different purposes over time. In general, it refers to physical and emotional well-being, especially that associated with normal functioning of the human body, absent of disease, p ...

and

nutrition Nutrition is the biochemistry, biochemical and physiology, physiological process by which an organism uses food and water to support its life. The intake of these substances provides organisms with nutrients (divided into Macronutrient, macro- ...

, early

literacy Literacy is the ability to read and write, while illiteracy refers to an inability to read and write. Some researchers suggest that the study of "literacy" as a concept can be divided into two periods: the period before 1950, when literacy was ...

and

language development Language development in humans is a process which starts early in life. Infants start without knowing a language, yet by 10 months, babies can distinguish speech sounds and engage in babbling. Some research has shown that the earliest learning b ...

, quality child care, and

smoking cessation Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is Addiction, addictive and can cause Substance dependence, dependence. As a resu ...

Funding

Proposition 10 established a 50 cent-per-pack tax on tobacco products towards the healthy development of California's children from prenatal to age five. Declining birth and smoking rates is causing First 5 LA's revenue stream to decrease. First 5 faces decreasing funding due to declining sales of tobacco products and increased administrative fees assessed by the State Board of Equalization for the collection of tobacco taxes. Additional funding declines are fore coming due to state cutbacks. Eighty percent of the commission's resources is divided among California's 58 counties, to be spent according to local needs and priorities.

Grants and contracts

Since 1998, First 5 LA has contributed $800 million in grants and programs to benefit the children of LA County. First 5 LA manages funding for proposals or projects through a transparent Request for Proposal/Request for Qualification process. Proposals or projects can fall under the following categories:Contracting Elements and Performance Based Contracting. (2013). Retrieved February 2014, from First 5 LA: http://www.first5la.org/files/Webinar%20Training%20%28FINAL%29.pdf *Direct Services (Grant Agreement): Services where the grant recipient directly interacts with First 5 LA's target population. *Professional Services (Contract): Services that benefit First 5 LA or where the contract is not directly interacting with target populations. *Vendor Agreements: Routine purchases of goods or services. First 5 LA's funding decisions are guided by the following principles: *Early learning: Programs that improve children's achievement of their developmental potential. *Health: Programs that improve access to and quality of health resources. *Safe children and families: Programs aimed to support families so they can raise their children safely. *Prenatal through three: Programs focused on children from prenatal to the age of three.

Controversy

First 5 LA has faced controversy due to the 2011 Harvey M. Rose

audit An audit is an "independent examination of financial information of any entity, whether profit oriented or not, irrespective of its size or legal form when such an examination is conducted with a view to express an opinion thereon." Auditing al ...

that prompted concerns over its financial management. It discovered that while the program was overstaffed, it underspent on programs, resulting in a surplus of $800 million unused funds. Auditors also noted a lack of transparency within the organization. Staff within First 5 LA failed to report over $200 million in contracts and grant awards in one fiscal year, despite the policy that contracts exceeding $25,000 were to be approved by commissioners. The lack of commission oversight made it impossible for auditors to determine whether or not agreements were made for appropriate purposes or qualified vendors and determine whether or not malfeasance had occurred. In response to the audit, First Five LA's former executive director, Evelyn V. Martinez, resigned.

Los Angeles County Board of Supervisors The Los Angeles County Board of Supervisors (LACBOS) is the five-member Board of Supervisors, governing body of Los Angeles County, California, United States. History On April 1, 1850 the citizens of Los Angeles elected a three-man Court of Se ...

voted 4–1 to make moves towards to transform First 5 LA from a separate legal entity to a county agency. In response to these challenges, the commission developed an accelerated plan to utilize nearly $400 million in program and services for county children. The plan, which began in 2012, is estimated to serve up to 200,000 children. Some of the initiatives provide services such as expanded health intervention programs, housing for homeless families, expansion of dental care for children age 5 and younger, and partnerships with

UCLA The University of California, Los Angeles (UCLA) is a public land-grant research university in Los Angeles, California, United States. Its academic roots were established in 1881 as a normal school then known as the southern branch of the C ...

to bring dental and vision care to preschoolers.

Public health implications

First 5 LA's four goal statements carry several

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the de ...

implications. Babies are born healthy. :By providing health insurance and access support programs, First 5 LA seeks to reduce the proportion low weight births, which account for 20 percent of neonatal deaths. Ensuring that babies are born healthy may result in a reduction of healthcare expenditures associated with delivery and care, as well a reduction in the prevalence of disabilities such as

cerebral palsy Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, spasticity, stiff muscles, Paresis, weak muscles, and tremors. There may b ...

mental retardation Intellectual disability (ID), also known as general learning disability (in the United Kingdom), and formerly mental retardation (in the United States), Rosa's Law, Pub. L. 111-256124 Stat. 2643(2010).Archive is a generalized neurodevelopmental ...

, and

vision Vision, Visions, or The Vision may refer to: Perception Optical perception * Visual perception, the sense of sight * Visual system, the physical mechanism of eyesight * Computer vision, a field dealing with how computers can be made to gain und ...

and

hearing impairment Hearing loss is a partial or total inability to Hearing, hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to Lang ...

s.Hack, M., Klein, NK, Taylor, HG. (1995). Long-term developmental outcomes of low birth weight infants. In: The Future of Children: Low Birth Weight. Vol. 5(1):19-34. Los Altos, CA: Center for the Future of Children. The David and Lucile Packard Foundation. Children maintain a healthy weight. :First 5 LA seeks to ensure that children maintain a healthy weight by supporting local advocacy efforts and access to nutritious foods. Tackling

childhood obesity Childhood obesity is a condition where excess adipose tissue, body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on Body mass index, BMI. ...

can result in decreased risks for

Type 2 diabetes Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent ...

cardiovascular disease Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...

respiratory disease Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, ...

arthritis Arthritis is a general medical term used to describe a disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, Joint effusion, swelling, and decreased range of motion of ...

, and poor social and

psychological development Developmental psychology is the science, scientific study of how and why humans grow, change, and adapt across the course of their lives. Originally concerned with infants and children, the field has expanded to include adolescence, adult deve ...

.U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. ockville, MD U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 001National Education Goals Panel. (1997). Special early childhood report. Washington, D.C.: National Education Goals Panel. Children are safe from

abuse Abuse is the act of improper usage or treatment of a person or thing, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as: physical or verbal maltreatment, injury, assault, violation, rape, unjust practices, ...

and

neglect In the context of caregiving, neglect is a form of abuse where the perpetrator, who is responsible for caring for someone who is unable to care for themselves, fails to do so. It can be a result of carelessness, indifference, or unwillingness and ...

. :First 5 LA seeks to ensure that children are safe from abuse and neglect through home visitation and parent education programs that may be tailored to target specific outcomes. Reducing prevalence of child abuse and neglect reduces cases of physical, psychological and emotional injuries. Child abuse and neglect are linked to an increased risk of

substance abuse Substance misuse, also known as drug misuse or, in older vernacular, substance abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder, differing definition ...

eating disorders An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's health, physical or mental health, mental health. These behaviors may include eating too much food or too little food. Types of eatin ...

obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...

, depression,

suicide Suicide is the act of intentionally causing one's own death. Risk factors for suicide include mental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress (such as from financial or ac ...

, and sexual promiscuity later in life.13 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Child Maltreatment; Fact Sheet. Accessed April 11, 2005. Children are ready for kindergarten. :First 5 LA seeks to support operations and development of preschools as well as a comprehensive system to assess, support, and incentivize preschool quality. Increased reading skills improve school performance and may lead to outcomes such as higher productivity and health literacy.

Outcomes

Evaluation of the Black Infant Health program has suggested that BIH clients have lower amounts of

birth defects A birth defect is an abnormal condition that is present at birth, regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can range from mild to severe. Birth de ...

, infant mortality, and higher amounts of breast-feeding when compared to other African American mothers in LA County and the U.S.Black Infant Health Evaluation Final Report. (2011, November 11). Retrieved February 2014, from First 5 LA: http://www.first5la.org/files/BIH_FinalReport_11112011_Combined.pdf Evaluation of the Healthy Birth Initiative showed more intermediary results. Rates of gestational age, pre-term birth weight, and infant mortality were higher in HBI clients when compared to LA County statistics.Healthy Births Initiative Evaluation Final Report. (2011, November 23). Retrieved February 2014, from First 5 LA: http://www.first5la.org/files/07828_FinalReport_11232011.pdf Although comparisons of infant mortality and pre-term birth rates between HBI clients and the outside community were not statistically significant, the proportion of Cesarean births and formula feeding was found to be significantly lower. First 5 LA's Early Developmental Screening Initiative has shown increased collaboration between clinicians, community groups, and patients.Early Developmental Screening and Intervention. (2012). Retrieved February 2014, from First 5 LA: http://www.first5la.org/Community-Change/Program-Evaluations/Early-Developmental-Screening-and-Intervention Physician practices that participated within EDSI's Physician Collaborative increased developmental screening rates from 20% to over 85%.The Early Developmental Screening and Intervention (EDSI) Initiative. (2011, April 1). Retrieved February 2014, from First 5 LA: http://www.first5la.org/files/EDSI_GoalsandAccomplishments.pdf Furthermore, rates of maternal depression screening also increased from 7% to 54%, and the percentage of participating practices which used comprehensive care prompting systems increased from 7% to 77%. Collaboration with Women, Infants, and Children (WIC) programs has shown modest gains in visit preparation; 18% of the 500,000 participants reported that the programs affected the way they approach doctors visits. The Family Literacy Initiative also showed moderately positive outcomes; in fact, greater family participation in the Family Literacy program was associated with greater increases in parent reading skills, library use, and school involvement.Evaluation of the First 5 LA Family Literacy Initiative: Final Evaluation Report. (2011, January 12). Retrieved February 2014, from First 5 LA: http://www.first5la.org/files/07096_FL_Final_Comprehensive_Evaluation_Report_final_011211.pdf Although child participation in early childhood education classes was not correlated to an increase in pre-literacy or math skills, parent participation was correlated with higher child ability to name numbers, understand stories, and learn English. The School Readiness Initiative showed small but statistically significant improvements in child communication and social-emotional school readiness skills. SRI children also had higher scores in English proficiency, and slightly higher scores on mathematical assessments.

References

{{Authority control Children's health-related organizations Healthcare in Los Angeles Organizations based in Los Angeles County, California Medical and health organizations based in California Government agencies established in 1998