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Cui Y.,Office of Health Assessment and Epidemiology | Baldwin S.B.,Office of Health Assessment and Epidemiology | Lightstone A.S.,Office of Health Assessment and Epidemiology | Shih M.,Office of Health Assessment and Epidemiology | Yu H.,University of California at Los Angeles
Journal of Urban Health | Year: 2012

Los Angeles County has among the lowest smoking rates of large urban counties in the USA. Nevertheless, concerning disparities persist as high smoking prevalence is found among certain subgroups. We calculated adult smoking prevalence in the incorporated cities of Los Angeles County in order to identify cities with high smoking prevalence. The prevalence was estimated by a model-based small area estimation method with utilization of three data sources, including the 2007 Los Angeles County Health Survey, the 2000 Census, and the 2007 Los Angeles County Population Estimates and Projection System. Smoking prevalence varied considerably across cities, with a more than fourfold difference between the lowest (5.3%) and the highest prevalence (21.7%). Higher smoking prevalence was generally found in socioeconomically disadvantaged cities. The disparities identified here add another layer of data to our knowledge of the health inequities experienced by low-income urban communities and provide much sought data for local tobacco control. Our study also demonstrates the feasibility of providing credible local estimates of smoking prevalence using the model-based small area estimation method. © 2011 The New York Academy of Medicine.

Shih M.,Office of Health Assessment and Epidemiology | Du Y.,Office of Health Assessment and Epidemiology | Lightstone A.S.,Office of Health Assessment and Epidemiology | Simon P.A.,University of California at Los Angeles | Wang M.C.,University of California at Los Angeles
Preventive Medicine | Year: 2014

Objective: The primary objective of this analysis was to examine the burden of diabetes among Asians and Asian subgroups in Los Angeles County, which has the largest county population of Asians in the U.S. Method: Data were analyzed from 6. cycles of the Los Angeles County Health Survey, 1997-2011 (n = 47,282). Asian adults (n = 4672) were categorized into the following ethnic subgroups: Chinese, Filipino, Korean, Japanese, Vietnamese, South Asian, and Other Asian. Descriptive and multivariable logistic regression analyses were conducted to examine trends in prevalence, prevalence among Asian subgroups, and factors associated with diabetes. Results: In 2005, we observed a rapid increase in diabetes prevalence among Asians compared to whites despite consistently lower BMI relative to other racial/ethnic groups. Diabetes prevalence was significantly higher among Filipinos and South Asians (>. 10%) compared to East Asians and Vietnamese (<. 7%). After adjusting for all covariates, Asians who were older, non-drinkers, insured, and overweight or obese were found to have increased odds of diabetes. Conclusion: Diabetes prevalence is increasing more rapidly among Asians compared to whites despite overall lower BMI. The significant heterogeneity among Asian subgroups highlights the need for disaggregated data and additional research to develop culturally appropriate interventions for diabetes prevention and control. © 2014 Elsevier Inc.

Smith L.V.,Office of Health Assessment and Epidemiology | Smith L.V.,University of California at Los Angeles | Piron J.,Office of Health Assessment and Epidemiology | Kuo T.,University of California at Los Angeles
Journal of Obesity | Year: 2014

Although US obesity prevention efforts have begun to implement a variety of system and environmental change strategies to address the underlying socioecological barriers to healthy eating, factors which can impede or facilitate community acceptance of such interventions are often poorly understood. This is due, in part, to the paucity of subpopulation health data that are available to help guide local planning and decision-making. We contribute to this gap in practice by examining area-specific health data for a population targeted by federally funded nutrition interventions in Los Angeles County. Using data from a local health assessment that collected information on sociodemographics, self-reported health behaviors, and objectively measured height, weight, and blood pressure for a subset of low-income adults (n = 720), we compared health risks and predictors of healthy eating across at-risk groups using multivariable modeling analyses. Our main findings indicate being a woman and having high self-efficacy in reading Nutrition Facts labels were strong predictors of healthy eating (P<0.05). These findings suggest that intervening with women may help increase the reach of these nutrition interventions, and that improving self-efficacy in healthy eating through public education and/or by other means can help prime at-risk groups to accept and take advantage of these food environment changes. © 2014 Brenda Robles et al.

Javanbakht M.,University of California at Los Angeles | Anderson L.J.,University of California at Los Angeles | Malek M.,Infection Control and Epidemiology Unit | Smith L.V.,University of California at Los Angeles | Smith L.V.,Office of Health Assessment and Epidemiology
American Journal of Public Health | Year: 2014

Objectives. We describe and report findings from a screening program to identify sexually transmitted infections (STIs) and HIV among female inmates in Los Angeles County Jail. Methods. Chlamydia and gonorrhea screening was offered to entering female inmates. Women were eligible if they were (1) aged 30 years or younger, or (2) pregnant or possibly pregnant, or (3) booked on prostitution or sex-related charges. Voluntary syphilis and HIV testing was offered to all women between 2006 and 2009. This analysis reports on data collected from 2002 through 2012. Results. A total of 76 207 women participated in the program. Chlamydia prevalence was 11.4% and gonorrhea was 3.1%. Early syphilis was identified in 1.4% (141 of 9733) and the overall prevalence of HIV was 1.1% (83 of 7448). Treatment levels for early syphilis and HIV were high (99% and 100%, respectively), but only 56% of chlamydia and 58% of gonorrhea cases were treated. Conclusions. Screening incarcerated women in Los Angeles County revealed a high prevalence of STIs and HIV. These inmates represent a unique opportunity for the identification of STIs and HIV, although strategies to improve chlamydia and gonorrhea treatment rates are needed. © 2014, American Public Health Association Inc. All rights reserved.

Cummings P.L.,Office of Senior Health | Sorvillo F.,Office of Health Assessment and Epidemiology | Sorvillo F.,University of California at Los Angeles | Kuo T.,Office of Senior Health | Kuo T.,University of California at Los Angeles
Journal of the American Geriatrics Society | Year: 2012

Objectives To update and examine Alzheimer's disease-related mortality trends according to age, sex, race and ethnicity, geography, and other case characteristics for a 10-year period. Design Trend and comparative analyses of the U.S. multiple-cause-of-death records for 1999 to 2008. Setting United States. Participants Participants were decedents with Alzheimer's disease (AD) coded as underlying or associated cause of death; decedents with other forms of dementia or cognitive disorder were excluded. Measurements Case frequency, age-specific death rates, and crude and age-adjusted mortality rates were estimated for all AD decedents from the sampled period. Measures of AD mortality burden were compared with those of other leading causes of death (e.g., diabetes mellitus, stroke). Results From 1999 to 2008, 879,281 AD-related deaths were identified. The age-adjusted mortality rate for AD increased from 45.3 per 100,000 population (95% confidence interval (CI) = 45.0-45.7) in 1999 to 50.0 per 100,000 population (95% CI = 49.7-50.3) in 2008. The average age at death was 85.9. Differences in AD-related deaths varied according to sex, race and ethnicity, and geography. The number of AD-related deaths and age-specific mortality for persons aged 85 and older (n = 532,338, 1,096.6 per 100,000 population) were comparable with those from the same age group who died from diabetes mellitus (n = 488,593, 1,006.5 per 100,000 population). Conclusion The burden of AD-related mortality was substantial for the period 1999 to 2008. This burden is expected to grow rapidly as the baby boomer generation ages. Findings from this study may have important implications for present and future planning in medicine, social services, public policy, and public health. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Shih M.,Office of Health Assessment and Epidemiology | Dumke K.A.,University of Southern California | Goran M.I.,University of Southern California
Pediatric Obesity | Year: 2013

What is already known about this subject Neighbourhood social, economic and environmental factors are associated with childhood obesity. Childhood obesity disproportionately impacts those living in low-income neighbourhoods. What this study adds Childhood obesity prevalence is strongly associated with community-level social and economic conditions as measured using a composite Economic Hardship Index. Childhood obesity prevalence among communities in the highest hardship quartile was more than double the prevalence among communities in the lowest hardship quartile (26.9 vs. 12.5%). The relationship between economic hardship and obesity differs by race/ethnicity. Objective The association between community-level economic hardship and childhood obesity prevalence was examined in Los Angeles County, one of the largest and most racially and ethnically diverse regions in the United States. Methods Data from the 2008-2009 California Department of Education's Physical Fitness Testing Program were analyzed to assess obesity prevalence among 5th, 7th and 9th grade students attending public schools (n=298485). Community-level socioeconomic conditions were compared using a census-tract-based Economic Hardship (EH) index. Mixed-effects modelling was used to examine the association between obesity prevalence and gender, grade, race/ethnicity and EH. Results Higher community-level EH was associated with higher childhood obesity prevalence (P<0.001). The obesity prevalence among communities in the highest EH quartile (26.9%) was more than double the obesity prevalence among communities in the lowest EH quartile (12.5%). The slope of the association between EH and childhood obesity differed by racial/ethnic group. The slope was higher for non-Hispanic White students, Hispanics, and non-Hispanic Asians, and lower for non-Hispanic Black students. Racial/ethnic disparities were observed across the socioeconomic spectrum. Conclusions Findings suggest that efforts to improve community socioeconomic conditions could reduce childhood obesity prevalence. Prevention efforts should target communities with high economic hardship and also focus on providing culturally relevant interventions that address disparities in obesity prevalence across communities. © 2012 The Authors.

Wise M.,University of California at Los Angeles | Wise M.,Centers for Disease Control and Prevention | Finelli L.,Centers for Disease Control and Prevention | Sorvillo F.,University of California at Los Angeles | Sorvillo F.,Office of Health Assessment and Epidemiology
Public Health Reports | Year: 2010

Objectives. Hepatitis C, an important cause of premature mortality, is the most common chronic bloodborne infection in the United States. The severity of disease is strongly affected by a number of other medical conditions and health behaviors. We sought to estimate the association of several exposures with hepatitis C on death certificates. Methods. We enrolled 63,189 hepatitis C deaths as cases in a case-control study using multiple-cause-of-death data for the U.S. from 1999 to 2004. Three control groups were assembled from all remaining deaths with no mention of hepatitis C, including a random sample of all deaths, digestive disease deaths, and circulatory disease deaths. Results. Hepatitis B, human immunodeficiency virus (HIV), hemochromatosis, and alcohol use were all strongly associated with hepatitis C, even after controlling for confounding variables. The simultaneous presence of many of these exposures had a synergistic association with hepatitis C being listed as a cause of death. Hepatitis B, HIV, and alcohol use were recorded among 6.4%, 10.5%, and 18.2% of case deaths, respectively. Conclusions. The strong association of alcohol use, HIV, and hepatitis B with hepatitis C, as well as the frequent occurrence of these conditions, indicates that targeted interventions for mitigating the potential effect of these exposures may present an efficient means of limiting progression of hepatitis C-related liver disease and reducing the population burden of hepatitis C mortality.

Du Y.,Office of Health Assessment and Epidemiology | Palmer P.H.,Claremont Graduate University | Sakuma K.-L.,Oregon State University | Blake J.,Office of Health Assessment and Epidemiology | Johnson C.A.,Claremont Graduate University
Preventive Medicine Reports | Year: 2015

Objective: The purpose of this study was to examine whether the prevalence of smoking was associated with family structure among multicultural adolescents and whether there was gender disparity on the association. Methods: Data were collected from a sample of 7th graders in Hawaii who completed in-class questionnaires in 2004. The final sample included 821 multicultural students from different family structures. Descriptive analyses, Chi-square tests and logistic regression were performed to examine the prevalence of smoking and the association between family structure and smoking prevalence. Results: This sample contained students who lived in intact (61.7%), single-parent (16.5%), step-parent (15.6%), and no-parent (6.2%) families. The overall prevalence of ever/lifetime smoking was 24.0%, and was not significantly different between genders in each family structure (P>. 0.05). Compared with living in intact families, living in single-parent, step-parent, or no-parent families was significantly associated with higher odds of ever/lifetime smoking among all students (P<. 0.05) and living in single-parent and step-parent families was significantly associated with higher odds of ever/lifetime smoking among females (P<. 0.05) and among males (P<. 0.05) respectively, after adjusting for covariates. Conclusions: These findings suggest that family structure is a risk factor for smoking among multicultural students. Anti-smoking programs should consider this factor. © 2015.

Vidyanti I.,Office of Health Assessment and Epidemiology | Basurto-Davila R.,Office of Health Assessment and Epidemiology
Proceedings - Winter Simulation Conference | Year: 2016

Heart attacks and strokes are the leading causes of death in Los Angeles County (LAC). Dietary sodium reduction policies may reduce the risk for heart disease and stroke. To determine the value of population-level sodium reduction policies in LAC in terms of averted morbidity, mortality, and total medical spending, we modeled a modest sodium consumption reduction scenario of 400 mg/day using the Future Elderly Model-Los Angeles (FEM-LA), a Monte Carlo microsimulation model that projects health and economic outcomes for all LAC residents aged 51 and older. The model projects that, over the period 2006-2051, 3,224-5,353 total deaths (annual average of 70-116 deaths) would be prevented due to reductions in the incidence of heart disease and stroke attributed to dietary salt reduction. Over the same period, this corresponds to a total savings of $2.28-3.56 billion in medical spending (annual average of $49.56-77.37 million). © 2015 IEEE.

Pourshaban D.,Office of Health Assessment and Epidemiology | Basurto-Davila R.,Office of Health Assessment and Epidemiology | Shih M.,Office of Health Assessment and Epidemiology
Journal of Public Health Management and Practice | Year: 2015

Context: Workforce shortages have been identified as a priority for US public health agencies. Voluntary turnover results in loss of expertise and institutional knowledge as well as high costs to recruit and train replacement workers. Objective: To analyze patterns and predictors of voluntary turnover among public health workers. Design: Descriptive analysis and linear probability regression models. Participants: Employees of state health agencies in the United States who participated in the Public Health Workforce Interests and Needs Survey (PH WINS). Main Outcome Measures: Intended retirement and voluntary departure; pay satisfaction; job satisfaction. Results: Nearly 25% of workers reported plans to retire before 2020, and an additional 18% reported the intention to leave their current organization within 1 year. Four percent of staff are considering leaving their organization in the next year for a job at a different health department. There was significant heterogeneity by demographic, socioeconomic, and job characteristics. Areas such as administration/management, health education, health services, social services, and epidemiology may be particularly vulnerable to turnover. The strongest predictors of voluntary departure were pay and job satisfaction, which were associated with 9 (P < .001) and 24 (P < .001) percentage-point decreases, respectively, in the probability to report the intention to leave. Our findings suggest that if all workers were satisfied with their job and pay, intended departure would be 7.4%, or less than half the current 18% rate. Controlling for salary levels, higher levels of education and longer work experience were associated with lower pay satisfaction, except for physicians, who were 11 percentage points (P = .02) more likely to be satisfied with their pay than employees with doctoral degrees. Several workplace characteristics related to relationships with supervisors, workplace environment, and employee motivation/morale were significantly associated with job satisfaction. Conclusions: Our findings suggest that public health agencies may face significant pressure from worker retirement and voluntary departures in coming years. Although retirement can be addressed through recruitment efforts, addressing other voluntary departures will require focusing on improving pay and job satisfaction. Copyright © 2015 Wolters Kluwer Health, Inc.

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