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Open Access Publications from the University of California

Scholarly Works (13 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2015)

Background. Rurality may influence racial/ethnic disparities in access to healthcare. This study sought to: (1) compare and contrast measures used to assess rurality and urbanicity; (2) determine if racial/ethnic disparities in access to healthcare differ for rural vs. urban areas; and, (3) determine if residential segregation and access to healthcare differ for rural vs. urban areas.

Sample. The sample was adult respondents to the 2005-2010 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of U.S. households. Each aim had five samples; sample size ranged from 49,839 to 112,125.

Measures. Aim 1 involved five measures used to identify rurality relative to urbanicity. Aim 2 and aim 3 involved five self-reported MEPS outcomes indicating whether respondents had (1) a usual source of healthcare, (2) unmet need for healthcare, (3) cholesterol screenings, (4) cervical cancer screenings, or (5) dental visits. The main explanatory factors, which were based on respondents’ residential location, were rurality and residential segregation, which were examined separately for blacks and Hispanics using the isolation index. Respondents’ residential areas were characterized by using geographic identifiers to link the MEPS data with census tract and county information available via the American Community Survey (2005-2010), the Area Health Resource File (2010), and five publically available rurality indicators.

Analysis. The descriptive analysis explored variable characteristics and bivariate associations. The main analysis involved multi-level, random intercept logistic regression to estimate disparities in each access to healthcare outcome while controlling for confounders.

Results. One outcome, unmet healthcare need, changed depending on the measure used to assess rurality. With respect to disparities, relatively more blacks than whites had preventive screenings in the fully adjusted models; this difference was smaller in rural than urban areas. Rural blacks and Hispanics had fewer screenings than urban ones did. Across rural and urban areas, blacks and Hispanics in segregated areas had lower levels of unmet need.

Discussion. Unadjusted estimates suggest disadvantaged rates for certain measures of access to healthcare by rurality and segregation, while adjusted models attenuated some of these disparities.

Conclusion. Place-based factors (rurality, segregation) and racial factors may jointly affect access to healthcare among diverse U.S. populations.

    Cover page: Rurality and Race: Inequities in Access to Five Types of Healthcare Services
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2014)
    Existing research suggests that religious institutions play a significant role in improving the health of communities, particularly those coping with racial and ethnic discrimination. Using the California Health Interview Survey, this article examines the relationship of self-reported experiences of racial/ethnic discrimination, worship attendance, and several health behaviors. Supporting existing research, higher self-reported racial/ethnic discrimination is associated with worse health behaviors. Logistic regression models indicate that the odds of engaging in healthy lifestyle behaviors significantly increase for those who report attending worship, compared with those who do not attend worship, with variations by race/ethnicity. Worship attendance moderates the association between discrimination and binge drinking, but does not moderate the association for smoking, walking, or being obese. Findings suggest that religious attendance plays an important role in the health and well-being of all population groups. More research is needed to ascertain the reasons why attending worship may have the ability to mitigate the relationship between racial/ethnic discrimination and health.
      Cover page: Does Attending Worship Mitigate Racial/Ethnic Discrimination in Influencing Health Behaviors? Results From an Analysis of the California Health Interview SurveyCreative Commons 'BY-SA' version 4.0 license
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2019)
      Healthy food marketing in the retail environment can be an important driver of fruit and vegetable purchases. In Los Angeles County, the Nutrition Education and Obesity Prevention (NEOP) program utilized this strategy to promote healthy eating among low-income families that shop at large retail chain stores. The present study assessed whether self-reported exposure to large retail NEOP interventions, including seeing at least one store visual, watching an in-store cooking demonstration, and/or seeing at least one program advertisement, were associated with increased fruit and vegetable purchases. During fall 2014, the Division of Chronic Disease and Injury Prevention in the Los Angeles County Department of Public Health partnered with Samuels Center to conduct store patron intercept surveys at six large food retail stores participating in NEOP across Los Angeles County. Of 1050 participants who completed the survey, almost a quarter (25.0%) reported seeing at least one visual throughout the store and 9.2% watched a cooking demonstration. Seeing at least one visual and watching a cooking demonstration were not significantly associated with percent dollars spent on fruits and vegetables each week. Among participants who reported being exposed to at least one store visual, those enrolled in the Supplemental Nutrition Assistance Program (SNAP) reported spending 6% more on fruits and vegetables than those who were not enrolled (p = 0.046). Although the NEOP store interventions did not individually increase store purchases, their educational value may still influence patron food selection, especially if coupled to the monetary resources of SNAP for those who are enrolled.
        Cover page: Healthy food marketing and purchases of fruits and vegetables in large grocery stores
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2020)
        Neighborhood conditions are associated with health outcomes, but whether individual health behaviors are independent of or associated with the settings are not clear. We analyzed the California Health Interview Survey (CHIS) (N = 11,152) data to determine if the perceptions and behaviors of similar individuals with an income low enough to be eligible for SNAP-Ed services differed based on whether they lived in high- or low-income neighborhoods. We found that SNAP-Ed eligible individuals living in low-income neighborhoods walked for transportation more frequently (3.04 times versus 2.38 times, p = 0.001), drank sugary beverages more frequently in the past month (2.93 times versus 1.69 times, p = 0.000), and had a higher risk of obesity than similar low-income individuals living in high-income neighborhoods (0.34 versus 0.26, p = 0.012).
          Cover page: Neighborhood Environments, SNAP-Ed Eligibility, and Health Behaviors: An Analysis of the California Health Interview Survey (CHIS).
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2021)

          Purpose and objectives

          The Supplemental Nutrition Assistance Program Education (SNAP-Ed), the educational branch of SNAP, can play an important role in improving dietary outcomes, eliminating food insecurity, and preventing chronic disease among low-income populations. This study examined the effects of local SNAP-Ed efforts on self-reported health behaviors and body mass index (BMI) over a 1-year period, using data collected from intercept surveys of program-eligible adults.

          Intervention approach

          From 2016 to 2020, the Los Angeles County Department of Public Health partnered with 24 community-based organizations to provide nutrition education and to implement policy, systems, and environmental changes in the community.

          Evaluation methods

          A cross-sectional survey was conducted in 2018 and repeated in 2019 to measure 6 outcomes describing population-level changes in health behaviors and BMI. The study recruited 4 samples: 2 samples from outside selected supermarkets (2018, n = 2,098; 2019, n = 2,323) and 2 samples from participants at SNAP-Ed class sites (2018, n = 651; 2019, n = 569).

          Results

          While study results showed an increase in consumption of fruits and vegetables and in vigorous physical activity, they also showed an increase in BMI and high consumption of unhealthy foods. Participating in SNAP-Ed classes was positively associated with several health behaviors but no change in BMI. Participants who experienced food insecurity had worse health behavior outcomes than those who did not experience this condition.

          Implications for public health

          SNAP-Ed interventions appear to have a favorable effect on fruit and vegetable consumption, but increases in BMI suggest that unhealthy food consumption is abundant and may be counteracting the benefits gained from eating more fruits and vegetables. Future efforts should take these results into consideration and optimize enrollment in nutrition assistance programs. These efforts should include coordinating with local programs to increase healthy food access for at-risk low-income populations in Los Angeles County.
            Cover page: Health Behavior Changes Among Adults in the Supplemental Nutrition Assistance Program Education, Los Angeles County, California.
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2020)
            In 2020, the US invested $441 million dollars in the Supplement Nutrition Assistance Program Education (SNAP-Ed), a program that encourages a healthy diet and promotes physical activity. Understanding the long-term health outcomes associated with promoting physical activity versus weight loss among the low-income population it serves could help guide the direction of future program efforts. We used the Future Americans Model (FAM), a microsimulation, to model over 10 years the impacts of changes in Body Mass Index (BMI) and exercise interventions on future health outcomes among adults aged 25 and older that could potentially accrue from SNAP-Ed interventions. We applied data from the Panel Study of Income Dynamics and data collected from 2,323 SNAP-Ed eligible adults in Los Angeles County in 2019. By 2029 interventions that increased vigorous physical activity by 20% would reduce the prevalence of difficulties with activities of daily living (ADL) by 4.72%. Interventions that would reduce BMI by 0.5 could decrease the prevalence of diabetes and heart disease by 5.34% and 0.66%, respectively. Helping people maintain weight loss, even as little as 3-4 lb, results in significant future health benefits. Given continued increases in weight at the population level, weight maintenance should be a focus of future interventions.
              Cover page: Simulating the impact of health behavior interventions in the SNAP-Ed population
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2019)
              The Los Angeles County Department of Public Health (DPH) launched the Nutrition Education and Obesity Prevention (NEOP) Project in fall 2013. As the local arm of the Supplemental Nutrition Assistance Program Education (SNAP-Ed), this project partnered with faith-based organizations (FBOs) in Los Angeles County to implement policy, systems, and environmental change interventions (PSEs) at selected church sites, alongside the usual delivery of health education. A 2-part programmatic assessment was conducted to better understand how the NEOP Faith Based Project at one of the FBOs was implemented during the 2013-2016 SNAP-Ed funding cycle. A qualitative component (key informant interviews) sought to understand and describe the PSE implementation process at each of the participating church sites, whereas the quantitative component (surveys) focused on assessing congregant perceptions about their awareness of the PSEs, their knowledge and beliefs about health, and their self-reported health behaviors after exposure to onsite changes. Among congregants who participated in the survey, 52% expressed desire for more health education classes. However, only 37% reported being aware of them at church sites that hosted them. When asked to compare their behaviors for "today" versus 6 months ago, more than half reported greater interest in eating more fruits and vegetables (66%), choosing water over soda (69%), and becoming more physically active (59%). Results from the NEOP Project have implications for how local health departments could partner with FBOs to outreach and promote health among congregants, particularly for those who are at high-risk of diet-related diseases due to poor nutrition and obesity.
                Cover page: Promoting congregant health in faith-based organizations across Los Angeles County, 2013–2016
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2017)
                This study examined the relationship between racial/ethnic residential segregation and access to health care in rural areas. Data from the Medical Expenditure Panel Survey were merged with the American Community Survey and the Area Health Resources Files. Segregation was operationalized using the isolation index separately for African Americans and Hispanics. Multi-level logistic regression with random intercepts estimated four outcomes. In rural areas, segregation contributed to worse access to a usual source of health care but higher reports of health care needs being met among African Americans (Adjusted Odds Ratio [AOR]: 1.42, CI: 0.96-2.10) and Hispanics (AOR: 1.25, CI: 1.05-1.49). By broadening the spatial scale of segregation beyond urban areas, findings showed the complex interaction between social and spatial factors in rural areas.
                  Cover page: Racial and ethnic residential segregation and access to health care in rural areas
                  • Article
                  • Peer Reviewed
                  Recent Work (2012)
                  In 2009, nearly 2.4 million adults in California reported having seriously thought about suicide during their lifetimes. Among these adults, more than half a million had thought seriously about suicide sometime during the past year. Members of sexual minorities were almost three times as likely as all adults in California to have had suicidal thoughts during the past year. This policy brief, based on data from the 2009 California Health Interview Survey (CHIS), presents a comprehensive overview of risk factors associated with suicidal thoughts among adults ages 18 and older and highlights differences in suicidal ideation among demographic groups and geographic regions in California.
                    Cover page: More Than Half a Million California Adults Seriously Thought About Suicide in the Past Year
                    • Article
                    • Peer Reviewed
                    UCLA Previously Published Works (2016)

                    Objectives

                    To examine whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care.

                    Methods

                    We linked Medical Expenditure Panel Survey (2005-2010) data to geographic data from the American Community Survey (2005-2009) and Area Health Resource File (2010). We categorized census tracts as rural and urban by using the Rural-Urban Commuting Area Codes. Respondent sample sizes ranged from 49 839 to 105 306. Outcomes were access to a usual source of health care, cholesterol screening, cervical screening, dental visit within recommended intervals, and health care needs met.

                    Results

                    African Americans in rural areas had lower odds of cholesterol screening (odds ratio[OR] = 0.37; 95% confidence interval[CI] = 0.25, 0.57) and cervical screening (OR = 0.48; 95% CI = 0.29, 0.80) than African Americans in urban areas. Whites had fewer screenings and dental visits in rural versus urban areas. There were mixed results for which racial/ethnic group had better access.

                    Conclusions

                    Rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply.
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