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Open Access Publications from the University of California

This series is automatically populated with publications deposited by UCLA Luskin School of Public Affairs Department of Social Welfare researchers in accordance with the University of California’s open access policies. For more information see Open Access Policy Deposits and the UC Publication Management System.

A Tale of Two Cities: Exploring the Role of Race/Ethnicity and Geographic Setting on PrEP Use Among Adolescent Cisgender MSM.

(2021)

Although pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV acquisition among adolescent cisgender men who have sex with men (cisMSM), various barriers faced by people of color, particularly within the southern region of the U.S., may lead to racial disparities in the utilization of PrEP. Few studies, however, have explored racial/ethnic differences in PrEP use by geographic setting among adolescent cisMSM. We conducted a cross-sectional analysis examining racial disparities in PrEP use among cisMSM ages 15-24 years in New Orleans, Louisiana, and Los Angeles, California recruited between May, 2017 and September, 2019. The odds of PrEP use among AA adolescents were considerably lower than White adolescents in New Orleans (OR (95% CI): 0.24 (0.10, 0.53)), although we did not find evidence of differences in Los Angeles. Our findings underscore the need for targeted interventions to promote PrEP use among adolescent MSM, particularly among AA adolescent cisMSM living in the southern region of U.S.

Cover page of Who Profits from Crisis? Housing Grabs in Time of Recovery

Who Profits from Crisis? Housing Grabs in Time of Recovery

(2020)

In Los Angeles, and across the United States, the COVID-19 pandemic has expanded and exposed social and economic inequalities. It has also become starkly apparent that such inequalities are structured through racialized risk, the disproportionate and systematic exposure of working-class communities of color to unemployment, unsafe jobs, eviction, homelessness, displacement, and wealth loss. In this research brief, we draw attention to how crisis serves as the opportunity for housing grabs, by which we mean the unregulated acquisition of residential property by powerful corporate actors. With a focus on Los Angeles, we show how the Great Recession set the stage for a significant expansion of the corporate control of residential property in working-class communities of color and argue that there will be a similar capitalization of distress in such communities over the next few years. Dispensing of the myth of “mom and pop landlords,” we provide the first robust analysis of the different types of corporate landlords active in Los Angeles and the varied strategies of profit-making that they deploy in wealth accumulation.

Cover page of Hotel California: Housing the Crisis

Hotel California: Housing the Crisis

(2020)

Los Angeles is on the cusp of a surge in evictions and homelessness, with thousands of households impacted by the COVID-19 pandemic likely to lose their housing. They will join the many thousands of Angelenos who are already unhoused in what is likely to be one of the largest mass displacements to unfold in the region. Black and Brown communities will bear the brunt of the crisis. Where will the currently unhoused and the newly unhoused go? Given the political failure to enact the tenant protections that would keep people in their homes, what are the plans for housing provision that must be put into place, without further ado, in order to meet this crisis? This report, the second publication in our Housing Justice in the Time of COVID-19 series, answers these pressing questions by laying out a comprehensive framework for the conversion of hospitality properties into housing through the large-scale public acquisition of tourist hotels and motels. We insist on immediate access to housing without conditions and with the guarantees of habitability and tenant rights. In addition, we argue for the conversion of such hotels and motels into social housing. In Los Angeles, publicly subsidized hotel development has mediated an extractive relationship between capital and community. It is time to redirect public resources and public purpose tools such as eminent domain for housing, especially in Black and Brown communities where public investment has primarily taken the form of policing and where the devastation of impending evictions will be most acutely felt.

Cover page of The Impact of Mental Health Conditions on Public Insurance Costs of Treating HIV/AIDS.

The Impact of Mental Health Conditions on Public Insurance Costs of Treating HIV/AIDS.

(2020)

Medicare and Medicaid insurance claims data for Californians living with HIV are analyzed in order to determine: (1)The prevalence of treatment for particular mental health diagnoses among people living with HIV (PLWH) with Medicare or Medicaid insurance in 2010; (2)The relationship between individual mental health conditions and total medical care expenditures; (3)The impact of individual mental health diagnoses on the cost of treating non-mental health conditions; and (4)The implications of the cost of mental health diagnoses for setting managed care capitation payments. We find that the prevalence of mental health conditions among PLWH is high (23% among Medicare and 28% among Medicaid enrollees). PLWH with mental health conditions have significantly higher treatment costs for both mental health and non-mental health conditions. Setting managed care capitations that account for these greater expenditures is necessary to preserve access to both mental health and physical health services for PLWH and mental health conditions.

Missed Opportunities for HIV Screening of New Enrollees in California's Low Income Health Program.

(2020)

The objective of this study was to measure HIV screening rates and variables associated with screening among new enrollees in California's Low Income Health Program (LIHP). A logit model was used to estimate associations between HIV screening and enrollment, claims, and encounter data for enrollees. HIV prevalence among new LIHP enrollees was 1.2%xd. Among 42,550 new LIHP enrollees with no prior HIV diagnosis, only 27% received screening within 12 months of their first medical evaluation. A total of 350 new HIV diagnoses were identified (incidence rate of 0.8%), exceeding the 0.1% level at which the Centers for Disease Control and Prevention (CDC) recommends routine HIV screening. California reduced screening barriers by removing required written informed consent and pretest counseling; the Affordable Care Act (ACA) eliminated cost-sharing and enhanced access. Removing financial and administrative barriers to HIV screening is necessary, but may be insufficient to reach CDC's recommended screening targets.

Cover page of Metodologías para la justicia de la vivienda: Guia de recursos

Metodologías para la justicia de la vivienda: Guia de recursos

(2020)

Esta Guía de Recursos es el resultado de un Instituto de Verano sobre Metodologías para la Justicia en la Vivienda convocado por el Instituto sobre Desigualdad y Democracia de UCLA Luskin como parte de la Red de Justicia en la Vivienda en Ciudades Desiguales, que es apoyada por la Fundación Nacional de Ciencias (BCS 1758774). Celebrado en Los Ángeles en agosto de 2019, el Instituto de Verano reunió a participantes de ciudades de todo el mundo. Al igual que el alcance y el propósito general de la Red de Justicia en las Ciudades Desiguales, creó un terreno compartido de para estudiosos del movimiento y académicos de universidades. Con una insatisfacción a los métodos canónicos que se utilizan en los estudios sobre la vivienda y guiado por los movimientos de justicia de la vivienda que son comunidades de investigación activa, el Instituto de verano se basó en la afirmación de que la metodología es política. La metodología se basa en argumentos sobre el mundo e implica relaciones de poder y conocimiento. El método por sí mismo -ya sea el contra ataque al mapeo o los diarios de la genteno asegura una ética de solidaridad y un propósito de justicia. Tales objetivos requieren metodologías para la liberación. Por lo tanto, como es evidente en esta Guía de Recursos, nuestro esfuerzo pone en primer plano los métodos innovadores que están siendo utilizados por los investigadores en todo el mundo académico y el activismo y sitúa explícitamente tales métodos en una orientación hacia la vivienda la justicia.

Cover page of Withdrawal effects confounding in clinical trials: another sign of a needed paradigm shift in psychopharmacology research.

Withdrawal effects confounding in clinical trials: another sign of a needed paradigm shift in psychopharmacology research.

(2020)

Randomized controlled trials' ability to produce evidence useful for people to decide whether to take, continue taking, or stop taking psychotropic drugs has been intensely critiqued, along with the trials' commercial, ideological, and regulatory contexts. This article applies the critique to the topic of withdrawal effects confounding the outcomes of relapse-prevention trials where prescribed psychotropic drugs are discontinued. Until recently, the complexity and reach of withdrawal and post-withdrawal effects were neglected by mainstream psychiatry, but not by lay users of prescribed psychotropics. This article discusses withdrawal effects as part of the pharmacology of psychotropic drugs but shaped by psychosocial factors, and possibly shaping the presentation of psychological distress generally. It outlines biases and misconceptions in assumptions, design, and reporting of general efficacy trials and findings from a recent review of 80 discontinuation trials. In theory, relapse-prevention trials are tautological and exaggerate efficacy. In publications, they pay little attention to the central feature of their design, favor abrupt or rapid discontinuations, do not attend to environmental factors, and provide insufficient data to allow re-analyses. Thus, relapse-prevention RCTs likely confound the detection of their main outcome of interest: "relapse." Using slower tapers, active placebo controls, and specific covariates in analyses would reduce the risk of withdrawal confounding, and better reporting would reduce the opaqueness of trials. The crisis in psychopharmacology is fueled partly by the disconnect between claims of therapeutic efficacy from so-called best-evidence methods despite unchanging population-level indicators of psychiatric sickness. Only by "stacking the deck" against trial sponsors' hoped-for outcomes can psychopharmacology trials regain scientific credibility.

Cover page of Methodologies for Housing Justice Resource Guide

Methodologies for Housing Justice Resource Guide

(2020)

This Resource Guide is the outcome of a Summer Institute on Methodologies for Housing Justice convened by the Institute on Inequality and Democracy at UCLA Luskin as part of the Housing Justice in Unequal Cities Network, which is supported by the National Science Foundation (BCS 1758774). Held in Los Angeles in August 2019, the Summer Institute brought together participants from cities around the world. As is the case with the overall scope and purpose of the Housing Justice in Unequal Cities Network, it created a shared terrain of scholarship for movement-based and university-based scholars. Dissatisfied with the canonical methods that are in use in housing studies and guided by housing justice movements that are active research communities, the Summer Institute was premised on the assertion that methodology is political. Methodology is rooted in arguments about the world and involves relations of power and knowledge. The method itself – be it countermapping or people’s diaries – does not ensure an ethics of solidarity and a purpose of justice. Such goals require methodologies for liberation. Thus, as is evident in this Resource Guide, our endeavor foregrounds innovative methods that are being used by researchers across academia and activism and explicitly situates such methods in an orientation towards housing justice.

Cover page of The Effect of Hospice on End-of-Life Costs for Terminal Medicare Patients With HIV.

The Effect of Hospice on End-of-Life Costs for Terminal Medicare Patients With HIV.

(2020)

One-quarter of annual Medicare expenses in the traditional program (non-Medicare Advantage) are expended for 5% of Medicare enrollees, with much of this expenditure occurring in the last year of life. Hospice use may reduce end-of-life costs. However, evidence has been inconclusive due to sample selection and differences in insurance coverage for hospice. Claims data for HIV-positive Californians enrolled in Medicare who died in the period 2008 to 2010 were used to examine the relationship between hospice use and costs in the last 6 months of life. Logit estimates related hospice use to sickness levels and demographics. Inpatient and outpatient costs were analyzed separately. Logit regressions examined hospitalization probability. Robust regressions were used to examine the determinants of conditional inpatient costs and non-inpatient costs. Bootstrapped post-estimates were then used to determine the marginal probability of costs for the sample by hospice use. Hospice users have greater disease burden and are less likely to be African American. Controlling for disease burden, hospice users would have non-inpatient costs that were $14 771 greater than hospice non-users, but inpatient costs that were $20 522 lower. Thus, hospice reduces costs on net. Hospice is chosen by patients with more comorbidities. Controlling for these comorbidities, hospice use is associated with lower inpatient costs, greater non-inpatient costs and reduced end-of-life costs.

Cover page of Trauma, Post-Migration Stress, and Mental Health: A Comparative Analysis of Refugees and Immigrants in the United States.

Trauma, Post-Migration Stress, and Mental Health: A Comparative Analysis of Refugees and Immigrants in the United States.

(2019)

Numerous studies describe mental health effects of pre-migration trauma and post-resettlement stress among refugees, yet less research examines these associations with non-refugee immigrants. Additionally, few studies assess the prevalence and impact of traumatic experiences after settlement in a new country. Using a U.S.-based representative sample of Asian (n = 1637) and Latino (n = 1620) refugees and immigrants, we investigated how traumatic events prior to and after migration, and post-migration stressors, are associated with mental illness and distress. Pre-migration trauma posed risk across a broad range of psychological outcomes for Asian refugees and Latino immigrants. Deleterious effects of post-migration trauma were notable for both groups of refugees and immigrants. Discrimination, acculturative stress, and family conflict increased risk for disorder and distress across groups in complex ways. Findings highlight the importance of examining trauma and stress at pre- and post-migration phases across migrant populations, including those not labeled as refugees.