Estimating the costs and benefits of providing free public transit passes to students in Los Angeles County: lessons learned in applying a health lens to decision-making.

In spite of increased focus by public health to engage and work with non-health sector partners to improve the health of the general as well as special populations, only a paucity of studies have described and disseminated emerging lessons and promising practices that can be used to undertake this work. This article describes the process used to conduct a Health Impact Assessment of a proposal to provide free public transportation passes to students in Los Angeles County. This illustrative case example describes opportunities and challenges encountered in working with an array of cross-sector partners and highlights four important lessons learned: (1) the benefits and challenges associated with broad conceptualization of public issues; (2) the need for more comprehensive, longitudinal data systems and dynamic simulation models to inform decision-making; (3) the importance of having a comprehensive policy assessment strategy that considers health impacts as well as costs and feasibility; and (4) the need for additional efforts to delineate the interconnectivity between health and other agency priorities. As public health advances cross-sector work in the community, further development of these priorities will help advance meaningful collaboration among all partners

Public Health Law Analysis of Shared Use Agreements in Los Angeles County,

Los Angeles County communities have implemented a variety of shared use arrangements to promote physical activity among residents who live near schools. However, little has been documented or is presently known about the strengths and limitations of these legal arrangements for achieving this goal. This legal analysis addresses a gap in public health practice. A public health law analysis was conducted to review 20 shared used agreements implemented in Los Angeles County during 2010-2014. Some schools and communities have entered into lengthy, detailed contracts; others have opted for simple applications, licenses, and permits; others have used memoranda of understanding. Findings suggest that regardless of the legal mechanism used to document the parties’ intentions, including language that describes each party’s interest in community health, health equity, and long-term sustainability represents a best practice that should be considered in every shared use agreement

An International Comparison of Attitudes Toward Traditional and Modern Medicine in a Chinese and an American Clinic Setting

Introduction. International comparative research on traditional medicine (TM) offers a useful method for examining differences in patient characteristics and can provide insight into: (i) more universal characteristics which may cross cultures and international borders; (ii) unique characteristics influenced by regional/national factors; and (iii) cultural values of immigrant populations. To explore these issues TM patients from the United States and China were compared. Methods. Data collection took place at two TM college clinics. A convenience sample of 128 patients in China and 127 patients in the United States completed a 28-item questionnaire. Results. There was a marked similarity between the two patient groups in terms of the biological characteristics of age and gender. Musculoskeletal issues were the most common presenting complaints in the United States; while in China TM was used for a more diverse array of conditions. The majority of patients in both countries had initially used allopathic medicine (AM); significantly, more of the United States respondents stopped allopathic treatment after beginning traditional treatment. In comparing the two countries, patients in China were significantly more satisfied with AM and American patients significantly more satisfied with TM. In comparing the two medicines, the patient samples in both countries were significantly more satisfied with TM than AM. Discussion. Although treatment often originated with allopathic providers, many patients sought alternatives presumably to find the best solution to their problems. This tendency toward self-assignment suggests that a pluralistic healthcare system may provide the greatest satisfaction resulting from personal choice and improved outcomes

Youths\u27 Perspectives on the Reasons Underlying School Truancy and Opportunities to Improve School Attendance

School truancy is common in the United States; however, youths’ perspectives on the underlying reasons for and the best ways to curtail this phenomenon are lacking. This project sought to better understand what factors contribute to youths’ decisions to skip classes or ditch full days of school over time and to solicit youths’ recommendations on how to reduce truancy and improve system functioning. We used a community partnered qualitative descriptive approach to conduct in-depth interviews with 39 youths with a history of truancy from South and East Los Angeles. Youths’ experiences and recommendations illustrate the multiple factors that influence school truancy and suggest potential leverage points for reducing truancy, including modifications to the school environment to increase student engagement; a more effective school response to address truancy; and further involvement and engagement of parents. Researchers, policy makers, and school practitioners can use results to help inform efforts to address school truancy

Evaluating Streetscape Modifications in Los Angeles, California with a Health Lens

Background and Purpose: Despite growing evidence linking health and the built environment, local health departments are often not involved in the evaluation of a streetscape modification project. This paper describes an assessment conducted by a local health department to address this gap by using a health lens to evaluate the installation of painted curb extensions on a commercial corridor in Los Angeles. Methods: The local health department conducted an observational pre-post study of pedestrian and motorist data at both an intersection receiving the painted curb extension and a comparison intersection along the same corridor that had already received the extension. The study also analyzed streetscape features along the corridor related to walkability, to understand the painted curb extension in the context of the broader built environment. Results: The painted curb extension did not appear to significantly impact pedestrian and motorist behavior, though some slight changes were observed. Pedestrians along the corridor generally exhibited safe behavior at intersections, but encountered dangerous driver behavior and built environment barriers, which can discourage walking. Conclusion: This case study demonstrates how health considerations can be integrated into an evaluation of a streetscape modification project, and can provide guidance for other health practitioners developing such evaluation projects in their own jurisdictions

A study of mechanics of triaxial fabrics

M.S.W. Denney Freeston, Jr

The Influence of Gender and Self-Efficacy on Healthy Eating in a Low-Income Urban Population Affected by Structural Changes to the Food Environment

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

Utility of Anthropometric Measures in a Multiethnic Population: Their Association with Prevalent Diabetes, Hypertension and Other Chronic Disease Comorbidities

Body mass index (BMI) and waist circumference (WC) are two common anthropometric measures of obesity in clinical and public health practice. Consensus, however, remains elusive regarding their utility for predicting cardiovascular disease risk in multiethnic populations. We address this gap in the literature by analyzing cross-sectional data from the first round of the Los Angeles County Health and Nutrition Examination Survey, 2011. We characterized the relationships between BMI, WC, waist-to-hip ratios, waist-to-height ratios, and chronic disease extent, as confirmed by the presence of hypertension, diabetes, and/or two or more other chronic conditions as defined by a composite indicator ‘comorbidity’. To account for race/ethnicity, age, gender, and cigarette smoking frequency, adjusted odds ratios (aOR) were generated and reported for each of the regression analyses. Whereas being overweight was associated with hypertension alone (aOR 2.10; 95% CI 1.12–3.94), obesity was associated with hypertension (aOR 5.04; 95% CI 2.80–9.06) as well as diabetes (aOR 5.28; 95% CI 2.25–12.3) and comorbidity (aOR 3.69; 95% CI 2.02–6.77). In whites and African-Americans, BMI and WC were positively related to diabetes, hypertension and comorbidity. In Hispanics, BMI and WC were also positively related to diabetes and comorbidity, but only the former measure was associated with hypertension (p\u3c0.050). In Asians, BMI was not a significant predictor of diabetes, hypertension and/or comorbidity. Collectively, the findings suggest that BMI is not universally informative and waist circumference and its derivatives may represent a viable, more racially/ethnically appropriate alternative for use with selected minority groups