The Status of Evaluation and Research on Effective Interventions Serving Boys and Men of Color

The authors draw upon Chandler's Life Course Framework for Improving the Lives of Boys and Men of Color to focus on health outcomes. They argue that investing in health and educational outcomes could yield improved health behaviors and access to healthcare, and post positive returns in cognitive and socioemotional skills for boys of color. The authors aim to identify opportunities for interdisciplinary collaboration between educators and health care providers that can improve the overall life course for boys and men of color

Medi-Cal Versus Employer-Based Coverage: Comparing Access to Care

This report takes a close look at access to care under Medi-Cal for nonelderly adults and children on the eve of Affordable Care Act (ACA) implementation. Using data from the 2012 and 2013 California Health Interview Surveys (CHIS), the research examines a total of 49 measures (45 on realized and potential access and 4 on health status and health behaviors) for nonelderly adults and 31 measures (28 on realized and potential access and 3 on health status and behaviors) for children.For adults, access under Medi-Cal is compared to access under employer-sponsored insurance (ESI) overall; among Medi-Cal enrollees, access is compared across subgroups defined by region, race/ethnicity, language, and other dimensions. For children, access under Medi-Cal and Healthy Families together (referred hereafter simply as "Medi-Cal") is compared against access under ESI. To account for differences in health status and socioeconomic status between those with Medi-Cal and those with ESI, for each measure, three sets of analyses are presented: unadjusted percentages, predicted percentages adjusted for health care need, and predicted percentages adjusted for both health care need and socioeconomic status. The same approach is used in the analysis of regional and subgroup differences within the Medi-Cal population

Who Gets Needed Mental Health Care? Use of Mental Health Services among Adults with Mental Health Need in California

Background and Purpose. Timely and appropriate treatment could help reduce the burden of mental illness. This study describes mental health services use among Californians with mental health need, highlights underserved populations, and discusses policy opportunities. Methods. Four years of California Health Interview Survey data (2011, 2012, 2013, 2014) were pooled and weighted to the 2013 population to estimate mental health need and unmet need (n=82,706). Adults with mental health need had “unmet need” if they did not use prescription medication and did not have at least four or more mental health visits in the past year. Multivariable logistic regression analysis was performed to predict the probability adults with mental health need did not receive past-year treatment (n=5,315). Results. Seventy-seven percent of Californians with mental health need received no or inadequate mental health treatment in 2013. Men, Latinos, Asians, young people, older adults, people with less education, uninsured adults, and individuals with limited English proficiency were significantly more likely to have unmet need. Cost of treatment and mental health stigma were common reasons for lack of care. Conclusion. Unmet mental health need is predominant in California. Policy recommendations include continued expansion of mental health coverage, early identification, and ensuring that treatment is culturally and linguistically appropriate

Process Evaluation of the Los Angeles Unified School District Nutrition Network

IntroductionThis study evaluated the Los Angeles Unified School District Nutrition Network, a large multicomponent nutrition and physical activity program in an ethnically diverse school district, launched in 2000.MethodsWe calculated descriptive statistics and performed hierarchical logistic regression on school-level demographic and implementation data.ResultsThirty-six percent of eligible schools participated in 2001, and 79% of participating schools reapplied the following year. Elementary schools and schools that applied for grant money were more likely to re-apply. Produce sampling was the most frequently cited program highlight, and making purchases with program grant money was the most frequently cited challenge.ConclusionOur findings suggest that schools serving students of low socioeconomic status and diverse ethnicities can be recruited into a large program to promote healthy dietary choices and physical activity, especially elementary schools. Effectiveness and institutionalization of the program might be positively affected by fostering local ownership, allowing school personnel who apply for the grant to tailor the program to their individual schools

Reach of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) interventions and nutrition and physical activity-related outcomes, California, 2011-2012.

IntroductionThis study combined information on the interventions of the US Department of Agriculture's Supplemental Nutrition Assistance Program-Education with 5,927 interview responses from the California Health Interview Survey to investigate associations between levels of intervention reach in low-income census tracts in California and self-reported physical activity and consumption of fruits and vegetables, fast food, and sugar-sweetened beverages.MethodsWe determined 4 levels of intervention reach (low reach, moderate reach, high reach, and no intervention) across 1,273 program-eligible census tracts from data on actual and eligible number of intervention participants. The locations of California Health Interview Survey respondents were geocoded and linked with program data. Regression analyses included measures for sex, age, race/ethnicity, and education.ResultsAdults and children from high-reach census tracts reported eating more fruits and vegetables than adults and children from no-intervention census tracts. Adults from census tracts with low, moderate, or high levels of reach reported eating fast food less often than adults from no-intervention census tracts. Teenagers from low-reach census tracts reported more physical activity than teenagers in no-intervention census tracts.ConclusionThe greatest concentration of Supplemental Nutrition Assistance Program-Education interventions was associated with adults and children eating more fruits and vegetables and adults eating fast food less frequently. These findings demonstrate the potential impact of such interventions as implemented by numerous organizations with diverse populations; these interventions can play an important role in addressing the obesity epidemic in the United States. Limitations of this study include the absence of measures of exposure to the intervention at the individual level and low statistical power for the teenager sample

The changing landscape: tobacco and marijuana use among young adults in California.

Summary: Use of tobacco products in any form and long-term recreational marijuana use among young adults can be harmful to their health and well-being, according to the National Academies of Sciences, Engineering, and Medicine. This policy brief summarizes findings from the California Health Interview Survey (CHIS) that describe use of, reasons for, and preferences for tobacco and marijuana use among young adults amid a changing policy landscape. Findings: In 2018, 1.66 million young adults (ages 18 to 25) in California were using at least one form of cigarette, electronic cigarette (e-cigarette), or marijuana product. Cigarette smoking, which had remained flat after a continued decade-long decline, was offset in 2018 by escalating use of e-cigarettes and marijuana among young adults: E-cigarette use climbed 48%, and marijuana use rose by 19% over one year. In 2018, only 1 in 5 young adults (19%) in the state reported using e-cigarettes as a means of quitting, replacing, or reducing cigarette smoking. Flavored cigarettes and e-cigarettes were popular, with nearly 8 in 10 young adults (77.8%) reporting that they were vaping flavored e-cigarettes

Addressing Barriers to Breast Cancer Care in California: The 2016 - 2017 Landscape for Policy Change

In 2018, over 29,000 women will be diagnosed with breast cancer in California and an estimated 4,500 will die of the disease. While the Affordable Care Act (ACA) has successfully expanded access to health insurance and breast cancer care, numerous population subgroups remain uninsured, and many others may lack adequate coverage for treatment and management of their breast cancer. Although insurance improves breast cancer outcomes compared to those with no insurance, challenges may remain even for the insured. Among those insured, there appear to be significant barriers to cancer care as health insurance premiums are increasing, networks are narrowing, and as the cost of breast cancer drugs is increasing.This report provides a comprehensive assessment of the significant barriers and challenges to accessing breast cancer care in California through the  completion of three key tasks: (1) a synthesis of the peer reviewed literature, news media, reports and policy briefs, (2) completion of a series of key informant/stakeholder interviews, and (3) an analysis of social media. The authors find five categories of barriers: (1) Health System Barriers, (2) Insurance Barriers, (3) High Costs, (4) Individual and Cultural Characteristics, and (5) Language.Although many barriers are shared across insurance types, where possible, this report provides insight on barriers unique to the insurance status of women, specifically for the uninsured, those covered by Medi-Cal, and those covered by commercial insurance. Findings from this report can be used to guide efforts of policymakers to improve timely access to breast cancer care among all women in California

Economic Perspectives on Personalized Health Care and Prevention

The objective of this paper is to provide an overview of economic evaluation of personalized medicine, focusing particularly on the use of cost-effectiveness analysis and other methods of valuation. We draw on insights from the literature and our work at the University of California, San Francisco Center for Translational and Policy Research on Personalized Medicine (TRANSPERS). We begin with a discussion of why personalized medicine is of interest and challenges to adoption, whether personalized medicine is different enough to require different evaluation approaches, and what is known about the economics of personalized medicine. We then discuss insights from TRANSPERS research and six areas for future research

Language barriers to health care access among Medicare beneficiaries

This study examined language barriers to health care access among a population-based sample of Medicare seniors in California in 2001 and 2003. Results indicate that Medicare beneficiaries with limited English proficiency (LEP) had less access to a usual source of care and were less likely to receive preventive cancer screening tests. LEP Medicare beneficiaries who also were covered by Medicaid tended to fare better than those without Medicaid. This could be due to federal civil rights rules that require Medicaid health care providers to offer free language assistance, but exclude from these requirements physicians who provide only Medicare services. Findings suggest the federal government should take steps to reduce language barriers in Medicare