UCLA researchers implement, evaluate effectiveness of pilot health-promotion program.

Wendy Slusser, UCLA

FINDINGS:
Research has shown that children from low-income neighborhoods are at higher risk of being obese and overweight than children from affluent neighborhoods; in fact, one-third of low-income children enter kindergarten either overweight or obese.

In an effort to address this issue, UCLA researchers implemented and evaluated the effectiveness of a pilot after-school health-promotion program that focused on increasing students’ opportunities for physical activity and healthy snacks — and boosting their knowledge about physical activity and nutrition — at four low-income, diverse elementary schools in Los Angeles County (four additional school sites were used as comparisons). The study involved students in grades 3 through 5.

After-school staff members were trained by UCLA researchers to implement the evidence-based, sequential nutrition and physical activity curriculum. Data were collected by researchers on students’ nutrition and physical activity knowledge and behavior, and their height and weight measurements, at the beginning and end of the academic year.

Results showed that the proportion of children who were obese or overweight in the intervention group decreased by 3.1 percent by the end of the school year, compared with a 2.0 percent reduction among children in the comparison group. The study found mixed results regarding diet and physical activity knowledge and behavior.

The authors conclude that enhancing after-school physical activity opportunities through evidence-based programs can potentially benefit low-income children who are overweight or obese.

IMPACT:
Findings from this study indicate that after-school programs have the potential to provide opportunities for enhanced physical activity and the development of healthy habits in children from socioeconomically disadvantaged families who may have limited access to nutritious foods and environments conducive to physical activity outside of school.

In addition, as approximately 60 percent of the students in the study were Asian American, the study helps address the dearth of published research on childhood obesity among Asian Americans. This is an important public health concern, given that Asian Americans are the fastest growing racial group in the U.S., and the literature suggests that current definitions of obesity underestimate the disease risk among this subgroup, the study authors said.

AUTHORS:
Study authors included Dr. Wendy M. Slusser, Michael L. Prelip, Mienah Z. Sharif and Janni J. Kinsler of UCLA; Jennifer Toller Erausquin of the North Carolina Division of Public Health; and Daniel Collin of California State University, Long Beach.

JOURNAL:
The article, “Improving Overweight Among At-Risk Minority Youth: Results of a Pilot Intervention in After-School Programs,” is published in a supplement to the current edition of  the Journal of Health Care for the Poor and Underserved.

FUNDING:
The study was supported by funds from the California Vitamin Settlement Fund (#20063972).

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UC Davis Health System invites patients to share sexual orientation, gender ID information.

UC Davis Health System will become the first academic health system in the country to incorporate sexual orientation and gender identity as standard demographic elements within the electronic health records for its patients. UC Davis physicians and patient advocates say the new measure is an important step toward improving health care for lesbian, gay, bisexual and transgender (LGBT) individuals who often have avoided medical clinics out of fear of being humiliated or rejected.

Today, the health system posted a questionnaire that invites its patients to share their sexual orientation (attraction to one’s own gender or a different gender) and gender identity (the gender an individual identifies with) with their providers. The questionnaire is accessible to about 76,000 patients who use UC Davis’ secure, online communications system to schedule appointments, request prescription refills and exchange messages with their physician’s office.

“Patients and physicians, even in the clinical setting, are not very good at talking about sex,” said Edward Callahan, professor of family and community medicine and one of the key coordinators for the new initiative. “Unfortunately, the problem is more than just one of embarrassment. LGBT individuals face significant health challenges that can be better addressed when a doctor’s office is seen as a truly welcoming and understanding environment. We’re inviting patients to voluntarily share their gender identity and sexual orientation information to help us create an atmosphere in which we’re able to provide the most knowledgeable and informed care possible.”

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UC’s California HIV/AIDS Research Program funds three projects to help curb HIV.

Studies funded by UC’s California HIV/AIDS Research Program hope to curb HIV in the state by engaging people at high risk in innovative prevention efforts in their communities.

Last year, Grant Lindsey visited Oakland’s Downtown Youth Clinic for the first time, accompanying his partner who was being treated there for HIV. Lindsey is not HIV-positive, but this was a new relationship, and he was there to offer help and encouragement.

“I really wanted to support my partner, and I wanted to get educated for myself,” he said. “I wanted to get up to date as far as HIV and safe sex were concerned.”

While at the clinic, Lindsey was tested for HIV. He also talked with the clinic director and medical staff about his new relationship, and he got answers to questions that had been worrying him.

Soon, he was volunteering for a new study to test an HIV prevention pill (Truvada), which has been found to protect uninfected persons against the virus. This prevention pill is part of a new strategy called PrEP (pre-exposure prophylaxis) that includes taking the daily antiretroviral medication, Truvada, which was approved last year by the FDA. Truvada is provided for the study by its maker, Gilead Sciences, Inc.

This bold research, which is funded by UC’s California HIV/AIDS Research Program (CHRP), engages people at high risk for HIV infection in an innovative new biomedical prevention effort in their communities. The study in Oakland and other East Bay cities is one of three PrEP research projects funded by CHRP to help curb HIV in California. The combined effort is the largest PrEP demonstration project in the U.S. (See “Combining a prevention pill with community treatment programs“)

“I didn’t know anything about this,” said Lindsey. “It’s amazing. HIV is still rampant, and not enough people are talking about it.”

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Related link:
UCTV: HIV: Past present and future — Mini Medical School for the public presented by UCSF Osher Center for Integrative Medicine

UCLA study is first to examine the burden of the disease on the population.

Karim Chamie, UCLA

Researchers at UCLA’s Jonsson Comprehensive Cancer Center led by Dr. Karim Chamie have found that more intense surveillance and treatment of bladder cancer in the first two years after diagnosis could reduce the number of patients whose cancer returns after treatment and lower the disease’s death rate. The study was published online ahead of press today (June 4) in the journal Cancer.

Based on the team’s previous research showing underutilization of care for patients with bladder cancer, this study is the first to examine the burden of the disease on the population. To date no one had examined the morbidity of recurrence of the disease in the U.S.

Chamie, assistant professor-in-residence in the UCLA department of urology, and his colleagues found that nearly three quarters of patients with high-grade, non–muscle-invasive bladder cancer suffered a return of the disease within 10 years. In 33 percent of patients, the cancer progressed to a more advanced form requiring removal of the bladder, radiation therapy or systemic chemotherapy. And in an additional 41 percent, the cancer recurred without further spread of the disease.

“Even though 80 percent of bladder cancer patients don’t die of their disease within five years, most patients will either die of other causes or bladder cancer, require aggressive treatment — removal of the bladder, radiation and/or chemotherapy — or have a recurrence of the disease,” Chamie said. “This study highlights the need to comply with treatment guidelines to prevent recurrences by instilling anticancer agents inside the bladder and following patients more closely within the first two years of diagnosis.”

The study was based on a nationwide sample of Medicare beneficiaries who had high-grade, non–muscle-invasive bladder cancer. “We have Level I evidence that demonstrates that a single instillation of chemotherapy into the bladder can minimize recurrences, and that six instillations can minimize recurrence and progression,” Chamie said. “Efforts should be increased to offer patients intravesical therapy with the goal of minimizing the burden of this disease.”

The researchers also found that the burden of bladder cancer on the population is very high, and that the elderly, women and African-American patients had a higher likelihood of dying of bladder cancer than younger patients, men and white patients, respectively.

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UCSF pediatrician: “The best thing to replace soda is water or milk.”

While there has been a steep decline in kids’ consumption of sugar-sweetened beverages in California, African-American and Latino children may be replacing soda with 100 percent fruit juice while their white peers are not, according to a new study from UC San Francisco.

The study was the first to compare trends of sugar-sweetened beverages and 100 percent juice consumption in California.

“The decrease in the consumption of sugar-sweetened beverages among kids is a promising public health trend,” said Amy Beck, M.D., M.P.H., lead author and pediatrician at UCSF Benioff Children’s Hospital and San Francisco General Hospital and Trauma Center. “But it is concerning that minority children are increasing their consumption of 100 percent fruit juice, which often has just as much sugar as soda.”

Researchers examined data from the California Health Interview Survey, a telephone survey conducted every two years from 2003 to 2009, which asked parents how many servings of sugar-sweetened beverages and 100 percent fruit juice their children, ages 2 to 11, consumed the day before.

“Parents who are thinking actively about nutrition wouldn’t give their kids Coca-Cola, but might give apple juice,” said Beck. “But 8 ounces of Coca-Cola contains 27 grams of sugar, as does 8 ounces of apple juice. We need to make sure parents understand the best thing to replace soda is water or milk.”

The results are published in the June/July issue of journal of Academic Pediatrics.

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Patients in “medical homes” more likely to get flu shots, receive regular care.

Too many cooks may spoil a recipe, and too many doctors may give you the flu.

That’s the takeaway from a new study by the UCLA Center for Health Policy Research that found that Californians who jump from provider to provider rather than seeing a regular doctor who coordinates their care may be less likely to get the kind of preventive treatment that protects against the flu and flare ups in their chronic conditions.

Specifically, the study used data from the 2009 California Health Interview Survey (CHIS) to estimate whether the approximately 4.76 million California adults with chronic conditions such as diabetes, asthma and heart disease had three key characteristics of “medical home” care. Those three characteristics are:

• The patient saw a regular doctor over time rather than switching from provider to provider.
• This regular doctor developed an individual treatment plan for the patient.
• The doctor coordinated the patient’s care.

The result? Californians who had all three of these characteristics were the most likely to get a regular flu shot, compared with those without a usual source of care. They were also more likely to have seen their doctor five or more times in the past year and to have called their doctor with a question about their care. Additionally, they were the most confident about their ability to manage their health.

“Seeing the same doctor over time builds familiarity, trust and confidence for both provider and patient,” said Nadereh Pourat, the UCLA center’s director of research and lead author of the study. “And if that doctor takes a coordinated approach to their patients’ care, there seems to be a big payoff in terms of better health for their patients.”

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Program to air May 30.

Sergio Aguilar-Gaxiola, UC Davis

Sergio Aguilar-Gaxiola, a UC Davis physician and internationally renowned expert on mental health and other conditions that frequently impact underserved populations, will appear in a documentary titled “A New State of Mind: Ending the Stigma of Mental Illness,” set to air Thursday, May 30, at 9 p.m. on Sacramento PBS station KVIE-Channel 6.

The documentary tells stories of hope, resilience and recovery for Californians who have battled mental illness. Aguilar-Gaxiola, professor of clinical internal medicine and director of the UC Davis Center for Reducing Health Disparities, was interviewed about the current state of mental health services and what needs to be done to expand access to culturally and linguistically appropriate care.

In 2012, Aguilar-Gaxiola led a team of researchers who published a report for the state of California on ways to address mental health care disparities for Latinos. The recommendations were based on feedback from consumers and their families, advocates, service providers, educators, students, researchers and policymakers throughout the state who participated in intensive town hall meetings or focus groups.

During the past 25 years, Aguilar-Gaxiola has directed several research initiatives focused on identifying the unmet mental health needs of immigrant populations and on developing community-based approaches to reducing disparities for those whose needs are not well served by traditional health care systems. He also has translated his research outcomes into practical information for providers and administrators to guide policy decisions about program development, interventions and services.

“A New State of Mind: Ending the Stigma of Mental Illness” was produced by KVIE, narrated by award-winning actress Glenn Close and funded by the voter-approved Mental Health Services Act (Proposition 63) as part of California Mental Health Services Authority’s Stigma and Discrimination Reduction Initiative. A trailer for the documentary can be viewed at www.eachmindmatters.org/great-minds-gallery.

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Past trauma, poor understanding of health care services is common, UC Davis study finds.

MESO staff member Rusul Tawffeq interviewed Iraqi refugees to learn about their current health conditions and challenges in accessing health care.

Past trauma and a lack of understanding of the U.S. health care system are key factors affecting the mental and physical health of Iraqi refugees in Sacramento, according to a new report released today (May 20) by UC Davis’ Center for Reducing Health Disparities and Clinical and Translational Science Center as well as two community groups  that serve refugee populations — Opening Doors Inc. and the Mesopotamia Organization (MESO).

The report, entitled “Mental and Physical Health of Recent Iraqi Refugees in Sacramento, California,” represents the views of 34 Iraqi men and women who lived in the Sacramento area from December 2008 to August 2012 and who agreed to share details about their current health conditions and the challenges they encountered while accessing health care services. It is the first study to assess the unmet health care needs of the Iraqi refugee population in Sacramento, one of the fastest growing ethnic groups in the region.

The study found that 79 percent of Iraqi refugees reported trauma as a major health concern, with insomnia (59 percent), depression (44 percent), headaches (41 percent), and fear (38 percent) as the most common physical and psychological symptoms experienced. These findings mirror previous health assessments of Iraqi refugees conducted in other U.S. cities, which also found depression, anxiety and post-traumatic stress disorder among the most common conditions affecting individuals who have fled war-torn Iraq.

Sacramento Iraqi refugees also believe the U.S. health care system is costly and difficult to understand and access. They were especially confused by the specialty care referral process, the separation of dental and vision care services, and the seemingly arbitrary nature regarding conditions that insurance plans cover. These factors, they said, were compounded by their inability to understand medical terminology, as many were still learning to speak English, and primary care providers’ lack of knowledge of Iraqi refugees, their health needs and the effects of trauma on mental and physical health.

The report also found that the vast majority of Iraqi refugees did not access mental health care, either due to a lack of knowledge about options, unwillingness to bring up the subject of trauma with providers, or cultural and linguistic barriers to understanding how mental health is viewed and treated in the U.S. To cope with their mental health needs, the group relied most on friends and family members (91 percent), religion and faith in God (65 percent) and exercise and sports (44 percent).

“Untreated mental health needs are very common problems, creating significant burdens for individuals and their families and reducing productivity and quality of life,” said Linda Ziegahn, community engagement and research program manager at the UC Davis Center for Reducing Health Disparities and an author of the study.

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Supports outreach, education to underserved populations about obtaining health insurance.

Sergio Aguilar-Gaxiola, UC Davis

The UC Davis Center for Reducing Health Disparities and UC Berkeley’s Health Initiative of the Americas each have received $1 million grants from Covered California, the state’s health insurance marketplace, to provide outreach and education to underserved populations about obtaining health insurance.

The agency is awarding 48 grants totaling $37 million.

The primary targets of Covered California’s outreach and education efforts are the estimated 5.3 million Californians projected to be uninsured or eligible for tax credit subsidies in 2014. Later this fall, Covered California will offer the state’s residents access to health care through marketplaces established through the federal Patient Protection and Affordable Care Act. Coverage will be available Jan. 1, 2014.

The UC Davis center will partner with El Concilio, the Council for the Spanish speaking, in a collaboration called Nuestra Salud es Primero (Our Health Comes First), to educate nearly 133,000 primarily Spanish-speaking Central Valley residents about Covered California. The grant begins July 1 and ends in December 2014.

The Center for Reducing Health Disparities was selected as an outreach partner because of its expertise in educating diverse underserved groups about health. With its partner El Concilio, it will reach out to Latinos eligible for affordable health insurance programs through Covered California. Efforts will focus on Latinos who live in counties in the Central Valley (Sacramento, Yolo, El Dorado, Placer, San Joaquin, Stanislaus, Merced, Madera, Fresno and Kern).

Fifty-four percent of California Latinos are uninsured — one in four from birth to age 64, said Sergio Aguilar-Gaxiola, the center’s director and a clinical professor of internal medicine.

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UC Davis event targets Asian-American adults.

A UC Davis medical student prepares to draw blood for hepatitis screening test.

Asian Americans and adult children of foreign-born Asian Americans are invited to a free hepatitis B screening event Sunday (May 19) at the UC Davis Comprehensive Cancer Center.

The event, from 10 a.m. to 2 p.m., is being held in recognition of Asian Pacific Islander Heritage Month and National Hepatitis Testing Day. It is funded with a federal grant aimed at boosting hepatitis B screening and preventing liver cancer in the Asian-American community.

“Our goal is to screen 1,000 foreign-born or children of foreign-born Asian Americans who are 18 years of age or older, and who are from areas where hepatitis B is endemic,” said Julie Dang, a community health program supervisor at the UC Davis Comprehensive Cancer Center and study program manager.

One of every 10 Asian Pacific Islanders has hepatitis, and most do not know they have been infected because often there are no symptoms. Untreated, hepatitis B virus can lead to liver cancer. Nearly 80 percent of liver cancer cases in Asian Americans can be directly traced to the Hepatitis B virus infection.

Screening participants who test negative and need vaccination will be put on a waiting list and contacted when vaccines become available.  All participants will receive a phone call and a result letter regarding their status.

“Individuals who test positive will receive individual counseling sessions to help them understand their status and get referrals for  care,” said Dang.

Additional event offerings will include risk-factor screenings (hepatitis C, diabetes and blood pressure), health education and light refreshments. All participants will receive a $10 Walmart gift card for their contribution to the study.

The event is co-sponsored by the Asian American Network for Cancer Awareness, Research and Training (AANCART), a national organization that is headquartered at the cancer center

The UC Davis Comprehensive Cancer Center is at 4501 X St. in Sacramento. To RSVP for the event, please contact Tina Fung at (916) 734-5371, or email her at tina.fung@ucdmc.ucdavis.edu.

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UCLA, partners to conduct two community-based trials of stroke-prevention interventions.

Barbara Vickrey, UCLA

UCLA researchers and their partners across Los Angeles County have been awarded an $11 million federal grant to fund research on community-based interventions aimed at reducing the higher rates of stroke and death from stroke among disadvantaged Hispanics, African Americans and Asian Americans.

Research has shown that stroke risk can be substantially lowered by increasing physical activity, controlling blood pressure, adopting a healthy diet, quitting smoking, lowering cholesterol and, for certain individuals, taking medication like aspirin.

However, the underserved populations targeted by this research program are frequently prevented from achieving these health goals by a variety barriers, including a lack of transportation for doctor visits, an inability to afford medication, insufficient knowledge about how to change their lifestyle, living in neighborhoods where infrastructure or safety concerns prevent walking, and an inability to read food labels in English, among others.

The Los Angeles Stroke Prevention/Intervention Research Program in Health Disparities is a multipartner research center funded by the National Institutes of Health that will conduct two randomized, controlled, community-based trials of stroke-prevention interventions. One will measure how much the risk of recurrent stroke is lowered by teaming community health workers with physicians and nurses at Los Angeles medical centers serving low-income populations.

“These community health workers will conduct home visits to outreach to patients with a recent stroke,” said the research center’s director, Dr. Barbara Vickrey, vice chair and professor of neurology at the David Geffen School of Medicine at UCLA. “They will use mobile health technology to help them educate and empower these patients to make changes in their diet and physical activity and to promote the use of home blood-pressure monitors and medications that substantially lower the risk of another stroke.”

A second trial will assess the impact and sustainability of a culturally tailored behavioral intervention designed to provide stroke risk–factor education and increase physical activity, primarily walking. This program will be delivered by staff at senior centers serving African American, Latino, Chinese and Korean communities in Los Angeles and is designed to be self-sustained after the study is over.

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