UC Irvine co-authored study indicates results of newly enacted reforms.

David Neumark, UC Irvine

Enrollment of uninsured patients in a program with benefits comparable to those offered under the Affordable Care Act of 2010 resulted in significant health care cost savings, a new study finds. Published in the February issue of Health Affairs, the research sheds light on the potential outcomes of newly enacted health care reforms.

“In a case study involving low-income people enrolled in a community-based health insurance program, we found that use of primary care increased but use of emergency services fell, and — over time — total health care costs declined,” said study co-author David Neumark, UC Irvine Chancellor’s Professor of economics and director of UC Irvine’s Center for Economics & Public Policy study.

Working with researchers from the Virginia Commonwealth University Health System, Neumark tracked the emergency room, inpatient, outpatient and primary care service utilization of about 26,000 previously uninsured Richmond residents between 2000 and 2007 whose household incomes fell 200 percent below the federal poverty level. Qualified enrollees were granted health insurance and assigned a primary-care provider for one year. They were required to proactively re-enroll for subsequent annual coverage.

The demographics of these participants paralleled those of the population that will be affected by changes under the Affordable Care Act of 2010, Neumark said. The legislation is set to extend Medicaid benefits to about 16 million uninsured, low-income adults and children by the end of 2014.

The study found that primary-care visits for patients who enrolled continuously over three years rose from 1.06 in year one to 1.60 annually, while emergency-room visits fell from 1.02 in year one to 0.74 by year three. Costs per visit for both inpatients and outpatients also decreased, as did the length of inpatient stays. On average, total health care costs per enrollee per year for this subset were cut nearly in half — from $8,899 in year one to $4,569 in year three. Overall costs per enrollee per year for all participants with at least one year of enrollment declined from $7,604 to $4,726.

“A lot of the debate about health care reform surrounds the issue of whether we’re setting up something that’s going to cost us more by increasing use of medical services or something that will cut costs through more appropriate and timely use of medical services,” Neumark said. “Our research shows that, over time, costs can be reduced through increased use of primary care and reductions in emergency-department visits and hospital admissions, but it may take several years of coverage for substantive savings to occur.”

Co-authors of the study include Cathy Bradley, professor and chair of health care policy & research at Virginia Commonwealth University; Sabina Gandhi, who earned a Ph.D. in economics at UC Irvine and is now a VCU assistant research professor; Sheryl Garland, vice president of health policy and community relations at the VCU Health System; and Dr. Sheldon Retchin, VCU professor of internal medicine, gerontology and health administration and CEO of the VCU Health System.

A full copy of the study is available at http://content.healthaffairs.org/content/31/2/350.full.

About the University of California, Irvine: Founded in 1965, UC Irvine is a top-ranked university dedicated to research, scholarship and community service. Led by Chancellor Michael Drake since 2005, UC Irvine is among the most dynamic campuses in the University of California system, with nearly 28,000 undergraduate and graduate students, 1,100 faculty and 9,000 staff. Orange County’s second-largest employer, UC Irvine contributes an annual economic impact of $4.2 billion. For more news, visit www.today.uci.edu.

UC San Diego’s Sandra Daley awarded federal grant for Health Careers Opportunity Program.

Sandra Daley, UC San Diego

The U.S. Department of Health and Human Services recently awarded $742,222 to UC San Diego’s Dr. Sandra Daley, professor of pediatrics and director of the Comprehensive Research Center in Health Disparities, to fund the Health Careers Opportunity Program, San Diego Regional Consortium (HCOP/SDRC). The program is designed to help students from disadvantaged backgrounds develop the skills needed to successfully compete, enter and graduate from health professions schools. HCOP/SDRC was one of just 14 programs in the nation to receive funding.

“UC San Diego is committed to providing students of all backgrounds with the tools and resources they need to be successful in their educational endeavors,” said Daley. “This grant supports our mission by funding programs that will help disadvantaged students in San Diego pursue their dreams of becoming doctors, nurses and other health professionals, and thereby ensure a strong and diverse health care workforce for our nation’s future.”

HCOP/SDRC works to build an educational pipeline of students on track to enter the health sciences field by offering a variety of academic enrichment programs, beginning in middle school and continuing through professional school, for students who otherwise might not have access. UC San Diego partners with schools in the San Diego Unified and Sweetwater school districts, and community colleges throughout San Diego and Imperial counties to provide students with mentoring programs, lab activities, workshops, hands-on research training and other support services that enhance student education. To date, more than 1,500 students have gone through these programs.

“A lot of underserved students have a tremendous amount of potential, but lack role models,” said Aldo Rodriguez, a third-year student at the UC San Diego School of Medicine and counselor for HCOP’s UniversityLink Medical Science Program (ULMSP). A summer program for community college students from disadvantaged backgrounds, ULMSP provides four weeks of rigorous academic training, including writing and science classes, combined with mentoring and networking opportunities.

“These programs bring together mentors, resources and networking — tools for success that more affluent students typically already have access to. It helps to level the playing field,” Rodriguez continued.

Originally from Fresno, Rodriguez recalls experiencing many of the same educational challenges as the students he mentors today. In high school, Rodriguez participated in college prep programs that connected him with mentors, networking, academic resources and other opportunities that helped him get accepted — and succeed — at UC Berkeley.

“When you have mentors with a similar background as you, it helps you to really see what’s possible,” he said. “I’ve seen definite improvements in all of the students I work with in ULMSP. Many who initially just wanted a four-year degree leave the program with a goal to pursue medical school or another type of professional school. As they go through the program, they discover what they’re really capable of.”

The Health Careers Opportunity Program, San Diego Regional Consortium (HCOP/SDRC) is a partnership between the UC San Diego School of Medicine, the San Diego State University Pre-College Institute, the Scripps San Diego Border Area Health Education Center, nine community colleges participating in the UC San Diego “UniversityLink” Transfer Student Guarantee Program and 12 of their “feeder” middle and high schools in inner city, border, east suburban and rural communities. HCOP was established in 2004 and is one of two Health Resources and Services Administration (HRSA) academic enrichment programs conducted at the UC San Diego School of Medicine. The other is the Hispanic Center of Excellence, established in 1993.

For more information about initiatives that enhance the UC San Diego campus and support a diverse community, visit http://giving.ucsd.edu/diversity.

UCLA researchers seek ways to address long-term effects of treatment.

Patricia Ganz, UCLA

Quality of life in younger patients treated for breast cancer is seriously compromised, and these women face more physical and mental health issues than women their age who haven’t had cancer and women over 50 who have, according to a study by researchers at UCLA’s Jonsson Comprehensive Cancer Center.

The study, published Jan. 20 in the peer-reviewed Journal of the National Cancer Institute, found that younger breast cancer survivors suffer from a slew of problems, including severe psychological distress, infertility, premature menopause, a decrease in physical activity and weight gain.

The study points to the need for oncologists to let these younger patients know from the beginning of their therapy what may happen to them after it’s finished, said the study’s lead author, Dr. Patricia Ganz, director of cancer prevention and control research at UCLA’s Jonsson Comprehensive Cancer Center.

“We know that educating and providing younger breast cancer patients with information about what they might experience once their treatment ends is very helpful,” said Ganz, who has been conducting research on quality of life after cancer treatment for 25 years. “If they know what to expect, their anxiety level will be greatly reduced. Up to now, oncologists have not done a good job of preparing these women for what will come.”

Reducing anxiety is crucial, Ganz said, as preclinical studies have shown that stress can promote cancer growth and spread in animal models. A study by Jonsson Cancer Center researchers published in 2010 in Cancer Research showed that chronic stress acted as a sort of fertilizer that fed breast cancer progression, significantly accelerating the spread of disease.

The need to prepare younger breast cancer survivors for any adverse effects they may experience and seek ways to address those problems is vital as more and more younger women are surviving their cancer due to improvements in early detection and treatment, Ganz said.

“A cancer diagnosis can challenge younger women with issues that don’t impact older patients,” she said. “A younger breast cancer patient may have young children and may be worried about living to raise them to adulthood. A younger breast cancer patient may not have had children yet and may be faced with infertility following her treatment or may return to the dating scene following treatment. We need to find ways to reduce the stress and anxiety that dealing with these issues may create.”

Ganz recently received a grant from the Centers for Disease Control and Prevention that will fund a leading-edge program that seeks to enhance outcomes for young breast cancer survivors in the Los Angeles region. The program is being done in collaboration with the Jonsson Cancer Center, the UCLA–LIVESTRONG Survivorship Center of Excellence and the Simms/Mann–UCLA Center for Integrative Oncology.

The three-year, $700,000 grant will focus on making life after breast cancer better for women aged 21 to 45 in Los Angeles County by funding a program designed to meet their unique needs, Ganz said. UCLA is one of seven organizations nationwide to receive funding for this focus on young breast cancer survivors. The resources and strategies developed in the diverse and populous Los Angeles region will serve as a model for other organizations across the country.

Services will be offered to these women through the UCLA Health System and with collaborators at Torrance Memorial Medical Center and the South Bay Cancer Survivorship Consortium, as well as the Olive View–UCLA Medical Center, a public hospital in northern Los Angeles County that treats mostly minority women who are underinsured or who have no insurance.

“These three health systems provide breast cancer services for a substantial number of ethnically diverse, newly diagnosed women with breast cancer under 45 years old. They see about 225 new cases annually,” Ganz said. “We estimate that there are hundreds of young breast cancer survivors who are being followed in these institutions who will directly benefit from the programs that we will develop.”

Read more

UC Davis findings support “medical home” movement to improve health outcomes.

Anthony Jerant, UC Davis

Greater access to features of high-quality primary care — comprehensiveness, patient-centeredness and extended office hours — is associated with lower mortality, according to a new national UC Davis study. Published in the January-February issue of the Annals of Family Medicine, the research is the first to link the availability of three specific attributes of primary care with reduced risk of death.

“There are a number of studies that found lower mortality risk in geographic areas with relatively high concentrations of primary care physicians, but these associations were not necessarily applicable to individual patients within those geographic areas,” said Anthony Jerant, professor of family and community medicine at UC Davis and lead author of the study. “These studies also defined ‘primary care’ by physician specialty rather than by specific aspects of health care. We wanted to know if patients who reported having access to critical elements of primary care had lower mortality risk.”

In conducting the study, Jerant and his colleagues used data from the 2000-05 Medical Expenditure Panel Surveys, which are large-scale surveys of people living in the U.S. and their health and health care. The study used data for 52,241 respondents aged 18 to 90 years for whom mortality information was available and who had one particular doctor’s office or clinic they visited for health information and treatment.

The researchers analyzed respondents’ reported access to three primary health care attributes:

• Comprehensiveness, which includes the provision of care for new health problems, preventive care and referrals to other health care professionals
• The availability of evening and weekend office hours
• Patient-centeredness, meaning that their health care provider listened to and sought the patient’s advice when deciding on treatments

The researchers found that after adjusting for age, health status, weight, tobacco use and other health characteristics, greater reported access to the primary-care attributes was associated with significantly lower mortality (hazard ratio 0.79) during up to six years of follow-up.

“Our findings suggest that ongoing efforts to provide all Americans with a ‘medical home’ offering the primary care attributes we studied could yield major public health benefits,” said Jerant, referring to the national movement to ensure access to patient-centered, comprehensive and continuously available primary care services.

The team also found evidence that racial/ethnic minorities, poorer and less educated individuals, and those lacking health insurance reported significantly lower access to the primary care attributes than others.

As a result, Jerant and his colleagues in their study wrote, “Although the wider adoption of primary care attributes may have promise for mitigating health disparities, interventions to promote equitable access to such attributes may be required to fulfill this promise.”

In addition to Jerant, authors of the study were Joshua Fenton and Peter Franks of UC Davis. A copy of their study, “Primary Care Attributes and Mortality: A National Person-Level Study,” is available at www.annfammed.org.

The UC Davis Department of Family and Community Medicine provides comprehensive, compassionate and personal care for patients within the context of family and community. The medical team integrates a humanistic approach to treating the “whole person” with evidence-based care. Special areas of faculty research are health-behavior change, physician-patient communication, chronic-illness care, women’s health issues, and reducing racial and ethnic health disparities. For information, visit the department’s website.

UC Davis’ WeCare! Peer Navigator Program helps address disparities.

(From left, front row) Kirollos "Cookie" Gendi, Sarah Wenstrand, Geoffrey Krieger, Liz Salmi; (back row) Azadeh Afkhami, Cheryl Johnson with the Leukemia & Lymphoma Society.

Adolescence and young adulthood generally is a time when young people step out on their own, start romances, attend college, launch careers and begin to build a life independent of their families.

It is a time for hubris, adventure, maybe even rebellion. So how does a cancer diagnosis fit into this period of life? Not well, according to researchers, patients and the health-care professionals who treat young adult cancer patients.

Partnership will cover telehealth, scientific and technical development, and neurodevelopmental disorders.

Sergio Aguilar-Gaxiola, UC Davis

UC Davis Health System has signed a memorandum of understanding (MOU) with the state of Sinaloa, Mexico, to partner to improve the health and well-being of its residents through the exchange of ideas, data and research on telehealth, scientific and technical development, and neurodevelopmental disorders.

Sinaloa has partnered with UC Davis because of the health system’s internationally recognized leadership in telehealth technology and neurodevelopmental research, said Sergio Aguilar-Gaxiola, who directs the UC Davis Center for Reducing Health Disparities and community engagement for the UC Davis Clinical and Translational Science Center.

Approximately 27 percent of Sinaloa’s population lives in rural settings. The government and secretariat of health of Sinaloa have pledged to strengthen the state’s health infrastructure and to increase access to quality health care using telehealth technology, particularly for populations residing in remote rural areas.

“The government of Sinaloa is interested in creating the infrastructure to support telemedicine and telehealth services to significantly improve access to primary-care services for its nearly 3 million residents,” said Aguilar-Gaxiola, a professor of clinical internal medicine.

“They also would like UC Davis to share its expertise in autism and fragile X syndrome with Mexican health professionals and families to improve early identification, diagnosis and treatment,” Aguilar-Gaxiola said. “A third goal is to foster scientific and technical development to support health education primarily aimed at primary-care settings.”

UC Davis is a national leader in extending access to health-care services to rural and underserved areas through telehealth. The UC Davis Center for Health and Technology uses high-speed data lines linked to video units to connect large, urban medical centers with community hospitals and clinics. The technology allows specialists and subspecialists to consult with community physicians and their patients via live, interactive videoconferencing.

Similarly, the UC Davis MIND Institute is internationally known for its leading-edge research into neurodevelopmental disorders, such as autism spectrum disorders and fragile X syndrome. The institute’s world renowned scientists engage in research to find improved treatments, as well as  causes and cures, for autism, attention-deficit hyperactivity disorder (ADHD), fragile X syndrome, Tourette syndrome and other neurodevelopmental conditions.

The MOU with Sinaloa is the most recent affiliation between UC Davis Health System and a Mexican entity.

Earlier this year, health system leaders traveled to Mexico City to forge a similar MOU with the Instituto Carlos Slim de la Salud (the Carlos Slim Health Institute), A.C. That agreement is focused on raising awareness of mental-health issues and sharing useful and innovative information to enable the early identification of autism and fragile X syndrome. Founded in 2007, the institute promotes research, develops initiatives and funds projects to address health challenges that affect Mexico and the broader Latin American region.

And in 2010, UC Davis Health System partnered with Shriners Hospital for Children — Northern California and the Mexican Health Ministry to establish a burn fellowship program for physicians from Mexico. The 12-month fellowship program trains two physicians each year in resuscitation and burn-care management, reconstructive surgery and clinical research.

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. The academic health system includes one of the country’s best medical schools, a 631-bed acute-care teaching hospital, an 800-member physician’s practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children’s hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.

Prevalence of nonaggressive symptoms increases dramatically among Mexican-origin families after U.S. migration.

Sergio Aguilar-Gaxiola, UC Davis

The prevalence of nonaggressive symptoms of conduct disorder increases dramatically across generations of Mexican-origin populations after migration to the United States, according to a study by an international team of researchers at the UC Davis Health System, RAND Corp. and National Institute of Psychiatry in Mexico City.

The study appears in the December issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

“Our study shows that there is a large difference in risk for conduct disorder between Mexicans living in Mexico and people of Mexican descent living in the United States,” said Sergio Aguilar-Gaxiola, a professor of clinical internal medicine who directs both the UC Davis Center for Reducing Health Disparities and the Community Engagement Program of the UC Davis Clinical and Translational Science Center. “This increase in risk occurring across generations within a migrating population strongly points to the influence of early childhood environmental factors in the United States and the potential to intervene to reduce the prevalence of conduct disorder.”

Conduct disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association, is characterized by persistent patterns of child or adolescent behavior involving aggression or other violations of age-appropriate norms that cause significant clinical impairment. Behaviors include bullying others, getting into fights, fighting with a weapon, cruelty to people or animals, stealing with confrontation, forced sex, property destruction, theft and rule breaking.

To study the prevalence of conduct disorder associated with migration from Mexico to the United States, UC Davis and RAND Corporation researchers assessed conduct disorder symptoms across four groups of people of Mexican origin with increasing levels of exposure to American culture: nonimmigrant households in Mexico with no exposure to the United States, Mexicans from migrant households who lived in Mexico until age 15, children of Mexican migrants raised in the United States and Mexican-American children of U.S.-born parents. The researchers obtained data by conducting face-to-face interviews with nearly 1,800 adults aged 18 to 44 years in the household populations of Mexico and those of Mexican descent in the United States.

The study found that, compared to the general population of Mexico with no history of migration to the United States and Mexicans from migrant households who lived in Mexico until age fifteen, 11.5 percent of Mexican-American children with at least one U.S.-born parent met the DSM-IV criteria for conduct disorder. This level is close to that of the non-Mexican-American, U.S.-born sample prevalence of 10.6 percent.

“We found a striking epidemiological pattern with differences across generations that are both larger in magnitude and more narrow in scope that anyone expected,” said Joshua Breslau, a researcher with the RAND Corporation in Pittsburgh who conducted the study while an assistant professor of internal medicine at UC Davis Health System. “Future studies will be needed to identify the specific environmental factors that contribute to these differences.”

Other researchers in the study include Daniel J. Tancredi, Richard Kravitz and Ladson Hinton from UC Davis School of Medicine; Guilherme Borges, Corina Benjet and Maria Elena Medina-Mora from the National Institute of Psychiatry in Mexico City; Kenneth S. Kendler from the Medical College of Virginia; and William Vega from the University of Southern California.

Most receive little or no treatment, UCLA report shows.

Nearly 2 million adults in California, about 8 percent of the population, need mental health treatment, but the majority receive no services or inadequate services, despite a state law mandating that health insurance providers include mental health treatment in their coverage options, a new report by the UCLA Center for Health Policy Research shows.

The report, which provides some of the first comprehensive data in recent years on the mental health of California’s adult population, found that one in 12 Californians reported symptoms consistent with serious psychological distress and experienced difficulty functioning at home or at work.

Over half of these adults reported receiving no treatment for their disorders, and about one-quarter received “inadequate” treatment, defined as less than four visits with a health professional over the past 12 months or using prescription drugs to manage mental health needs.

The study draws on data from the 2007 California Health Interview Survey (CHIS), which is conducted by the center.

“There is a huge gap between needing help and getting help,” said David Grant, the study’s lead author and director of CHIS. ”The data also shows large disparities in mental health status and treatment by demographic, economic and social factors. These findings can help direct the state’s limited resources to those in greatest need of help.”

Among the findings:

Insurance
Unsurprisingly, uninsured adults had the highest rate of unmet needs (87 percent), which includes receiving no treatment or receiving less than minimally adequate treatment; 66 percent of these adults received no treatment. By contrast, 77 percent of privately insured and 65 percent of publically insured Californians reported unmet needs. Although poverty and mental health needs are strongly correlated, the lower rate of unmet needs by public program participants suggests that these programs are more likely to effectively offer mental health services than even private insurance policies.

Symposium highlights work being done in growing field.

Barbara Gerbert, UC San Francisco

UC San Francisco’s faculty and students are taking a wide-ranging look at the inequities that exist in the Unites States, in terms of both health itself and the quality of health care, across racial, ethnic and socioeconomic lines.

Sadly, they don’t have to look too far to find great disparities in health.

Maisha Davis, a second-year medical student at UCSF, has been investigating the life of teens in the Bayview neighborhood of San Francisco. Her study, titled “Community Violence and Adolescent Sexual Health: The 3rd Street Clinic Experience,” looked at the 744 most recent visits to the clinic between 2005 and 2011. The clinic serves mostly low-income African American youth.

Davis said the research team focused on 417 patients. Their findings are alarming:

• Forty-five percent had lost a friend or family member to violence, 18 percent had witnessed violence and 8 percent had been involved in the juvenile justice system.
• They started having sex, on average, at the age of 14.
• Those who had witnessed violence had four times the odds of being diagnosed with a sexually transmitted disease.

Davis describes why she thinks there is a link between violence and adolescent sex.

“If you perceive all this community violence and instability in the space you’re supposed to be functioning in most of your day, then you might not have this long-term view of how your life is going to play out,” Davis said. “Your misbehavior might increase just because you don’t think you’re going to live that long anyway — and so you might as well do what you can do in the short amount of time that you do have left.”

Davis said the clinic does a good job of creating a safe space and that it has served more than 1,700 youths since it opened six years ago, functioning as a drop-in center as well as a place in which 40 percent of clients receive their primary care. Its dual role offers a valuable buffer against the surrounding violence, Davis said.

Research into health disparities around the U.S. was the topic of discussion at the fifth annual symposium at UCSF. Each year, the symposium attracts more submissions from faculty and students who are investigating issues of inequity.

“I feel like this project, and all of us, have come a very long, long way,” symposium co-chair Barbara Gerbert told the audience at the end of the Oct. 7 symposium.

Gerbert, Ph.D., a professor in the Division of Behavioral Sciences and Community Dental Education in the UCSF School of Dentistry, organized the conference with co-chairs Eliseo Perez-Stable, M.D., and Victor Fujimoto, M.D., to highlight the work being done at UCSF in a field that has exploded — in practice as well as research — at the university and nationally.

The symposium at the Laurel Heights campus consisted of nine oral presentations, 30 posters and a keynote address by Spero Manson, Ph.D., a distinguished professor at the University of Colorado, who is the country’s leading investigator on American Indian health. Their findings amply demonstrated gaps in outcomes, treatments and the presence of disease on many different fronts.

Read more

$1.75M grant will allow UCSF faculty, students to provide integrated model for delivering primary health, dental care to children at five Oakland middle schools.

The Havenscourt Health Center recently opened in an Oakland middle school to serve youth and families as part of the Elev8 project.

UC San Francisco, the Oakland Unified School District and an array of community-based partners are embarking on a quest to improve the lives of disadvantaged middle-school students, thanks to a $1.75 million grant from The Atlantic Philanthropies.

The three-year award to UCSF’s Elev8 Healthy Students and Families project will allow faculty and students from UCSF’s schools of nursing and dentistry to provide a new, integrated model for delivering primary health and dental care to children at five Oakland middle schools. The project also will increase health education and expose middle school youth and their families to health careers.

“Good health is fundamental to children reaching their full potential in school and in life and so our UCSF Elev8 Healthy Students and Families project dovetails perfectly with the work of our partners,” said lead applicant, Linda Franck, R.N., Ph.D., chair of the Department of Family Health Care Nursing at UCSF.

The program also offers UCSF nursing and dental students important learning opportunities, says co-leader Bill Bird, D.D.S., M.P.H., Dr.P.H., a professor in the Department of Preventive and Restorative Dental Sciences.

“This project gives us the opportunity to establish a new model for interdisciplinary education of advanced practice nursing and dental students in community-based health care,” Bird said, “and builds a health workforce for the future that is better equipped to work for and meet the health needs of disadvantaged communities.”

Elev8 is a national initiative funded by The Atlantic Philanthropies that brings together schools, families and the community in underserved neighborhoods to help students succeed in school and in life. Work is underway in Chicago, Baltimore and New Mexico. In Oakland, the new grant will augment a previous Elev8 grant that will:

• Provide coordinated health, mental health and dental services,
• Engage families to support and advocate for their youth, and
• Offer academic and mentoring support in extended day, Saturday and summer programs.

Alameda County has supported school-based health centers for more than 15 years. Through the UCSF Elev8 project, faculty, nurse practitioner and dental students will enhance and expand primary care services at these existing Federally Qualified Health Center partners and increase preventative services, particularly in the areas of dental care and healthy lifestyles, as well as treat children with chronic health conditions.

The youth who will benefit from the new funds are sixth-to-eighth-graders at five Oakland campuses: Roosevelt, Havenscourt, Madison, West Oakland and United for Success. In fall 2010, these schools enrolled 1,639 students, of whom 763 were Latino, 480 were African American, 247 were Asian and 1,259 were economically disadvantaged. In fact, more than 85 percent of students at Elev8 Oakland schools are living in poverty.

These students face a variety of other challenges: violence, safety concerns, drugs, health problems, and parents with low levels of education and high levels of unemployment. These factors can negatively affect the health and academic achievement of students, according to Elev8 Oakland. The project targets middle-school students because research shows that children who make the transition to high school smoothly are more likely to graduate and go on to and finish college.

“We’re really excited about the chance to enliven our curriculum and to add a social justice component,” said Naomi Schapiro, R.N., Ph.D., C.P.N.P. “Middle-school students are not on people’s radar. They are at the cusp between being children and adolescents. And they’re going through a lot of physical and developmental changes.”

Read more

UCLA helps convert East L.A. corner stores to offer healthier food choices; local leaders celebrate first store’s reopening.

Michael Prelip, UCLA

To determine whether stores that prominently display healthy food items while relegating chips, soda and candy to the back of the store can be financially sustainable and improve the health behaviors of a community, the UCLA–USC Center for Population Health and Health Disparities at the UCLA School of Public Health, along with Los Angeles County Supervisor Gloria Molina, announced Oct. 29 the conversion of the first of four corner stores in East Los Angeles to offer healthier food choices.

The conversion was funded by the National Institutes of Health as part of an ongoing effort to reduce cardiovascular disease risk among Latinos in East Los Angeles, where high rates of obesity-related chronic diseases are the norm. East L.A. is a neighborhood that is considered by many to be a “food desert” due to its poor access to comprehensive grocery stores and foods recommended for a healthy and balanced diet and its preponderance of fast food restaurants.

The first converted store to be reopened was the YASH La Casa Market on Hammel Street, which underwent a substantial overhaul to both the exterior and interior, including the removal of boards and re-bar that covered the front of the store, the removal of all soda and beer advertising posters, new paint, and larger windows to allow for natural light to the interior.

Inside, displays were rearranged to more prominently display healthier food items at the front of the store, including canned fruits and vegetables, fresh produce, bottled waters and healthy snacks. A juice bar with high tables and stools will also be a new feature, along with free Wi-Fi.  An empty lot at the back of the store was converted into a vegetable garden with a sitting area for customers.

Los Angeles County Supervisor Gloria Molina (District 1) was on hand, along with UCLA faculty and community members, to celebrate the reopening of the converted store.

“The conversion of this corner store is an important step in the right direction for the residents of East Los Angeles,” Molina said. “I would like to applaud the Songu Family, owners of the YASH La Casa Market, for allowing this wonderful transformation that will help improve the health of the residents of our community.”

In addition to the store conversions, the community-based projects also include an intensive home-environment intervention involving families in which one member is newly enrolled in a diabetes clinic, as well as an evaluation of vascular function and cardiovascular disease risk biomarkers among individuals of various generational and immigrant statuses in order to increase understanding of the basis for the Latino “acculturation paradox” in cardiovascular disease risk.

“These store conversions are part of a comprehensive intervention to understand the effects of immigration and acculturation on health outcomes,” said Michael Prelip, principal investigator for the Corner Store Makeover in East Los Angeles and a professor of community health sciences at the UCLA School of Public Health. “We hope our findings will lead to improvements in the overall health of underserved communities.”

The project is also working with high school students from various East Los Angeles high schools to promote corner store conversions and encourage healthier food options and meal-preparation strategies.

As part of the project, the four converted stores will be evaluated over two years using community surveys, patron surveys and observations. Final results of entire evaluation will be available in two to three years.

The UCLA School of Public Health is dedicated to enhancing the public’s health by conducting innovative research; training future leaders and health professionals; translating research into policy and practice; and serving local, national and international communities.

UC Davis study shows that fast-food dining is most popular for those with middle incomes, not those with lowest incomes.

J. Paul Leigh, UC Davis

>>Read release in Spanish

A new national study of eating out and income shows that fast-food dining becomes more common as earnings increase from low to middle incomes, weakening the popular notion that fast-food should be blamed for higher rates of obesity among the poor.

“There is a correlation between obesity and lower income, but it cannot be solely attributed to restaurant choice,” said J. Paul Leigh, professor of public health sciences at UC Davis and senior author of the study, which is published online in Population Health Management. “Fast-food dining is most popular among the middle class, who are less likely to be obese.”

In conducting the study, Leigh and co-author DaeHwan Kim, specialists in health economics, used data from the 1994 to 1996 Continuing Survey of Food Intakes by Individuals and the accompanying Diet and Health Knowledge Survey. The nationally representative sample of nearly 5,000 people in the U.S. included data about food consumption patterns, including restaurant visits, over two nonconsecutive days, which was compared with demographic variables such as household income, race, gender, age and education.

They found that eating at full-service restaurants, which involve a range of food choices and sit-down service, followed an expected pattern: as income rose, visits increased. In contrast, eating at fast-food restaurants, characterized by minimal table service and food preparation time, followed a different pattern. Fast-food restaurant visits rose along with annual household income up to $60,000. As income increased beyond that level, fast-food visits decreased.

Leigh noted that the fast-food industry attracts the middle class by locating restaurants right off freeways in middle-income areas and by offering products that appeal to a large proportion of Americans.

“Low prices, convenience and free toys target the middle class — especially budget-conscious, hurried parents — very well,” said Leigh.

Additional correlations revealed in the study included:

• Men were more likely than women to go to both fast-food and full-service restaurants.
• People with more education were more likely to go to full-service restaurants.
• People who worked more hours were more likely to go to both fast-food and full-service restaurants.
• Smokers were more likely to go to fast-food rather than full-service restaurants.

The study was limited by the fact that the data came from the mid-1990s, the most recent information available on this subject. Although incomes have changed considerably since then, Leigh believes that the eating-out patterns found in this study would still hold if more up-to-date data were available.

“It has traditionally been difficult to define patterns of restaurant consumption for Americans according to their incomes,” said Leigh. “By using a very large, nationally representative database that includes detailed information on income, we have solved that puzzle.”

Based on his findings, Leigh, who is affiliated with the UC Davis Center for Healthcare Policy and Research, suggests that policymakers and researchers look beyond restaurant type for reasons for and solutions to the obesity epidemic. He will study the effects of food pricing on food choices.

“Pricing is critical to low-income families, and over the past 30 years the costs of less healthy options have dropped compared to healthier fare,” said Leigh. “One potential way to encourage healthier eating could be to charge taxes that increase based on the number of calories in food. Proceeds from the taxes could then be used to subsidize and reduce the costs of healthy foods.”

Co-author DaeHwan Kim, who earned his doctorate in economics at UC Davis, is currently with the Korea Insurance Research Institutes in Seoul.

Kim and Leigh’s study — “Are Meals at Full-Service and Fast-Food Restaurants ‘Normal’ or ‘Inferior’?” — will be published in the December print issue of the journal. A copy can be requested by emailing kruehle@liebertpub.com.

The research was funded in part by the National Institute of Occupational Safety and Health.

About the UC Davis Center for Healthcare Policy and Research:
The Center for Healthcare Policy Research conducts research on health-care access, delivery, costs, outcomes and policy to improve the practice of medicine, especially primary care. Established as an interdisciplinary unit, the center includes more than 80 health-care researchers who represent disciplines ranging from business management and epidemiology to psychiatry and pediatrics. For more information, visit the center’s website.