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BACKGROUND: Districts with federal nutrition programs must have an updated local school wellness policy (LSWP) to promote nutrition, physical activity, and student wellness. This study evaluates factors associated with LSWP quality among low‐income districts. METHODS: In 2018, we collected LSWPs from websites of 200 randomly selected, county‐stratified, low‐income‐serving California public districts. Multivariable linear regression assessed associations between district characteristics, model LSWP use (national, state, none), and adoption date on policy quality. RESULTS: On the WellSAT 3.0 scale of 0‐100, mean (95% CI) comprehensiveness was 65.0 (63.2‐66.7) and strength was 37.3 (35.3‐39.2). Nearly verbatim adoption of model LSWPs was high (68.5% state model, 13.0% a national model). Half were adopted before mandated updates. District size (≥1000 students) and national model LSWP adoption were associated with higher comprehensive scores. National model LSWP adoption was associated with higher strength scores in updated policies compared with those not updated. IMPLICATIONS: LSWPs have improved school food and activity environments, but district engagement in LSWP is low. Integration into education frameworks that reduce learning barriers could provide synergy for re‐engagement. CONCLUSIONS: High adoption of model policies and low update compliance indicate little district engagement in LSWP. Mixed methods studies of districts with high‐quality LSWP are needed. [ABSTRACT FROM AUTHOR]

The visibility of populations, policies, and the state matters greatly for questions of power, inequality, and democratic life. This article builds on existing scholarship by examining how visibility operates as a lever and effect of social control in a racially and economically stratified society. By doing so, the article identifies a paradox. Race- and class-empowered groups often pressure state actors to implement punitive policies or otherwise visibly contain and control disadvantaged populations. But they also tend to decry and disavow the necessary public costs of these disciplinary interventions. This creates a conundrum for authorities: how to satisfy popular demands for social control while concealing resource commitments. We use the term disciplinary tensions to describe the contradictory political desires that state actors must navigate to maintain legitimacy with privileged constituents. We examine two state projects that, in different ways, crystallize this dilemma: the expansion of low-income housing development in New York in the 1960s and 1970s and state prison construction in California in the 1980s and 1990s. In both episodes, officials responded to disciplinary tensions by turning to covert public finance options: specifically, revenue bonds, which seemingly detach policy from conventional tax-and-spend public finance. We argue that these cases shed light on the shifting nature of power as finance has come to pervade all aspects of government and covert governing tactics supplement and supplant society's more direct practices of social control. Revenue bonds, in particular, allow governing actors to appease and placate the populace by reconfiguring the state's disciplinary power so that social control appears to pay for itself. [ABSTRACT FROM AUTHOR]

The 1968 Fair Housing Act required local government recipients of federal money to take meaningful actions to affirmatively further fair housing (AFFH). Current fair housing analysis requirements are copious but do not request an assessment of how land use policies affect the potential for neighborhood integration. A recent California law requires local governments to include AFFH analysis in existing planning processes, and state guidelines encourage the measurement of the spatial distribution of planned sites for low-income housing with respect to opportunity. We propose and evaluate a fair housing land use score (FHLUS) that measures whether local governments' land use policies promote inclusion across neighborhoods. We illustrate the FHLUS by examining zoning and housing plans for three municipalities in California that differ in terms of neighborhood variation in incomes. In all three cases, we found that municipal zoning and housing plans exacerbated patterns of segregation rather than reversed them. Our metric is more precise than existing approaches, but all measures of this phenomenon will be less useful in smaller, more homogenous jurisdictions. The analysis raises important questions about the geographic scale and outcome measures for AFFH analysis and expectations for municipalities of different sizes and levels of diversity. Our metric is a useful tool for advocates and planners at all levels of government. We recommend the federal government consider incorporating it into the AFFH toolkit and practicing planners employ the measure to analyze local zoning and investment decisions. The Technical Appendix is a step-by-step guide, including an Excel formula. [ABSTRACT FROM AUTHOR]

This paper investigates the long-term impacts of the federal Home Owners' Loan Corporation (HOLC) mortgage risk assessment maps on the spatial dynamics of recent income and racial distributions in California metropolitan areas over the 1990-2010 period. We combine historical HOLC boundaries with modern Census tract data and apply recently developed methods of spatial distribution dynamics to examine if legacy impacts are reflected in recent urban dynamics. Cities with HOLC assessments are found to have higher levels of isolation segregation than the non-HOLC group, but no difference in unevenness segregation between the two groups of cities are found. We find no difference in income or racial and ethnic distributional dynamics between the two groups of cities over the period. At the intra-urban scale, we find that the intersectionality of residing in a C or D graded tract that is also a low-income tract falls predominately upon the minority populations in these eight HOLC cities. Our findings indicate that neighborhoods with poor housing markets and high minority concentrations rarely experience a dramatic change in either their racial and ethnic or socioeconomic compositions—and that negative externalities (e.g. lower home prices and greater segregation levels) emanate from these neighborhoods, with inertia spilling over into nearby zones. [ABSTRACT FROM AUTHOR]

Objectives: To assess psychometric properties of two scales developed to measure the quality of person-centered care during pregnancy and childbirth in the United States—the Person-Centered Prenatal Care (PCPC-US) and Person-Centered Maternity Care (PCMC-US) scales—in a low-income predominantly Latinx population in California. Methods: Data were collected from July 2020 to June 2023 from surveys of low-income pregnant and birthing people in Fresno, California, participating in the "Engaging Mothers and Babies; Reimagining Antenatal Care for Everyone" (EMBRACE) trial. Research staff administered the 26-item PCPC-US scale at 30–34 weeks' gestation (n = 315) and the 35-item PCMC-US scale at 10–14 weeks after birth (n = 286), using the language preferred by the participant (English or Spanish). We assessed construct, criterion, and known group validity and internal consistency of the scales. Results: 78% of respondents identified as Latinx. Factor analysis identified one dominant factor for each scale that accounted for over 60% of the cumulative variance, with most items loading at > 0.3. The items also loaded adequately on sub-scales for "dignity and respect," "communication and autonomy," and "responsive and supportive care." Cronbach's alpha for the full scales were > 0.9 and between 0.70 and 0.87 for the sub-scales. Summative scores range from 0 to 100, with higher scores indicating higher person-centered care. Correlations with scores on scales measuring prenatal care quality and birth experience provided evidence for criterion validity, while associations with known predictors provided evidence for known-group validity. Conclusions: The PCPC-US and PCMC-US scales, which were developed using a community-engaged process and found to have good psychometric properties in a largely high-income sample of Black women, were shown to also have good psychometric properties in a sample of low-income primarily Latinx women. Both scales provide valid and reliable tools to measure person-centered care experiences among minoritized communities to support efforts to reduce existing birth inequities. [ABSTRACT FROM AUTHOR]

The affordable housing crisis and the lack of housing for low-income individuals is a significant problem in major metropolitan areas in the United States and specifically in California. This article introduces the affordable housing crisis, how building codes impact the affordable housing crisis, and how private citizens are responding to the crisis with private solutions in the form of "illegal housing." Illegal housing is housing that is built in violation of state and local building and safety codes and includes any informal housing such as illegally converted garage apartments, warehouses, accessory dwelling units, or tiny houses. This article argues that state and local governments should relax building and zoning codes to allow for some informal housing. This would encourage government oversight of currently existing illegal housing, allowing the government to ensure the proper health and safety of these alternate housing situations, while simultaneously ameliorating the housing crisis by allowing for informal housing solutions. [ABSTRACT FROM AUTHOR]

The article presents the discussion on California introducing paid family leave (PFL) providing six weeks of paid leave for mothers with a newborn baby. Topics include understanding the effect of paid leave on employment among low-income mothers being of particular interest given the economic instability; and precariously attached to the labor force at the time of pregnancy and birth than are more educated women.

Recent California legislation extends the application of prevailing wage regulations to construction workers building subsidized low-income residential projects. Econometric evidence based on micro data covering 205 residential projects subsidized by the California Low Income Housing Tax Credit since 1996 and completed by mid-2002 demonstrates that construction costs increased substantially under prevailing wage requirements. Estimates of additional construction costs in the authors' most extensive models range from 9%% to 37%. The analysis controls for variations in cost by geographical location and for differences in project characteristics, financing, and developer attributes. The authors estimate the effect of uniform imposition of these regulations on the number of new dwellings for low-income households produced under the tax credit program in California. Under reasonable assumptions, the mid-range estimate of the prospective decrease exceeds 3,100 units per year. [ABSTRACT FROM AUTHOR]

This study examined differences in the associations between food insecurity and serious psychological distress (SPD) by key sociodemographic factors in a population-based sample of low-income adults from the 2017 California Health Interview Survey (n = 6266). After adjusting for sociodemographic characteristics, low food security, and very low food security were both positively associated with SPD among all low-income adults. Upon stratification, these associations were most pronounced among adults under age 50, males, and in adults with children. Understanding disparities in the associations between food insecurity and psychological distress is critical in developing effective programs or policies to target the most vulnerable sub-groups. [ABSTRACT FROM AUTHOR]

Routine physical activity is important for everyone, and most urban areas have an infrastructure of neighborhood parks that are intended to serve as a setting for recreation and leisure. However, parks are not used proportionally by all age groups, genders, and socioeconomic groups. This paper explores factors associated with park use by different age and gender groups in low-income neighborhoods in Los Angeles, CA. We found that women's visits to parks generally centered around children, whereas men's visits were more likely to be associated with their own physical activity. Barriers for seniors are associated with limited facilities and programming that meet their needs. Park managers should consider park renovations that include social meeting places, comfortable sitting areas, and walking paths to better serve women and seniors. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To evaluate implementation of a community-engaged approach to scale up COVID-19 mass testing in low-income, majority-Latino communities. Methods: In January 2021, we formed a community-academic "Latino COVID-19 Collaborative" with residents, leaders, and community-based organizations (CBOs) from majority-Latinx, low-income communities in three California counties (Marin/Merced/San Francisco). The collaborative met monthly to discuss barriers/facilitators for COVID-19 testing, and plan mass testing events informed by San Francisco's Unidos en Salud "test and respond" model, offering community-based COVID-19 testing and post-test support in two US-census tracts: Canal (Marin) and Planada (Merced). We evaluated implementation using the RE-AIM framework. To further assess testing barriers, we surveyed a random sample of residents who did not attend the events. Results: Fifty-five residents and CBO staff participated in the Latino collaborative. Leading facilitators identified to increase testing were extended hours of community-based testing and financial support during isolation. In March-April 2021, 1,217 people attended mass-testing events over 13 days: COVID-19 positivity was 3% and 1% in Canal and Planada, respectively. The RE-AIM evaluation found: census tract testing coverage of 4.2% and 6.3%, respectively; 90% of event attendees were Latino, 89% had household income <$50,000/year, and 44% first-time testers (reach), effectiveness in diagnosing symptomatic cases early (median isolation time: 7 days) and asymptomatic COVID-19 (41% at diagnosis), high adoption by CBOs in both counties, implementation of rapid testing (median: 17.5 minutes) and disclosure, and post-event maintenance of community-based testing. Among 265 non-attendees surveyed, 114 (43%) reported they were aware of the event: reasons for non-attendance among the 114 were insufficient time (32%), inability to leave work (24%), and perceptions that testing was unnecessary post-vaccination (24%) or when asymptomatic (25%). Conclusion: Community-engaged mass "test and respond" events offer a reproducible approach to rapidly increase COVID-19 testing access in low-income, Latinx communities. [ABSTRACT FROM AUTHOR]

The article examines the significant impact of urbanism and environmentalism on the need to build more affordable housing quickly in Minnesota and California. Topics include the limits of municipalities acting alone to address affordable housing as a result of the tension between urbanism and environmentalism, why coordination with state legislatures is needed as environmental laws can delay or prohibit building more housing, and a background on the 2040 plan passed in Minneapolis in 2019.

Delayed medical care is a negative consequence of the COVID-19 pandemic for families with young children. Our study used data from the Accessing California Communities' Experiences with Safety net Supports (ACCESS) survey, a cross-sectional study that assessed experiences with safety-net programs among working families with low incomes (n=491). From August 2020 to May 2021, we conducted interviewer-administered surveys of low-income families with young children (ages zero to eight) in California and asked questions about whether participants had delayed medical care for their children or themselves. We found that delaying care for children was associated with lack of childcare and with the child having pre-existing conditions. Delaying parental medical care was associated with lack of childcare, experiences of racism, government mistrust, and perceptions of welfare stigma. These results suggest that health care access may be improved through a focus on supporting childcare systems and addressing structural racism. [ABSTRACT FROM AUTHOR]

360 Background: Community-engaged research is an effective approach to address health disparities that is well-established in the public health domain and has not been widely applied in childhood cancer survivorship. We present our multi-year experience building a community-academic partnership and community-engaged childhood cancer survivorship research portfolio. Methods: We have developed a partnership between Jacob's Heart Children's Cancer Support Services, a nonprofit community-based organization (CBO) and an academic pediatric cancer survivorship team, with the goal of improving health outcomes for childhood cancer survivors and their families in the Salinas Valley, a rural, low-income region in California with majority Hispanic/Latino/a/e residents. Our partnership process is guided by principles of community-based participatory research, prioritizing trust and involving community members as equal partners in all phases of research. Results: In year 1 (2021-2022), we held successive meetings which identified common goals and shared values, established the collaboration, and sought funding to advance our goals. In year 2 (2022-2023), with internal grant funding, we conducted a qualitative needs assessment interviewing childhood cancer survivors, parents, and CBO staff. Teamwork enriched the data analysis and allowed us to identify problems in communication as an area of need, which directly informed subsequent grant proposals. In year 3 (2023-2024), with external funding we began a multi-year study to understand and improve survivorship-related communication among Hispanic/Latino/a/e young adult childhood cancer survivors, their parents, and clinicians. Current and future projects include collaborative design and pilot testing of a novel communication intervention, formation of a dedicated community advisory board, and a CBO-driven program evaluation. Findings from our community-engaged studies have prompted new sets of research questions and illustrate opportunities for institutional change in the clinic setting. In parallel, the CBO has leveraged research findings in real-time to identify barriers to seeking support among childhood cancer survivors and families, and adapted and improved programming for families in response. Through our joint research portfolio, we have incorporated training and mentorship for staff at the CBO and medical trainees at the academic center. Conclusions: A community-academic partnership in a rural, low-income region has the potential to reduce health disparities and improve childhood cancer survivors' health outcomes through collaborative program development and community-engaged research. Fueled by mutual investment and strong momentum, our partnership facilitates an interconnected cycle of research and practice change that is grounded in community needs. [ABSTRACT FROM AUTHOR]

168 Background: Medicaid expansion is associated with increased insurance coverage and improved health outcomes among patients diagnosed with cancer < 65 years. Although not the target population, individuals ≥65 years may benefit from Medicaid expansion through "welcome mat" effects – the indirect increase in enrollment, particularly those with low income eligible for both Medicaid and Medicare (dual-eligible). This study aims to examine the associations of Medicaid expansion with Medicaid coverage, including both dual-eligible and Medicaid-only, among individuals diagnosed with cancer. Methods: Using the National Cancer Database, we identified patients ≥65 years newly diagnosed with cancer between 2010-2019 with income below 138% federal poverty level. We applied a quasi-experimental design, the difference-in-difference approach, with multivariable linear probability models to compare the changes in the percentage of dual-eligible or Medicaid-only coverage post (vs. pre) Medicaid expansion in expansion v. non-expansion states. Analyses were also stratified by key demographic characteristics. Results: A total of 256,997 patients with cancer were identified, with 136,373 patients from expansion states and 120,624 patients from non-expansion states. After adjusting for sociodemographic characteristics, the percentage of patients with dual or Medicaid-only coverage increased from 16.84 to 18.09 in expansion states and decreased from 14.14 to 12.62 in non-expansion states, resulting in a net increase of 2.11 percentage points (ppt, 95% confidence interval: 1.55, 2.67) associated with Medicaid expansion. Differences were more pronounced among patients diagnosed with stage III-IV cancers (DD: 2.53 ppt, 95%CI: 1.58, 3.48), racialized as non-Hispanic Black (DD: 3.71 ppt, 95%CI: 2.70, 4.73), residing in metropolitan areas (DD: 2.77 ppt, 95%CI: 2.08, 3.47), with two or more comorbidities (DD: 4.14 ppt, 95%CI: 2.47, 5.80), and treated in comprehensive (DD: 2.98 ppt, 95%CI: 2.02, 3.94) or academic cancer centers (DD: 3.31 ppt, 95%CI: 2.14, 4.49). Conclusions: Medicaid expansion was associated with an increase in Medicaid enrollment among patients diagnosed with cancer at 65 or older, suggesting spillover benefits of Medicaid expansion in supporting low-income elderly populations with cancer. [ABSTRACT FROM AUTHOR]

Summary: Background: The complex multifactorial nature of childhood obesity makes community interventions difficult to evaluate using traditional approaches; innovative methods are needed. Objective: To evaluate the impact of various interventions targeting childhood obesity‐related behaviours, and classified as using a micro‐level (e.g., home visitation programs) or macro‐level (e.g., business practices) strategy, on obesity among children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: We simulated a population of 1500 children enrolled in WIC, with specific diet, physical activity, breastfeeding behaviours and body mass index z‐scores (BMIz), following them from age 2 to 5 years. Results: Combined interventions targeting breastfeeding appeared to be moderately effective, reducing BMIz by 0.03 (95% CI −005, −0.01). Two strategy‐specific interventions, home visitation programs and business practices targeting obesity‐related behaviours, appeared to be moderately effective at reducing BMIz by 0.04 (95% CI −0.06, −0.02) and 0.02 (95% CI −0.04, 0.00), respectively. Contrary to expectation, combining all micro and macro interventions appeared to have no impact or moderately increased the proportion of obesity/overweight among children. Conclusion: Interventions targeting breastfeeding behaviour were most effective when both micro and macro strategies were implemented. Interventions targeting obesity‐related behaviours in general were effective for two strategies, home visitation and business practices. [ABSTRACT FROM AUTHOR]

PURPOSE Lung cancer is the second most common cancer and the leading cause of cancer death in the United States. Persistent disparities remain in the incidence, mortality, and quality of lung cancer care received among minorities and populations with low income. This study aims to evaluate perspectives of low-income and minority patients with lung cancer on health system-level barriers and facilitators to high-quality lung cancer care delivery. METHODS Informed by community-based participatory research, we conducted semistructured interviews with 48 patients with lung cancer in the San Francisco Peninsula and Central Coast regions of California. We recorded, transcribed, and analyzed interviews using thematic analysis. RESULTS Participants described four major structural and process barriers in current lung cancer care: unmet psychosocial support needs, lack of understanding of precision medicine, undertreated symptoms, and financial concerns about cancer, which exacerbate concerns regarding families' well-being. Participants described that trusting relationship with their cancer care team members was a facilitator for high-quality care and suggested that proactive integration of proactive psychosocial and community-based peer support could overcome some of the identified barriers. CONCLUSION This study identified modifiable health system lung cancer care delivery barriers that contribute to persistent disparities. Opportunities to improve care include integration of community-based peer support. [ABSTRACT FROM AUTHOR]

Background To achieve elimination of hepatitis C virus (HCV) infection, limited resources can be best allocated through estimation of "care cascades" among groups disproportionately affected. In San Francisco and elsewhere, these groups include young (age ≤ 30 years) people who inject drugs (YPWID), men who have sex with men who inject drugs (MSM-IDU), and low-income trans women. Methods We developed cross-sectional HCV care cascades for YPWID, MSM-IDU, and trans women using diverse data sources. Population sizes were estimated using an inverse variance-weighted average of estimates from the peer-reviewed literature between 2013 and 2019. Proportions of past/current HCV infection, diagnosed infection, treatment initiation, and evidence of cure (sustained virologic response at 12 weeks posttreatment) were estimated from the literature using data from 7 programs and studies in San Francisco between 2015 and 2020. Results The estimated number of YPWID in San Francisco was 3748; 58.4% had past/current HCV infection, of whom 66.4% were diagnosed with current infection, 9.1% had initiated treatment, and 50% had confirmed cure. The corresponding figures for the 8135 estimated MSM-IDU were: 29.4% with past/current HCV infection, 70.3% diagnosed with current infection, 28.4% initiated treatment, and 38.9% with confirmed cure. For the estimated 951 low-income trans women, 24.8% had past/current HCV infection, 68.9% were diagnosed with current infection, 56.5% initiated treatment, and 75.5% had confirmed cure. Conclusions In all 3 populations, diagnosis rates were relatively high; however, attention is needed to urgently increase treatment initiation in all groups, with a particular unmet need among YPWID. [ABSTRACT FROM AUTHOR]

BACKGROUND Low‐income and racial/ethnic minority students often face distinct challenges in attending school eading to lower academic performance, low graduation rates, and overall, an indicator of diminished long‐term social and financial stability. Chronic absenteeism is a national problem and to address this, a better understanding of risks and points of intervention for the students most at risk is needed. This cross‐sectional study sought to assess risks and protective factors associated with chronic absenteeism in a predominantly low‐income minority school district in Southern. METHODS: Conducted in southern California, students (N = 24,439) ages 9 to 21 years were recruited. A logistic regression was used to assess the role poor physical and mental health, safety, bullying, and family risk factors attributed to chronic absenteeism. RESULTS: Results revealed that asthma (odds ratio [OR] = 1.35, p <.001), being overweight/obese (OR = 1.38, p <.01), presence of family risk factors (OR = 1.49, p <.001), bullying (OR = 0.84, p <.05) and perceptions of safety at school (OR = 1.24, p <.05) increased the odds of chronic absenteeism, while protective factors such as support (OR = 1.30, p <.001), increased sleep (OR = 0.96, p <.001) and positive growth mindset (OR = 0.96, p <.001), mitigated it. CONCLUSION: This study not only identifies risk but protective factors worth adhering to, to promote school attendance. Future research should further examine the role of mental health in chronic absenteeism. [ABSTRACT FROM AUTHOR]

Many victims of violence may benefit from trauma-focused evidence-based psychotherapies (EBPs), but fail to utilize treatment. The current study investigated factors associated with treatment access and treatment initiation in a low-income, racially and ethnically diverse, urban population of victims of violence who were screened for EBPs. The sample consisted of 941 adults, mean age = 35.87 (SD = 12.8), who were screened for mental health treatment and offered an EBP. Overall, 55.7% of individuals accessed treatment by attending an in-person screening appointment and intake, and 79.0% of the individuals who accessed treatment then initiated treatment by attending the first EBP session. Analysis revealed higher age (odds ratio [OR] = 1.05, 95% confidence interval (CI) = [1.04, 1.09]) and lower expression of posttraumatic stress disorder (PTSD) symptoms predicted higher rates of accessing treatment (OR = 0.20, 95% CI = [0.05, 0.82]). Higher global severity of distress (OR = 3.22, 95% CI = [1.14, 9.10]), poor quality of life in the area of psychological health (OR = 0.90, 95% CI = [0.81, 1.00]), and better quality of life in the area of physical health significantly predicted initiation of treatment (OR = 1.11, 95% CI = [0.998, 1.24]). Findings suggest that low-income, ethnically and racially diverse victims of violence may effectively utilize trauma-focused EBPs offered in a community setting. [ABSTRACT FROM AUTHOR]

Objective: Substantial literature has documented adverse childhood experiences' (ACEs) link with poor health in childhood and adulthood. Despite many American low-income families spending more than a third of their income toward housing costs, little research has been published about a link between severe housing-cost burden and ACEs. The objective of this study was to examine the association of severe housing-cost burden to the ACEs to which young, low-income children are exposed. Methods: Participants were 2–5-year-olds who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County. We used data from the 2017 Los Angeles County WIC Survey, a survey of a random sample of all WIC participants living in Los Angeles County. Separate multiple logistic regression analyses were conducted to examine the association of severe housing-cost burden (very difficult to pay for housing) with the ACEs of financial hardship (household food insecurity, extreme poverty, parent's unemployment and underemployment), household dysfunction (parent's poor mental well-being and parent's separation), housing insecurity (doubled up and residential instability), and parent's experience with homelessness. Results: Sixteen percent of children lived in severe housing-cost burdened households and 14% experienced at least 4 ACEs. After adjusting for sociodemographic characteristics and social support, severe housing-cost burden was associated with an increase in the odds of each of the ACEs. Conclusions for Practice: While further research is needed, findings highlight the need for policymakers to provide resources and support for housing-cost burdened children. Also, service providers should identify ACEs among housing cost-burdened children. [ABSTRACT FROM AUTHOR]

Background: Surgical volume is a surgical indicator that was described in the Lancet Commission on Global Surgery (LCoGS) and the World Bank World Development Indicators as an important metric for tracking the delivery of surgical care. Objectives: We aimed to characterize the reports on surgical volume (SV) in the existing literature by using a systematic review to assess studies that examine surgical procedures as a ratio of a population (procedures/100,000 population). Methods: The PRISMA guideline was employed in the systematic review of articles that addressed the measurement of SV in low- and middle-income countries (LMICs), with the primary outcome of surgical procedures/100,000 population. Findings: The search result consisted of 6,657 preliminary studies. Following the title and abstract screening, 6,464 articles were excluded, and the remaining 193 were included in the full text review. From the full text review of the 193, only 26 of these articles defined SV as the ratio of number of procedures per population of the catchment/geographical area. The reported SV was a mean of 765, with an SD of 1260 operations per 100,000. The median SV was 180 (min = 0.900, max = 4470). Conclusion: Our findings support the LCoGS assessment of the gap in surgical care. The target for SV is 5000 per 100,000 population, compared to the average of 765 per 100,000 population as found in this review. The challenges for assessing surgical volume gaps are vast, including the nature of written records, which limits SV reports to an absolute number of procedures per year without a reference to the catchment population. For the purpose of tracking SV, we recommend using proxies that account for the capacity of facilities to deliver care regardless of the catchment population. [ABSTRACT FROM AUTHOR]

112 Background: Immune checkpoint inhibitors are unavailable or unaffordable to many patients in LMIC, including Mexico. Some proposed strategies to improve access include weight-based dosing, vial sharing, or using low-dose IO (immunotherapy) schedules. Despite the potential advantages of low-dose IO to increase access and improve outcomes, there is limited information regarding the use of low-dose IO in real-world clinical practice in LMICs. Methods: We conducted a cross-sectional online survey of medical oncologists and hematologists practicing in Mexico. The survey was distributed via email using databases from the Mexican Society of Oncology and the Mexican Society of Hematology, and through physician Whatsapp groups in April and May 2024. The primary objective was to examine the prevalence and reasons of low-dose IO use in real-world clinical practice across Mexico. The survey assessed provider characteristics, prevailing attitudes, and potential barriers to low-dose IO adoption. Results: A total of 154 specialists answered the online survey, of which 77 completed it. The median age was 41 years (range 30-73); forty-five (58.4%) were men, thirty-one were women (40.2%), and two were non-binary. Fifty-nine (77%) were medical oncologists and 18 (23%) were hematologists. Twenty-two (29.3%) worked in private practice, nine (12%) in public institutions, and forty-four (58.7%) practiced in both. Seventy-two percent of respondents reported barriers in acquiring IO and forty-eight percent reported utilizing low-dose IO. For low-dose IO users, nivolumab was the most frequently prescribed drug (76%), followed by pembrolizumab (43%). The most frequent reason for using low-dose IO was reducing treatment-related cost (83% of respondents). Common barriers to low-dose IO use included concerns regarding the efficacy and safety of lower doses and a lack of knowledge about dosing protocols. Fifty respondents (67%) reported complete or moderate confidence in the efficacy of low-dose IO for patients with advanced disease, while only 36 respondents (49%) reported confidence on its efficacy for patients with localized disease. Conclusions: Despite its potential benefits of low-dose IO and a need to improve access to treatment, there are concerns about the efficacy and safety of this strategy among Mexican cancer specialists. Addressing these barriers and identifying facilitators could improve the acceptability of prospective trials studying low-dose IO in Mexico. [ABSTRACT FROM AUTHOR]

Objective: Almost no previous research has examined the impact of the US Department of Agriculture's (USDA) Summer Food Service Program and related Seamless Summer Option, which provide meals and snacks to low-income children over the summer. The present study investigated whether geographic accessibility of summer meals programme sites (a proxy for programme participation) was associated with food insecurity for low-income households.Design: The study used data from the California Health Interview Survey (CHIS) and administrative data on summer meals sites in California. Geocoding was used to calculate driving time between CHIS households and nearby summer meals sites. Geographic accessibility was measured using a gravity model, which accounted for the spatially distributed supply of and demand for summer meals. Food insecurity and very low food security were measured using a standard six-item measure from the USDA.Subjects: Low-income families with children (n 5394).Setting: A representative surveillance study of non-institutionalized households in California.Results: Geographic accessibility was not associated with food insecurity. However, geographic accessibility was associated with a significantly lower probability of very low food security in the full sample and among households with younger children and those living in less urban areas.Conclusions: The USDA's summer meals programme may be effective at reducing the most severe form of food insecurity for low-income households with children. Expanding the number of summer meals sites, the number of meals served at sites and sites' hours of operation may be effective strategies to promote nutritional health over the summer months. [ABSTRACT FROM AUTHOR]

This paper presents pollutant concentrations and performance data for code‐required mechanical ventilation equipment in 23 low‐income apartments at 4 properties constructed or renovated 2013‐2017. All apartments had natural gas cooking burners. Occupants pledged to not use windows for ventilation during the study but several did. Measured airflows of range hoods and bathroom exhaust fans were lower than product specifications. Only eight apartments operationally met all ventilation code requirements. Pollutants measured over one week in each apartment included time‐resolved fine particulate matter (PM2.5), nitrogen dioxide (NO2), formaldehyde and carbon dioxide (CO2) and time‐integrated formaldehyde, NO2 and nitrogen oxides (NOX). Compared to a recent study of California houses with code‐compliant ventilation, apartments were smaller, had fewer occupants, higher densities, and higher mechanical ventilation rates. Mean PM2.5, formaldehyde, NO2, and CO2 were 7.7 µg/m3, 14.1, 18.8, and 741 ppm in apartments; these are 4% lower, 25% lower, 165% higher, and 18% higher compared to houses with similar cooking frequency. Four apartments had weekly PM2.5 above the California annual outdoor standard of 12 µg/m3 and also discrete days above the World Health Organization 24‐hour guideline of 25 µg/m3. Two apartments had weekly NO2 above the California annual outdoor standard of 30 ppb. [ABSTRACT FROM AUTHOR]

There is increasing interest in the potential of source water protection to address chronic challenges with small systems and rural drinking water provision. Such a planning and management approach to increasing safe drinking water access, however, will likely require leveraging multi-stakeholder collaborative governance venues to this effect. This paper investigates the prospects of doing so using the case of California's groundwater reform process known as the Sustainable Groundwater Management Act or SGMA. Interviews with drinking water stakeholders from small low-income communities in the San Joaquin Valley show how existing power and resource disparities limit the prospects of integrating rural drinking water priorities into regional planning. Long-term, more fundamental changes will be needed to meaningfully transform water management in this direction. Short-term state intervention is needed to protect equity and public good goals, raising potential contradictions between devolved water management and improved drinking water access that need to be addressed. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to determine the store types from which people in low-income neighbourhoods purchase most sugar-sweetened beverages (SSB) and to identify associations between purchasing location and demographic characteristics.Design: Street-intercept surveys of passers-by near high foot-traffic intersections in 2016. Participants completed a beverage frequency questionnaire and identified the type of store (e.g. corner store, chain grocery) from which they purchased most SSB.Setting: Eight low-income neighbourhoods in four Bay Area cities, California, USA.ParticipantsSample of 1132 individuals who reported consuming SSB, aged 18-88 years, who identified as African-American (41 %), Latino (29 %), White (17 %) and Asian (6 %).Results: Based on surveys in low-income neighbourhoods, corner stores were the primary source from which most SSB were purchased (28 %), followed by discount stores (18 %) and chain groceries (16 %). In fully adjusted models, those with lower education were more likely to purchase from corner stores or discount groceries than all other store types. Compared with White participants, African-Americans purchased more frequently from corner stores, discount groceries and chain groceries while Latinos purchased more frequently from discount groceries.Conclusions: The wide range of store types from which SSB were purchased and demographic differences in purchasing patterns suggest that broader methodological approaches are needed to adequately capture the impact of SSB taxes and other interventions aimed at reducing SSB consumption, particularly in low-income neighbourhoods. [ABSTRACT FROM AUTHOR]

The Supplemental Nutrition Assistance Program Education (SNAP-Ed) aims to prevent obesity and chronic disease among SNAP-eligible families by facilitating healthy eating and active living. This study aimed to capture the voices of California SNAP-Ed eligible parents to inform program planners of their challenges in feeding their families, their available supports and priorities for intervention. We conducted eight focus groups with 55 participants across five counties in California from May through August 2017. Trained researchers used Dedoose to code and analyze data for substantive themes and overarching findings.Ten key findings and 4 additional findings were identified. Participants experience multiple challenges, primarily inadequate income and limited access to high quality, affordable healthy food contrasted with easy access to affordable unhealthy food. Despite efforts to manage food resources, most struggle to afford adequate diets. Employed parents confront a particularly challenging dual poverty of money and time. Many parents report feeling guilt related to feeding their children. Participants appreciate available programs and services and suggest increasing community input; providing sustainable programs; lowering the cost of and improving access to healthy food; reducing access to unhealthy food; modifying food assistance efforts; and improving nutrition education and promotion. Overall, low-income parents in California struggle to feed their families the way they would like. Participants generally understand what to feed their children, but struggle with how to do it, perceiving their circumstances and environments as inhospitable to healthy eating. Participants' suggestions can help SNAP-Ed programs and other efforts better support families' needs. [ABSTRACT FROM AUTHOR]

This article examines financial capability among low-income older Asian immigrants, using data from in-depth interviews with 13 participants in a subsidized employment program in Los Angeles. Overall, respondents present a portrait of economic insecurity. Qualitative analyses indicate that respondents perceived little need to improve their financial knowledge and management skills because they had "no money to manage. " Most respondents lacked either financial knowledge or financial management skills, which resulted in substantial financial losses among some respondents. Mistrust of financial institutions ("Banks are always vampires") and other financial barriers (for example, lack of credit history) blocked respondents' access to formal financial services. In some cases, ethnic financial resources (for example, ethnic banks) reduced the effects of such barriers. There is evidence that respondent financial knowledge and management skills may improve after opening a bank account, suggesting a potential role for financial access in expanding financial capability. Findings demonstrate the importance of financial capability–building interventions for low-income older Asian immigrants. Social workers should be equipped with financial literacy and in-depth understanding of financial needs, perceptions, values, behaviors, and resources of this population. [ABSTRACT FROM AUTHOR]

Objectives The present study sought to examine the association between maternal depressive symptoms and characteristics of offspring physical health, including health status, health behaviors, and healthcare utilization, among low-income families. Maternal engagement was explored as a mediator of observed effects. Methods Cross-sectional survey data from a community sample of 4589 low-income women and their preschool-age children participating in the WIC program in Los Angeles County were analyzed using logistic, Poisson, and zero-inflated negative binomial regression. Mediation was tested via conditional process analyses. Results After controlling for the effects of demographic characteristics including maternal health insurance coverage, employment status, education, and preferred language, children of depressed women (N = 1025) were significantly more likely than children of non-depressed women (N = 3564) to receive a “poor” or “fair” maternal rating of general health (OR 2.34), eat fewer vegetables (IRR: 0.94) more sweets (IRR: 1.20) and sugary drinks daily (IRR: 1.32), and consume fast food more often (OR 1.21). These children were also less likely to have health insurance (OR 1.59) and more likely to receive medical care from a public medical clinic or hospital emergency room (OR 1.30). Reduced maternal engagement partially mediated associations between maternal depressive symptoms and several child health outcomes including poor diet, health insurance coverage, and use of public medical services. Conclusions for Practice Maternal depressive symptoms are associated with poor health among preschool-age children in low-income families. Prevention, screening, and treatment efforts aimed at reducing the prevalence of maternal depression may positively affect young children’s health. [ABSTRACT FROM AUTHOR]

Budget cuts have reduced courses and student services within California community colleges. This coincides with the growth of low-income Latino male (Latinos) and Latina female (Latinas) student enrollment. Budget cuts have been implemented throughout the system, including in the Extended Opportunity Programs and Services (EOPS), which disproportionately serve low-income Latino/a students. The purpose of this study was to analyze the experiences and perceptions of low-income Latino/a students enrolled in the community college and in EOPS at a time of budget cuts. The research revealed that the students in the study experienced additional difficulties in completing their educational objectives due to budget cuts, resulting in the perception that their education was of less social significance. To ensure full and equal access for this student population, students, educators, and administrators will need to become advocates for student equity at a time of budget cuts. [ABSTRACT FROM AUTHOR]

Objective: To assess produce availability, quality and price in a large sample of food stores in low-income neighbourhoods in California.Design: Cross-sectional statewide survey.Setting: Between 2011 and 2015, local health departments assessed store type, WIC (Supplemental Nutrition Program for Women, Infants, and Children)/SNAP (Supplemental Nutrition Assistance Program) participation, produce availability, quality and price of selected items in stores in low-income neighbourhoods. Secondary data provided reference chain supermarket produce prices matched by county and month. t Tests and ANOVA examined differences by store type; regression models examined factors associated with price.Subjects: Large grocery stores (n 231), small markets (n 621) and convenience stores (n 622) in 225 neighbourhoods.Results: Produce in most large groceries was rated high quality (97 % of fruits, 98 % of vegetables), but not in convenience stores (25 % fruits, 14 % vegetables). Small markets and convenience stores participating in WIC and/or SNAP had better produce availability, variety and quality than non-participating stores. Produce prices across store types were, on average, higher than reference prices from matched chain supermarkets (27 % higher in large groceries, 37 % higher in small markets, 102 % higher in convenience stores). Price was significantly inversely associated with produce variety, adjusting for quality, store type, and SNAP and WIC participation.Conclusions: The study finds that fresh produce is more expensive in low-income neighbourhoods and that convenience stores offer more expensive, poorer-quality produce than other stores. Variety is associated with price and most limited in convenience stores, suggesting more work is needed to determine how convenience stores can provide low-income consumers with access to affordable, high-quality produce. WIC and SNAP can contribute to the solution. [ABSTRACT FROM AUTHOR]

Prior research suggests that parents of Hispanics, English learners, and students living in poverty exercise school choice less frequently than other parents, which may be a factor in the resegregation of public schools. This quasi-experimental, causal–comparative design tests whether ethnicity, language dominance, or socioeconomic status of the student are related to the exercise of parental choice of magnet middle school programs in a majority, minority community. The primary finding was that in this Hispanic, English learner, low-income majority California community, none of the independent variables studied predicted the exercise of parental magnet school choice. The discussion compares these findings with prior studies and suggests some possible explanations. [ABSTRACT FROM AUTHOR]

Specific causes of preterm birth remain unclear. Several recent studies have suggested that immune changes during pregnancy are associated with the timing of delivery, yet few studies have been performed in low-income country settings where the rates of preterm birth are the highest. We conducted a retrospective nested case-control evaluation within a longitudinal study among HIV-uninfected pregnant Kenyan women. To characterize immune function in these women, we evaluated unstimulated and stimulated peripheral blood mononuclear cells in vitro with the A/California/2009 strain of influenza to understand the influenza-induced immune response. We then evaluated transcript expression profiles using the Affymetrix Human GeneChip Transcriptome Array 2.0. Transcriptional profiles of sufficient quality for analysis were obtained from 54 women; 19 of these women delivered <34 weeks and were defined as preterm cases and 35 controls delivered >37 weeks. The median time to birth from sample collection was 13 weeks. No transcripts were significantly associated with preterm birth in a case-control study of matched term and preterm birth (n = 42 women). In the influenza-stimulated samples, expression of IFNL1 was associated with longer time to delivery—the amount of time between sample collection and delivery (n = 54 women). A qPCR analysis confirmed that influenza-induced IFNL expression was associated with longer time to delivery. These data indicate that during pregnancy, ex vivo influenza stimulation results in altered transcriptional response and is associated with time to delivery in cohort of women residing in an area with high preterm birth prevalence. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that Latina women appear to be less physically active than women of other racial/ethnic groups. This study evaluated how different domains of physical activity (PA) contributed to overall levels of PA among low-income Latinas, the validity of Latinas' self-reported PA, and potential moderators of self-report bias in PA. Methods: A community sample of 105 Latinas (mean age = 35.9 ± 9.0 years; mean body mass index = 31.6 ± 7.2) completed the long form Spanish-language version of the International Physical Activity Questionnaire (IPAQ), wore an accelerometer for seven days, and completed self-reported measures of acculturation and socioeconomic status. Results: Ninety-six percent of IPAQ-reported moderate-intensity PA (MPA) was accrued during household activities, with only 4% accrued during leisure time. Seventy-two percent of participants met national recommendations for PA using IPAQ data, but only 20% met recommendations when measured by accelerometer. When bouts of MPA lasting >10 mm were included, 0% met recommendations. Age appeared to moderate self-report bias of vigorous PA, and there were nonsignificant trends for acculturation and income to moderate MPA and vigorous-intensity PA, respectively. Conclusions: Data suggest that it is important to measure household activity of Latinas, and that the IPAQ yield overestimates of self-report PA. [ABSTRACT FROM AUTHOR]

This study examines the external neighborhood effects of Low-Income Housing Tax Credit (LIHTC) Projects built in Santa Clara County, California from 1987 to 2000. Three types of developers have built LIHTC projects in this area: nonprofit, for-profit, and a county public housing authority. Using a difference-in-difference hedonic regression approach, this study finds that almost all the LIHTC projects examined have generated significantly positive impacts on nearby property value. In particular, the study also finds that most nonprofit projects have delivered benefits similar to those of for-profit projects. Yet projects built by some of the largest nonprofits and the county housing authority have generated the greatest neighborhood impacts. Low-income neighborhoods have also benefited more from LIHTC developments than other types of neighborhoods. [ABSTRACT FROM AUTHOR]

Assessment caps on property taxes are often assumed to benefit affluent homeowners the most with little gains for low-income households. Quantile regression results for Los Angeles County show that on average effective property tax rates decrease by $1994 per year due to length of ownership in the 50th percentile because of California's Proposition 13 assessment cap. There is evidence of both horizontal and vertical inequity across the entire sample. Low-income households do benefit from California's assessment cap as they are typically infrequent movers but their effective tax rates decrease over time. However, the most affluent households by market value do not gain the most and there is no evidence of horizontal inequity for these homeowners. There is also no evidence of horizontal inequity for middle-income households. Property tax savings vary between $18,000 and $40,000, depending on the assessed value decile and percentage quantile. [ABSTRACT FROM AUTHOR]

Data from 66 446 low-income adults who participated in the California Health Interview Survey are used to describe trends in food insecurity between 2001 and 2009. Food security was assessed using the short form of the Household Food Security Survey Module. There was a statistically significant increase in food insecurity between 2001 and 2009, from 28.6% to 40.5%. During the same time period, the prevalence of very low food security nearly doubled, from 8.3% to 15%. The increase in food insecurity remained significant even after controlling for differences in income, employment status, participation in food assistance programs, and other sociodemographic factors. [ABSTRACT FROM AUTHOR]

Government funding accounts for a large proportion of conservation and environmental improvements, and is often the result of citizen votes on state ballot measures. A key concern surrounding public investments in the environment is whether that funding serves lower-income communities, which are often the communities of greatest need. We applied three statistical methods to analyze the spatial distribution of conservation funding derived from California’s Proposition 84, which distributed nearly $4 billion across California between 2006 and 2015. First, we used hurdle models to ask if income, population density, urban coverage, or pollution could explain receipt of grants or magnitude of funding. Second, we compared the income levels of funded and unfunded communities for each chapter of the proposition. Finally, we examine two sections of the proposition that were intended to fund parks around the state and compare the attributes of funded and unfunded communities. Proposition 84 offers lessons for environmental legislation and future research. While there were general tendencies for more funding to flow to poor areas and areas with pollution problems, the language in Proposition 84 as a whole was vague with respect to the funding of disadvantaged areas, and as a result the targeting of these areas overall was at best modest. However, when enabling legislation (AB 31) defined specific “metrics of disadvantage” that had to be met by communities to receive funds from some sections of Proposition 84, the funds did flow much more selectively to poorer communities. This suggests that future ballot measures should be very explicit in their language if they want to promote equity in conservation investments, and that future research should investigate the extent to which technical workshops and outreach could further increase the number of funded grant proposals from low-income communities. [ABSTRACT FROM AUTHOR]

Context: States face increasing Medicaid expenditures largely as a result of growing dual-eligible populations. In this article we examine self-reported community-based Medicaid participation among Medicare recipients 65 and older in California and Texas, with a particular focus on the older Mexican-origin population. Methods: We use six waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) covering the period from 1993-94 to 2010-11. Findings: The data reveal relatively high Medicaid participation rates by older individuals of Mexican origin, but significant differences between the two states. At baseline, 30% of older Mexican-origin Medicare beneficiaries in California reported receiving Medicaid compared to 41% in Texas. Conclusions: Despite California's more liberal eligibility criteria, community-dwelling Texans were more likely than Californians to report coverage at some point during the 17-year follow-up. Our data, as well as administrative data, reveal that California classifies nearly all of its communitydwelling Medicaid recipients as "full duals," meaning that they receive full benefits, whereas Texas is more likely to classify similarly poor and disabled individuals as "partial duals," meaning that they receive less coverage, thereby lowering overall program expenditures. Cost containment strategies that restrict access may be especially consequential for vulnerable Hispanic populations. [ABSTRACT FROM AUTHOR]

The article refers to a survey of low-income Mexican-American consumers in East Los Angeles, California and the retail trade serving this market segment. Consumers showed a preference for cultural reinforcement by shopping in local markets where Spanish is spoken and Mexican foods are available. They also had a high level of satisfaction regarding business practices and prices. Statistics show the size of grocery, clothing, and furniture or appliance stores most frequented, price differentials for five items, price comparison for an automobile purchased by Mexican-American and Anglo-White shoppers, and loan practices are mentioned, as well as the price-quality relationship and challenges of adapting a business to an ethnic community.

Background: Low-income Hispanic women experience elevated rates of high postpartum weight retention (PPWR), which is an independent risk factor for lifetime obesity. Sociocultural factors might play an important role among Hispanic women; however, very few studies have examined this association. Objective: The purpose of our study was to examine the associations between acculturation and maternal diet, physical activity, and PPWR. Design: This is a cross-sectional study of baseline data from 282 Hispanic women participating in the FitMoms/Mamás Activas study, a randomized controlled trial examining the impact of primarily an internet-based weight control program, in reducing PPWR among low-income women. We performed multivariable linear regression to examine the association of acculturation with diet quality, physical activity, and PPWR at study entry. Results: A total of 213 (76%) women had acculturation scores reflecting Mexican orientation or bicultural orientation, whereas 69 (24%) had scores that represented assimilation to Anglo culture. Women who were more acculturated had lower intakes of fruits and vegetables, lower HEI scores, and lower physical activity levels than women who were less acculturated ( p < 0.05). We found an association between acculturation and PPWR in that for every 1-unit increase in acculturation score, PPWR increased, on average, by 0.80 kg. Conclusion: Higher acculturation was associated with poorer diet and physical activity behaviors and greater PPWR. [ABSTRACT FROM AUTHOR]