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Study objective: To estimate the relative health effects of the income and health insurance provisions of the Los Angeles City living wage ordinance. Setting and participants: About 10000 employees of city contractors are subject to the Los Angeles City living wage ordinance, which establishes an annually adjusted minimum wage ($7.99 per hour in July 2002) and requires employers to contribute $1.25 per hour worked towards employees' health insurance, or, if health insurance is not provided, to add this amount to wages. Design: As part of a comprehensive health impact assessment (HIA), we used estimates of the effects of health insurance and income on mortality from the published literature to construct a model to estimate and compare potential reductions in mortality attributable to the increases in wage and changes in health insurance status among workers covered by the Los Angeles City living wage ordinance. Results: The model predicts that the ordinance currently reduces mortality by 1.4 deaths per year per 10 000 workers at a cost of $27.5 million per death prevented, if the ordinance were modified so that all uninsured workers received health insurance, mortality would be reduced by eight deaths per year per 10000 workers at a cost of $3.4 million per death prevented. Conclusions: The health insurance provisions of the ordinance have the potential to benefit the health of covered workers far more cost effectively than the wage provisions of the ordinance. This analytical model can be adapted and used in other health impact assessments of related policy actions that might affect either income or access to health insurance in the affected population. [ABSTRACT FROM AUTHOR]

This article presents a study investigating the impact of the millennium changeover on cardiovascular mortality in Los Angeles County, California. Cardiac morbidity and mortality, reportedly, had increased during December and January 2000 even in regions with mild climates. Uniquely increased levels of stress, anxiety, and overindulgence at the turn of the millennium led researchers to hypothesize that the millennium changeover was associated with an increased number of deaths attributable to cardiac causes. Therefore, they have conducted the said study based on daily death certificate data and population data from the County's Department of Health Services Data Collection and Analysis Unit. The data were analyzed by deaths attributable to ischaemic heart disease (IHD) and congestive heart disease. Researchers have found a consistent and statistically significant increase in IHD death before New Year's Day 2000 compared with previous years.

Background We conducted a large registry-based study in California to investigate the association between race/ethnicity and childhood leukaemia focusing on two subtypes: acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). Methods We obtained information on 5788 cases and 5788 controls by linking California cancer and birth registries. We evaluated relative risk of childhood leukaemia by race and ethnicity of the child and their parents using conditional logistic regression, with adjustment for potential confounders. Results Compared with Whites, Black children had lower risk of ALL (OR=0.54, 95% CI 0.45 to 0.66) as well as children of Black/Asian parents (OR=0.31, 95% CI 0.10 to 0.94). Asian race was associated with increased risk of AML with OR=1.643, 95% CI 1.10 to 2.46 for Asian vs Whites; and OR=1.67, 95% CI 1.04 to 2.70 for Asian/Asian vs White/White. Hispanic ethnicity was associated with increased risk of ALL (OR=1.37, 95% CI 1.22 to 1.52). A gradient in risk of ALL was observed while comparing Hispanic children with both parents Hispanic, one parent Hispanic and non-Hispanic children (p Value for trend <0.0001). The highest risk of ALL was observed for children with a combination of Hispanic ethnicity and White race compared with non-Hispanic whites (OR=1.27, 95% CI 1.12 to 1.44). The lowest risk was observed for non-Hispanic blacks (OR=0.46, 95% CI 0.36 to 0.60). Associations for total childhood leukaemia were similar to ALL. Conclusions Our results confirm that there are ethnic and racial differences in the incidence of childhood leukaemia. These differences indicate that some genetic and/or environmental/cultural factors are involved in aetiology of childhood leukaemia. [ABSTRACT FROM AUTHOR]

Objective Studies have shown that immigrants' acculturation is associated with numerous unhealthy behaviours. Yet, the role of environmental factors in modifying the effect of acculturation on health behaviours has received little attention. This study aims to create a more nuanced understanding of the health effects of acculturation by examining how neighbourhood immigrant composition modifies the association between individuals' eating patterns and acculturation. Methods Cross-sectional Data from Los Angeles County Health Survey 2007 adult sample were linked to data on retail food establishments and US Census 2000 neighbourhood characteristics. Acculturation was measured by language spoken at home and years stayed in the US. Eating fast food more than once per week and eating zero serving of fruit or vegetables during the previous day were used as proxy indicators for unhealthy dietary behaviour. Multilevel logistic regression models were performed in the full sample and in the sample with only Latino adults. Results Immigrants' lack of acculturation and living in a neighbourhood with a high percentage immigrants were associated with healthier dietary behaviour. We also identified that lack of acculturation conveyed a significantly stronger protective effect on regular fast-food consumption for immigrants living in neighbourhoods with higher percentage immigrants (OR: 0.34, 95% CI: 0.12 to 0.93). Conclusions Among immigrants in Los Angeles County, living in a neighbourhood with a high density of other immigrants attenuates the negative effects of acculturation on healthy eating behaviours. Healthy eating promotion efforts should build on this protective effect in outreach to acculturating immigrant communities. [ABSTRACT FROM AUTHOR]

Background: While studies have attributed the favourable birth outcomes of Mexico-born mothers in the USA to a ‘healthy immigrant effect’ that confers protection to immigrants, a comparison of immigrants with the source population in Mexico has been lacking. We compared preterm delivery (PTD) rates of Mexico-born immigrants who delivered in California with Mexico-born women who delivered in Mexico (WIMX) and with a subgroup who delivered in the five top immigrant sending states in Mexico. Methods: Using 2009 birth records, we selected all live-born singletons of primiparous WIMX (699 129) and immigrants in California (33 251). We examined the unadjusted and adjusted association between place of delivery and any PTD (<37 weeks gestation), including PTD subcategories (early, moderate, late), using relative risks (RR) and 95% CIs. Multivariate models controlled for demographic and health system characteristics. Results: PTD rates were higher among immigrants in California (6.7%) than WIMX (5.8%) and compared to women in the sending states (5.5%). The unadjusted risk of any PTD (RR=1.17 (1.12 to 1.22)), early/ moderate PTD (<34 weeks gestation; RR=1.27 (1.18 to 1.38)) and late PTD (34–36 weeks; RR=1.14 (1.08 to 1.19)) was higher for immigrants than for WIMX and remained higher when controlling for age, education and healthcare variables. Birth weight <1500 g was also higher among immigrants (RR=1.27 (1.14 to 1.44)). Similar patterns were observed when comparing women in the sending states. Conclusions: We found no evidence of a ‘healthy immigrant effect’. Further research must assess the comparability of gestational-age data in Mexican and Californian birth certificates [ABSTRACT FROM AUTHOR]

Background: Older people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people.Methods: A randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60-95 years (mean age 74.9±7.7 years;53% <$12 000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area.Results: Intervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US $41 218/UK £24 868 per unit). No intervention effect was found for cognitive functioning outcome measures.Conclusions: A lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people.Trial Registration clinical trials.gov identifier:NCT0078634. [ABSTRACT FROM AUTHOR]

Background: The relationship between asthma and socio-economic status remains unclear. The authors investigated how neighbourhood, school and community social environments were associated with incident asthma in Southern California schoolchildren. Methods: New-onset asthma was measured over 3 years of follow-up in the Children's Health Study cohort. Multilevel random-effects models assessed associations between social environments and asthma, adjusted for individual risk factors. At baseline, subjects resided in 274 census tracts (ie, neighbourhoods) and attended kindergarten or first grade in one of 45 schools distributed in 13 communities throughout Southern California. Neighbourhoods and communities were characterised by measures of deprivation, income inequality and racial segregation. Communities were further described by crime rates. Information on schools included whether a school received funding related to the Title 1 No Child Left Behind programme, which aims to reduce academic underachievement in disadvantaged populations. Results: Increased risk for asthma was observed in subjects attending schools receiving Title I funds compared with those from schools without funding (adjusted HR 1.71, 95% CI 1.14 to 2.58), and residing in communities with higher rates of larceny crime (adjusted HR 2.02, 95% CI 1.08 to 3.02 across the range of 1827 incidents per 100 000 population). Conclusions: Risk for asthma was higher in areas of low socio-economic status, possibly due to unmeasured risk factors or chronic stress. [ABSTRACT FROM AUTHOR]

Background The incidence of autism rose dramatically between 1992 and 2001, while the age at which children were first diagnosed declined. During this period the size and composition of the autism caseload has changed, but little is known about whether the factors associated with the timing of diagnosis may also have shifted. Using a multilevel analysis strategy, the individual and community-level factors associated with age of diagnosis were modelled across 10 birth cohorts of California children. Methods Linked birth and administrative records on 17 185 children with diagnoses of autistic disorder born in California between 1992 and 2001 and enrolled with the California Department of Developmental Services (DDS) were analysed. Information on cases, their parents and their residential location were extracted from birth and DDS records. Zip codes of residence were matched to census data to create community-level measures. Multilevel linear models were estimated for each birth cohort, with individual-level effects for sex, race, parental characteristics, poverty status, birth order and symptom expression. At the community level measures of educational and economic composition, local autism prevalence and the presence of a child psychiatrist were included. Results Children with highly educated parents are diagnosed earlier, and this effect has strengthened over time. There is a persistent gap in the age of diagnosis between high and low socioeconomic status (SES) children that has shrunk but not disappeared over time. Conclusion Routine screening for autism in early childhood for all children, particularly those of low SES, is necessary to eliminate disparities in early intervention. [ABSTRACT FROM AUTHOR]

Background Although chronic obstructive pulmonary disease (COPD) is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race–ethnicity on health outcomes. Methods The aim of this study is to determine the independent impacts of SES and race–ethnicity on COPD severity status, functional limitations and acute exacerbations of COPD among patients with access to healthcare. Data were used from the Function, Living, Outcomes and Work cohort study of 1202 Kaiser Permanente Northern California Medical Care Plan members with COPD. Results Lower educational attainment and household income were consistently related to greater disease severity, poorer lung function and greater physical functional limitations in cross-sectional analysis. Black race was associated with greater COPD severity, but these differences were no longer apparent after controlling for SES variables and other covariates (comorbidities, smoking, body mass index and occupational exposures). Lower education and lower income were independently related to a greater prospective risk of acute COPD exacerbation (HR 1.5; 95% CI 1.01 to 2.1; and HR 2.1; 95% CI 1.4 to 3.4, respectively). Conclusion Low SES is a risk factor for a broad array of adverse COPD health outcomes. Clinicians and disease management programs should consider SES as a key patient-level marker of risk for poor outcomes. [ABSTRACT FROM PUBLISHER]

Background A study was undertaken to assess the impact of air quality warnings associated with ground-level ozone on outdoor activities in Southern California. Methods Data on aggregate daily attendance at two major outdoor facilities were collected and merged with observed and forecasted air quality and meteorology at the daily level. A quasi-experimental regression discontinuity design was used to estimate the impact of warnings. Results Attendance declined significantly when stage 1 air quality warnings ('smog alerts') were issued. Consistent with expectations, responses were greater for populations more likely to be considered susceptible and more likely to be local residents. Conclusions Air quality warnings are an important policy tool for protecting the public's health from high levels of ambient air pollution. [ABSTRACT FROM AUTHOR]

Objective: To measure the childhood and life course socioeconomic exposures of people born between 1871 and 1949, and then to estimate the probability of death between 1965 and 1994, the probability of functional limitation in 1994, and the combined probability of dying or experiencing functional limitation during this period. Setting, participants and design: Data were from the Alameda County Study (California) and pertained to people aged 17–94 years (n = 6627) in 1965 (baseline). Socioeconomic position (SEP) in childhood was based on respondent's reports of their father's occupation, and life course disadvantage was measured by cross-classifying childhood SEP and the respondent's education and household income in 1965. The health outcomes were all-cause mortality (n = 2420) and functional limitation measured using the Nagi index (n = 453, 17.4% of those alive in 1994). Relationships were examined before and after adjustment for changed socioeconomic circumstances after 1965. Results: Those from a low SEP in childhood, and those exposed to a greater number of episodes of disadvantage over the life course before 1965, were subsequently more likely to die, to report functional limitation and to experience the greatest health-related burden. Conclusions: All-cause mortality, functional limitation and overall health-related burden in middle and late adulthood are shaped by socioeconomic conditions experienced during childhood and cumulative disadvantage over the life course. The contributions made to adult health by childhood SEP and accumulated disadvantage suggest that each constitutes a distinct socioeconomic influence that may require different policy responses and intervention options. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effects of neighbourhood level socioeconomic status (SES) and convenience store concentration on individual level smoking, after consideration of individual level characteristics. Design: Individual sociodemographic characteristics and smoking were obtained from five cross sectional surveys (1979-1990). Participants' addresses were geocoded and linked with census data for measuring neighbourhood SES and with telephone yellow page listings for measuring convenience store concentration (density in a neighbourhood, distance between a participant's home and the nearest convenience store, and number of convenience stores within a one mile radius of a participant's home). The data were analysed with multilevel Poisson regression models. Setting: 82 neighbourhoods in four northern California cities. Participants: 8121 women and men aged 25-74 from the Stanford heart disease prevention programme. Main results: lower neighbourhood SES and higher convenience store concentration, measured by density and distance, were both significantly associated with higher level of individual smoking after taking individual characteristics into account. The association between convenience store density and individual smoking was modified by individual SES and neighbourhood SES. Conclusions: These findings are consistent with a growing body of literature suggesting that the socioeconomic and physical environments of neighbourhoods are associated with individual level smoking. [ABSTRACT FROM AUTHOR]

Background The San Joaquin Valley (SJV) in California ranks among the worst in the USA in terms of air quality, and its residents report some of the highest rates of asthma symptoms and asthma-related emergency department (ED) visits and hospitalisations in California. Using California Health Interview Survey data, the authors examined associations between air pollution and asthma morbidity in this region. Methods Eligible subjects were SJV residents (2001 California Health Interview Survey) who reported physician-diagnosed asthma (n=1502, 14.6%). The authors considered two outcomes indicative of uncontrolled asthma: (1) daily or weekly asthma symptoms and (2) asthma-related ED visits or hospitalisation in the past year. Based on residential zip code, subjects were assigned annual average concentrations of ozone, PM10 and PM2.5 for the 1-year period prior to the interview date from their closest government air monitoring station within an 8 km (5 miles) radius. Results Adjusting for age, gender, race/ethnicity, poverty level and insurance status, the authors observed increased odds of experiencing daily or weekly asthma symptoms for ozone, PM10 and PM2.5 (ORozone 1.23, 95% CI 0.94 to 1.60 per 10 ppb; ORPM10 1.29, 95% CI 1.05 to 1.57 per 10μg/m3; and ORPM2.5 1.82; 95% CI 1.11 to 2.98 per 10μg/m3). The authors also observed increased odds of asthma-related ED visits or hospitalisations for ozone (OR 1.49, 95% CI 1.05 to 2.11 per 10 ppb) and a 29% increase in odds for PM10 (OR 1.29, 95% CI 0.99 to 1.69 per 10μg/m3). Conclusions Overall, these findings suggest that individuals with asthma living in areas of the SJV with high ozone and particulate pollution levels are more likely to have frequent asthma symptoms and asthma-related ED visits and hospitalisations. [ABSTRACT FROM AUTHOR]