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Peer respites are short-term residential mental health programs staffed by peers with lived experience of mental distress. This case study examines qualitative data of peer staff and non-peer program directors' experiences working at the first peer respite in California. Throughout a five-year study (2010–2015), researchers conducted 20 semi-structured interviews and three focus groups with 25 peer staff and three program directors. The study found that peer staff reported differences in recovery-oriented service delivery between the county health system and their training in Intentional Peer Support. Peer staff indicated that such differences contributed, in part, to the program's gradual acceptance of the service delivery model promoted by the county, and the program's integration enabled its continued support via public funds. This paper concludes with policy recommendations to transform public mental health systems in collaboration with peer staff. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is an important cause of cancer death in adults in the U.S.; screening is effective but underutilized, particularly among minorities. The purpose of this paper was to explore whether health belief model (HBM) constructs pertaining to CRC screening differ by race/ethnicity and primary language. Data were from the baseline surveys of 933 participants (93.5%) in a randomized trial promoting CRC screening in San Francisco. Composite scores for each construct were created from multiple items, dichotomized for analysis, and analyzed using multivariate logistic regression. Most participants were Asian (29.7%) or Hispanic (34.3%), and many were non-English speakers. Non-English speaking Hispanics (p<.001) and English-speaking Asians (p=.002) reported lower perceived susceptibility than non-Hispanic Whites (NHW). Non-English speaking Hispanics reported more and non-English speaking Asians fewer perceived barriers (psychological and structural) than NHW. Understanding how different populations think about CRC screening may be critical in promoting screening in diverse populations. [ABSTRACT FROM AUTHOR]

As interest grows in the diffusion of evidence-based interventions (EBIs), there is increasing concern about how to mitigate implementation challenges; this paper concerns adapting an EBI for homeless women. Complementing earlier focus groups with home-less women, homeless service providers (n = 32) were engaged in focus groups to assess capacity, needs, and barriers with implementation of EBIs. Deductive analyses of data led to the selection of four EBIs. Six consensus groups were then undertaken; three each with homeless women (n = 24) and homeless service providers (n = 21). The selected EBI was adapted and pretested with homeless women (n = 9) and service providers (n = 6). The structured consensus group process provided great utility and affirmed the expertise of homeless women and service providers as experts in their domain. Engaging providers in the selection process reduced the structural barriers within agencies as obstacles to diffusion. [ABSTRACT FROM AUTHOR]

The United States Department of Housing and Urban Development (HUD)-Veteran Administration Supportive Housing (VASH) program uses project- and tenant-based vouchers to provide permanent supportive housing for homeless Veterans. We compared Veteran characteristics, health service utilization, and neighborhood characteristics between HUD-VASH participants with project-based (n=114) vs. tenant-based (n=978) vouchers. We found that project-based voucher holders were older and more ill than tenant-based voucher holders. Project-based vouchers were also associated with higher-quality neighborhoods and higher rates of health service utilization than tenant-based vouchers. With the limited availability of project-based vouchers, juxtaposed with the increased service use and better neighborhood quality with this voucher type, our findings suggest a need to think strategically about how best to allocate housing vouchers to meet homeless Veteran's needs. [ABSTRACT FROM AUTHOR]

We conducted a preliminary study to rapidly assess (1) whether an underground cigarette market exists in the area known as Oakland Chinatown in Oakland, California; and if so, (2) who consumes untaxed cigarettes in this ethnic enclave to provide a basis for further investigation. [ABSTRACT FROM AUTHOR]

The King Library in San José, California, is a unique combination of academic and public library. It serves the diverse populations of the City of San José and San José State University (SJSU). This article provides analysis of data collected in a study on the concept of "library as place" and SJSU students' sense of belonging toward the King Library building. This study involved a mixed quantitative-qualitative research approach. In total, 744 students were surveyed. The results show that SJSU students use the library and it is relevant to their needs. Ideas for improvement and creation of services are offered. [ABSTRACT FROM AUTHOR]

While schools serve as a common entry point into mental health services for underserved youth, engagement of students in need of care remains a problem. Little is known about the ways schools can best address students' mental health needs, especially from the perspective of youth who struggle to attend school, a vulnerable group with a high burden of mental health problems. A qualitative descriptive approach was used to analyze data from in-depth interviews with a sample of 18 youth with a history of school truancy and mental health problems. Analyses explored how youth expressed mental health symptoms, and their trajectories through, and perceptions of, school- based mental health services. Results suggest that participants experienced multiple, overlapping symptoms; only a portion had their needs addressed. The quality of relationships with school staff and the perceived efficacy of treatment affected service trajectories. Promising school-based approaches to address students' mental health needs are discussed. [ABSTRACT FROM AUTHOR]

This manuscript describes the development and implementation of community engagement as a mission at UCLA’s David Geffen School of Medicine (DGSOM) and UCLA Health System, and summarizes survey results documenting existing community- engaged projects and interest between 2010 to 2013. [ABSTRACT FROM AUTHOR]

Background. Community health centers (CHCs) are critical sources of primary care for medically underserved populations. Electronic health records (EHRs) are important for implementation of evidence-based approaches for cancer control. Methods. Cross-sectional study of CHCs from the Cancer Prevention Control Research Networks community health center Clinic Characteristics Survey. Proportions of CHCs using EHR data to: 1) measure colorectal cancer screening, 2) deliver reports, and 3) provide patient reminders for colorectal cancer screening. Results. Only 27% of CHCs perceive EHR system's colorectal cancer screening data as very accurate. Over half (57%) of respondent CHCs with EHRs reported it is easy or very easy to do colorectal cancer screening activities using EHR systems. Conclusions. Poor EHR data quality and cumbersome EHR systems may be significant barriers to implementation of evidence-based approaches to colorectal cancer screening in CHCs. [ABSTRACT FROM AUTHOR]

San Francisco (SF), a city with large HIV-infected and homeless populations, expanded supportive housing for HIV-infected people in 2007. We used the SF HIV/AIDS registry to compare survival between people who were homeless and who were housed at time of HIV diagnosis from 2002 through 2011. Housing status was obtained from medical records and deaths from local, state, and national vital registration. Survival was estimated using the Kaplan-Meier product-limit method. Ten percent of the 5,474 cases were homeless. Among people diagnosed between 2002 and 2006, the five-year survival was worse for people who were homeless at HIV diagnosis than for housed individuals (79% vs. 92%, pc.0001), but not for those diagnosed between 2007 and 2011 (92% vs. 93%, p=.3938). The improved survival among HIV-infected homeless people occurred during the time of increased supportive housing for this population. Our findings support including housing as an essential component of HIV care. [ABSTRACT FROM AUTHOR]

Community health centers (CHCs) are expected to play a major role in expanding primary care access under the Affordable Care Act (ACA). Although benefits of such health centers among Medicaid populations have been documented, little is known about their impact on the uninsured. Additionally, the effect of health center density on preventable hospitalizations is unknown. This study calculated health center density within five miles of California hospitals using geocoding and Haversine distance formula. Using the 2010 California inpatient dataset, rates of preventable hospitalizations were classified by Prevention Quality Indicators (PQIs). After adjusting for patient and community covariates, we found that as health center density increased, the odds ratio of preventable hospitalizations decreased in both Medicaid and uninsured patients. (OR 0.79 and 0.86 for Medicaid and uninsured respectively p<.001, .044) These findings suggest health centers are contributing to lowering preventable hospitalizations and supports plans to expand such health centers. [ABSTRACT FROM AUTHOR]

The National Postbaccalaureate Collaborative (NPBC) is a partnership of Postbaccalaureate Programs (PBPs) dedicated to helping promising college graduates from disadvantaged and underrepresented backgrounds get into and succeed in medical school. This study aims to determine long-term program outcomes by looking at PBP graduates, who are now practicing physicians, in terms of health care service to the poor and underserved and contribution to health care workforce diversity. Methods. We surveyed the PBP graduates and a randomly drawn sample of non-PBP graduates from the affiliated 10 medical schools stratified by the year of medical school graduation (1996-2002). Results. The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations. Conclusion. The NPBC graduates serve a critical role in providing access to care for underserved populations and serve as a source for health care workforce diversity. [ABSTRACT FROM AUTHOR]

Objective. To determine Latino parents' beliefs regarding the effects of television viewing on infants and toddlers. Methods. We conducted interviews with 26 Latino parents of infants and toddlers. We evaluated parents' beliefs about the health effects of television viewing, sources of information on this topic and facilitators and barriers to following the American Academy of Pediatrics (AAP) screen-time guidelines. Results. Parents believed that television viewing was educational for children but were concerned that watching television could worsen childrens vision. Parents would be motivated to limit television viewing by children if it were recommended by a health care provider. Most parents were confident that they could limit their childrens television viewing, although some perceived logistical challenges to following guidelines. Conclusions. Parents in our study had limited knowledge of the effects of television. Counseling on television by health care providers for Latino parents may decrease Latino infants and toddlers' television exposure. [ABSTRACT FROM AUTHOR]

Background. This study was conducted to validate use of electronic health record (EHR) data for measuring colorectal cancer (CRC) screening rates at community health centers (CHCs). Methods. Electronic health records were queried to assess screening via colonoscopy, flexible sigmoidoscopy, or fecal occult blood testing (FOBT) in 2011. Results. Multiple iterations were required to maximize query accuracy. Manual chart reviews, stratified by screening modality, confirmed query results for 112 of 113 (99.1%) reviewed colonoscopies, 110 of 110 (100%) reviewed FOBTs, and 111 of 120 (92.5%) unscreened patients. At participating CHCs, CRC screening rates ranged from 9.7% to 67.2% (median, 30.6%). Adherence to annual FOBT ranged from 3.3% to 59.0% (median, 18.6%). Most screening was done by colonoscopy. Conclusions. Colorectal cancer screening varies substantially across CHCs. Electronic health record data can validly measure CRC screening, but repeated assessments of programming accuracy are required. Community health centers may need support to measure quality using EHR data and increase screening. [ABSTRACT FROM AUTHOR]

High rates of racial discrimination and non-ceremonial tobacco smoking exist among American Indian/Alaska Native (ALAN) Two-Spirit/LGBT (Lesbian, Gay, Bisexual, Transgender) populations. The authors examined whether or not pain mediates between racial discrimination and smoking among Two-Spirits. Two-Spirit adults (n=447) from seven urban U.S. locations were surveyed during the HONOR project. The Indigenist stress coping model was used as framework in which to conduct descriptive, bivariate and regression analyses. A majority of the participants reported smoking (45.2%) and pain (57%). Pain was found to mediate the association between racial discrimination and smoking. Racial discrimination appears to be a significant factor influencing tobacco smoking and health behaviors within Two-Spirit populations. Effective tobacco cessation and/or prevention planning for Two-Spirits and others who experience frequent racial discrimination, stress, and trauma should also consider the influence of pain. Pain may serve as the embodiment of discrimination, and this possibility requires future research. [ABSTRACT FROM AUTHOR]

Cancer self-efficacy (CSE) and spiritual well-being (SWB) have been associated with better self-rated health (SRH) among breast cancer survivors (BCS), but have not been well studied among Latina BCS (LBCS). Multivariate logistic regression analyses of secondary data from a cross-sectional population-based telephone survey of 330 LBCS explored relationships of language acculturation, CSE, and SWB subdomains of inner peace and faith with SRH. English proficiency was associated with SRH, independent of other covariates (OR=2.26, 95% CI 1.15, 4.45). Cancer self-efficacy attenuated this effect and was positively associated with SRH (OR=2.24, 95% CI 1.22, 4.10). Adding inner peace (a SWB subscale) attenuated the association of CSE and SRH (OR=1.67, 95% CI 0.88, 3.18). Inner peace remained associated with SRH (OR= 2.44, 95% CI 1.30, 4.56), controlling for covariates. Findings support the importance of a sense of inner peace and control over breast cancer to LBCS' perceived health. [ABSTRACT FROM AUTHOR]

Latino migrant day laborers (LMDLs) live under challenging conditions in the San Francisco Bay Area. This study explored day laborer alcohol use guided by a structural vulnerability framework, specifically problem vs. non-problem drinking as perceived by LMDLs and how they cope with or try to avoid problem drinking given their broader environment. The study utilized ethnographic methods including in-depth semi-structured qualitative interviews with 51 LMDLs. Findings revealed the considerable challenge of avoiding problem drinking given socio-environmental factors that influence drinking: impoverished living and working conditions, prolonged separation from home and family, lack of work authorization, consequent distress and negative mood states, and peer pressure to drink. While participants shared strategies to avoid problem drinking, the success of individual-level efforts is limited given the harsh structural environmental factors that define day laborers' daily lives. Discussed are implications for prevention and intervention strategies at the individual, community, national and international levels. [ABSTRACT FROM AUTHOR]

We examined whether a combination of predisposing, enabling, need, and primary care experience variables would predict trust in medical health care providers for homeless veterans over 18 months. Linear mixed model analysis indicated that, among these variables, race, social support, service-connected disability status, and satisfaction and continuity with providers predicted trust in provider over time. Trust in providers improved during the initial stages of the relationship between patient and provider and then declined to slightly below baseline levels over time. Further research is needed to determine generalizability and effects of provider trust on patient health care status over longer periods of time. [ABSTRACT FROM AUTHOR]

To identify homeless people with chronic kidney disease (CKD) who were at highest risk for end-stage renal disease (ESRD), we studied 982 homeless and 15,674 domiciled people with CKD receiving public health care. We developed four risk prediction models for the primary outcome of ESRD. Overall, 71 homeless and 888 domiciled people progressed to ESRD during follow-up (median: 6.6 years). Homeless people with CKD experienced significantly higher incidence rates of ESRD than poor but domiciled peers. Most homeless people who developed progressive CKD were readily identifiable well before ESRD using a prediction model with five common variables. We estimated that program following homeless people in the highest decile of ESRD risk would have captured 64-85% of those who eventually progressed to ESRD within five years. Thus, an approach targeting homeless people at high risk for ESRD appears feasible and could reduce substantial morbidity and costs incurred by this highly vulnerable group. [ABSTRACT FROM AUTHOR]

This study explored the presence and characteristics of natural mentors among 197 homeless youth and the association between natural mentoring relationships and youth functioning. Few studies have explored protective factors in the lives of homeless youth and how these may buffer against poor health outcomes. Relationships with natural mentors have been shown to have protective effects on adolescent functioning among the general adolescent population, and, thus, warrant further investigation with homeless youth. Results from this study revealed that 73.6% of homeless youth have natural mentoring relationships, split between kin and non-kin relationships. Having a natural mentor was associated with higher satisfaction with social support and fewer risky sexual behaviors. Findings suggest that natural mentors may play a protective role in the lives of homeless youth and should be considered an important source of social support that may enhance youth resilience. [ABSTRACT FROM AUTHOR]

Introduction. Racial/ethnic minority older adults in low-income status might be at a greater risk than others of developing chronic illness. We sought to examine the effects of race/ethnicity on end-of-life (EOL) treatment preference among low-income older adults. Methods. A cross-sectional study surveyed 256 low-income older adults (90 Whites, 82 Hispanics, 84 Blacks) in a California city. Results. Hierarchical multiple regression results showed that participants with greater religiosity (p < .01) or more frequent doctors' visits (p < .05) had greater preference for life-sustaining treatments during the final phase of life. Conversely, those with greater comfort about death (p < .01) or a belief that life and death are predestined (p < .05) preferred life-sustaining treatments less often. Race/ethnicity had no significant relationship with EOL treatment preference after accounting for other factors. Conclusion. Race/ethnicity encompasses multiple life contexts. Understanding the influences of both cultural beliefs and individual circumstances on EOL treatment preference is imperative. [ABSTRACT FROM AUTHOR]

Methods. The authors designed a survey instrument to examine the effect of involvement in a student-run free clinic project (SRFCP) on medical student self-reported attitudes toward the underserved and interest in primary care. From 2001-2010, first- and second-year medical students in an introductory service-learning elective course rated each of 15 statements on a seven-point Likert scale pre/post survey. Wilcoxon's signed rank test was performed on all matched pairs and an intent-to-treat analysis included unmatched pairs. Results. The response rate was 97.9%, with 914 of 934 students enrolled participating. Significant increases were seen in each of the 15 items in matched pre/post survey pairs, N = 433 (47.4%), or with an intent-to-treat analysis, N = 914 (p ≤ .002 for all). Conclusions. This study found that medical student involvement in a SRFCP improved student knowledge, skills, attitudes and self-efficacy with the underserved, interest in work with the underserved after graduation, and interest in primary care. [ABSTRACT FROM AUTHOR]

Electronic health record (EHR) implementation may affect patient-clinician communication for diverse safety-net populations. We conducted a cross-sectional survey of English-, Spanish-, and Cantonese-speaking patients in a public hospital clinic with a basic EHR. We examined multivariate associations of patient race/ ethnicity, language, and education with perceptions of primary-care provider (PCP) computer use. Among 399 respondents, 25% had less than a high school education, 22% preferred Spanish, and 17% Cantonese. Asian (AOR 3.1), non-English-speakers (AOR 3.6) were more likely to report that PCPs used the computer half or more of the visit. Asians were more likely to report that computers helped PCPs remember patient concerns (AOR 5.6). Non-English- speakers had lower odds of reporting that PCPs listened less carefully to them because of computers (AOR 0.3). Patients at risk for communication barriers may perceive advantages of PCP computer use. Safety-net clinics should consider EHR impact on communication disparities. [ABSTRACT FROM AUTHOR]

We sought to examine the influence of social and clinical factors on risk of progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD) in the urban poor. We studied 15,353 individuals with moderate-to-advanced CKD who received ambulatory care within a large public health system during 1996-2005. The primary outcome was progression to ESRD. Overall, 559 cases of ESRD occurred over a median follow-up of 2.8 years. Among traditional predictors of ESRD, younger age, male sex, non-White race/ ethnicity, public health insurance coverage, diabetes, lower kidney function, higher proteinuria, lower hemoglobin level, and lower serum albumin concentration were significantly associated with a higher adjusted ESRD risk (p<.001 for all). There was no significant association between HIV/ AIDS (p=.07), viral hepatitis (p=.11), or non-English language (p=.27) and ESRD risk. Our results highlight the importance of addressing traditional risk factors for progressive CKD to reduce the disproportionate burden of ESRD among disadvantaged populations. [ABSTRACT FROM AUTHOR]

Background. Previous work suggests hospitals serving high percentages of patients with Medicaid are associated with worse colon cancer survival. It is unclear if practice patterns in these settings explain differential outcomes. Hypothesis: High Medicaid hospitals (HMH) have lower compliance with evidence-based care processes (examining 12 or more lymph nodes (LN) during surgical staging and providing appropriate chemo- therapy). Methods. Retrospective analysis of stage I-III colon cancers from California Cancer Registry (1996-2006) linked to discharge abstracts and hospital profiles predicted hospital compliance with guidelines and trends in compliance over time. Results. Cases (N=60,000) in 439 hospitals analyzed. High Medicaid hospital settings had lower odds of compliance with the 12 LN exam (ORHMH0.91, CIHMH [0.85, 0.98]) and with the delivery of appropriate chemotherapy (ORHMH0.76, CIHMH [0.67, 0.86]). Conclusions. High Medicaid hospital status is associated with poor performance on evidence-based colon cancer care. Policies to improve the quality of colon cancer care should target these settings. [ABSTRACT FROM AUTHOR]

Childhood overweight and obesity disproportionately affect low-income com- munities. Most school-based health promotion efforts occur during the school day and are limited in scope. This study evaluated the effectiveness of an after-school program among 3rd-5th graders (n=121; 73% 8 to 9 years old; 57% female; 60% Asian) at eight study site (four intervention, four comparison). After-school staff were trained on implementing the Catch Kids Club Curriculum on nutrition and physical activity. Data were collected on students' nutrition and physical activity knowledge and behavior, and their height and weight measurements. Using Stata 10.1/SE, cross-lagged regression models assessed changes over time. Results showed a reduction in overweight and obesity (defined as body mass index >85th percentile for age and sex) among children in the intervention group, but mixe results regarding diet and physical activity knowledge and behavior. Enhancing after-school physical activity opportunities through evidence-based programs can potentially improve overweight and obesity among low-income children. [ABSTRACT FROM AUTHOR]

This study explored how Chinese American, Korean American, and Mexican American women modify their health behaviors following breast cancer treatment and identified motivators and barriers that influence their changes. An exploratory, descriptive, qualitative study was undertaken using six focus groups. Discussions were transcribed and translated for content analysis. Significant differences among the ethnic groups were noted in the following health behavior practices which were most commonly stated as changed behaviors after a breast cancer diagnosis: 1) eating habits, 2) physical activity, 3) alternative medicine, 4) sleeping, 5) social activity, 6) weight control, and 7) alcohol consumption. Family, financial concerns, environment, and religious faith were commonly mentioned as motivators of and/or barriers to changes in health behaviors. Findings provide insight into different perspectives related to changes in health behaviors by ethnicity, which is critical for developing culturally tailored behavioral interventions to improve underserved breast cancer survivors' quality of life and to reduce health disparities. [ABSTRACT FROM AUTHOR]

This qualitative study explored the barriers and facilitators of cancer screening among women of Hmong origin. Using a community-based participatory research approach, we conducted focus groups (n=44) with Hmong women who represented four distinct demographic groups among the Hmong community. The participants described sociocultural barriers to screening, which included a lack of accurate knowledge about the causes of cervical cancer, language barriers, stigma, fear, lack of time, and embarrassment. Structural barriers included attitudes and practices of health care providers, lack of insurance, and negative perceptions of services at clinics for the uninsured. Health care providers may require additional training and increased time per visit to provide culturally sensitive care for refugee groups such as the Hmong. Health-related social marketing efforts aimed at improving health literacy may also help to reduce health inequities related to cancer screening among the Hmong. [ABSTRACT FROM AUTHOR]