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Background: Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. Methods: This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. Results: Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24–2.00), 42 days (aOR 1.51, 95% C.I 1.20–1.91), and 365 days (aOR 1.40, 95% C.I 1.11–1.75), compared to patients who had their first documented plan in the third trimester. Conclusions: Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally. Plain language summary: Permanent contraception is a highly desired form of postpartum contraception in the United States, however there are several barriers to accessing it. In this paper, we investigate whether the timing of when a patient has a documented plan for postpartum contraception has an impact on if they achieve postpartum contraception. This is a cohort study from four hospitals in Illinois, Ohio, California, and Alabama for patients with a desire for postpartum permanent contraception documented in their medical record. We specifically investigated the trimester (first, second, or third) where a patient had a plan for permanent contraception first documented. We then used univariate and multivariate models to determine the relationship between the timing of a plan for permanent contraception and if a patient achieved the procedure at three time-points: hospital discharge, 42-days, and 365-days. Our findings showed that of the 3103 patients in our cohort, only 69.1% of them had a documented plan for postpartum contraception at any point before going to the hospital for their delivery admission. We additionally found that patients who had a documented plan for permanent contraception in the first or second trimester had a higher odds of receiving their postpartum contraception procedure compared to people who had their first documented plan in the third trimester. This showed us the importance of earlier counseling regarding contraception for pregnant patients. There are many barriers to accessing postpartum contraception, so having patient focused counseling about future goals around reproductive health early on in pregnancy is critical. [ABSTRACT FROM AUTHOR]

The misuse and abuse of opioids has become a serious public health threat in the United States. The state of California has been hit particularly hard by the opioid epidemic, with a noticeable increase in opioid-related fatalities and hospitalizations. This brief report paper aims to contribute to the growing literature by conducting a geospatial analysis of opioid dispensing patterns in California in 2021. The primary objective was to identify areas characterized by high-risk opioid dispending patterns and explore possible contributing factors. This retrospective study analyzed data from over 7 million records of opioid and benzodiazepine prescriptions dispensed by outpatient pharmacies in California in 2021. A series of generalized linear regression models was employed to assess the impact of neighborhood characteristics on opioid recipients and high-risk opioid dispensing. The study defined high-risk opioid dispensing behavior as: (1) multiple provider episodes, (2) overlapping opioid prescriptions for seven or more days, (3) overlapping opioid and benzodiazepine prescriptions for seven or more days, and (4) a high standardized dosage of opioid prescriptions per month. The study identified variables associated with high-risk opioid dispensing behaviors, including age, population density, income, and housing-related variables, as well as marital status and family-related variables. The study uncovered that there are noticeable disparities in opioid dispensing among different racial and ethnic groups within California. The findings indicated a correlation of high-risk dispensing indicators with certain demographic and socioeconomic factors. There was a substantial regional variation in opioid dispensing practices, with certain rural areas having higher rates of opioid prescriptions than urban areas. [ABSTRACT FROM AUTHOR]

INTRODUCTION American Indian (AI) people experience a disproportionate tobacco and marijuana burden which may have been exacerbated by the COVID-19 pandemic. Little is known about the tobacco and marijuana habits of American Indian individuals during the COVID-19 pandemic. The objective of this study is to examine tobacco and marijuana use as well as change in use during the COVID-19 pandemic among the American Indian community. METHODS This cross-sectional study analyzes survey data from a convenience sample of American Indian individuals residing in California and Oklahoma and included adults with and without cancer that resided in both rural and urban areas (n=1068). RESULTS During October 2020 -- January 2021, 36.0% of participants reported current use of tobacco products, 9.9% reported current use of marijuana products, and 23.7% reported increased use of tobacco and/or marijuana in the past 30 days, with no difference between those with cancer and those without cancer. Tobacco use was associated with marital status, age, employment status, COVID-19 exposure, COVID-19 beliefs, and alcohol consumption. Marijuana use was associated with COVID-19 beliefs, alcohol consumption, and income level. Increased tobacco and/or marijuana use was associated with baseline use of those products. Nearly a quarter of participants reported increased use of tobacco and/ or marijuana products during the COVID-19 pandemic. CONCLUSIONS We observed high rates of tobacco use during the COVID-19 pandemic, consistent with other studies. Research is needed to examine whether tobacco and marijuana use will decrease to pre-pandemic levels post-pandemic or if these behaviors will persist post-pandemic. Given these findings, there is a pressing need to increase access to evidence-based tobacco and marijuana treatment services in the AI population post COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: There is increased recognition in clinical settings of the importance of documenting, understanding, and addressing patients' social determinants of health (SDOH) to improve health and address health inequities. This study evaluated a pilot of a standardized SDOH screening questionnaire and workflow in an ambulatory clinic within a large integrated health network in Northern California. Methods: The pilot screened for SDOH needs using an 11-question Epic-compatible paper questionnaire assessing eight SDOH and health behavior domains: financial resource, transportation, stress, depression, intimate partner violence, social connections, physical activity, and alcohol consumption. Eligible patients for the pilot receiving a Medicare wellness, adult annual, or new patient visits during a five-week period (February-March, 2020), and a comparison group from the same time period in 2019 were identified. Sociodemographic data (age, sex, race/ethnicity, and payment type), visit type, length of visit, and responses to SDOH questions were extracted from electronic health records, and a staff experience survey was administered. The evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: Two-hundred eighty-nine patients were eligible for SDOH screening. Responsiveness by domain ranged from 55 to 67%, except for depression. Half of patients had at least one identified social need, the most common being stress (33%), physical activity (22%), alcohol (12%), and social connections (6%). Physical activity needs were identified more in females (81% vs. 19% in males, p <.01) and at new patient/transfer visits (48% vs. 13% at Medicare wellness and 38% at adult wellness visits, p <.05). Average length of visit was 39.8 min, which was 1.7 min longer than that in 2019. Visit lengths were longer among patients 65+ (43.4 min) and patients having public insurance (43.6 min). Most staff agreed that collecting SDOH data was relevant and accepted the SDOH questionnaire and workflow but highlighted opportunities for improvement in training and connecting patients to resources. Conclusion: Use of evidence-based SDOH screening questions and associated workflow was effective in gathering patient SDOH information and identifying social needs in an ambulatory setting. Future studies should use qualitative data to understand patient and staff experiences with collecting SDOH information in healthcare settings. [ABSTRACT FROM AUTHOR]

Objective: The present paper examines the influence of age and gender on food patterns of Latino children.Design: Data are from baseline of a 5-year, quasi-experimental obesity prevention study: Niños Sanos, Familia Sana (NSFS; Healthy Children, Healthy Families). In 2012, the researchers interviewed Latino parents, using a thirty-item questionnaire to ask about their children's food consumption and feeding practices. Statistical tests included t tests and ANCOVA.Setting: Rural communities in California's Central Valley, USA.Subjects: Two hundred and seventeen parents (87-89% born in Mexico) and their children (aged 2-8 years).Results: Fifty-one per cent of the children were overweight or obese (≥85th percentile of BMI for age and gender). Mean BMI Z-scores were not significantly different in boys (1·10 (SD 1·07)) and girls (0·92 (SD 1·04); P=0·12). In bivariate analysis, children aged 2-4 years consumed fast and convenience foods less often (P=0·04) and WIC (Supplemental Nutrition Program for Women, Infants, and Children)-allowable foods more often than children aged 5-8 years (P=0·01). In ANCOVA, neither age nor gender was significantly related to food patterns. Mother's acculturation level was positively related to children's consumption of fast and convenience foods (P=0·0002) and negatively related to consumption of WIC foods (P=0·01). Providing role modelling and structure in scheduling meals and snacks had a positive effect on the vegetable pattern (P=0·0007), whereas meal skipping was associated with more frequent fast and convenience food consumption (P=0·04).Conclusions: Acculturation and child feeding practices jointly influence food patterns in Latino immigrant children and indicate a need for interventions that maintain diet quality as children transition to school. [ABSTRACT FROM AUTHOR]

INTRODUCTION Electronic cigarettes (e-cigarettes) have rapidly become the most commonly used tobacco product among youth in the United States. Exposure to advertising, peer use, and household use, increases the risk of current e-cigarette use; however, the influence of these factors may be dynamic across adolescence. The aim of this study is to examine the age-varying associations between e-cigarette use and peer use, household use, and exposure to e-cigarette commercials among alternative high school students in Southern California. METHODS Using data previously collected for a tobacco marketing study, we examine the age-varying associations of current e-cigarette use and three risk factors (peer use, exposure to commercials, and household use) across ages 15 to 20 years using time-varying effect modeling (TVEM). Analyses include three waves of data from alternative high school students (N=1060 students; 2036 observations). RESULTS The probability of e-cigarette use gradually increased over the age of 15 years and then decreased by the age of 17 years for females and after the age of 18 years for males. Significant gender differences were observed between the ages of 17 and 19.5 years. Peer e-cigarette use was associated with higher odds of current e-cigarette use across all ages for females and after the age of 16 years for males. Exposure to e-cigarette commercials increased current use significantly for males between the ages of 16 and 18 years. Household use increased the odds of current use of e-cigarettes between the ages of 17 and 19 years for males and under 16.5 and over 18 years for females. CONCLUSIONS The findings highlight the utility of TVEM in understanding the risk factors of e-cigarette use and suggest that these factors are dynamic across adolescence. [ABSTRACT FROM AUTHOR]

In this study, we provide an assessment of data accuracy from the 2020 Census. We compare block-level population totals from a sample of 173 census blocks in California across three sources: (1) the 2020 Census, which has been infused with error to protect respondent confidentiality; (2) the California Neighborhoods Count, the first independent enumeration survey of census blocks; and (3) projections based on the 2010 Census and subsequent American Community Surveys. We find that, on average, total population counts provided by the U.S. Census Bureau at the block level for the 2020 Census are not biased in any consistent direction. However, subpopulation totals defined by age, race, and ethnicity are highly variable. Additionally, we find that inconsistencies across the three sources are amplified in large blocks defined in terms of land area or by total housing units, blocks in suburban areas, and blocks that lack broadband access. [ABSTRACT FROM AUTHOR]

Aim: To examine the use of social networking sites in recruiting research participants. Background: Workplace violence is an important issue for staff and patients. One workplace that reports the highest levels of violence is the emergency department. The ability to research issues such as workplace violence in real time is important in addressing them expeditiously, and social media can be used to advertise and recruit research subjects, implement studies and disseminate information. Review methods: The experience of recruiting subjects through social networks, specifically Facebook, and the use of participant information clips (PICs) for advertising. Discussion: A brief discussion of the history of advertising and communication using the internet is presented to provide an understanding of the trajectory of social media and implications for recruitment in general. The paper then focuses on the lead author’s experience of recruiting subjects using Facebook, including its limitations and advantages, and her experience of using participant information clips. The low cost of advertising and recruiting participants this way, as well as the convenience provided to participants, resulted in almost half the study’s total participants being obtained within 72 hours. Conclusion: Using Facebook to target a younger age range of nurses to participate in a study was successful and yielded a large number of completed responses in a short time period at little cost to the researcher. Recording the PIC was cheap, and posting it and a link to the site on pre-existing group pages was free, providing valuable viral marketing and snowball recruiting. Implications for research/practice: Future researchers should not overlook using social network sites for recruitment if the demographics of the desired study population and subject matter permit it. [ABSTRACT FROM AUTHOR]

Background: Mobile medical clinics have been used for decades to provide primary and preventive care to underserved populations. While several studies have examined their return on investment and impact on chronic disease management outcomes in the Mid-Atlantic and East Coast regions of the United States, little is known about the characteristics and clinical outcomes of adults who receive care aboard mobile clinics on the West Coast region. Guided by the Anderson Behavioral Model, this study describes the predisposing, enabling, and need factors associated with mobile medical clinic use among mobile medical clinic patients in Southern California and examines the relationship between mobile clinic utilization and presence and control of diabetes and hypertension. Methods: We conducted a retrospective cohort study of 411 adults who received care in four mobile clinic locations in Southern California from January 1, 2018, to December 31, 2019. Data were collected from patient charts on predisposing (e.g., sex, race, age), enabling (e.g., insurance and housing status), and need (e.g., chronic illness) factors based on Andersen's Behavioral Model. Zero-truncated negative binomial regression was used to examine the association of chronic illness (hypertension and diabetes) with number of clinic visits, accounting for potential confounding factors. Results: Over the course of the 2-year study period, 411 patients made 1790 visits to the mobile medical clinic. The majority of patients were female (68%), Hispanic (78%), married (47%), with a mean age of 50 (SD = 11). Forty-four percent had hypertension and 29% had diabetes. Frequency of mobile clinic utilization was significantly associated with chronic illness. Patients with hypertension and diabetes had 1.22 and 1.61 times the rate of mobile medical clinic visit than those without those conditions, respectively (IRR = 1.61, 95% CI, 1.36–1.92; 1.22, 95% CI, 1.02–1.45). Conclusions: Mobile clinics serve as an important system of health care delivery, especially for adults with uncontrolled diabetes and hypertension. [ABSTRACT FROM AUTHOR]

If the pattern of fertility, mortality and interregional migration exhibited by the United States population during 1950-60 were to continue in the future, the proportions of persons in the various age groups and regions would fluctuate from decade to decade. These fluctuations would become less marked with time, however, and eventually all the proportions would stabilize at certain fixed values. This collection of values may be called a stable age by region composition corresponding to the given schedule of fertility, mortality and migration. The same phenomenon may be observed when individuals move between socioeconomic categories as, for example, socioeconomic status or educational attainment levels. The substantial differences between these various situations conceal remarkable similarities. In each case the continued operation of schedules of fertility, mortality and mobility between categories may result in a stable composition. The purpose of this paper is to shed some light on the nature of these stable compositions, on the interrelation between their various components, and on their relation to the patterns of fertility, mortality and mobility which generate them. [ABSTRACT FROM AUTHOR]

Patients with diabetes must have self-efficacy to perform necessary self-care tasks. Self-efficacy has been considered as one of the primary motivators on diabetes self-care; therefore, it is essential for health care professionals to assess the self-efficacy of patients with diabetes to provide optimal care. Despite older Korean immigrants having greater difficulty in diabetes management, research on self-efficacy for them is lacking. This study aims to examine the psychometric property of the General Self-Efficacy scale Korean version for older Korean immigrants with diabetes in the United States. In this cross-sectional, methodological study, data were collected using convenience sampling. Cronbach's alpha, exploratory factor analysis, and confirmatory factor analysis were employed to examine the psychometric properties. Cronbach's alpha for the entire GSE scale Korean version is 0.81. The initial Eigenvalues show two factors, coping and confidence; however, the confirmatory factor analysis showed reasonable goodness of fit to the data (χ2(35) = 86.24, p < 0.01), χ2/df ratio = 2.46, AGFI = 0.87, GFI = 0.91, IFI = 0.90, ECVI = 0.74, CFI = 0.89, and RMSEA = 0.093 in the one-factor model. The General Self-Efficacy scale Korean version demonstrated acceptable reliability and validity. It can be used to investigate self-efficacy and to devise culturally tailored diabetes interventions. [ABSTRACT FROM AUTHOR]

This article focuses on the racial aspect of the differential fertility in California in 1930. In California, problems connected with the racial differential are particularly significant. The racial minorities are numerically important. They form rather distinct cultural groups and are, in the main, clearly set off from the majority by skin color. Many of them are denied the privilege of citizenship, and miscegenation is either prohibited by law or enforced by custom. And they are markedly differentiated from the white majority in another respect: they are not only guaranteeing the stability of their numbers in the future but were, in 1930, reproducing at a rate so high that they might be expected, when their age distribution becomes stabilized, to double in numbers in little more than a generation, while the reproductive level of the whites was, under the same conditions, at so low a level that a decline in numbers by about a third per generation might have been expected. The aim of this paper is to uncover some of the factors underlying this differential.

Background and Objectives: Over 25% of United States (US) community-dwelling, older adults are at nutritional risk. Health and cost burdens of poor nutrition can be lowered by nutrition programs for hospital inpatients, but few studies have looked at the impact on outpatients. The objective of our study was to assess outcomes of a nutrition focused quality improvement program (QIP) on healthcare resource use and costs in poorly nourished outpatients. Methods: This pre-post QIP study was implemented at 3 US healthcare system clinics. Included patients (n = 600) were ≥45 years old, had ≥2 chronic conditions, and were enrolled over a 15-month interval. For comparison, historical (n = 600) and concurrent control (n = 600) groups were used. Assessment of poor nutritional status was performed during each patient's baseline visit. Healthcare resource use (hospitalizations, emergency department visits, and outpatient clinic visits), medication use, and costs were determined for a 90-day interval. Results: QIP patients (mean age 61.6 years) were predominantly female (62.5%) and overweight/obese (81.7%). The proportion of QIP outpatients presenting for healthcare services was significantly reduced compared to both historical and concurrent controls—relative risk reduction (RRR) versus historical (11.6%, P <.001) and versus concurrent (8.9%, P =.003). Of those who presented, RRR for healthcare resource use by QIP was significant in comparison with historical (12.9%, P =.022) but not concurrent controls. No significant differences were observed for medication usage. Lower resource use among QIP patients yielded total cost savings of $290 923 or per-patient savings of $485. Conclusions: Nutrition QIPs in outpatient clinics are feasible and can reduce healthcare resource use and cut costs. Such findings underscore benefits of nutritional interventions for community-dwelling outpatients with poor nutritional status. [ABSTRACT FROM AUTHOR]

Objectives: Racial differences in mortality in the United States have narrowed and vary by time and place. The objectives of our study were to (1) examine the gap in life expectancy between white and black persons (hereinafter, racial gap in life expectancy) in 4 states (California, Georgia, Illinois, and New York) and (2) estimate trends in the contribution of major causes of death (CODs) to the racial gap in life expectancy by age group. Methods: We extracted data on the number of deaths and population sizes for 1969-2013 by state, sex, race, age group, and 6 major CODs. We used a Bayesian time-series model to smooth and impute mortality rates and decomposition methods to estimate trends in sex- and age-specific contributions of CODs to the racial gap in life expectancy. Results: The racial gap in life expectancy at birth decreased in all 4 states, especially among men in New York (from 8.8 to 1.1 years) and women in Georgia (from 8.0 to 1.7 years). Although few deaths occurred among persons aged 1-39, racial differences in mortality at these ages (mostly from injuries and infant mortality) contributed to the racial gap in life expectancy, especially among men in California (1.0 year of the 4.3-year difference in 2013) and Illinois (1.9 years of the 6.7-year difference in 2013). Cardiovascular deaths contributed most to the racial gap in life expectancy for adults aged 40-64, but contributions decreased among women aged 40-64, especially in Georgia (from 2.8 to 0.5 years). The contribution of cancer deaths to inequality increased in California and Illinois, whereas New York had the greatest reductions in inequality attributable to cancer deaths (from 0.6 to 0.2 years among men and from 0.2 to 0 years among women). Conclusions: Future research should identify policy innovations and economic changes at the state level to better understand New York's success, which may help other states emulate its performance. [ABSTRACT FROM AUTHOR]

Self-weighing may promote attainment and maintenance of healthy weight; however, the natural temporal patterns and factors associated with self-weighing behavior are unclear. The aims of this secondary analysis were to (1) identify distinct temporal patterns of self-weighing behaviors; (2) explore factors associated with temporal self-weighing patterns; and (3) examine differences in percent weight changes by patterns of self-weighing over time. We analyzed electronically collected self-weighing data from the Health eHeart Study, an ongoing longitudinal research study coordinated by the University of California, San Francisco. We selected participants with at least 12 months of data since the day of first use of a WiFi- or Bluetooth-enabled digital scale. The sample (N = 1041) was predominantly male (77.5%) and White (89.9%), with a mean age of 46.5 ± 12.3 years and a mean BMI of 28.3 ± 5.9 kg/m2 at entry. Using group-based trajectory modeling, six distinct temporal patterns of self-weighing were identified: non-users (n = 120, 11.5%), weekly users (n = 189, 18.2%), rapid decliners (n = 109, 10.5%), increasing users (n = 160, 15.4%), slow decliners (n = 182, 17.5%), and persistent daily users (n = 281, 27.0%). Individuals who were older, female, or self-weighed 6–7 days/week at week 1 were more likely to follow the self-weighing pattern of persistent daily users. Predicted self-weighing trajectory group membership was significantly associated with weight change over time (p <.001). In conclusion, we identified six distinct patterns of self-weighing behavior over the 12-month period. Persistent daily users lost more weight compared with groups with less frequent patterns of scale use. [ABSTRACT FROM AUTHOR]

A(H1N1) strains of Influenzavirus were responsible for 2 pandemics in the last 100 years. Because infections experienced early in life may have a long-lasting influence on future immune response against other influenza strains, we drew on previously collected seroincidence data from Singapore (n = 2,554; June–October 2009) to investigate whether the 1918 pandemic influenza virus and its early descendants produced an age-related signature in immune responses against the A/California/7/2009(H1N1)pdm09 virus of 2009. Hemagglutination inhibition assays revealed a J-shaped relationship; the oldest birth cohort (born in 1911–1926) had the highest titers, followed by the youngest (born in 1987–1992). Differential response by vaccination history was also observed, with seasonal influenza vaccine being associated with higher titers mainly in the oldest birth cohort. On the assumption that antibody titers are a correlate of protection, structural equation modeling predicted that a titer-mediated effect by the vaccine could, on its own, account for a negative association with seroconversion equivalent to a risk reduction of 23% (relative risk = 0.77, 95% confidence interval: 0.60, 0.99) in the oldest birth cohort. A subset of 503 samples tested against the A/Brisbane/59/2007(H1N1) and A/Puerto Rico/8/1934(H1N1) strains also revealed different age-related antibody profiles. The effectiveness of seasonal influenza vaccines against future pandemic strains could thus be age-dependent and related to early-life exposures. [ABSTRACT FROM AUTHOR]

Birds found outside their typical range, or vagrants, have fascinated naturalists for decades. Despite broad interest in vagrancy, few attempts have been made to statistically examine the explanatory variables potentially responsible for the phenomenon. In this study, we used multiple linear regression to model the occurrence of 28 rare warbler species (family Parulidae) in autumn in northern California and southern Oregon as a function of migration distance, continental population size, distance, and bearing to both closest breeding population and breeding population center. In addition to our predictive model, we used capture data from the California coast to 300 km inland to examine relationships between the presence of vagrant warblers, regional warbler species richness and age class distribution. Our study yielded three important results: (1) vagrancy is strongly correlated with larger North American population size; (2) vagrants are more common at some coastal sites; and (3) where young birds are overrepresented, vagrants tend to occur—such as on the coast and at far inland sites. Of the many explanations of rare and vagrant individuals, we feel that the most likely is that these birds represent the ends of the distributions of a normal curve of migration direction, bringing some few migrants to locations out of their normal migratory range as vagrants. We also examine the underrepresented species that, according to our model, are overdue for being recorded in our study area. [ABSTRACT FROM AUTHOR]

Objective: The objective of our study was to assess meningococcal ACWY (MenACWY) vaccine uptake among men who have sex with men (MSM) during an ongoing, invasive meningococcal disease outbreak in Southern California. This research was important to inform future vaccination uptake interventions for this high-priority population. Methods: We conducted venue-based sampling to recruit and enroll MSM living in Los Angeles County, California, from December 2016 through February 2017. We conducted bivariate and multivariable analyses to evaluate associations between MenACWY vaccine uptake and other predetermined factors. Results: Of 368 participants, 138 (37.5%) reported receiving the MenACWY vaccine. In multivariable analyses, older age (adjusted odds ratio [aOR] = 2.57; 95% confidence interval [CI], 1.31-5.03), previous diagnosis of a sexually transmitted infection (aOR = 2.22; 95% CI, 1.14-4.30), belief that MenACWY vaccine is important (aOR = 3.49; 95% CI, 1.79-6.82), confidence in the MenACWY vaccine (aOR = 5.53; 95% CI, 3.11-9.83), and knowing someone who had been vaccinated (aOR = 5.82; 95% CI, 3.05-11.12) were significantly associated with MenACWY vaccine uptake. Conclusions: Our findings reflect low uptake of the recommended MenACWY vaccine among MSM after a local outbreak, despite public health efforts. In addition to ongoing, widespread campaigns to inform MSM about local outbreaks and vaccination recommendations, MSM may be responsive to direct outreach from peers who have been vaccinated. [ABSTRACT FROM AUTHOR]

Physical inactivity is a known risk factor for obesity and a number of chronic diseases. Modifying the physical features of neighborhoods to provide residents with equitable and convenient access to spaces for physical activity (PA) is a promising strategy for promoting PA. Public urban recreation spaces (e.g., parks) play an important role in promoting PA and are potentially an important neighborhood element for optimizing social capital and liveability in cities. Most studies examining the effects of park availability and use on PA have focused on traditional, permanent parks. The aims of this study were to (1) document patterns of park use and park-based PA at a temporary urban pop-up park implemented in the downtown business district of Los Altos, California during July-August 2013 and May-June 2014, (2) identify factors associated with park-based PA in 2014, and (3) examine the effects of the 2014 pop-up park on additional outcomes of potential benefit for park users and the Los Altos community at large. Park use remained high during most hours of the day in 2013 and 2014. Although the park attracted a multigenerational group of users, children and adolescents were most likely to engage in walking or more vigorous PA at the park. Park presence was significantly associated with potentially beneficial changes in time-allocation patterns among users, including a reduction in screen-time and an increase in overall park-time and time spent outdoors. Park implementation resulted in notable use among people who would otherwise not be spending time at a park (85% of surveyed users would not be spending time at any other park if the pop-up park was not there-2014 data analysis). Our results (significantly higher odds of spending time in downtown Los Altos due to park presence) suggest that urban pop-up parks may also have broader community benefits, such as attracting people to visit downtown business districts. Pending larger, confirmatory studies, our results suggest that temporary urban pop-up parks may contribute to solving the limited access to public physical activity recreation spaces many urban residents face. [ABSTRACT FROM AUTHOR]

Objective: The ability to use serving size information on food labels is important for managing age-related chronic conditions such as diabetes, obesity and cancer. Past research suggests that older adults are at risk for failing to accurately use this portion of the food label due to numeracy skills. However, the extent to which older adults pay attention to serving size information on packages is unclear. We compared the effects of numeracy and attention on age differences in accurate use of serving size information while individuals evaluated product healthfulness.Design: Accuracy and attention were assessed across two tasks in which participants compared nutrition labels of two products to determine which was more healthful if they were to consume the entire package. Participants' eye movements were monitored as a measure of attention while they compared two products presented side-by-side on a computer screen. Numeracy as well as food label habits and nutrition knowledge were assessed using questionnaires.Setting: Sacramento area, California, USA, 2013-2014.Subjects: Stratified sample of 358 adults, aged 20-78 years.Results: Accuracy declined with age among those older adults who paid less attention to serving size information. Although numeracy, nutrition knowledge and self-reported food label use supported accuracy, these factors did not influence age differences in accuracy.Conclusions: The data suggest that older adults are less accurate than younger adults in their use of serving size information. Age differences appear to be more related to lack of attention to serving size information than to numeracy skills. [ABSTRACT FROM AUTHOR]

The housing foreclosure crisis was harmful to the financial well-being of many households. In the present study, we investigated the health effects of the housing foreclosure crisis on glycemic control within a population of patients with diabetes. We hypothesized that an increase in the neighborhood foreclosure rate could worsen glycemic control by activating stressors such as higher neighborhood crime, lower housing prices, and erosion of neighborhood social cohesion. To test this, we linked public foreclosure records at the census-block level with clinical records from 2006 to 2009 of patients with diabetes. We specified individual fixed-effects models and controlled for individual time-invariant confounders and area-level time-varying confounders, including housing prices and unemployment rate, to estimate the effect of the foreclosure rate per census-block group on glycated hemoglobin. We found no statistically significant relationship between changes in the neighborhood foreclosure rate per block group in the prior year and changes in glycated hemoglobin. There is no evidence that increased foreclosure rates worsened glycemic control in this continuously insured population with diabetes. More research is needed to inform our knowledge of the role of insurance and health-care delivery systems in protecting the health of diabetic patients during times of economic stress. [ABSTRACT FROM AUTHOR]

Background: The clinical effects of age occur over an age continuum, yet age as a primary predictor is often analyzed using arbitrary age cut-points. Objective: To assess whether transformation of a continuous variable such as age using a spline function can uncover nonlinear associations between age and cardiovascular outcomes. Design: Observational retrospective cohort study in 1015 Kaiser Permanente Northern California patients with end-stage renal disease after index coronary revascularization. Age, the primary predictor, was modeled by 5 different techniques: 1) dichotomized at 65 years or older; 2) at 80 years or older (as a sensitivity analysis); 3) categorized as younger than 55 years (reference), 55 to 64, 65 to 74, and 75 years or older; 4) linear (every 5 years) variable; and 5) nonlinear by transformation into a cubic spline. Age categories were changed in a sensitivity analysis. Main Outcome Measures: Primary and secondary outcomes were all-cause mortality and repeat revascularization, respectively. Results: Graphical assessment demonstrated that age dichotomized at either 65 years and older or 80 years and older led to loss of information. Categorized age underestimated or overestimated risk at the extremes of age. A sensitivity analysis demonstrated that an arbitrary change in the age category led to a different conclusion. Age modeled linearly adequately represented mortality risk but was suboptimal with repeat revascularization. Only the cubic spline demonstrated the nonlinear association between age and repeat revascularization. Conclusion: Employing the continuous variable age as a case study, we have demonstrated that the use of flexible transformations, such as spline functions, can unearth clinically meaningful associations that would not have been possible otherwise. Future research should determine whether incorporation of these methods can improve decision making at a population level. [ABSTRACT FROM AUTHOR]

Background: The United States Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with dual-energy x-ray absorptiometry (DXA) for women aged ≥ 65 years and younger women with increased risk. "Choosing Wisely" initiatives advise avoiding DXA screening in women younger than 65 years without osteoporosis risk factors.Objective: We aimed to determine the extent to which DXA screening is used in accordance with USPSTF recommendations within a regional health system.Design: This was a retrospective longitudinal cohort study within 13 primary care clinics in the Sacramento, CA region.Patients: The study included 50,995 women aged 40-85 years without prior osteoporosis screening, diagnosis, or treatment attending primary care visits from 2006 to 2012, observed for a mean of 4.4 years.Main Measures: We examined incidence of DXA screening. Covariates included age, race/ethnicity, and osteoporosis risk factors (body mass index < 20, glucocorticoid use, secondary osteoporosis, prior high-risk facture, rheumatoid arthritis, alcohol abuse, and current smoking).Key Results: Among previously unscreened women for whom the USPSTF recommends screening, 7-year cumulative incidence of DXA screening was 58.8 % among women aged 60-64 years with ≥ 1 risk factor (95 % CI: 51.9-65.8 %), 57.8 % for women aged 65-74 years (95 % CI: 55.6-60.0 %), and 42.7 % for women aged ≥ 75 years (95 % CI: 38.7-46.7 %). Among women for whom the USPSTF does not recommend screening, 7-year cumulative incidence was 45.5 % among women aged 50-59 years (95 % CI 44.1-46.9 %) and 58.6 % among women aged 60-64 years without risk factors (95 % CI 55.9-61.4 %).Conclusions: DXA screening was underused in women at increased fracture risk, including women aged ≥ 65 years. Meanwhile, DXA screening was common among women at low fracture risk, such as younger women without osteoporosis risk factors. Interventions may be needed to augment the value of population screening for osteoporosis. [ABSTRACT FROM AUTHOR]

African-American men who have sex with men (AA MSM) have been disproportionately infected with and affected by HIV and other STIs in San Francisco and the USA. The true scope and scale of the HIV epidemic in this population has not been quantified, in part because the size of this population remains unknown. We used the successive sampling population size estimation (SS-PSE) method, a new Bayesian approach to population size estimation that incorporates network size data routinely collected in respondent-driven sampling (RDS) studies, to estimate the number of AA MSM in San Francisco. This method was applied to data from a 2009 RDS study of AA MSM. An estimate from a separate study of local AA MSM was used to model the prior distribution of the population size. Two-hundred and fifty-six AA MSM were included in the RDS survey. The estimated population size was 4917 (95% CI 1267-28,771), using a flat prior estimated 1882 (95% CI 919-2463) as a lower acceptable bound, and a large prior estimated 6762 (95% CI 1994-13,863) as an acceptable upper bound. Point estimates from the SS-PSE were consistent with estimates from multiplier methods using external data. The SS-PSE method is easily integrated into RDS studies and therefore provides a simple and appealing tool to rapidly produce estimates of the size of key populations otherwise difficult to reach and enumerate. [ABSTRACT FROM AUTHOR]

Objective: Patients' expectations predict important health outcomes. The goal of this study is to describe the types of expectations that hernia and gallbladder patients have for the outcomes of their surgery and to identify relationships between these expectations and both patient‐ and surgeon‐reported variables. Design: Patients (N = 143) at an out‐patient surgery clinic completed self‐report questionnaires before and after a pre‐surgical consultation in which they learned they would be scheduled for surgery. After indicating their general expectations for their surgical outcomes (positive or negative), patients reported specific outcome expectations, which were coded into eight categories: functional improvement, symptom relief, quality‐of‐life improvement, emotional improvement, general health, no effect expected, no response (or unsure) and negative expectations. Results: Functional improvement and symptom relief were the most common types of expectations mentioned by patients. A key finding was a significant difference in the pattern of expectations provided by Hispanic versus non‐Hispanic patients, as well as between patients across the range of health literacy. Conclusions: Patients undergoing hernia and gallbladder surgery have a variety of expectations, and these expectations vary across demographic groups. Patients who are particularly vulnerable to poor physician communication have positive but diffuse expectations. [ABSTRACT FROM AUTHOR]

Background: Timely individualized treatment is essential to improving relapsing-remitting multiple sclerosis (RRMS) patient health outcomes, yet little is known about how patients make treatment decisions. We sought to evaluate RRMS patient preferences for risks and benefits of treatment. Methods: Fifty patients with RRMS completed conjoint analysis surveys with 16 hypothetical disease-modifying therapy (DMT) medication profiles developed using a fractional factorial design. Medication profiles were assigned preference ratings from 0 (not acceptable) to 10 (most favorable). Medication attributes included a range of benefits, adverse effects, administration routes, and market durations. Analytical models used linear mixed-effects regression. Results: Participants showed the highest preference for medication profiles that would improve their symptoms (β = 0.81-1.03, P < .001), not a proven DMT outcome. Preventing relapses, the main clinical trial outcome, was not associated with significant preferences (P = .35). Each year of preventing magnetic resonance imaging changes and disease symptom progression showed DMT preferences of 0.17 point (β = 0.17, P = .002) and 0.12 point (β = 0.12, P < .001), respectively. Daily oral administration was preferred over all parenteral routes (P < .001). A 1% increase in death or severe disability decreased relative DMT preference by 1.15 points (P < .001). Conclusions: Patient preference focused on symptoms and prevention of progression but not on relapse prevention, the proven drug outcome. Patients were willing to accept some level of serious risk for certain types and amounts of benefits, and they strongly preferred daily oral administration over all other options. [ABSTRACT FROM AUTHOR]

To assess the relationship between antioxidant vitamin intake and all-cause mortality in older adults, we examined these associations using data from the Leisure World Cohort Study, a prospective study of residents of the Leisure World retirement community in Laguna Hills, California. In the early 1980s, participants (who were aged 44–101 years) completed a postal survey, which included details on use of vitamin supplements and dietary intake of foods containing vitamins A and C. Age-adjusted and multivariate-adjusted (for factors related to mortality in this cohort—smoking, alcohol intake, caffeine consumption, exercise, body mass index, and histories of hypertension, angina, heart attack, stroke, diabetes, rheumatoid arthritis, and cancer) hazard ratios for death were calculated using Cox regression for 8,640 women and 4,983 men (median age at entry, 74 years). During follow-up (1981–2013), 13,104 participants died (median age at death, 88 years). Neither dietary nor supplemental intake of vitamin A or vitamin C nor supplemental intake of vitamin E was significantly associated with mortality after multivariate adjustment. A compendium that summarizes previous findings of cohort studies evaluating vitamin intake and mortality is provided. Attenuation in the observed associations between mortality and antioxidant vitamin use after adjustment for confounders in our study and in previous studies suggests that such consumption identifies persons with other mortality-associated lifestyle and health risk factors. [ABSTRACT FROM PUBLISHER]

The aim of this study is to determine the likelihood and net amount of parent-child transfers over the adult life cycle across European welfare regimes. The study introduces an economic life-cycle model of family transfers to describe the evolution of family exchanges across generations over time, which reveals a nonlinear relationship of age and net family transfers. Furthermore, it refines the method of estimating parent-child net transfers. Data come from the Survey of Health, Ageing, and Retirement in Europe, and include 36,095 parent-child dyads from 11 European countries representing social democratic, conservative, and traditional welfare-state regimes. The findings reveal net value of family intergenerational support follows a nonlinear pattern across the adult life cycle, with positive transfers from parents to adult children decreasing modestly until advanced old age when the decrease intensifies. Net family support benefits individuals and generations with larger relative need. The transition in the net family support pattern starts later and is less pronounced across social democratic welfare-regime countries while the opposite is true in traditional welfare-regime countries. These findings might be interpreted as being linked to differences in the public policies guaranteeing different levels of provision for dependent populations across different welfare regimes. They are consistent with a comparatively smaller role of family support in the intergenerational redistribution of resources in societies with larger public intergenerational support to dependent populations. [ABSTRACT FROM AUTHOR]

Objectives. We considered interactions between physical activity and body mass index (BMI) and neighborhood factors. Methods. We used recursive partitioning to identify predictors of low recreational physical activity (<2.5 hours/week) and overweight and obesity (BMI‡25.0 kg/m2) among 118 315 women in the California Teachers Study. Neighborhood characteristics were based on 2000 US Census data and Reference US business listings. Results. Low physical activity and being overweight or obese were associated with individual sociodemographic characteristics, including race/ethnicity and age. Among White women aged 36 to 75 years, living in neighborhoods with more household crowding was associated with a higher probability of low physical activity (54% vs 45% to 51%). In less crowded neighborhoods where more people worked outside the home, the existence of fewer neighborhood amenities was associated with a higher probability of low physical activity (51% vs 46%). Among non-African American middle-aged women, living in neighborhoods with a lower socioeconomic status was associated with a higher probability of being overweight or obese (46% to 59% vs 38% in high-socioeconomic status neighborhoods). Conclusions. Associations between physical activity, overweight and obesity, and the built environment varied by sociodemographic characteristics in this educated population. [ABSTRACT FROM AUTHOR]

Background. Differentiated thyroid carcinoma (DTC) is prognosticated upon a combination of tumor characteristics, such as histology and stage, and patient age. DTC is also notable for having a strong female predominance. Using a nationwide database with long follow-up times, we explored the interplay between tumor biology and patient characteristics in predicting mortality. Methods. The Surveillance, Epidemiology, and End Results (SEER) registry data 1973-2005 was examined for patients with DTC as their only known malignancy. Coxmultivariate analyses were used to generate mortality hazard ratios to evaluate the effects of age, gender, ethnicity, and marital status. Results. We identified 55,995 patients with DTC as their only malignancy. Consistent with the existing literature, the tumors are primarily diagnosed in women (77.5%), and predominantly affect Caucasians (78.3%). Female gender had a protective effect resulting in a 37% decrease in mortality. Age at diagnosis predicted mortality over age 40. Black ethnicity was associated with a 51% increase in mortality compared to Caucasians. Conclusion. Multiple demographic factors predict mortality in patients with DTC after adjusting for tumor characteristics, and they appear to have complex interactions. Recognizing the importance of these factors may enable clinicians to better tailor therapy. [ABSTRACT FROM AUTHOR]

Despite the disease prevention benefits of engaging in life-long regular physical activity, many adults remain sedentary. The social environment provides an important context for health and health behavior across the lifespan, as well as a potential point of intervention for increasing physical activity. Self-reports of perceived social support, social strain, positive social control, and negative social control were examined for their cross-sectional relationships to physical activity frequency in purposive samples of younger and older adults (N = 371, ages from 18 to 97, 68% women). Hierarchical regression analyses revealed that perceived support and perceived strain were not correlated with physical activity. However, age and sex interacted with social control, such that more positive social control was associated with more frequent physical activity for younger men. Furthermore, more positive and negative social control were significantly associated with less frequent physical activity for older men, while social control was not associated with physical activity among women. While younger men may be encouraged toward healthier behaviors by positive social control messages, social control attempts may backfire when targeting older men. Implications for physical activity promotion are discussed. [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]

With temperatures expected to increase because of climate change, it is essential to study the health outcomes of elevated temperature in vulnerable populations, such as expectant mothers. In this study, the authors estimated the association between heat and humidity, as measured by apparent temperature, and preterm delivery. They conducted a case-crossover analysis of almost 60,000 births spanning 16 counties in California that occurred from 1999 to 2006 between May and September. The authors identified cases of preterm birth from a state registry of births, which were combined with meteorologic and air pollution monitoring data based on residential zip code. High ambient temperature was significantly associated with preterm birth for all mothers, regardless of maternal racial/ethnic group, maternal age, maternal education, or sex of the infant. Results indicated that an 8.6% increase (95% confidence interval: 6.0, 11.3) in preterm delivery was associated with a 10°F (5.6°C) increase in weekly average (lag06) apparent temperature. Greater associations were observed for younger mothers, blacks, and Asians. These associations were independent of air pollutants. Given the significant associations for apparent temperature and preterm delivery found in this study, more large-scale studies of temperature and preterm delivery are warranted. [ABSTRACT FROM PUBLISHER]

Background: We investigated the association between hypertension, antihypertensive (AH) medication use, and breast cancer in a large prospective study, the California Teachers Study (CTS).Methods: Information on history of hypertension and lifetime regular use of AH medications was collected from 114,549 women in 1995-1996. Among them, 4,151 invasive breast cancers were diagnosed between 1995 and 2006. Additional information on AH use was collected from 73,742 women in 2000-2001, and 1,714 of these women were subsequently diagnosed with breast cancer. Cox proportional hazards regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) for breast cancer.Results: Use of AH medication for ≥5 years, when compared with no use, was associated with a modest increased risk of invasive breast cancer (RR = 1.18, 95%CI 1.02-1.36). This increased risk appeared to be confined to estrogen receptor (ER)-positive tumors (RR = 1.21, 95%CI 1.03-1.43) and pre-/peri-menopausal women (RR = 1.58, 95%CI 1.11-2.25).Conclusions: Increased risk of invasive breast cancer was observed for long-term (≥5 years) AH use, and this appeared to be confined to ER + breast cancer and younger women. [ABSTRACT FROM AUTHOR]