Search

There is considerable controversy as to whether a healthy diet is affordable given recent inflation. In order to determine whether a healthy, climate-friendly sustainable diet can be obtained within the allotments of the Supplemental Nutrition Assistance Program (SNAP), we created and purchased 26 weeks of meal plans designed to meet the EAT-Lancet sustainability guidelines and > 90% of the RDAs for 23 macro/micronutrients for households with at least 2 adults and 1-3 children. We compared the food quantities and cost of a healthy sustainable diet purchased in Los Angeles, 2023, to the Thrifty Food Plan, 2021. We compared the volume of food and cost of basic groceries to those recommended in the Thrifty Food Plan, 2021. The costs of the sustainable diet fell within the 2023 SNAP allotments as long as the average calories required per person did not exceed 2000. The volume of fruits, vegetables, legumes, nuts, and seeds were considerably higher for the sustainable diet compared to the Thrifty Food Plan. Given that calorie needs are the determinants of food quantity and costs, the USDA may consider offering supplemental coverage for individuals with higher calorie needs to make healthy eating affordable., (© 2024. The New York Academy of Medicine.)

Introduction: Food insecurity is a major public health problem in the United States which was exacerbated by the COVID-19 pandemic. We used a multi-method approach to understand barriers and facilitators to implementing food insecurity screening and referrals at safety net health care clinics in Los Angeles County before the pandemic., Methods: In 2018, we surveyed 1013 adult patients across eleven safety-net clinic waiting rooms in Los Angeles County. Descriptive statistics were generated to characterize food insecurity status, attitudes toward receiving food assistance, and use of public assistance programs. Twelve interviews with clinic staff explored effective and sustainable approaches to food insecurity screening and referral., Results: Patients welcomed the opportunity to access food assistance in the clinic setting; 45% preferred discussing food issues directly with the doctor. Missed opportunities to screen for food insecurity and refer patients to food assistance were identified at the clinic level. Barriers to these opportunities included: competing demands on staff and clinic resources, difficulty establishing referral pathways, and doubts surrounding data., Discussion: Integrating food insecurity assessment in clinical settings requires infrastructure support, staff training, clinic buy-in, and more coordination and oversight from local government, health center entities, and public health agencies., Competing Interests: Conflicts of interest: None., (© Copyright by the American Board of Family Medicine.)

Churches can be important settings for promoting physical activity (PA) among Latinx populations. Little is known about what factors across the church context-social, organizational, and physical (outdoor spaces)-are associated with Latinx PA to inform faith-based PA interventions. This study investigated associations of church contextual factors with Latinx PA. We used cross-sectional data from a Latinx adult sample recruited from 6 churches that each had a nearby park in Los Angeles, California (n = 373). Linear or logistic regression models examined associations of church PA social support, PA social norms, perceived quality and concerns about the park near one's church, and church PA programming with 4 outcomes: accelerometer-based moderate-to-vigorous PA (MVPA) and self-reported adherence to PA recommendations, use of the park near one's church, and park-based PA. Park quality and concerns were positively associated with using the park near one's church. Church PA programming was positively associated with park-based PA. None of the factors were related to accelerometer-based MVPA or meeting PA recommendations. Findings suggest targeting church PA programming and nearby parks may be key to improving Latinx park use. Church and local parks department partnerships may help enhance park conditions to support churchgoing Latinx PA and health., Competing Interests: All authors declare that they have no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose and Objectives: The Supplemental Nutrition Assistance Program Education (SNAP-Ed), the educational branch of SNAP, can play an important role in improving dietary outcomes, eliminating food insecurity, and preventing chronic disease among low-income populations. This study examined the effects of local SNAP-Ed efforts on self-reported health behaviors and body mass index (BMI) over a 1-year period, using data collected from intercept surveys of program-eligible adults., Intervention Approach: From 2016 to 2020, the Los Angeles County Department of Public Health partnered with 24 community-based organizations to provide nutrition education and to implement policy, systems, and environmental changes in the community., Evaluation Methods: A cross-sectional survey was conducted in 2018 and repeated in 2019 to measure 6 outcomes describing population-level changes in health behaviors and BMI. The study recruited 4 samples: 2 samples from outside selected supermarkets (2018, n = 2,098; 2019, n = 2,323) and 2 samples from participants at SNAP-Ed class sites (2018, n = 651; 2019, n = 569)., Results: While study results showed an increase in consumption of fruits and vegetables and in vigorous physical activity, they also showed an increase in BMI and high consumption of unhealthy foods. Participating in SNAP-Ed classes was positively associated with several health behaviors but no change in BMI. Participants who experienced food insecurity had worse health behavior outcomes than those who did not experience this condition., Implications for Public Health: SNAP-Ed interventions appear to have a favorable effect on fruit and vegetable consumption, but increases in BMI suggest that unhealthy food consumption is abundant and may be counteracting the benefits gained from eating more fruits and vegetables. Future efforts should take these results into consideration and optimize enrollment in nutrition assistance programs. These efforts should include coordinating with local programs to increase healthy food access for at-risk low-income populations in Los Angeles County.

Healthcare clinics are uniquely positioned to screen for food insecurity and refer patients to food resources. This study examines this approach to address this social condition. A 2018 intercept survey of 1,103 adult patients recruited from across 11 clinic waiting rooms in Los Angeles County was conducted to describe the prevalence of food insecurity and whether Supplemental Nutrition Assistance Program (SNAP) participation and the degree to which patients anticipated their clinics to help them locate food varied by socio-demographic factors. The prevalence of food insecurity was high for this low-income survey sample (63.4%); 72% of Spanish-speaking Latinx reported experiencing it. For those who experienced food insecurity, older age was associated with lower odds of SNAP participation. Spanish-speaking Latinx had higher odds of anticipating help from a clinic to find food relative to English-speaking Latinx (Adjusted Odds Ratio 1.88, 95% Confidence Interval: 1.18, 2.98). An exploratory analysis showed that common reasons for not enrolling in SNAP included older adults not knowing how to apply to the program and Spanish-speaking Latinx worrying about citizenship status as it relates to the eligibility process. Findings revealed disparities in the prevalence of food insecurity and SNAP participation among patients of Los Angeles' low income clinics. Information from this study can help inform low-income clinics' efforts to intervene on food insecurity in their patient population., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Women use parks less for physical activity than men, and explanations include gendered concerns regarding personal safety and access to walking paths. This study conducted mediation analyses to examine the effects of gender and presence of park walking path on park use, participation in park programs, and park-based physical activity through the hypothesized mediator (perception of crime). The sample included 3213 park users from 48 parks in high poverty neighborhoods in Los Angeles surveyed between 2013 and 2015; park-level factors were assessed through systematic observations of study parks. Women reported fewer park visits than men in the last 7 days (β = -0.17, p = 0.02) and had significantly higher perceived crime (β = 0.12, p < 0.0001) and perceived crime partially mediated the gender association with park visits (β gender, direct  = -0.09, p = 0.19; β gender, indirect  = -0.07, p < 0.0001). Similarly, the existence of a walking path in the park was significantly related to increased park use (β = 0.27, p = 0.006) and a lower level of perceived crime (β = -0.25, p = 0.0034) and perceived crime partially mediated the association of walking path with park visits (β walking path, direct  = 0.18, p = 0.10; β walking path, indirect  = 0.15, p = 0.005). The associations between gender, walking path, and park-based exercise and program participation were not meaningfully mediated by perceived crime. Among park users in majority Latino, high poverty neighborhoods, addressing crime concerns are likely necessary to increase park use among women and adults whose parks do not have a walking path. For park-based exercise and participation in park programs, gendered preferences regarding park-based physical activity should be explored., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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

Objective: We aimed to explore the range of stakeholders' perceptions of the Balance Calories Initiative (BCI), under which the American Beverage Association pledged to decrease per capita US consumption of beverage energy by 20 % by 2025., Design: Semi-structured cross-sectional interviews were conducted in 2017., Setting: Participants were recruited from communities targeted by the BCI (Montgomery, AL; North Mississippi Delta, MS; Eastern Los Angeles, CA).ParticipantsA total of thirty-three parents and thirty-eight youths aged 10-17 years were recruited through youth-serving organizations, street intercept and snowball sampling; sixteen store/restaurant managers were recruited at businesses. Participants were asked about their awareness of the BCI. Parents and youths were asked to 'think aloud' as they viewed BCI messages (e.g. 'Balance What You Eat, Drink, and Do') and managers were asked about beverage marketing., Results: Twelve parents and twenty-four youths had seen BCI messages; only four managers were aware of the BCI. Many parents and youths showed some misunderstanding of BCI messages (e.g. that they should drink more sugar-sweetened beverages (SSB) or they needed to equalize healthy and unhealthy beverage intake). Only one manager had communicated with beverage companies about the BCI., Conclusions: We found mixed comprehension and low awareness of BCI messages in communities targeted by the American Beverage Association for reduced SSB consumption. Industry self-regulation attempts to reduce SSB consumption may have limited effectiveness if stakeholder input is not addressed. Public health practitioners should be aware of the need to address youths' and parents' misunderstandings about SSB consumption, especially in BCI-targeted communities.

Neighborhood parks are important venues for the urban population to do moderate-to-vigorous physical activity in leisure time. Parks can be particularly important for low-income neighborhoods, whose residents suffer from high rates of chronic diseases and may have less access to fee-based fitness exercise facilities. This study assessed the contribution of parks to local populations' physical activity in 48 high-poverty neighborhoods in the city of Los Angeles, using systematic observation of park use and surveys of park users and residents conducted between 2013 and 2015. We found that parks accounted for approximately 2.1% (between-park SD = 1.4%) of moderate physical activity time and 3.1% (between-park SD = 2.1%) of vigorous physical activity time of the local population, both of which were notably lower than the city-level average previously reported. Parks' contribution to physical activity was positively associated with park size (β = 0.13, p < 0.0001) and negatively associated with poverty (β = - 0.10, p < 0.0001) and local population density (β = - 0.25, p = 0.005). Parks in high-poverty neighborhoods in Los Angeles are underutilized, and more efforts are needed to fully realize their potential for population health.

Introduction: Crime and safety are often cited as potential hurdles to park use and park-based physical activity. Using comprehensive data sources including both objective and subjective measurements at the park level and the individual level, this study aimed to assess the association between crime rates and use of local parks in low-income urban neighborhoods., Methods: The authors observed 48 parks and conducted local resident surveys in low-income neighborhoods in Los Angeles during a 2-year study period (2013-2015). Crime data were geocoded within a 1-mile radius of parks' addresses and longitudinal models were fitted to estimate the association between crime rates and park use outcomes in 2017., Results: One gun-related violent crime per 10,000 people during the 6-month period prior to data collection was associated with an average of 13.5%-15.8% reduction in observed park use and park-based moderate to vigorous physical activity (p<0.05) in the 6-month observation period. The relationship was significant in seniors (33%-40% reduction) and adults (13%-18%), but insignificant for teenagers (2%-4%) and children (10%-12%). Homicide rates were also significantly related to lower self-reported park use (p<0.05)., Conclusions: Gun-related violent crimes have relatively long-term negative associations with population health by reducing utilization of outdoor park space. There can be additional population health benefits from controlling and reducing gun-related violent crimes beyond immediate impacts on public safety and mortality., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Physical inactivity is more prevalent among women than men and is related to poor health outcomes. Neighborhood parks constitute an important resource for physical activity (PA), however, previous studies of park users have found fewer women being physically active., Methods: We conducted a hierarchical mixed-effect regression analysis of the independent associations between gender and park use and PA among a population-based sample in high-poverty neighborhoods in Los Angeles. Data sources included 1) structured interviews with adults (≥18 years of age) in randomly selected households within 1 mile of study parks (n = 2,973), 2) systematic observations of study parks (n = 48), and 3) neighborhood characteristics from the 2010 U.S. Census., Results: After controlling for race/ethnicity, education, body mass index of 30 kg/m 2 or greater, health status, proximity to park, having children under the age of 18, perceived park safety, estimated screen time, and park- and neighborhood-level variables, statistically significant differences were found between women and men on all outcomes. Compared with men, women reported fewer park visits in the past week (-0.28 times/week; p < .001) and shorter durations of a typical park visit (-11.11 min/visit; p < .001). Women were also less likely than men to report levels of PA that meet national guidelines (≥150 minutes of moderate to vigorous PA per week; risk difference = -0.06; p < .01) or to exercise in the park (risk difference = -0.13; p < .001) or elsewhere (risk difference = -0.13; p < .001)., Conclusions: Women living in high-poverty neighborhoods use parks less for PA than men. Improved park-level design, programming, and other policy interventions may be needed to mitigate disparities in park use and PA for all., (Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Objective: To conduct a pilot study to assess the feasibility of modifying food truck meals to meet the My Plate guidelines as well as the acceptability of healthier meals among consumers., Design: We recruited the owners of Latino food trucks (loncheras) in 2013-2014 and offered an incentive for participation, assistance with marketing and training by a bilingual dietitian. We surveyed customers and we audited purchases to estimate sales of the modified meals., Setting: City of Los Angeles, CA, USA., Subjects: Owners or operators of Latino food trucks (loncheras) and their customers., Results: We enrolled twenty-two lonchera owners and eleven completed the intervention, offering more than fifty new menu items meeting meal guidelines. Sales of the meals comprised 2 % of audited orders. Customers rated the meals highly; 97 % said they would recommend and buy them again and 75 % of participants who completed the intervention intended to continue offering the healthier meals. However, adherence to guidelines drifted after several months of operation and participant burden was cited as a reason for dropout among three of eleven lonchera owners who dropped out., Conclusions: Lonchera owners/operators who participated reported minimal difficulty in modifying menu items. Given the difficulty in enrolment, expanding this programme and ensuring adherence would likely need to be accomplished through regulatory requirements, monitoring and feedback, similar to the methods used to achieve compliance with sanitary standards. A companion marketing campaign would be helpful to increase consumer demand.

Racial-ethnic disparities in physical activity present important challenges to population health. Public parks provide access to free or low-cost physical activity opportunities, but it is unclear to what extent parks are utilized by various race-ethnic groups in diverse urban settings. Here, we examine racial ethnic differences in park use and physical activity among adult residents (n = 7506) living within 1 mi of 50 parks in the city of Los Angeles. In multivariate analyses, we find few differences among race-ethnic groups in terms of their frequency of having visited the park in the past 7 days; however, we find numerous differences in how the groups used the park and in their levels of physical activity: Blacks and English-speaking Latinos were less likely than whites to report being physically active, exercising in the park, and exercising outside the park; Spanish-speaking Latinos were equally likely as whites to report exercising in park but less likely to report exercising outside the park and more likely to report using the parks for social interactions; Asians/Pacific Islanders (PI)/others were more likely than whites to report visiting the park in the past 7 days and using the parks for social interactions. Urban parks appear to be an important resource for physical activity and socialization, in particular among Spanish-speaking Latino and Asians/PI groups. Additional efforts may be needed for other racial-ethnic minorities to experience the same benefits.

Objective: To quantify the contribution of neighborhood parks to population-level, moderate-to-vigorous physical activity (MVPA)., Method: We studied park use in 83 neighborhood parks in Los Angeles between 2003 and 2014 using systematic observation and surveys of park users and local residents. We observed park use at least 3-4 times per day over 4-7 clement days. We conducted a meta-analysis to estimate total, age group and gender-specific park use and total MVPA time in parks., Results: An average park measuring 10 acres and with 40,000 local residents in a one-mile radius accrued 5301 h of use (SE=1083) during one week, with 35% (1850 h) spent in MVPA and 12% (635 h) spent in vigorous physical activity (VPA). As much as a 10.7-fold difference in weekly MVPA hours was estimated across study parks. Parks' main contribution to population-level MVPA is for males, teenagers, and residents living within a half mile., Conclusion: Neighborhood parks contribute substantially to population MVPA. The contribution may depend less on size and facilities than on "demand goods" - programming and activities--that draw users to a park., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: The aim of this study is to describe implementation of a randomized controlled trial of community-based participatory research (CBPR) approaches to increase park use and physical activity across 33 diverse neighborhoods in Los Angeles., Methods: Fifty parks were randomly assigned based on park size, facilities and programs, and neighborhood socio-demographic characteristics to: park director (PD, 17 parks); PD and park advisory board of interested community members (PD+PAB, 16 parks); and no-intervention control (17 parks) arms. Between 2007 and 2012, PDs and PABs from the 33 intervention parks participated in community engagement, baseline assessment, marketing training, intervention design and implementation, and follow-up assessment., Results: Intervention parks (PD and PD+PAB) invested in new and diversified signage, promotional items, outreach or support for group activities like fitness classes and walking clubs, and various marketing strategies. Scaling up CBPR methods across parks in 33 diverse neighborhoods was challenging. Working with departmental management and established structures for community input (PABs) and park policy (PDs) facilitated implementation and sustainability., Conclusion: Scaling up CBPR methods across diverse communities involved tradeoffs. CBPR is useful for tailoring research and enhancing community impact and sustainability, but more work is needed to understand how to conduct multi-site trials across diverse settings using CBPR., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To assess the use of new pocket parks in low-income neighborhoods., Design: The design of the study was a quasi-experimental post-test only comparison., Setting: Los Angeles, California, was the setting for the study., Subjects: Subjects were park users and residents living within .5 mile of three pocket parks and 15 neighborhood parks., Intervention: The creation of pocket parks., Measures: We used the System of Observing Play and Recreation in Communities (SOPARC) tool to measure park use and park-based physical activity, and then surveyed park users and residents about their park use., Analysis: We surveyed 392 and 432 household members within .5 mile of the three pocket parks before and after park construction, respectively, as well as 71 pocket park users, and compared them to 992 neighborhood park users and 342 residents living within .5 mile of other neighborhood parks. We compared pocket park use to playground area use in the larger neighborhood parks. We used descriptive statistics and generalized estimating equations for the analysis., Results: Overall, pocket park use compared favorably in promoting moderate-to-vigorous physical activity with that of existing playground space in nearby parks, and they were cost-effective at $0.73/MET hour (metabolic equivalent hour) gained. Pocket park visitors walked an average of .25 miles to get to a park., Conclusions: Pocket parks, when perceived as attractive and safe destinations, may increase physical activity by encouraging families with children to walk there. Additional strategies and programs may be needed to encourage more residents to use these parks.

Background: Physical inactivity is an important health risk factor that could be addressed at the community level., Purpose: The goal of the study was to determine whether using a community-based participatory approach with park directors and park advisory boards (PABs) could increase physical activity in local parks. Whether involving PABs would be more effective than working with park directors alone was also tested., Design: An RCT intervention from October 2007 to April 2012 was used, with partial blinding of observers to the condition. All data were analyzed in 2012., Setting/participants: Of 183 eligible parks in the City of Los Angeles, 50 neighborhood park/recreation centers serving diverse populations participated. Parks were randomized to three study arms: (1) park-director intervention (PD-only); (2) PAB intervention (PAB/PD); and (3) a control arm. Physical activity in each park was systematically observed, and park users and residents living within 1 mile of the park were interviewed., Intervention(s): The intervention included assessing park use, obtaining feedback from park users and community residents, training on outreach and marketing, and giving each intervention park $4000 to increase park-based physical activity. The PAB/PD arm required participation and concurrence on all purchases by the PAB., Main Outcome Measure(s): Change in the number of park users and change in the level of park-based physical activity, expressed as MET-hours., Results: Relative to control parks where physical activity declined, in both the PD-only and PAB/PD parks, physical activity increased, generating an estimated average of 600 more visits/week/park, and 1830 more MET-hours of physical activity/week/park. Both residents and park users in the intervention arms in the intervention arms reported increased frequency of exercise. No differences were noted between the PD-only and PAB/PD study arms., Conclusions: Providing park directors and PABs with training on outreach and marketing, feedback on park users, and modest funds increased the amount of physical activity observed in parks., (© 2013 American Journal of Preventive Medicine.)

Background: Recent research has shown that neighborhood characteristics are associated with obesity prevalence. While food advertising in periodicals and television has been linked to overweight and obesity, it is unknown whether outdoor advertising is related to obesity., Methods: To test the association between outdoor food advertising and obesity, we analyzed telephone survey data on adults, aged 18-98, collected from 220 census tracts in Los Angeles and Louisiana. We linked self-reported information on BMI and soda consumption with a database of directly observed outdoor advertisements., Results: The higher the percentage of outdoor advertisements promoting food or non-alcoholic beverages within a census tract, the greater the odds of obesity among its residents, controlling for age, race and educational status. For every 10% increase in food advertising, there was a 1.05 (95% CI 1.003 - 1.093, p<0.03) greater odds of being overweight or obese, controlling for other factors. Given these predictions, compared to an individual living in an area with no food ads, those living in areas in which 30% of ads were for food would have a 2.6% increase in the probability of being obese., Conclusions: There is a relationship between the percentage of outdoor food advertising and overweight/obesity.

Background: The Systematic Observation of Play and Recreation in Communities (SOPARC) was designed to estimate the number and characteristics of people using neighborhood parks by assessing them 4 times/day, 7 days/week. We tested whether this schedule was adequate and determined the minimum number of observations necessary to provide a robust estimate of park user characteristics and their physical activity levels., Methods: We conducted observations every hour for 14 hours per day during 1 summer and 1 autumn week in 10 urban neighborhood parks: 2 each in Los Angeles, CA; Albuquerque, NM; Columbus, OH; Durham, NC; and Philadelphia, PA. We counted park users by gender, age group, apparent race/ethnicity, and activity level. We used a standardized Cronbach's alpha and intraclass correlation coefficients to test the reliability of using fewer observations., Results: We observed 76,632 individuals, an average of 547/park/day (range 155-786). Interobserver reliability ranged from 0.80 to 0.99. Obtaining a robust estimate of park user characteristics and their physical activity required a schedule of 4 days/week, 4 times/day., Conclusion: An abbreviated schedule of SOPARC was sufficient for estimating park use, park user characteristics, and physical activity. Applying these observation methods can augment physical activity surveillance.

Objectives: There are many contributors to obesity, including excess consumption of "discretionary calories" (foods high in sugar and fat and low in essential nutrients), lack of fruit/vegetable consumption, and insufficient physical activity. This study contrasted physical activity, fruit/vegetable consumption, and discretionary calorie consumption from selected foods relative to the 2005 dietary guidelines., Methods: We conducted a cross-sectional survey in 228 urban census tracts in Los Angeles County (LAC) and Southern Louisiana (SL) and estimated calories in the past 24 hours from fruit, vegetables, cookies, candy, salty snacks, sweetened soda, and alcohol among 2,767 participants., Results: The population-weighted mean daily intake of calories from candy, cookies, salty snacks, soda, and alcohol was 438 in LAC and 617 in SL. Alcohol comprised a small portion of the calories consumed. Reported discretionary calorie consumption from a small set of items exceeded guidelines by more than 60% in LAC and 120% in SL. In contrast, the mean consumption of fruit and vegetables fell 10% short in LAC and 20% in SL. There was significant heterogeneity in consumption of cookies, candy, salty snacks, and soda across income, gender, and race., Conclusions: The overconsumption of discretionary calories was much greater than the underconsumption of fruit and vegetables. This finding suggests that unless the excessive consumption of salty snacks, cookies, candy, and sugar-sweetened beverages is curtailed, other interventions focusing on increasing physical activity and fruit and vegetable consumption will have a limited impact on obesity control. It may be politically more expedient to promote an increase in consumption of healthy items rather than a decrease in consumption of unhealthy items, but it may be far less effective.

A regulation banning new fast-food establishments for one year in Los Angeles, California, was passed unanimously by the city council in July 2008. It was motivated by health concerns and excessive obesity rates in South Los Angeles. However, it might not have had the impact that was intended. This paper reviews the empirical evidence for the regulation and whether it is likely to target the primary levers of obesity. We argue that the premises for the ban were questionable. For example, the density of fast-food chain restaurants per capita is actually higher in other parts of Los Angeles than in South LA. Other changes, such as menu calorie labeling, are likely to have a bigger impact on overweight and obesity.

Dietary patterns may be influenced by the availability and accessibility within stores of different types of foods. However, little is known about the amount of shelf space used for healthy and unhealthy foods in different types of stores. We conducted measurements of the length of shelf space used for fruits, vegetables, and snack foods items in 419 stores in 217 urban census tracts in southern Louisiana and in Los Angeles County. Although supermarkets offered far more shelf space of fruits and vegetables than did other types of stores, they also devoted more shelf space to unhealthy snacks (mean 205 m for all of these items combined) than to fruits and vegetables (mean 117 m, p < 0.001). After supermarkets, drug stores devoted the most shelf space to unhealthy items. The ratio of the total shelf space for fruits and vegetables to the total shelf space for these unhealthy snack items was the lowest (0.10 or below) and very similar in convenience stores, drug stores, and liquor stores, was in a middle range (0.18 to 0.30) in small food stores, and was highest in medium-sized food stores (0.40 to 0.61) and supermarkets (0.55 to 0.72). Simple measurements of shelf space can be used by researchers to characterize the healthfulness of the food environment and by policymakers to establish criteria for favorable policy treatment of stores.

Eating away from home and particularly fast food consumption have been shown to contribute to weight gain. Increased geographic access to fast food outlets and other restaurants may contribute to higher levels of obesity, especially in individuals who rely largely on the local environment for their food purchases. We examined whether fast food and restaurant concentrations are associated with body mass index and whether car ownership might moderate this association. We linked the 2000 US Census data and information on locations of fast food and other restaurants with the Los Angeles Family and Neighborhood Study database, which consists of 2,156 adults sampled from 63 neighborhoods in Los Angeles County. Multilevel modeling was used to estimate associations between body mass index (BMI), fast food and restaurant concentration, and car ownership after adjustment for individual-level factors and socioeconomic characteristics of residential neighborhoods. A high concentration of local restaurants is associated with BMI. Car owners have higher BMIs than non-car owners; however, individuals who do not own cars and reside in areas with a high concentration of fast food outlets have higher BMIs than non-car owners who live in areas with no fast food outlets, approximately 12 lb more (p = 0.02) for an individual with a height of 5 ft. 5 in. Higher restaurant density is associated with higher BMI among local residents. The local fast food environment has a stronger association with BMI for local residents who do not have access to cars.

It is assumed that higher quality recreation facilities promote physical activity and serve communities better. We tested this assumption by comparing changes in the use of an expanded and renovated skate park (a facility for skateboarding) and a modernized senior citizen's center to two similar facilities that were not refurbished. The skate park was nearly tripled in size, and the senior center was remodeled and received new exercise equipment, a courtyard garden, and modern architectural features. We assessed use of these facilities through direct observation and surveyed both facility users and residents living within 2 miles of each facility. We found that making improvements to facilities alone will not always guarantee increased use. Although there was a 510% increase in use of the expanded skate park compared to a 77% increase in the comparison skate park, the senior center had substantially fewer users and provided fewer hours of exercise classes and other programmed activities after the facility was renovated. The implication of our study is that use results from a complex equation that includes not only higher quality recreation facilities but also progamming, staffing, fees, hours of operation, marketing, outreach, and perhaps a host of other human factors.

The objective of this study was to assess the relationship between alcohol availability, as measured by the density of off-premise alcohol outlets, and alcohol consumption in Los Angeles county and southern Louisiana, USA. Consumption information was collected through a telephone survey of 2,881 households in Los Angeles county and pre-Katrina southern Louisiana, nested within 220 census tracts. Respondents' addresses were geo-coded and both neighbourhood (census tracts and buffers of varying sizes) and individual (network distance to the closest alcohol outlet) estimates of off-sale alcohol outlet density were computed. Alcohol outlet density was not associated with the percentage of people who were drinkers in either site. Alcohol outlet density was associated with the quantity of consumption among drinkers in Louisiana but not in Los Angeles. Outlet density within a one-mile buffer of the respondent's home was more strongly associated with alcohol consumption than outlet density in the respondent's census tract. The conclusion is that the relationship between neighbourhood alcohol outlet density and alcohol consumption is complex and may vary due to differences in neighbourhood design and travel patterns.

Background: Historically, the alcohol and tobacco industries have been the biggest users of outdoor advertising. However, the 1999 Master Settlement Agreement (MSA) outlawed tobacco billboards and transit furniture (e.g., bus, bench) ads, and the Outdoor Advertising Association of America (OAAA) has pledged to voluntarily eliminate ads for alcohol and tobacco within 500 feet of schools, playgrounds, and churches., Methods: Outdoor advertisements were observed (2004-2005) in a sample of urban census tracts (106 in pre-Katrina southern Louisiana and 114 in Los Angeles County) to evaluate tobacco and alcohol advertisers' compliance with the MSA and the OAAA Code of Industry Principles. Data were analyzed in 2007-2008., Results: More than one in four tobacco ads in Louisiana failed to comply with the MSA. In Los Angeles, 37% of alcohol ads and 25% of tobacco ads were located within 500 feet of a school, playground, or church; in Louisiana, roughly one in five ads promoting alcohol or tobacco fell within this distance. In Los Angeles, low-income status and the presence of a freeway in the tract were associated with 40% more alcohol and tobacco billboards near children. In Louisiana, each additional major roadway-mile was associated with 4% more tobacco ads-in violation of MSA-and 7% more small ads near schools, playgrounds, and churches; city jurisdiction accounted for 55% of MSA violations and more than 70% of the violations of OAAA guidelines., Conclusions: Cities must be empowered to deal locally with violations of the MSA. Legislation may be needed to force advertisers to honor their pledge to protect children from alcohol and tobacco ads.

Collective efficacy, i.e., perception of mutual trust and willingness to help each other, is a measure of neighborhood social capital and has been associated with positive health outcomes including lower rates of assaults, homicide, premature mortality, and asthma. Collective efficacy is frequently considered a "cause", but we hypothesized that environmental features might be the foundation for or the etiology of personal reports of neighborhood collective efficacy. We analyzed data from the Los Angeles Family and Neighborhood Study (LAFANS) together with geographical data from Los Angeles County to determine which social and environmental features were associated with personal reports of collective efficacy, including presence of parks, alcohol outlets, elementary schools and fast food outlets. We used multi-level modeling controlling for age, education, annual family income, sex, marital status, employment and race/ethnicity at the individual level. At the tract level, we controlled for tract-level disadvantage, the number of off-sale alcohol outlets per roadway mile, the number of parks and the number of fast food outlets within the tract and within 1/2 mile of the tract's boundaries. We found that parks were independently and positively associated with collective efficacy; alcohol outlets were negatively associated with collective efficacy only when tract-level disadvantage was not included in the model. Fast food outlets and elementary schools were not linearly related to collective efficacy. Certain environmental features may set the stage for neighborhood social interactions, thus serving as a foundation for underlying health and well-being. Altering these environmental features may have greater than expected impact on health.

Alcohol and food items can compromise or contribute to health, depending on the quantity and frequency with which they are consumed. How much people consume may be influenced by product availability and promotion in local retail stores. We developed and tested an observational tool to objectively measure in-store availability and promotion of alcoholic beverages and selected food items that have an impact on health. Trained observers visited 51 alcohol outlets in Los Angeles and southeastern Louisiana. Using a standardized instrument, two independent observations were conducted documenting the type of outlet, the availability and shelf space for alcoholic beverages and selected food items, the purchase price of standard brands, the placement of beer and malt liquor, and the amount of in-store alcohol advertising. Reliability of the instrument was excellent for measures of item availability, shelf space, and placement of malt liquor. Reliability was lower for alcohol advertising, beer placement, and items that measured the "least price" of apples and oranges. The average kappa was 0.87 for categorical items and the average intraclass correlation coefficient was 0.83 for continuous items. Overall, systematic observation of the availability and promotion of alcoholic beverages and food items was feasible, acceptable, and reliable. Measurement tools such as the one we evaluated should be useful in studies of the impact of availability of food and beverages on consumption and on health outcomes.

In prior research, neighborhood effects have often been weak or inconsistent in predicting specific causes of mortality and morbidity. To determine whether residential neighborhood effects are suppressed by exposure to other environments, we examined the effect on adult self-rated health of non-residential environments that figure in individuals' daily routines. We linked the 2000 US Census data with the Los Angeles Family and Neighborhood Study (L.A.FANS) database, which consists of 3323 adults sampled from neighborhoods in LA County. Characteristics of census tracts where respondents lived, worked, shopped, sought medical care, worshipped and spent "other" time were obtained from the 2000 US Census. Weighted multilevel linear and clustered generalized ordered logistic regressions were used to estimate associations between self-rated health and non-residential neighborhood exposures after adjustment for individual-level factors and exposure to residential neighborhoods. We found that residence in disadvantaged neighborhoods was associated with worse self-rated health. In a dose-response fashion, the greater the exposure to less disadvantaged non-residential neighborhoods in the course of routine activities, the greater the magnitude in improved self-rated health. Models including non-residential neighborhood exposure increase the magnitude and significance of the association between residential neighborhoods and health. In conclusion, individuals' exposure to non-residential neighborhoods confounds and suppresses the association of residential neighborhoods with health and could explain why previous studies may not have found robust associations between residential neighborhood predictors and health.

Background: The Surgeon General has called for an expansion of school-based extracurricular sports programs to address the obesity epidemic. However, little is known about the availability of and participation in high school extracurricular sports and how participation in these sports is related to high-risk behaviors., Methods: We surveyed Los Angeles County public high schools in 2002 to determine the number of extracurricular sports programs offered and the percentage of students participating in those programs. We used community data on rates of arrests, births, and sexually transmitted diseases (STDs) among youth to examine associations between risk behaviors and participation in sports programs., Results: The average school offered 14 sports programs, and the average participation rate was 39% for boys and 30% for girls. Smaller schools and schools with higher percentages of disadvantaged students offered fewer programs. The average school offering 13 or fewer programs had 14% of its students participating, while the average school offering 16 or more programs had 31% of its students participating in sports. Controlling for area-level demographics, juvenile arrest rates and teen birth rates, but not STD rates, were lower in areas where schools offered more extracurricular sports., Conclusions: Opportunities for participation in high school extracurricular sports are limited. Future studies should test whether increased opportunities will increase physical activity and impact the increasing overweight problem in youths.

This study tests the effect of neighborhood changes on gonorrhea rates. Prior studies that indicate gonorrhea rates are associated with alcohol outlet density and neighborhood deterioration have been cross-sectional and cannot establish causality. After the 1992 Civil Unrest in Los Angeles, 270 alcohol outlets surrendered their licenses due to arson and vandalism thus providing a natural experiment. We geocoded all reported gonorrhea cases from 1988 to 1996 in LA County, all annually licensed alcohol outlets, and all properties damaged as a result of the civil unrest. We ran individual growth models to examine the independent effects of changes in alcohol outlets and damaged buildings on gonorrhea. The individual growth model explained over 90% of the residual variance in census tract gonorrhea rates. After the civil unrest, a unit decrease in the number of alcohol outlets per mile of roadway was associated with 21 fewer gonorrhea cases per 100,000 (p<.01) in tracts affected by the Unrest compared to those not affected. Neighborhood alcohol outlets appear to be significantly associated with changes in gonorrhea rates. The findings suggest that efforts to control sexually transmitted diseases, including gonorrhea and HIV, should address contextual factors that facilitate high-risk behaviors and disease transmission.

Social determinants have been identified as a fundamental cause of health and disease in most industrialized countries. However, much less is known about which characteristics of communities may lead to disparities in health outcomes. Collective efficacy--the willingness of community members to look out for each other and intervene when trouble arises--is a social factor shown to be associated with outcomes related to obesity, including premature mortality and cardiovascular disease. The objective of this study is to determine whether neighborhood collective efficacy is associated with individual measures of body mass index (BMI) in adolescents. We use a multi-level, cross-sectional survey in Los Angeles County, involving 807 adolescents in 684 households in 65 neighborhoods in addition to a sample of 3000 adult respondents. The main outcomes measures are BMI, at risk of overweight, and overweight status. Using a two-level model, we find significant relationships between collective efficacy and all three outcomes, net of levels of neighborhood disadvantage. The associations between BMI and collective efficacy could potentially be explained by several factors, including a metabolic pathway, neighborhood differences in the physical and social environments, or a combination of these two. If group-level collective efficacy is indeed important in the regulation of individual-level net energy balance, it suggests that future interventions to control weight by addressing the social environment at the community level may be promising.

Reports of congenital syphilis in 1987 were reviewed to determine how new national guidelines for defining congenital syphilis would influence reported rates in Los Angeles County. After reviewing all reported reactive serologic tests for syphilis, we found 166 additional cases, resulting in a 426 percent increase in the 1987 reported rate of congenital syphilis. Rates of congenital syphilis are dependent upon surveillance practices, screening policies, and case definition.