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Research on neighborhood effects has focused largely on residential neighborhoods, but people are exposed to many other places in the course of their daily lives-at school, at work, when shopping, and so on. Thus, studies of residential neighborhoods consider only a subset of the social-spatial environment affecting individuals. In this article, we examine the characteristics of adults' "activity spaces"-spaces defined by locations that individuals visit regularly-in Los Angeles County, California. Using geographic information system (GIS) methods, we define activity spaces in two ways and estimate their socioeconomic characteristics. Our research has two goals. First, we determine whether residential neighborhoods represent the social conditions to which adults are exposed in the course of their regular activities. Second, we evaluate whether particular groups are exposed to a broader or narrower range of social contexts in the course of their daily activities. We find that activity spaces are substantially more heterogeneous in terms of key social characteristics, compared to residential neighborhoods. However, the characteristics of both home neighborhoods and activity spaces are closely associated with individual characteristics. Our results suggest that most people experience substantial segregation across the range of spaces in their daily lives, not just at home.

The prevalence of both diabetes and obesity has grown significantly in California. Six million adults are obese and an additional 9.3 million are overweight. Obesity is a significant risk factor for diabetes; more than two million adults have been diagnosed with diabetes in California. Obesity and diabetes disproportionately affect people of color, the poor and those with the least education in California. Policy and environmental changes that promote and encourage physical activity and healthy eating will likely prove most effective in combating obesity and related conditions.

This study reports geographic variations in consumption of sugar-sweetened beverages among children, adolescents, and adults and examines the correlation between soda consumption and obesity. Among the findings: researchers found that adults who drink a soda or more per day are 27 percent more likely to be overweight than those who do not drink sodas, regardless of income or ethnicity. Among children, the study found that 40 percent of young children (2-11 years of age) are drinking at least one soda or sugar-sweetened beverage every day. Adolescents (12-17) represent the biggest consumers, with 62 percent(over 2 million youths) drinking one or more sodas every day – the equivalent of consuming 39 pounds of sugar each year in soda and other sugar-sweetened beverages.Data was drawn from the 2005 California Health Interview Survey (CHIS), which interviewed more than 43,000 adults and 4,000 adolescents from every county in the state.

Every day, over two million California adolescents (62%) drink soda and 1.4 million (43%) eat fast food, but only 38% eat five or more servings of fruits and vegetables. This policy brief examines adolescent consumption of fruits and vegetables, soda (not including diet soda) and fast food and the relationship to parental dietary behaviors using data from the 2005 California Health Interview Survey (CHIS 2005). It finds that adolescents are more likely to eat at least five servings of fruits and vegetables if their parents do so. Additionally, teens whose parents drink more soda in turn drink more soda themselves. The findings suggest that improving parents' diets may help to improve the eating behavior of adolescents. Parents can influence their children's dietary habits positively through serving as role models and through the food environment at home. Promoting retail food environments that encourage healthy choices and supporting parents in modeling healthy behaviors can help both parents and adolescents to improve dietary behavior, and reduce risk for obesity and chronic disease. Policymakers and health educators can help alter these patterns by developing supportive environments at home, at school and in the community. Support for this policy brief was provided by a grant from The California Endowment.

In California, 90,000 adults with current asthma have experienced problems understanding their doctors. There are significant disparities in who experiences these communication problems according to education, income, insurance status, English proficiency, race/ethnicity and nativity. In addition, adults with asthma who experience these problems are more likely to go to the emergency department or urgent care facility (ED/urgent care) for asthma care and are less likely to receive asthma management plans from their health care providers. The authors of this policy brief suggest that improvements in education and communication strategies are needed to facilitate understanding between health care providers and asthma patients, especially when patients have limited English proficiency (LEP) or have low health literacy. Support for this policy brief was provided by a grant from The California Endowment.

The current US Food and Drug Administration (FDA) licensure process underestimates the potential benefits of vaccines at both the individual and population levels by considering only direct clinical outcomes of vaccination. While all approved vaccines do protect the person who takes them from poor clinical outcomes for a specific infectious disease, many vaccines also have the potential to offer measurable, direct nonclinical benefits. For example, coronavirus disease 2019 (COVID-19) vaccinations for school-aged children may prevent school absenteeism. Also, by preventing infection or reducing its length and severity, some vaccines also protect—to some extent—the patient's immediate contacts from contracting the same disease. These nonclinical and population-level benefits are not considered as part of the FDA's current vaccine approval process, but they could be. We argue that the FDA's structured benefit-risk assessment framework, used for vaccine approvals, can and should consider both clinical and nonclinical benefits of vaccination when sufficient evidence exists to make an informed assessment. Including them could incentivize vaccine developers to measure additional vaccination effects, inform population health, and address health inequalities—including inequalities in the social determinants of health. [ABSTRACT FROM AUTHOR]

Background. We examined whether questions addressing the effect of pain on day-to-day function add unique information to the standardized verbal descriptor scale for pain severity in nursing homes (NHs). Methods. Interviews were conducted with 123 residents in two Veterans Affairs NHs. All participants were asked about pain presence. Residents reporting pain were asked about severity of worst pain (mild, moderate, severe, very severe/horrible), degree of bother (not at all, a little, a moderate amount, a great deal), and the effect of pain on daily function (whether pain made it hard to 'sleep,' 'get out of bed,' or 'spend time with other people' and whether activities were limited because of pain). Results. Fifty-one percent of participants reported pain. The correlation between pain severity report and overall count of activity interference was significant (Spearman's rho = .449, p = .001). In general, for each activity, the proportion reporting interference increased as severity increased. Fischer's exact test showed significant association only for 'hard to get out of bed' (p = .0175) and 'hard to sleep' (p = .0211). As expected, residents reporting 'mild' pain reported less activity interference than those reporting 'very severe' pain. The association between pain and activity interference was more variable and less predictable among residents with 'moderate' or 'severe' pain. Conclusion. Questions addressing the effect of pain on day-to-day functions are an important addition to standardized pain assessments, particularly for persons who report intermediate levels of pain severity because the perceived effect on daily function may vary most among individuals at these levels. Key Words: Pain--Nursing home--Activity limitation.

Purpose: Emphasis on consumer-centered care for frail and institutionalized older adults has increased the development and adaptation of surveys for this population. Conventional methods used to pretest survey items fail to investigate underlying sources of measurement error. However, the use of the cognitive interview (CI), a method for studying how respondents answer survey items, is not well established or documented in this population. This study demonstrates how CIs can be used to improve questionnaires intended for nursing home residents. Design and Methods: CIs were conducted with 29 nursing home residents in order to identify potential problems with prospective survey items. We used scripted probes to standardize the interviews and adapted the Question Appraisal System to enumerate and classify the problems discovered. Results: We fielded between one and five versions of each item in an iterative process that identified 61 item-specific problems. Additionally, residents' cognitive responses suggested that some screened their answers on the basis of perceived physical and environmental limitations, and some had difficulty answering items about preferences that fluctuate day to day. These findings led us to modify the items and response set to simplify the respondents' cognitive task. Implications: This study illustrates how CI techniques can be used to understand residents' comprehension of and response to survey items. Key Words: Cognitive interviewing, Institutionalized adults, Nursing home residents, Questionnaires

Background: Research on adolescent physical activity is mixed regarding the role of parent activity. This study tested parent encouragement, direct modeling, and perceived influence as moderators of objectively-measured (accelerometer) parent and child moderate-to-vigorous physical activity (MVPA) associations. Methods: Parent-child dyads (n = 423; mean child age = 11.33 yrs.) wore accelerometers for 7 days; parents completed surveys. Hierarchical linear regression models tested moderation using a product of constituent terms interaction. Results: Parentreported encouragement moderated the association between parent and child MVPA (β = -.15, P = .01, ΔR² = .02, P < .01). Among parents with lower MVPA, child MVPA was higher for children receiving high encouragement (mean = 3.06, SE = .17) vs. low (mean = 3.03, SE = .15, P = .02) and moderate encouragement (mean = 3.40, SE = .09) vs. low (P = .04). Conclusions: Physical activity promotion programs may use parent encouragement as a tool to boost child activity, but must consider other child and parent characteristics that could attenuate effects. [ABSTRACT FROM AUTHOR]

Introduction: Human papillomavirus (HPV) infection poses significant public health concerns due to its prevalence and association with various cancers. This study assesses a 2014 quality improvement initiative in Wisconsin's largest health care system. The intervention aimed to improve HPV vaccine initiation and completion among eligible patients and to reduce the gap in vaccination rates between males and females., Methods: Educational sessions delivered to health care providers and staff at select clinics focused on current HPV vaccination recommendations and strategies for patient communication. Preintervention and postintervention surveys assessed changes in clinician knowledge and attitudes. Clinic-level data on HPV vaccination rates compared intervention and control clinics at 12 and 36 months following the intervention., Results: Postintervention knowledge and attitudes regarding HPV vaccination improved, and intervention clinics demonstrated notable increases in HPV vaccine initiation and completion rates across various age and sex groups at 12- and 36-month follow-up. The gap between female and male HPV vaccination rates narrowed in some age groups in intervention clinics, but the effect was inconsistent., Conclusions: This study highlights the potential effectiveness of an in-person educational intervention in improving HPV vaccination rates in a health care system. Clinicians' enhanced understanding of vaccination guidelines, coupled with real-time data feedback, contributed to sustained improvements. To address resource challenges, future interventions may explore cost-effective alternatives. These findings underscore the pivotal role of clinicians in increasing HPV vaccine uptake, emphasizing the importance of aligning interventions with evolving vaccination recommendations to combat HPV-related cancers more effectively., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

The prevalence of both diabetes and obesity has grown significantly in California. Six million adults are obese and an additional 9.3 million are overweight. Obesity is a significant risk factor for diabetes; more than two million adults have been diagnosed with diabetes in California. Obesity and diabetes disproportionately affect people of color, the poor and those with the least education in California. Policy and environmental changes that promote and encourage physical activity and healthy eating will likely prove most effective in combating obesity and related conditions

Background The prevalence of overweight and obesity has increased dramatically in both adults and children in the last three decades in the n California, 62% of adolescents ages 12-17 and 41% of children ages 2-11 drink at least one soda or other sweetened beverage every day. In addition, 24% of adults drink at least one soda or other sweetened beverage on an average day. Adults who drink soda occasionally (not every day) are 15% more likely to be overweight or obese, and adults who drink one or more sodas per day are 27% more likely to be overweight or obese than adults who do not drink soda, even when adjusting for poverty status and race/ethnicity. This policy brief, produced collaboratively by the California Center for Public Health Advocacy and the UCLA Center for Health Policy Research, examines soda consumption in California by cities and counties using data from the 2005 California Health Interview Survey (CHIS 2005). In addition, the brief investigates whether there is an association between soda consumption and the prevalence of overweight and obesity. There are major differences in soda consumption rates by geographic area in California, suggesting that social and environmental factors affect the consumption of soda. Also, the prevalence of overweight and obesity is higher among those who drink one or more sodas or other sweetened beverages every day than among those who do not consume these soft drinks. Establishing public policies that focus on reducing soda consumption could contribute to reversing California's increasing overweight and obesity problem.