| 5/3/2019 | 263 | | Approved | 12/14/2016 12:57 PM |  i:0#.f|uclachissqlmembershipprovider|celeste | 7/8/2019 8:42 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Jennifer Cabe, MA | jcabe@ucla.edu | UCLA Center for Health Policy Research | 310-794-0930 | | | | | 1583 | | Y | | | | Publication | | | | | | | The Center is pleased to host leading health policy experts at our monthly seminar series.
Spring 2019: “Medicare for All: Is It Finally Time for Single Payer in the United States?”
Kominski explored the latest developments in the high-stakes conversation about the possibility of making universal health care available to all Californians. Kominski is a sought-after expert at local, state, national, and global levels for his expertise in evaluating the costs and cost-effectiveness of health care programs, and is co-founder of the UCLA/UC Berkeley CalSIM microsimulation model used for estimating the impacts of health reform in California.
This seminar is part of the UCLA Center for Health Policy Research 25th anniversary celebration. The Center was founded in 1994 by its first director, acclaimed public health leader and advocate for health care reform E. Richard Brown, and several visionary colleagues, including Kominski.
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Join us in person or by livestreaming webinar here:
**This is a brown bag event.
Light refreshments served for in-person attendees.
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March 26: “Economic Insecurity Among Older Adults of Color: Housing and Health as Cause and Effect”
In the Center’s March Health Policy Seminar, Associate Center Director Steven P. Wallace discussed elder economic insecurity using Elder IndexTM data and how the housing burden borne by elders, particularly those of color, affects health. Find the recorded video here. Feb. 19: “Reducing Access Disparities in California by Insuring Low-income Undocumented Immigrants”
Using the latest California Health Interview Survey data on the health insurance, demographics, health status, and access to care of undocumented low-income adults ages 19-64, new research led by Associate Center Director Nadereh Pourat reveals the demographics and characteristics of undocumented adults, how their access to health care compares to documented counterparts, and the implications of extending Medi-Cal eligibility to the last remaining uninsured population who have limited options for coverage. Find the recorded video here.
Jan. 23: "Improving California's Behavioral Health Workforce for Older Adults"
Center Faculty Associate Janet Frank and Center Research Scientist Kathryn Kietzman recommended training and funding strategies that state policymakers, educational institutions and county mental health/behavioral health departments and their contracted providers can take to improve the state mental health care workforce that serves the unique needs of older adults. Find the recorded video here.
November 7: "How Proposed Changes to the 'Public Charge' Rule Will Affect Health, Hunger, and the Economy in California"
Ninez A. Ponce, director of the UCLA Center for Health Policy Research; Laurel Lucia; director of the health care program at the UC Berkeley Center for Labor Research and Education; and Tia Shimada, director of programs at California Food Policy Advocates, presented analysis from their report and shared estimates of the health and economic impact the federal "public charge" immigration rule change will have on California, its regions, and its racial and ethnic groups. Under proposed changes to Department of Homeland Security immigration rules, people could be denied status as lawful permanent residents if they receive certain health care, nutrition and other benefits. Find the recorded video here and download the seminar slides here. (Note: Updated version as of 11/29/18.)
See all previous health policy seminars here.
| | 4/25/2019 | 317 | | Approved | 4/25/2019 2:59 PM | i:0#.f|uclachissqlmembershipprovider|celeste | 4/25/2019 3:16 PM | i:0#.f|uclachissqlmembershipprovider|celeste | Penelope Whitney | penelopewhitney@berkeley.edu | UC Berkeley | 510-643-8756 | | | | | 1569 | | N | | | | Publication | 3.6 Million Californians Would Benefit if California Takes Bold Action to Expand Coverage and Improve Affordability | 1815 | | | | | Berkeley ― California made historic gains in health insurance coverage under the Affordable Care Act (ACA), but several million Californians remain uninsured and many struggle to afford individual market insurance.
A new brief from the Labor Center at University of California, Berkeley and Center for Health Policy Research at UCLA is the first to evaluate the combined effects of near-term policies proposed by California state policymakers that do not require federal approval but address the immediate challenges of improving affordability and expanding coverage. “Taking bold action by implementing these improvements would benefit 3.6 million Californians,” said Labor Center research associate Miranda Dietz. That projection includes 1.7 million Californians who would be enrolled in coverage instead of being uninsured in 2023. In addition, it would lower health insurance costs for 2.3 million people enrolled in the individual market. They would either receive state assistance with health care costs or experience lower premiums.
Near-term policy options currently being considered in the Legislature include:
Providing robust help with individual market premium and out-of-pocket costs for those already eligible for ACA subsidies and eliminating the ACA eligibility cliff at four times the federal poverty level (similar to AB174); and Implementing a state individual mandate penalty that mirrors the federal ACA penalty that was eliminated starting in 2019 (SB175, AB 414).
If the state takes no action, the number of Californians uninsured is projected to increase to 4.4 million in 2023. This is due to the elimination of the individual mandate penalty as well as other trends such as premium growth, population growth, and changes in eligibility due to minimum wage increases.
“Taking bold action would not only protect our progress under the ACA, but also further reduce the uninsured,” said Gerald Kominski, senior fellow at the UCLA center and co-author of the policy brief.
These projections are based on version 2.4 of the UCLA-UC Berkeley California Simulation of Insurance Markets (CalSIM) model.
| | 3/28/2019 | 316 | | Approved | 3/18/2019 7:16 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 3/28/2019 12:34 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Jennifer Cabe, MA | jcabe@ucla.edu | | 310-794-0930 | | | | | 1583 | | Y | | | | Publication | Green Space and Serious Psychological Distress Among Adults and Teens: A Population-Based Study in California (Health & Place) | 1805 | | | | |
Researchers used California Health Interview Survey data from 2011 to 2014, combined with information from a satellite-generated map showing the density of vegetation. They found that when the level of “greenness” within 350 meters of a home — a radius of approximately two city blocks — is in the top 25 percentile, a teen living in that home is 36 percent less likely to have serious psychological distress than a teen living in an area with greenness in the bottom 25 percentile.
The study, published in the journal Health & Place, also found that adults 65 and older who have greater exposure to greenness also have lower rates of serious psychological distress, although younger adults do not have the same mental health benefit as seniors.
According to previous research, that may be because older teens and seniors are more likely to stay within their neighborhoods and have a stronger response to their local environment. Meng said that because teens’ brains are still developing, the finding that teens benefit more from being near green space is significant.
“The study suggests that older adults and teens seem to respond well mentally to nearby ‘doses’ of plants and trees,” said Ying-Ying Meng, co-director of the center’s Chronic Disease Program and a co-author of the study.
Pan Wang, the study’s lead author and a former statistician at the center, said city and neighborhood planners should be aware that greater numbers of trees and more park space can support the health of teens and seniors in their communities. She added that residents can also contribute by planting trees on their own property.
“Making a neighborhood greener and healthier is a mission that involves everybody,” she said.
Other authors of the study are Ninez Ponce, director of the UCLA Center for Health Policy Research, and Vanessa Lam, a former research associate at the center.
| | 3/2/2019 | 314 | | Approved | 1/27/2019 4:42 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 4/2/2019 1:52 PM | i:0#.f|uclachissqlmembershipprovider|celeste | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | UCLA hosted experts on universal health care and discussed policy formulation in California | | Participants learned about the origins of universal health care systems in other countries, how they operate, and whether one could be implemented in California during the E. Richard Brown Symposium on universal health care on March 1 and 2. The symposium featured a trio of international health policy experts--Tsung-Mei Cheng, Princeton University, discussed Taiwan's system; Raisa Deber, University of Toronto, spoke about Canda's regional models; and Joseph Kutzin, World Health Organization, covered a number of systems in developing and moderate-income countries.
► Watch the Sacramento webcast of the E. Richard Brown Symposium on universal heath care
The experts stressed the benefits of universal care models and measured outcomes against the current multi-payer model of health care in the United States. As an example, Kutzin presented data that showed that while the U.S. had 4 percent of the world's population in 2016, it accounted for 43 percent of world health expenditures.
“Everyone should be able to have access to good-quality health services, without fear of the financial consequences for themselves, their families, their businesses and their jobs,” Kutzin said.
Approximately 130 people, including legislative staff, media and students, attended either the panel presentation and discussion at the state Capitol building in Sacramento March 1 or the workshop at UCLA on March 2. More than 500 people viewed the live webcast from Sacramento (recording available here). The office of State Senator Richard Pan (D-Sacramento) helped organize the Sacramento event.
At a reception that kicked off the symposium, California Insurance Commission Ricardo Lara decried that high health care costs forces Californians to choose between losing homes or savings to care for loved ones and thanked the Center for its research to help inform the state on facts about public health systems.
“Your work is critical to getting us to a place where we can have the data, we can have the facts of how the public enormously benefits,” Lara said. “We're California. We lead. We don't wait for the rest of the country.”
Assemblymember Jim Wood (D-Santa Rosa) called the Center’s research a “driving force in how we can get to the ultimate goal to get health coverage for everyone in California.”
Center Director Ninez Ponce presented Marianne Brown, widow of UCLA Center for Health Policy Research founder E. Richard Brown, with a resolution from State Senator Ben Allen (D-Santa Monica) honoring her for a lifetime of work improving the health of Californians.
At the UCLA event Saturday, David Carlisle, president and CEO of Charles Drew University of Medicine and Science, said the symposium’s namesake, E. “Rick” Brown, “taught me everything I know about health policy.” Carlisle said Brown converted him from treating one patient at a time to treating a population. “He was always a guiding light that informed my work.”
Other Center staff participating in the symposium included Director Ninez Ponce; Associate directors Steven P. Wallace and Nadereh Pourat; Senior Fellow Gerald Kominski; and Faculty associates Jack Needleman, Michael Rodriguez and Mark Peterson.
The symposium launched the 25th anniversary of the UCLA Center for Health Policy Research, founded by E."Rick" Brown in 1994. Brown spent his life advocating strongly for a care-for-all system that would ensure health services for every Californian.
Ninez Ponce said a goal of the symposium is to "honor Rick in a way that gets action; honors Rick in a way that all the presentations are not just 'feel good,' but that they get used."
Agenda for the E. Richard Brown Symposium -- Universal Health Care in California
UCLA CAMPUS
Saturday, 2 March 2019
Universal Health Care in California – Global Lessons
Location: UCLA campus (Covel Commons, 3rd floor)
Time: 10 a.m. – 3 p.m. PST
A workshop featuring discussion of the successful development and implementation of universal health care systems in Taiwan, Canada and other middle-income countries. What research is available, and where are the gaps in knowledge?
Workshop Objectives – Draft a research agenda
1. Introductory Speaker – Ninez Ponce – overview of the Friday event
2. Tom Rice – Realizing Rick Brown’s wish for universal care
3. David Carlisle – Local perspective from the president and CEO of Charles R. Drew University of Medicine and Science
4. Panel presentations – Overview of Universal Health Care in California – Global Lessons
5. Break
6. Working Lunch – students move between 7-10 tables lead by guest speakers, faculty. Facilitators: Steve Wallace, Michael Rodriguez, Ninez Ponce, Mark Peterson. Lunch will be provided.
a. Financial/Economic Considerations
b. Health System Design
c. Workforce Concerns
d. Public Health and Policy
7. Break
8. Reconvene panel for work group recommendations on research agenda
a. Have students react to the recommendations
9. Wrap-Up: Ninez Ponce
SACRAMENTO
Friday, 1 March 2019
Universal Health Care in California – Planning, Policy & Political Perspectives
Location: California State Capitol, Room 4203
MC: AJ Scheitler
1. Welcome: Ninez Ponce
2. Center Contributions to Coverage Policies: Gerald Kominski
3. Overview of Report to the Assembly and Rick Brown: Rick Kronick
4. Presentations (5 questions for the experts)
- Tsung-Mei Cheng, Woodrow Wilson School of Public and International Affairs, Princeton University
- Raisa Deber, Institute of Health Policy, Management and Evaluation, University of Toronto [See Deber slide presentation]
- Joseph Kutzin, World Health Organization Coordinator & Lead of Health Financing Team [See Kutzin slide presentation]
- Jim Kahn, UCSF Phil Lee Center for Health Policy Studies — conducted systematic review of single payer studies
- Richard Scheffler, UCB School of Public Health [See Scheffler slide presentation]
5. Panel Discussion – reaction to the presentations and topics:
What can new commission do? What data infrastructure is needed to inform the discussion? Debunking the myths of other universal care systems. Moderator: Mark Peterson.
Anthony Wright – Health Access Hector Rodriguez, UCB & CPAC Laurel Lucia, UCB Labor Center Sarah de Guia, CPEHN Art Chen, CAPA & AHS
6. Wrap Up: AJ Scheitler. Lunch Break at 12:15
| | 2/19/2019 | 315 | | Approved | 2/4/2019 1:42 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 2/18/2019 11:51 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Reducing Access Disparities in California by Insuring Low-Income Undocumented Adults | 1804 | | | Nine in 10 lack insurance | | Implementation of the Affordable Care Act cut in half the percentage of low-income, uninsured Californians under age 65, from 23 percent in 2013 to 11 percent in 2016-17. But federal law bars undocumented residents from federally funded Medicaid health services and from purchasing health insurance on the ACA Marketplaces. This leaves them the largest group of uninsured people in California, according to a new study by the UCLA Center for Health Policy Research.
The study reports that of the 2.2 million undocumented people living in the state, three in five are low income and of those, nine in 10 are uninsured. In comparison, about one in 10 U.S.-born and documented low-income residents in the state is uninsured. The study defines low income as earnings at or below 138 percent of the federal poverty level ($16,754 for a single person; $34,638 for a household of four in 2018).
“We have left a significant number of low-income California residents without an affordable way to get preventive and primary care services because of their legal status.”
Relatively healthy, but less likely to receive care when needed
Low-income undocumented adults in California are relatively young, relatively healthy, and likely to be working, according to the study.
Using 2016 and 2017 California Health Interview Survey data for adults ages 19 to 64, authors of the study found that, compared to U.S.-born and documented low-income residents in the state, undocumented low-income adults are more likely to be 26 to 44 years of age (56 percent vs. 19 percent), be in families with children (63 percent vs. 37 percent), and employed (67 percent vs. 60 percent). They are less likely to have multiple chronic health conditions (26 percent vs. 42 percent).
Pourat said that to maintain health, people need timely access to affordable care. But the current study reports the undocumented are more likely to lack a regular source of care (44 percent vs. 24 percent of U.S.-born and documented people) and to have gone without preventive care in the past year (38 percent vs. 21 percent).
“All Californians benefit from improving access as a means of preventing disease and improving our residents’ health,” Pourat said.
The study was supported by the California Health Care Foundation.
| | 1/16/2019 | 312 | | Approved | 12/20/2018 1:31 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 1/16/2019 10:12 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | California’s Behavioral Health Services Workforce Is Inadequate for Older Adults | 1798 | | | | | By 2030, there will be 9 million adults over age 65 in California — up from 6 million now — according to an estimate by the state’s department of finance. But a new study by the UCLA Center for Health Policy Research finds that California’s public mental health workforce is poorly prepared to address their mental health needs and provide treatment for substance abuse. The report’s publication coincides with a meeting this week in San Diego of the California Behavioral Planning Council, which will discuss the workforce problem and a five-year workforce education and training plan. But Janet Frank, a faculty associate at the center and the study’s lead author, said the council’s current proposed plan does not specifically mention workforce needs for older adults.
“Mental health professionals with geriatric training are retiring, and there is a limited number of doctors, psychiatrists and nurses with adequate geriatric training to take their place,” Frank said. “The state can be proactive and plan ahead to make sure behavioral health workers are trained to serve the increasing number of older adults.”
According to the study, existing research paints a stark picture of the need for behavioral health care for adults in their golden years throughout the U.S., which is mirrored in California:
• Between 8 and 16 percent of America’s noninstitutionalized older adults have symptoms of depression, and the percentage is even higher for those with medical conditions.
• Depression and anxiety disorders, the most common mental illnesses in late life, often go undiagnosed in older adults.
• Suicide rates for older men are four times higher than for any other age group, and suicide attempts are more often carried out among older adults than among younger adults.
• Alcohol and prescription drug misuse is one of the nation’s fastest-growing health problems among adults 60 and older, and older adults with those problems are more likely to have undiagnosed psychiatric and medical problems.
A previous study by Frank and coauthors documented that the state’s geriatric behavioral health workforce is deficient in knowledge, skill and numbers, particularly in rural areas. The new study compares the available workforce against the behavioral health needs of older Californians and makes recommendations on how to better prepare and build a workforce to bridge that gap.
For instance, according to the new report, the state has just 721 certified geriatricians. And that predicament reflects the national health care workforce’s preparedness to treat older adults: According to literature cited in the report, only 1 percent of nurses, 4 percent of psychologists and 4 percent of social workers have training or specialize in geriatrics, and only 3 percent of medical students take geriatrics during their training.
The UCLA report recommends nearly a dozen policy strategies aimed at ensuring the state’s mental health workforce is adequately staffed and trained to serve older adults. The recommendations are aimed primarily at three groups: legislators, state agencies and policymakers; universities and colleges, accreditation and licensing boards; and county mental health departments and their contractors.
Among the recommendations:
• Give stipends and other financial incentives to trainees who specialize in geriatric behavioral health services, particularly in small rural counties that will have the biggest shortages.
• California should fund behavioral health training programs that include geriatric content.
• Improve the statewide data collection system to better track the behavioral health workforce as well as activities funded through California’s Mental Health Services Act of 2004, which funds state mental health intervention and services.
• Universities should include geriatrics as part of training for workers entering the mental and behavioral health professions.
• Counties should develop peer training programs in which people who have had a family member treated for behavioral health issues are made available to help older adults navigate public mental health services.
The research was supported by Archstone Foundation.
| | 12/24/2018 | 313 | | Approved | 12/24/2018 1:37 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/24/2018 1:46 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | |
The Center will be closed in observance of the winter holiday from Monday, Dec. 24, 2018, through Tuesday, Jan. 1, 2019. Media needing assistance during this time can contact Venetia Lai, interim communications director.
| | 12/18/2018 | 310 | | Approved | 12/6/2018 9:25 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/17/2018 11:58 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Civic Engagement Among California High School Teens | 1795 | | | Researchers discover gap by race, income between those interested in and those who participate in activity | | High school teens in California who volunteer, take part in community aid groups, and join school or other clubs are healthier and more likely to aspire to attending college, according to a study by the UCLA Center for Health Policy Research.
The study found that regardless of race or family income, one in three teens have a high level of civic efficacy, defined as caring about issues, feeling connected to others who are engaged in civic activities and feeling as if they can make a difference. However, there is a significant gap by race and income between those who are interested in and those who engage in civic activity.
“Latino teens had the lowest rates of participation in clubs and volunteering,” said Susan Babey, research scientist at the UCLA Center for Health Policy Research and lead author of the report. “Our research showed teens who don’t participate in these types of community activities say they aren’t as healthy and are less likely to see college in their future.”
Teen civic involvement by income, race, citizenship
Using responses of 2,253 teens from the statewide 2013-2014 California Health Interview Survey, the study looked at four areas of civic engagement among high school age teens in its analysis:
• Civic efficacy
• Participating in school or extracurricular clubs
• Volunteering
• Being part of an organization that tries to make a difference
Two-thirds, or 64 percent, of the teens surveyed said they volunteered in the past year, making it the most common civic activity. Those from lower-income households (below 200 percent of the federal poverty level) had the lowest rates of volunteering, 45 percent. Of racial and ethnic groups, 55 percent of Latino teens said they volunteered, compared to 66 percent of multiracial teens and Asians, 68 percent of African-Americans and 78 percent of whites.
Based on citizenship status, naturalized teens exceeded U.S.-born teens in rates of civic participation in three of four measures: They have high civic efficacy (45 percent vs. 33 percent, respectively); belong to two or more clubs (42 percent vs. 29 percent); and are in an organization that is trying to make a difference (61 percent vs. 40 percent). They match their U.S.-born counterparts in the remaining category, volunteer activity, 66 percent.
Health, education and civically active teens
The survey showed that teens with high levels of civic efficacy are more likely to say they are in “very good” or “excellent” health, compared to those with low civic efficacy, 76 percent to 49 percent, respectively. The latter group of teens is more likely to miss school for health reasons than the first group, 29 percent vs. 16 percent. Teens who participate in an organization that strives to make a difference are more likely to say they will attend college, 72 percent to 50 percent.
“California’s youth are an asset and we need to provide opportunities so they can contribute to the larger good by participating in civic life,” said Robert Ross, president and CEO of The California Endowment, which supported the study.
Authors of the study recommend that community groups and schools increase opportunities for civic engagement among teens by expanding and supporting programs that help youth improve their communities; encourage participation in civic engagement at middle and high school levels, particularly in low-income areas and communities of color; and actively seek out, engage and welcome youth who are not traditionally included in community and school civic activities.
“In many cases, it’s not that teens lack interest in community and political issues,” said Joelle Wolstein, center research scientist and co-author of the study. “What they may lack is the means and opportunity to participate.”
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians. | | 12/13/2018 | 311 | | Approved | 12/12/2018 12:28 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/17/2018 2:32 PM | i:0#.f|uclachissqlmembershipprovider|venetia | | | | | | | | | | | | | | | Publication | | | | | | | Ninez Ponce, MPP, PhD
Director, UCLA Center for Health Policy Research
Professor, UCLA Fielding School of Public Health
Department of Health Policy and Management
December 10, 2018
Samantha Deshommes, Chief
Regulatory Coordination Division, Office of Policy and Strategy
U.S. Citizenship and Immigration Services Department of
Homeland Security
20 Massachusetts Avenue NW
Washington, DC 20529-2140
Re: DHS Docket No. USCIS-2010-0012, RIN 1615-AA22, Inadmissibility on Public Charge Grounds
Dear Ms. Deshommes:
The Center for Health Policy Research at the University of California, Los Angeles (UCLA) strongly opposes the changes proposed by the Department of Homeland Security (DHS) regarding “public charge,” published in the federal register on October 10, 2018.
As part of the university’s Fielding School of Public Health, we conduct the California Health Interview Survey, which provides information on the state of all Californians to help legislators, county health departments, and advocates make decisions and take action on what kind of health issues need attention, with the ultimate goal being to improve the health of all Californians.
How it will affect our university/Center communities
California is built upon – and thrives upon – the contributions of immigrants. As one of the world’s leading public universities, UCLA both cultivates and benefits from those contributions in terms of the faculty we recruit, the staff we hire, and the students and communities surrounding the university who give back as much as we give.
The proposed changes to public charge would potentially affect a portion of our faculty, staff and students and their families who hold visas they are attempting to renew, or new hires attempting to get a new visa. Our UCLA Center for Health Policy Research projects are staffed by many public health professionals, methodologists and policy analysts who immigrated to the United States.
How it will affect the immigrant community in California regarding health
Beyond the university’s faculty, staff and students, the proposed changes to public charge are complex and will lead to misinformation, confusion, and fear about enrollment in public programs, including nutrition assistance, health care coverage, and housing assistance. Recent analysis of the Supplemental Nutrition Assistance Program (SNAP, known as CalFresh in California) and Medicaid (known as Medi-Cal in California) indicates that this “chilling effect” could impact up to 2.2 million immigrant families in California alone.i If just 35 percent of these Californians in immigrant families disenroll from SNAP and Medicaid, 765,000 people across the state would lose access to critical resources for nutritious food and health care services.ii
Research shows there was significant disenrollment in public benefits after the enactment of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) among immigrants who remained eligible for public benefits post- PRWORA. A prominent and highly cited piece of research by Fix et al. (1999)iii examined immigrant disenrollment over the 1994-1997 period and found that while PRWORA changed immigrant eligibility requirements (i.e., public benefits eligible only to immigrants who have had green cards for at least 5 years), there was still significant disenrollment in public benefits due to fear and confusion among immigrants who had no change in eligibility and were fully eligible. This prior research indicates a 35 percent disenrollment rates is reasonable. This scenario has been used in recent analyses on the proposed public charge rule published by the Kaiser Family Foundation,iv California Health Care Foundation,v and the Fiscal Policy Institute.vi
Page 51266 of the proposed rule states that the “chilling effect” of this rule would not be comparable to that which was observed following the enactment of PRWORA because that law changed eligibility requirements, whereas this rule would change enrollment incentives. However, this assertion does not explain why refugee Food Stamp use dropped 60 percent between 1994 and 1997, despite their eligibility remaining unchanged by PRWORA.vii The assumption of a 2.5 percent rate of disenrollment is a gross underestimate of this proposal’s potential chilling effect. If DHS were to calculate the costs and consequences of this policy using a more accurate, evidence-based rate of disenrollment, the projected negative impacts on public health and the economy would be significantly worse.
Disenrollment from SNAP and Medicaid would increase poverty, hunger, and poor health in communities statewide by reducing the resources that California residents have for health care, food, and other basic necessities. Among California’s immigrant adults potentially impacted by the proposed rule, Medi-Cal enrollees are 1.8 times more likely to have a usual place to get health care and are 1.5 times more likely to have had a preventive care visit in the past year, compared with people who are uninsured.viii More than 400,000 of California’s immigrant adults are food insecure, which means that they lacked consistent access to enough food at some point in the past year.ix Disenrollment from CalFresh could increase food insecurity in California for these adults and others in their households, including children.x
SNAP mitigates hunger and is associated with better health. Nationwide, SNAP decreases food insecurity by up to 30 percent, with the largest effects among households with children and households with very low food security.xi Exposure to SNAP is also associated with positive birth outcomes (healthier birth weights), increased likelihood of reporting excellent or very good health, decreased risk of chronic diseases in adulthood, and increased likelihood of adhering to prescription medicines among seniors.xii
The effects of Medi-Cal are also seen throughout the life course of participants. For instance, children with Medi-Cal are more likely than uninsured children to graduate from high school and college and as adults, earn more and pay more taxes.xiii Children with Medi-Cal are twice as likely to receive routine preventive medical and dental care than uninsured children.xiv Adults with Medi-Cal are 40 percent more likely to receive routine check-ups than uninsured adults.xv Medi-Cal saves thousands of lives every year.xvi
The proposed changes to public charge will predominately affect children and people of color. Nearly 70 percent of California residents projected to disenroll from health care and nutrition assistance benefits as result of the proposed rule would be children.xvii Throughout the state, disenrollment from CalFresh and Medi-Cal would most significantly impact Latinos (88 percent) and Asians (8 percent).xviii
How it will affect the economy of the state
The harm of the proposed changes to public charge extends beyond immigrants and immigrant families. Analysis shows that if just 35 percent of Californians in immigrant families disenroll from Medi-Cal and CalFresh, the state would lose up to $2.8 billion in economic output.xix For every lost dollar in federal benefits, the state would lose approximately $1.60 in economic activity.xx Up to 17,700 jobs would be eliminated statewide. An estimated 57 percent of the job losses would come from California’s health care sector (8,400 jobs) and food-related industries (1,800 jobs).xxi These anticipated economic losses show that deterring immigrants from accessing much-need public programs will hurt individuals, families, and entire communities, regardless of immigration status. The evidence provided by UCLA researchers and their esteemed colleagues across that country makes clear that the proposed changes to public charge will leave us a sicker, hungrier, poorer nation.
The proposed rule is an affront to our country’s core values, our social contract, and our history as a nation of immigrants. In driving immigrants from resources that support health, well-being, education, and upward economic mobility, this policy will force us to forego the many contributions immigrants make to the economy and our society.
For all of these reasons, we ask that DHS immediately withdraw this proposed rule.
Ninez A. Ponce, MPP, PhD
Professor, Fielding School of Public Health Director
UCLA Center for Health Policy Research,
UCLA Fielding School of Public Health i Ponce NA, Lucia L, Shimada T. December 2018. Proposed changes to immigration rules could cost California jobs, harm public health. Los Angeles, CA: UCLA Center for Health Policy Research, UC Berkeley Labor Center & California Food Policy Advocates.ii ibidiii Fix M.E., Passel J.S. (1999). Trends in Noncitizens’ and Citizens’ Use of Public Benefits Following Welfare Reform: 1994 – 1997. Washington, D.C.: The Urban Institute. Available at https://www.urban.org/research/publication/trends-noncitizens-and-citizens-use-public-benefits- following-welfare-reformiv Artiga, S., Damico, A., Garfield, R. Potential Effects of Public Charge Changes on Health Coverage for Citizen Children. Kaiser Family Foundation. May 18, 2018. Available at: https://www.kff.org/disparities-policy/issue-brief/potential-effects-of-public-charge-changes-on- health-coverage-for-citizen-children/v Zallman, L., Finnega, K. Changing Public Charge Immigration Rules: The Potential Impact on Children Who Need Care. California Health Care Foundation. October 23, 2018. Available at: https://www.chcf.org/publication/changing-public-charge-immigration-rules/vi Fiscal Policy Institute. “Only Wealthy Immigrants Need Apply” How a Trump Rule’s Chilling Effect will Harm the U.S. October 2018. Available at: http://fiscalpolicy.org/wp-content/uploads/2018/10/US-Impact-of-Public-Charge.pdfvii United States Department of Agriculture Food and Nutrition Service, Office of Analysis, Nutrition, and Evaluation. (1999) Who is Leaving the Food Stamp Program? An Analysis of Caseload Changes from 1994 to 1997. Available at https://fns-prod.azureedge.net/sites/default/files/cdr.pdfviii Ponce NA, Lucia L, Shimada T. December 2018. Proposed changes to immigration rules could cost California jobs, harm public health. Los Angeles, CA: UCLA Center for Health Policy Research, UC Berkeley Labor Center & California Food Policy Advocates.ix ibidx ibidxi James Mabli et al. (2013). Measuring the Effect of Supplemental Nutrition Assistance Program (SNAP)Participation on Food Security. Food and Nutrition Service, USDA. Available at: https://www.fns.usda.gov/measuring-effect-snap-participation-food-security-0xii Carlson, S., Keith-Jennings, SNAP Is Linked with Improved Nutritional Outcomes and Lower Health Care Costs, Center on Budget and Policy Priorities, 2018. Available at: https://www.cbpp.org/research/food-assistance/snap-is-linked-with-improved-nutritional- outcomes-and-lower-health-carexiii Harbage Consulting, “Medi-Cal Matters: A Snapshot of How Medi-Cal Coverage Benefits Californians, California Health Care Foundation September 2017.xiv ibid xv ibid xvi ibidxvii Ponce NA, Lucia L, Shimada T. December 2018. Proposed changes to immigration rules could cost California jobs, harm public health. Los Angeles, CA: UCLA Center for Health Policy Research, UC Berkeley Labor Center & California Food Policy Advocates.xviii ibidxix Ponce NA, Lucia L, Shimada T. December 2018. Proposed changes to immigration rules could cost California jobs, harm public health. Los Angeles, CA: UCLA Center for Health Policy Research, UC Berkeley Labor Center & California Food Policy Advocates. xx ibidxxi ibid | | 12/3/2018 | 308 | | Approved | 11/20/2018 9:39 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/7/2018 1:43 PM | i:0#.f|uclachissqlmembershipprovider|venetia | AJ Scheitler, EdD | ajscheitler@ucla.edu | | (310) 794-8286 | | | | | 5 | | Y | | | | Publication | Proposed Changes to Immigration Rules Would Cost California Jobs, Harm Public Health | 1789 | | | Report by UCLA, partners finds the state could lose up to $1.67 billion in federal benefits with changes to the ‘public charge’ test | Possible changes in federal immigration policy could cost California billions of dollars and thousands of jobs. | U.S. immigration officials use the term “public charge” to describe people applying for a green card who are deemed likely to become primarily dependent on the government to meet their basic needs. Under proposed changes to Department of Homeland Security immigration rules that could be implemented as soon as spring 2019, people could be denied status as lawful permanent residents if they’ve received certain health care, housing or nutrition assistance benefits.
If those changes are implemented, California could lose up to $1.67 billion in federal benefits, according to an analysis by the UCLA Center for Health Policy Research, the UC Berkeley Labor Center and California Food Policy Advocates, a nonprofit organization. And that loss would also have a ripple effect across multiple industries through direct and indirect spending by the affected families and the jobs that spending supports. As a result, the state economy could ultimately lose $2.8 billion and as many as 17,700 jobs, the analysis found.
An estimated 47 percent of the job losses would come from California’s health care sector; another 10 percent would come from the state’s food-related industries.
“California is home to nearly 40 million people, and more than a quarter of our population was not born in the United States,” said Ninez Ponce, director of the UCLA center. “Immigrants make crucial contributions to California’s workforce, economy and tax base. The proposed changes to the ‘public charge’ test would significantly reduce the use of much-needed public programs among those who are eligible, and the economic ripple effect would hurt communities statewide.”
Ponce said the proposed changes could prompt an estimated 765,000 immigrants in California to disenroll from nutrition assistance and health care programs, and that nearly 70 percent of those losing benefits would be children.
Currently, only two public programs — cash assistance and long-term institutional care — are considered for the public charge test. If the proposed changes are enacted, immigrant parents of citizen children and immigrant individuals who use Medi-Cal health insurance (California’s Medicaid program), Medicare Part D low-income subsidies, housing assistance, and CalFresh nutrition assistance (California’s Supplemental Nutrition Assistance Program) could have reduced chances of being approved for a green card. In addition, the rule adds harsher standards for personal circumstances that make someone less likely to receive a green card, such as having limited English proficiency, limited education and low income, being a child or being a senior.
“One in 10 Californians use CalFresh to put enough food on the table,” said Tia Shimada, director of programs at California Food Policy Advocates. “Among households participating in CalFresh, nearly 75 percent include children. Entire communities benefit when everyone has access to food, health care, and other basic resources — and entire communities bear the brunt when access is withheld. The proposed changes to the public charge test would make us a sicker, hungrier and poorer state.”
Misinformation, confusion and fear generated by the proposed changes could drive people to disenroll from public assistance programs, even if they’re not legally subject to the new test.
The authors estimate that as many as 301,000 Californians could remove themselves from the CalFresh nutrition assistance program and up to 741,000 could drop their Medi-Cal coverage. The analysis indicates that this disenrollment would primarily hurt children, Latinos and Asians, while increasing poverty, hunger, and poor health in communities across California.
“California’s health care system would lose as much as $1.2 billion in federal Medi-Cal dollars if over 700,000 people no longer access Medi-Cal benefits,” said Laurel Lucia, health care program director at the UC Berkeley Labor Center. “Approximately two-thirds of those who may leave Medi-Cal would be children, and that’s particularly unfortunate because children enrolled in Medi-Cal are more likely to get preventive dental care and medical care such as check-ups and immunizations than uninsured children.”
Public comments about the proposed changes to the public charge test can be submitted through December 10, 2018; all comments must be counted and considered by public officials before a final rule is issued. Visit the Protecting Immigrant Families website to learn more.
The analysis was funded by the California Health Care Foundation and The California Endowment.
| | 11/27/2018 | 307 | | Approved | 11/19/2018 11:37 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 11/27/2018 1:13 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Penelope Whitney | penelopewhitney@berkeley.edu | | 510-643-8756 | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | 1569 | 1092 | N | Y | | | Publication | California’s Health Coverage Gains to Erode Without Further State Action | 1788 | | | UCLA-UC Berkeley report finds up to 4.4 million Californians could be uninsured in 2023 because of changes in federal law | | A new study by researchers at UC Berkeley and UCLA projects that hundreds of thousands more Californians could become uninsured because of forthcoming changes in federal health insurance law. Beginning in January 2019, new policy will remove the Affordable Care Act’s individual mandate penalty, the fee assessed to people who do not have health insurance. The report uses the California Simulation of Insurance Markets (CalSIM) model, which was developed by the UCLA Center for Health Policy Research and the UC Berkeley Labor Center, to forecast how many Californians will be uninsured in 2020 and 2023. The authors suggest policies that could help California protect the progress the state made under the ACA in expanding health coverage, and to reduce the remaining gaps in coverage, including: - Expand Medi-Cal to all low-income residents regardless of their immigration status;
- Provide state subsidies to individual market premiums and out-of-pocket costs more affordable;
- Implement a state individual mandate; and
- Continue to support and strengthen outreach and enrollment efforts
“Federal decisions threaten to reverse health coverage gains around the country,” said Gerald Kominski, a senior fellow at the UCLA center and co-author of the policy brief. “These policies would help to ensure that California continues to build on its successes and drive toward its goal of achieving universal health coverage.”Thanks to California’s effective implementation of the ACA, the percentage of uninsured non-elderly Californians fell to 10.4 percent in 2016 (representing 3.55 million Californians under the age of 65), from 17.6 percent in 2012.The report projects that without California taking action to protect and build upon these gains in coverage, the uninsurance rate could grow to 11.7 percent in 2020, or approximately 4.0 million people under age 65, and to 12.9 percent in 2023, or 4.4 million people. These estimates include undocumented Californians who only have restricted-scope Medi-Cal.“Unless the state takes action, we could see 500,000 to 800,000 more Californians become uninsured as a result of the individual mandate penalty going away,” said Miranda Dietz, the report’s lead report author and a research and policy associate at the UC Berkeley Labor Center. “Policies supporting broader enrollment matter even more now.”The report forecasts that the most substantial enrollment changes will occur in the individual market. It also details which populations are projected to remain uninsured — such as undocumented Californians — and which will struggle to afford insurance.
| | 11/27/2018 | 309 | | Approved | 11/24/2018 9:45 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 11/26/2018 8:44 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | Find 2011, 2013 and 2015 data on the percentage, number and demographic characteristics of seniors with incomes below the Elder Index in all 58 California counties using our new, free Elder Index Demographic Data online dashboard.
The Elder Index is a more accurate measure of how much it costs seniors to live in California than outdated federal poverty level (FPL) guidelines that ignore regional differences in living costs.
The user-friendly dashboard enables you to quickly find numbers on how many seniors have incomes below the Elder Index, how many are among the hidden poor, and how many the FPL recognizes as being in poverty compared to the Elder Index. You can query, sort and compare data using simple pull-down menus. The resulting visuals include a county-by-county bar chart and a color-coded map of all counties for easy comparison. The information can be downloaded as a PDF or CSV Excel file.
The new 2015 data includes information for 6 additional family types of senior households for a total of 12 different household arrangements, ranging from a single elder living alone to complex 3-generation households.
“This is the most comprehensive online collection of data on the number of California seniors who are economically insecure,” said D. Imelda Padilla-Frausto, Center research scientist. “And this new tool makes it even easier to see how inadequately the FPL captures the number of seniors who are struggling to make ends meet in high-cost states like California.”Padilla-Frausto spearheaded the effort to make the Elder Index Demographic Data more accessible in collaboration with former California Health Interview Survey Statistician Yueyan Wang.
| | 11/5/2018 | 306 | | Approved | 10/23/2018 8:03 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 11/12/2018 5:57 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai; F. Lurmann | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092; 756 | | Y; N | | | | Publication | | | | | | | How do racism and citizenship affect health? Whom does "junk" food and drink marketing hurt most? What does access to health care look like in rural communities? How can we meet current and future health needs of a diverse, aging population? These are just some of the pressing health policy issues Center researchers will address at the APHA 2018 Annual Meeting in San Diego.
Nearly 5 dozen presentations, roundtables and poster sessions feature Center researchers or research that uses California Health Interview Survey (CHIS) data at APHA Nov. 11-14.
In addition, on Monday, Nov. 12, the APHA Aging and Public Health Section will present Associate Center Director Steven P. Wallace with the 2018 Aging & Public Health Lifetime Achievement Award. The award is presented to an individual with a career exceeding 20 years who has made a significant contribution to public service, scholarship, or science in the areas of geriatrics and gerontology.
Visit us at Booth #1226! Assistant CHIS director Royce Park will be among the staff members demonstrating AskCHIS© and AskCHIS© Neighborhood Edition. You can also pick up free publications, pens or one of our popular stress-relief bears.
Find the Center/CHIS APHA sessions calendar here. | | 10/31/2018 | 304 | | Approved | 9/26/2018 10:55 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 10/31/2018 12:02 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | ACA Reduces Racial/Ethnic Disparities in Health Coverage | 1787 | | | UCLA’s California Health Interview Survey also shows increase in mental health distress among young adults; majority of adults have used marijuana | | Just 8.5 percent of Californians under age 65 did not have health insurance in 2017, down from 15.5 percent in 2013, before the full expansion of the Patient Protection and Affordable Care Act — extending the state’s lowest-ever noninsured rate for a second year — according a policy brief jointly produced by the California Health Care Foundation and the UCLA Center for Health Policy Research. Those findings are excerpted from thousands of new and updated data estimates in the latest California Health Interview Survey, which is conducted by the Center and covers a broad range of health topics.
For the 2017 edition, which includes responses from children, teens and adults in nearly 21,300 households, new topics included voter engagement, marijuana use by teens, prescription drug misuse by adults and child behavior. It is the largest single-state health survey in the U.S.
“The survey data give us a wide picture of the well-being of Californians,” said Ninez Ponce, director of the Center and the survey’s principal investigator. “With the legalization of recreational marijuana, more restrictions in immigration policy and expansion of health care coverage for all California children, the survey tracks how changes in both state and federal policies affect the lives of individuals and their families in the state.”
Insurance stability for most; rebound in employer-sponsored plans
According to the related policy brief, the continuing low proportion of people without health insurance illustrates the continued success of the Affordable Care Act. During 2017, there were 2.8 million Californians under age 65 without insurance, down from 5.1 million in 2013.
But Tara Becker, the Center’s senior public administration analyst and lead author of a policy brief accompanying the survey results, said the ACA’s success is at risk. Federal policy changes — such as the elimination of the individual mandate, which is scheduled to go into effect in January — are carving away at the law’s protections.
“People who recently gained access to health care may be in grave danger of losing it,” Becker said. “If premiums and out-of-pocket costs continue to rise in the private insurance market, fewer Californians will be able to afford coverage and more will delay or forgo needed care.”
The study shows the percentage of adults insured by Medi-Cal, the state health insurance program for low-income and disabled adults, dipped to 29 percent in 2017 from 33 percent in 2016; and that the percentage of people with employer-sponsored insurance increased to 51.2 percent, from 48.2 percent in 2016.
Overall, 58.7 percent of Californians had private health insurance, up from 55 percent the previous year.
According to the policy brief, the percentage of people without insurance among whites, blacks, Asian-Americans and Latinos declined by more than 40 percent for each group between 2013 and 2016 — and the percentage of uninsured whites, blacks and Asian-Americans were virtually the same in 2016 (5.8 percent, 5.8 percent, and 5.6 percent respectively). The low rates of uninsured among those groups continued in 2017, with 7.3 percent of black Californians, 5.7 percent of whites and 4.4 percent of Asian-Americans lacking health coverage last year. But 12.4 percent of Latinos lacked insurance in 2017 — the highest figure for any of the major race groups analyzed.
Other selected survey findings from 2017 data:
Mental health distress among young adults. The percentage of Californians ages 18 to 24 who said that they had psychological distress in the past year was 21.1 percent, up 6.9 percentage points from 2016 — and more than double the figure for all adults, which was 10 percent. The percentage of adults who have thought seriously about committing suicide in their lifetime increased to 11.6 percent in 2017, from 9.3 percent in 2016.
Children’s emotions and behavior. For children between the ages of 4 and 11, parents reported that 18 percent had issues with behavior, controlling emotions, concentrating or getting along with others; 7.1 percent of all children in that age range had severe behavioral issues.
Interest in voting. Although 88 percent of eligible adults said they are registered to vote, just 54.2 percent say they always or frequently vote.
Daily exercise among adults. Of all adults, 20.6 percent exercise daily, and 14.5 percent exercise three days a week, while 19.2 percent don’t exercise.
Teens and electronics. Among teens, 70.2 percent said their home had rules for turning off or putting away computers, smartphones and other electronics. Thirty percent said their doctor had talked to them about their use of online technology for activities such as social media and gaming.
Use of marijuana, heroin and painkillers. Slightly more adult Californians have tried marijuana or hashish (51 percent) than haven’t (49 percent). Less than 1 percent of adults said they used heroin in the past year, and 2 percent of adults said they had misused prescription painkillers. Among teens, a large majority — 87.6 percent — had never tried marijuana or hashish, while 12.4 percent said they had.
Tobacco smoking. The percentage of adults who smoke continued to dip in 2017, reaching 10.2 percent, and the percentage of adults who have never smoked reached 68 percent, the highest it has been since the survey began in 2001.
Dental coverage. Sixty-five percent of adults had dental health coverage in 2017, up from 61.3 percent in 2016.
Diabetes and prediabetes. The rate of adults with diabetes climbed to 10.7 percent, compared to 9 percent in 2016 and 7.8 percent in 2007. In the current survey, 15.6 percent of respondents said they had prediabetes, compared to 13.5 percent in 2016 and 8 percent in 2009, when the survey first tracked that figure.
The new survey results are available to the public for free through the center’s AskCHIS query tool. In addition, public use files with the new data are downloadable from the website, and researchers can access confidential data files from the study. The California Health Interview Survey encompasses numerous categories, including general health status, health conditions (such as asthma, physical disability and hypertension), health behaviors (fast food consumption and sleep), neighborhood environment, access to and use of health care, food environment (hunger and access to fresh produce), health insurance, teen bullying, involvement and supervision of parents or adults, child care, employment, income, and other measures such as race, marital status, sexual orientation, citizenship and more.
Find 2017 California Health Interview Survey data: AskCHIS.com
The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo.
| | 10/17/2018 | 303 | | Approved | 9/23/2018 11:38 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 10/16/2018 11:58 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Disparities in Health Care Access and Health Among Lesbians, Gay Men, and Bisexuals in California | 1786 | | | UCLA study analyzes rates of insurance coverage in California, access to health care and healthy behaviors | | Lesbian, gay and bisexual adults in California have rates of health insurance coverage on par with or better than that of straight men and women in the state, but they are more likely to wait to see the doctor when they need medical care, according to a new policy brief by the UCLA Center for Health Policy Research.
Why the delay? According to Susan H. Babey, a co-author of the study, one reason cited in other research is that sexual minorities sometimes experience discrimination when they seek health care.
“Sexual minorities who have had a bad experience with a medical provider because of their sexual orientation may try to avoid repeating it,” said Babey, who is also co-director of the Chronic Disease Program at the Center.
The UCLA study looks at differences in access to care, behaviors that negatively affect health (such as smoking or not exercising) and health problems that can result from those behaviors (such as developing hypertension or being overweight), based on people’s sexual orientation. The findings show that 24 percent of bisexual men and 22 percent of straight men say they do not have a doctor they regularly see, compared with only 13 percent of gay men; but 20 percent of gay men and 21 percent of bisexual men delayed seeking health care in the past year, compared with 13 percent of straight men.
Thirteen percent of straight women and 15 percent of lesbians reported that they do not have a doctor they regularly see, while a higher percentage of bisexual women, 22 percent, said they do not have one. However, 29 percent of lesbians and bisexual women said they delayed seeking medical care in the past year compared with just 18 percent of straight women.
The study uses data from the combined 2011 to 2014 California Health Interview Survey. (Data on transgender people is not included because the survey only began collecting transgender data in 2015-16.) More than 1 million California adults, 4.5 percent of the state’s adult population, identify as lesbian, gay, homosexual or bisexual, according to the survey.
Other key findings from the research:
Bisexuals have the worst overall access to a doctor they see on a regular basis and high rates of unhealthy behaviors. Among lesbian/gay, bisexual and straight adults, bisexual men and women are the least likely to have a regular source of care, are most likely to delay care and are mostly likely to seek care in an emergency room. Bisexual men have higher rates of unhealthy behaviors in four of the five categories analyzed in the study. Among women, bisexuals in the study have higher rates of smoking and binge drinking, and are more likely to eat fast food two or more times a week.
Gay men report better overall health and fewer behaviors that lead to obesity and hypertension than straight men. Sixty-one percent of gay men said they considered themselves to be in excellent or very good health, compared to 52 percent of straight men and 44 percent of bisexual men. Gay men are less likely to drink sugary beverages daily and were less likely to binge drink than straight and bisexual men. Twenty-seven percent of straight men in the study were obese, compared with 21 percent of gay men and 20 percent of bisexual men.
Straight women have the best access to a doctor they see on a regular basis, overall health and the lowest rates of unhealthy behaviors. Half of straight women said they were in excellent or very good health, versus 44 percent of lesbians and 45 percent of bisexual women. Twenty-seven percent said they had engaged in binge drinking within the previous year, compared to 50 percent of bisexual women. Ten percent of straight women were smokers, compared with 23 percent of bisexual and lesbian women. Lesbians had the highest rate of obesity, 35 percent, compared with 26 percent of bisexual women and 24 percent of straight women.
“Our study shows bisexuals have among the greatest need for regular health care, but are the least likely to get it,” said Joelle Wolstein, a research scientist at the Center and the study’s lead author. “Even if they have a high-quality insurance plan through an employer, health equity is far from a reality for many LGBTQ patients.”
| | 10/12/2018 | 305 | | Approved | 10/13/2018 12:35 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 11/2/2018 1:30 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | 
On Oct. 10, the federal government proposed changes to the “public charge” rule, which is used to determine whether certain immigrants can obtain “green cards” and sponsor the immigration of family members. If the proposed changes are enacted, using public benefits to help meet basic needs ― including food and health care ― will count against immigrants who are working toward permanent residency in the U.S.
Immigration policy experts say the rule change will result in a “chilling” effect of fear and confusion, keeping individuals and families from using essential programs ― even if they are not actually subject to the “public charge” rule.
The resulting loss of federally funded public benefits will have a broad ripple effect throughout the economy, affecting health care providers, businesses, and workers in health care, food-related industries and other sectors.
There is a 60-day public comment period for the proposed rule.
On Nov. 7, Ninez A. Ponce, director of the UCLA Center for Health Policy Research; Laurel Lucia; director of the health care program at the UC Berkeley Center for Labor Research and Education; and Tia Shimada, director of programs at California Food Policy Advocates, will preview a forthcoming report and share estimates of the health and economic impact the rule change will have on California, its regions, and its racial and ethnic groups.
The research is supported by the California Health Care Foundation and The California Endowment.
To attend in person: Please RSVP at https://bit.ly/2EfNbyQ
To attend online: goo.gl/6Vp8eB (No RSVP needed)
| | 9/27/2018 | 302 | | Approved | 8/28/2018 9:58 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 9/26/2018 11:50 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Few California Children and Adolescents Meet Physical Activity Guidelines | 1776 | | | Related report by Center for Health Policy Research finds adults are walking more than they did a decade ago | | California‘s weather encourages year-round outdoor activity. Yet just 1 in 3 children and only 1 in 5 teens in the state exercise for the one hour per day that’s recommended by the Centers for Disease Control and Prevention, according to a study by the UCLA Center for Health Policy Research.
In contrast, a greater percentage of California adults are walking regularly. A related report by the Center found that 4 in 5 adults walk for transportation (to reach work, for example), for leisure or both – an increase from 3 in 4 a decade earlier. In fairness to children, though, the study’s authors estimate that just 1 in 3 adults meet the CDC-recommended goal of 150 minutes per week of moderate-intensity aerobic exercise.
“It’s encouraging that adults showed improvement, but a lot of Californians still need to move more,” said Susan Babey, co-director of the Center’s Chronic Disease Program and lead author of both studies. “Regardless of age, exercising helps people stay in better physical and mental shape.”
Both studies are based on the 2013–14 California Health Interview Survey of more than 40,000 households in the state, and the adult study also compared results to the 2003 version of the same survey.
The main findings from the study of children and teens:
• An estimated 38 percent of young children (5 to 7 years old) meet the recommended daily physical activity level, but the proportion drops to 25 percent for 8- to 11-year olds, and to just 18 percent for 12- to 17-year-olds.• Boys are significantly more likely to meet the physical activity goal than girls, except among the youngest age group.• Half of white children exercise for an hour daily, a slightly higher percentage than among black and American Indian/Alaska native children. Rates for Asian-American and Latino children were lower, at 41 percent and 36 percent, respectively.• Overall, roughly 1 in 10 children and teens never get an hour of physical exercise on any given day.• Forty-four percent of children and teens who live within walking distance of a park meet their recommended physical activity goals, versus just 36 percent of those who do not live near a park.
The key findings from the adult study:
• Half of adults walk for transportation, but 65 percent walk for leisure.• A higher proportion of men (53 percent) than women (47 percent) walk for transportation. But a higher proportion of women (67 percent) walk for leisure compared to men (62 percent).• Adults from all racial groups have higher rates of walking for leisure than transportation, but non-white adults are more likely to walk for transportation than whites. In addition, low-income earners are more likely to walk for transportation than people with higher incomes.• Adults who said they feel safe in their neighborhood all of the time walk for leisure for an hour and a half per week; those who said they never feel safe walk for about an hour per week. • Adults who live in an area where they know and trust their neighbors walk for 101 minutes per week, while those who live in neighborhoods with less social cohesion walk for 74 minutes per week.
The study’s authors recommend that governments and community leaders advance policies and programs that would support more walking among adults and encourage physical activity among children and adolescents by adding more parks, developing neighborhood crime prevention programs and promoting social cohesion in neighborhoods.
The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians.
| | 9/18/2018 | 301 | | Approved | 8/28/2018 6:59 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 9/18/2018 11:44 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Rise in Medi-Cal Enrollment Corresponded to Increases in California County Health Spending During ACA Implementation | 1771 | | | | | The number of Californians who gained health insurance grew by 3 million people after the Affordable Care Act expanded Medi-Cal coverage in 2014 and 2015. But anticipated federal funding changes could over time force counties to shoulder more of the cost of paying for health care, or cut back enrollment and programs, according to a study by the UCLA Center for Health Policy Research.
Nearly one-third of the state’s 33 million people under the age of 65 are enrolled in the health insurance program for low-income and disabled residents known in California as Medi-Cal (or Medicaid in the rest of the United States). However, the percentage of Californians enrolled in the program varies greatly by county, as does the amount of money each county is spending on health care after that expansion, according to the study.
If the federal government acts to cap Medicaid funding to states, California counties such as San Bernardino, San Joaquin, Riverside, Placer, Mendocino, Monterey, Fresno and the Northern/Sierra region could see public health care take a bigger bite of their budgets.
Under the current version of Medi-Cal, anyone who qualifies is guaranteed benefits, and the program grows in response to increases in enrollment and health care costs. That would change under a block grant.
“The counties that had a big increase in enrollment will have a tougher time sustaining the same level of coverage because under a capped block grant, funding is at a set level,” said Shana Alex Charles, faculty associate at the center and the study’s lead author. “If you have an economic downturn and more people need Medi-Cal for health coverage, many counties will have to make a hard choice: the financial health of their county or the physical and mental health of their Medi-Cal beneficiaries.”
The study, which uses data from the California Health Interview Survey and the California State Controller's Office, contains maps as well as Medi-Cal enrollment and expenditure figures for 44 counties or county groups on:
- The percentage of residents under 65 who were enrolled during 2014-15: Fresno County had the highest proportion, 49 percent; Marin County the lowest, 10 percent.
- The percentage point change in enrollment from 2012 to 2014-2015: San Joaquin County had the highest increase, 22 percent; Madera and Yolo counties the largest declines, each down 5 percent.
- Per capita expenditures in 2015: Humboldt County had highest expense, $387 per capita; Yuba County the lowest, $79 per capita.
- The percent change in public health expenditures per capita from 2012 to 2015: Riverside County had largest increase at 39 percent; Yuba County the biggest decline, down 12 percent.
| | 8/30/2018 | 298 | | Approved | 7/6/2018 6:40 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 9/4/2018 7:09 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Proposal to Reduce Adult Immunization Barriers in California | 1761 | | | | | Requiring health insurers to pay for adult vaccinations given at retail pharmacies could help prevent the spread of deadly communicable diseases such as influenza, pneumococcal infection and human papillomavirus, according to a new study by the UCLA Center for Health Policy Research.
Many insurers do not cover pharmacy-administered vaccines; cover a limited selection of vaccines; or require people they insure to get vaccinated only at pharmacies within their insurance network, the study reports.
Overall vaccination rates in state are low
The overall vaccination rate among adult Californians is far below federal recommendations, according to the study. For example, the flu vaccination rate in California was 39 percent in 2015-16, 31 percentage points below the 70 percent goal set by Healthy People 2020, a federal health promotion program. The pneumococcal immunization rate for Californians 18 to 64 years of age who are at high risk for pneumonia (including smokers and people with asthma, chronic heart disease and chronic obstructive pulmonary disease) was 34.1 percent in 2016 compared to the recommended goal of 60 percent.
“California may be ahead of other states in pushing for health care expansion, but our immunization rates for communicable diseases are fairly dismal,” said Gerald Kominski, senior fellow at the center and one of the study’s co-authors.
Influenza and pneumonia-related illnesses contributed to an estimated 57,000 deaths in the country in 2015-16, making it one of the top 10 leading causes of death, according to data from the Centers for Disease Control and Prevention. In California, 324 adults under the age of 65 died of flu-related illness during the 2017-18 influenza season as of Aug. 4, according to the California Department of Public Health surveillance report.
Racial disparities in vaccination rates
While California’s pneumococcal vaccination rate for those with a higher risk of infection is low for all major racial groups in the state, it is particularly low among Hispanics, 23.9 percent. Vaccination rates for human papillomavirus, a sexually transmitted virus that causes cancer, is significantly lower among women ages 23 to 31 who are Latino, black and Asian, compared to white women, according to previous research cited in the study.
Also, the study reports the infection rate of vaccine-preventable Hepatitis B is three to four times higher among Asian-Americans than among other races. However, the vaccination rate for the disease among Asian-Americans, 11.7 percent, is higher than for blacks and Hispanics, which are in single-digit territory, 7.7 percent and 9.3 percent, respectively.
Barriers to getting immunized
Many barriers keep adult Californians from getting immunized, according to the study. These include:
• Confusing and inconsistent insurance policy coverage. A patient may have difficulty knowing if their commercial or government insurance program covers pharmacy vaccine benefits. As a result, some customers forgo vaccination because of potential or actual out-of-pocket cost.
• Unaffordable upfront costs. Some patients are required to pay upfront for vaccinations at a pharmacy and file a claim in order to get reimbursement, a hardship for low-income adults.
• Lack of access to a doctor. Scheduling an appointment for immunization can be difficult for patients who lack a regular care provider.
• Unawareness or personal objections. Lack of knowledge about the benefits of adult vaccines; the health system’s focus on child vaccinations and its lack of prioritization about adult vaccinations; and cultural suspicion about vaccinations all can hinder immunization.
Medi-Cal, the state’s insurance program for low-income and disabled Californians, in 2016 approved paying for a wide range of adult vaccinations at a doctor’s office or a local pharmacy. Pharmacists are required to inform the state immunization registry and the patient’s primary care doctor about vaccinations given to the patient to avoid duplication.
Department of Health Care Services Medi-Cal Claims data from calendar years 2016 and 2017 suggest that since opening pharmacies to Medi-Cal Managed Care patients on December 23, 2016, the number of flu, pneumococcal disease and shingles vaccine doses administered has increased by 44.4 percent.
The study’s authors recommend that the state Legislature require the Department of Managed Health Care and the Department of Insurance follow the lead of Medi-Cal and expand the insurance pharmacy benefit to include adult vaccines for all public and commercial insurance plans.
“Including pharmacy-administered vaccines as a covered benefit will help many adult patients who have financial constraints, transportation issues or are unable to take time off work during a doctor’s office hours,” said Ozlem Equils, a steering committee member at the Immunization Coalition of Los Angeles County and lead author of the study. “It’s a step toward making adult immunizations more accessible for more Californians.”
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
| | 8/21/2018 | 299 | | Approved | 7/31/2018 11:09 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 8/20/2018 11:53 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | More Than Three-Quarters of Low-Income Older Californian Tenants Are Rent Burdened | 1762 | | | | |
Low-income seniors who rent — numbering more than half a million — can be forced to move far from their established social and medical networks to find rentals they can afford; they may end up in substandard housing; or — at worst — homeless, according to authors of the study.
“Older Californians with limited incomes struggle to pay for shelter, food, medical care and other basic necessities. Escalating rent prices can push them out the door,” said D. Imelda Padilla-Frausto, research scientist and co-author of the fact sheet. “If they’re lucky, they can land at a relative or friend’s home.”
Rent that requires more than half a household’s pretax income is identified as a “severe burden,” while rent that consumes more than 30 percent but less than half is a “moderate burden,” according to the U.S. Department of Housing and Urban Development.
According to the study, 55.8 percent of low-income seniors in California shoulder a severe rent burden and 22.6 percent are moderately burdened. California renters of all ages also feel the pinch, but not to the same extreme: 28.7 percent bear a severe rent burden, according to a recent state housing report. The UCLA study uses the most currently available census data, the 2016 American Community Survey.
Regional and county differences
Sacramento-area counties have the highest proportion of severely rent-burdened low-income seniors, 63.7 percent. Combined with the 18.6 percent of low-income seniors who are moderately burdened, that region has the highest regional rent burden, affecting more than 8 in 10 low-income seniors, according to the study. Of the seven regions analyzed, the San Joaquin Valley area and Los Angeles County (counted as a region because of its large population) were close behind, at 80.3 percent and 80 percent, respectively.
Counterintuitively, the high-cost Bay Area region has a slightly lower overall rent burden among low-income seniors, 77.1 percent, because some long-term tenants in the area live in rent-controlled units, which reduces their rents paid, the study reports. Still, 40.9 percent of low-income senior renters in this broad region have a severe rent burden.
The same held true when the authors studied the severe rent burden rate in specific large counties: Sacramento County has a severe rent burden rate that is 25 percent higher than San Francisco County, 68.2 percent to 43.3 percent, respectively. Other county variations: In Los Angeles County (excluding the city of Los Angeles), 61.5 percent of residents have severe rent burdens, compared to 53.7 percent in the city of Los Angeles. The other large counties analyzed in the study — Orange, San Diego, Santa Clara and Alameda — also have high rates of moderate burden and even higher rates of severe rent burden.
“In California, we have a rapidly aging population,” said Steven P. Wallace, associate director of the center and lead author of the study. “The gap between many older adults’ fixed incomes and increasing rents is likely to widen to a chasm unless changes occur in rental costs, incomes or both.”
| | 8/6/2018 | 300 | | Approved | 8/6/2018 11:43 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 8/6/2018 11:51 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | Nadereh Pourat has a new role as an associate center director at the UCLA Center for Health Policy Research.
Pourat joined the Center in 1996 as a senior research scientist and has served as the Center’s director of research since 2013. She also directs the Health Economics and Evaluation Research Program, where she manages a large and diverse portfolio of federal, state and local evaluations and research projects. These projects include evaluation of the health center program funded by the Health Resources and Services Administration, and the Section 1115 Medicaid waiver demonstrations, which include the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program and Whole Person Care (WPC) pilot program, among others.
Pourat is a professor at the UCLA Fielding School of Public Health in the Department of Health Policy and Management and at UCLA’s School of Dentistry. Her research focuses on policy and system-level changes to improve disparities in access to care and health status within the safety net and for the general U.S. population. She has in-depth expertise in approaches to enhancing primary care delivery, as well as system-level integration of medical, mental, oral health and social services to efficiently improve population health.
Congratulations, Nady!
| | 7/25/2018 | 296 | | Approved | 5/29/2018 7:56 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 7/25/2018 9:27 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Parks After Dark Evaluation Brief, July 2018 | 1759 | | | UCLA study finds that employment opportunities, access to mental health services, and gang intervention are new keys to Parks After Dark | | A County of Los Angeles Department of Parks and Recreation program called Parks After Dark provides a safe space for the community during evening hours. According to a report by the UCLA Center for Health Policy Research, new initiatives added to the program in 2017, its eighth year, paid notable dividends.
The UCLA report found that the expanded services not only saved the county money, but also provided residents with easier ways to access mental health services, as well as valuable gang intervention and other activities for youth and young adults in at-risk neighborhoods.
The report found that Parks After Dark’s safety efforts prevented 41 violent crimes and nearly 480 nonviolent crimes in neighborhoods near county parks between 2010 and 2017. The reduction in crime saved the county about $2.2 million in criminal justice costs in 2017 alone, according to the report.
Parks After Dark programming like guided walking clubs, group exercise, team sports and other physical activities also helped reduce costs — for both Los Angeles County and the participants — by reducing expenditures for treating chronic diseases; the report estimated a savings of $1.1 million for 2017. Given the program’s $2.4 million budget for 2017, the report estimated that the net savings for the county and residents was $900,000.
“Providing a safe place for people to meet, exercise and have fun is the primary goal of Parks After Dark,” said Nadereh Pourat, director of the Health Economics and Evaluation Research Program at the Center and the report’s lead author. “Yet the county has found novel ways to add to the program to support deeper health and social benefits that promote healthier communities.”
Among the new programs added in 2017:
- Mental health and wellness. Park therapy workers provided residents with mental health screenings, led mental health discussion groups and offered other services in accessible, approachable ways, such as using a mental health mobile game truck to reduce stigma about and create a relaxed environment for conversations on the topic.
- Probation enrichment program. Deputy probation officers at the parks worked with neighborhood youth, offering access to educational resources, job training and placement, and field trips to cultural events outside the community.
- Intervention workers. Through a partnership with the City of Los Angeles Office of Gang Reduction and Youth Development, community intervention workers resolved potential conflicts, encouraged at-risk youth to avoid joining gangs, and connected current gang members with community resources and services.
When Parks After Dark was launched at three parks in 2010, it primarily focused on improving safety and reducing gang-related crime at the parks. With investments from Los Angeles County departments of public health and probation, and from other key partners, the program evolved into a key prevention and intervention strategy that encompasses safety, health, social cohesion and community well-being. In 2017, residents made nearly 200,000 nighttime visits to the 23 parks participating in the program.
As in previous years, concerts and movie nights remain Parks After Dark’s most popular offerings, according to the UCLA report. Deputy sheriffs continue to build positive relationships with residents through participation in Parks After Dark activities, face-to-face conversations, and foot patrols of the parks. In 2017, the evening park program employed about 50 youth and young adults — including teens for whom the experience was their first job — and more than 300 youth volunteered at the evening park programs.
“The community has discovered that there’s a safe place right in their backyard that they can go to at night with family and friends,” said Tatevik Magakyan, the parks department’s Parks After Dark coordinator. “When people feel safe, they are more willing to come out the parks to exercise, socialize and access needed services. It should be our priority to sustain programs – like Parks After Dark — that help high-need communities thrive.”
The report recommends that Parks After Dark expand by providing additional programs at the parks already in the program; that the program uses parks as hubs to link at-risk youth with more social services through strategic partnerships; and identify a sustainable funding source for the program.
The program was implemented in partnership with the Los Angeles County Board of Supervisors; several county agencies, including the Chief Executive Office, Los Angeles County Department of Public Health, Los Angeles County Sheriff’s Department, Los Angeles County Probation Department, Los Angeles County Department of Mental Health; and local community-based organizations.
| | 6/28/2018 | 297 | | Approved | 6/19/2018 8:27 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 6/28/2018 9:11 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | Health impact of secondhand smoke on vulnerable Angelenos is focus | | The UCLA Center for Health Policy Research has been awarded a two-year project to evaluate smoke-free multi-unit housing throughout the city of Los Angeles.
The project, awarded by the Los Angeles County Department of Public Health, will include two city-wide surveys: The first will assess tenants’ exposure to secondhand tobacco and whether they support policies that restrict smoking in apartments and other multi-unit residences; the second will ask landlords their views on smoke-free housing and how they view benefits and barriers for implementing and enforcing smoke-free policy on their properties.
“Secondhand smoke is an important public health concern, and we need data to understand residents’ and landlords’ experiences with it and their views on smoke-free housing,” said Peggy Toy, Center Health DATA director, who will direct the project. “We’ll also look closely at the degree to which the most vulnerable ― children, people with chronic health conditions, and the elderly ― are exposed to secondhand smoke and the level of support for protecting Los Angeles renters from its harmful effects.”
As part of the project, the team will also analyze California Health Interview Survey (CHIS) data from 2013-16 to find disparities in smoking and smoking-related chronic conditions by socio-economic status and living conditions (e.g., living in multi-unit apartment housing). In collaboration with the Los Angeles County Tobacco Control and Prevention Program (TCPP), the project team will organize a conference on survey findings and best practices for smoke-free housing for community, housing, and tenant and landlord stakeholders.
“Public Health’s partnership with UCLA’s Center for Health Policy Research will help advance community-driven interventions to make home environments safe places where families grow and thrive,” said Barbara Ferrer, director of the Los Angeles County Department of Public Health. “We believe that fostering relationships with neighbors and community partners will encourage creative solutions that reduce exposure to the harmful effects of tobacco smoke.”
The new project builds on the Center’s recent four-year effort, UCLA-Smokefree Air for Everyone (UCLA-SAFE), which was funded by The U.S. Department of Health and Human Services. UCLA-SAFE aided community efforts to reduce smoking and encourage smoke-free policies in 30 high-density, multi-unit apartment complexes in specific communities in Los Angeles where the majority of residents are African-American and Latino.
The project team, includes Toy, Center Director of Research Nadereh Pourat, Center Senior Research Scientist Ying-Ying Meng, and Project Coordinator Marlene Gomez.
| | 5/23/2018 | 295 | | Approved | 5/1/2018 10:48 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 5/23/2018 9:36 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Sugary Beverage Consumption Among California Children and Adolescents | 1752 | | | African-American and low-income kids are most at risk for health problems as the biggest consumers of sweetened beverages | | Children and teenagers in California are filling up on sports and energy drinks that contain similar amounts of sweeteners and pose the same health risks as soda, according to a new study by the UCLA Center for Health Policy Research.
“There should be a warning label on flavored water, sports and energy drinks that says, ‘We may seem like a healthy choice, but we’re loaded with sugar, too,’” said Joelle Wolstein, research scientist at the center and lead author of the study. “People seem unaware that these drinks have the same or even higher amounts of added sweeteners as soda.”
According to research cited in the study, drinking beverages that contain added sweeteners is linked to adults and children becoming overweight or obese, which increases the risk of developing Type 2 diabetes, liver disease, dental decay and other health problems. Nearly 1 in 3 California adolescents ages 12 to 17 is overweight or obese, according to previous research by the authors.
Using California Health Interview Survey data from 2003 through 2014, the study focuses on consumption of regular soda, sports, energy and juice drinks with added sweeteners by Californians ages 2 to 17. The authors found that overall, 2 in 5 of those children drank at least one sugary beverage a day in 2013-14, the most recent data available.
More children drank sports and energy drinks than soda in all age groups, according to the study, which was supported by The California Endowment. Fifteen percent of children ages 2 to 5 have one or more sports or energy drinks daily, nearly double the 8 percent who drink one or more sodas. Rates for children 6 to 11 are 22 percent and 18 percent, respectively, and for teens, 37 percent and 34 percent.
The preference for sports and energy drinks among teens is a switch from five years ago, when 43 percent had at least one soda a day compared to 31 percent who had one or more sports or energy drinks.
“If the trend continues, sports and energy drinks could overtake soda as the primary source of liquid sugar in kids’ diets,” said Susan Babey, co-author of the study and co-director of the center’s Chronic Disease Program.
The authors say the upswing in sugary beverage consumption is especially troubling because it reverses a 10-year decline. In 2003, half of children ages 2 to 11 drank at least one sugar-sweetened beverage every day, but the rate consistently declined, reaching 26 percent in 2009. However, the rate increased the next two survey years, to 31 percent in 2013-14. The rate for teens has a slim silver lining, with the rate dropping from 65 percent in 2011-12 to 59 percent in 2013-14.
Children in specific communities are the biggest consumers of sugary beverages, which puts them at the greatest risk for future related health issues, according to the study. More than half of African-American and multiracial children, 44 percent of Latinos, and nearly 40 percent of Asians have one or more sugary drinks a day, compared to 34 percent of white children. Consumption by children from the lower-income households is 13 percentage points higher than those from wealthier households, 46 percent to 33 percent, respectively.
“It is ironic that manufacturers of these drinks feature athletes with superior health to market sugary drinks to vulnerable children, exposing them to poorer health as adults,” said Robert Ross, president and CEO of The California Endowment. “Instead, these athletes should be promoting to children the benefits of drinking H2O.”
Chart: See a county-by-county breakdown of the percentage of children ages 2 to 17 who drink one or more sugary beverages a day.
The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians.
| | 4/19/2018 | 290 | | Approved | 2/9/2018 3:49 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 4/19/2018 12:35 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | UCLA Center for Health Policy Research | 310-794-6963 | Flojaune Cofer | | Public Health Advocates | (404) 668-0735 | 1092 | 1524 | Y | N | | | Publication | One in Three Young Children in California Consumed One or More Sugary Beverages a Day in 2013-14 | 1739 | | | Increase since 2009 alarms public health professionals | | Nearly one-third of California children between the ages of 2 and 11 drink one or more sugary drinks per day, according to a UCLA fact sheet published today.
That percentage represents an alarming increase since 2009, when just over one-quarter of the state’s children had one or more sugary drinks per day.
“The numbers we observed are especially troubling because they show that the reductions in consumption observed in the past are reversing,” said Susan Babey, lead author of the study and co-director of the UCLA Center for Health Policy Research’s Chronic Disease Program.
Between 2003 and 2009, the proportion of children consuming at least one sugary drink per day decreased from 49 percent to 26 percent. However, since 2009, the percentage has risen to 31 percent. Research confirms that one sugary drink a day can increase people’s risk for Type 2 diabetes, liver disease, dental decay and obesity.
The researchers found disparities in sugary drink consumption rates from region to region within the state. Nearly 40 percent of young children in San Bernardino County had at least one sugary drink per day, compared to less than 30 percent in the more affluent San Diego County.
“This study shows that children are still drinking too much sugar. In order to keep our kids healthy and our chronic disease rates and costs from skyrocketing, we need to reverse this trend,” said Flojaune Cofer, state policy director at Public Health Advocates, a California-based nonprofit dedicated to addressing policy solutions to emerging health issues. “The problem is especially severe among low-income communities heightening the need for local and state policymakers to redouble efforts to protect these communities.” According to previous research by Babey, one in three young adults in California already have prediabetes, a precursor to life-threatening Type 2 diabetes.
Research suggests sugary drink consumption is influenced by social and environmental factors such as the food environment and aggressive beverage marketing. The increased consumption among California children suggests the need for greater policy and education efforts, Cofer said.
“Our kids don’t need to be drinking anything with added sugar,” she said. “That’s why continued pressure and advocacy for standard drink options without sugar, along with accurate labeling and advertising, are important for creating a healthy environment for our children. We can work together to ensure our kids can live healthy and vibrant lives.”
Dr. Robert Ross, president and CEO of The California Endowment, said, “The consumption of sugar-sweetened beverages poses a serious threat to the health of children. Type 2 diabetes is preventable, so it’s important for children to have access to healthy alternatives to junk drinks, like water and flavored, unsweetened sparkling water.”
The California Endowment,
a private, statewide health foundation, was established in 1996 to
expand access to affordable, quality health care for underserved
individuals and communities and to promote fundamental improvements in
the health status of all Californians.
Public Health Advocates is an independent, nonpartisan, nonprofit organization at the forefront of solving the obesity and diabetes epidemics by advocating for groundbreaking policies that build a healthier California. For more information visit, www.PHAdvocates.org.
| | 4/2/2018 | 294 | | Approved | 3/29/2018 1:52 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 4/2/2018 2:29 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | Gerald Kominski to remain as senior fellow and professor | | Dr. Ninez Ponce, a UCLA professor and passionate advocate on behalf of evidence-based health policies that represent and serve the nation’s increasingly diverse population, has been appointed the new director of the UCLA Center for Health Policy Research at the Jonathan and Karin Fielding School of Public Health, starting July 1.
She will succeed Dr. Gerald (Jerry) Kominski, a professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health and a distinguished health policy analyst and health economist who has advocated on behalf of coverage for the underserved throughout his 30-year career at UCLA.
Ponce, also a professor in the UCLA Fielding School of Public Health's Department of Health Policy and Management, is internationally recognized as a disparities researcher. She is also a noted expert in survey-based research and helped develop the California Health Interview Survey (CHIS), the nation’s largest state health survey.
“The UCLA Center for Health Policy Research is a cornerstone of policy in California and our data collection methods are a model for how to understand a rapidly changing nation,” said Ponce. “It will be an honor to lead this renowned research center at a crucial time in our country’s ongoing conversation about race, equity, and access to health care.”
Kominski was appointed director in January 2012 and served as an associate director for 18 years prior to that. He will continue to research critical issues in health policy as a senior fellow at the Center and in his continuing role as a professor in the UCLA Fielding School of Public Health.
“My commitment to social justice began in the 1960s, when I was inspired by the civil rights movement and Dr. King to fight for a more equal and just society,” Kominski said. “The Center embodies those ideals that inspired me so early in my life. But now it’s time to ‘pass the torch‘ to a new generation of leaders in the fight for social equality.”
Measuring the nation’s diversity
Ponce led pioneering efforts in multicultural survey research, including some of the first scientific techniques to accurately measure race and ethnicity, cultural assimilation, generational status, and discrimination. As the Principal Investigator for the Center’s California Health Interview Survey (CHIS), she led efforts to expand the survey’s already-comprehensive understanding of race and ethnicity, including adapting the survey into Chinese (Cantonese and Mandarin), Korean, Vietnamese, and Tagalog (along with Spanish and English), and implementing Asian ethnic oversamples. Under her leadership, CHIS became a national and increasingly global model of how to collect health information about many little-studied racial, ethnic, indigenous, and sexual minority groups. That data has made the Center’s research pivotal on many national issues, from single-payer health care, to the health of the undocumented, to gay marriage.
“Ninez Ponce is uniquely qualified to serve as the next director of the Center,” said Kominski. “She is a committed advocate for the underserved, and her leadership of CHIS makes her the perfect person to continue the Center’s core mission, begun by Rick Brown, of fighting for universal access to health care in California, the nation, and the world.”
Since joining the Center at its founding in 1994, Kominski helped build the Center into one of the nation’s leading think tanks, known in particular for its evidence-based research on the uninsured before and after the passage of the Affordable Care Act, as well as for its large-scale evaluations of state and federal health programs. During the past 8 years, he has led the Center’s efforts, in collaboration with UC Berkeley, to develop complex predictive modeling of enrollment and other factors affecting implementation of the Affordable Care Act. He is widely recognized as a strong and effective public defender of that landmark legislation in the media and in his many speaking appearances.
“It is an enormous pleasure to appoint Ninez Ponce as the new director of the Center,” said Dr. Jody Heymann, dean of the UCLA Fielding School of Public Health, which serves as the Center’s organizational home. “Ninez’s outstanding leadership in advancing our understanding of health disparities, and in moving from developing the best evidence base to public policy which changes lives represents public health at its most transformative. She will be following in the footsteps of a truly extraordinary leader who has contributed immensely to increasing access to health across the country: Jerry Kominski. We are deeply indebted to him for his leadership of the Center and the endless energy he brings to ensuring all Americans have access to health care.”
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 3/19/2018 | 293 | | Approved | 3/13/2018 7:47 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 3/19/2018 12:08 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Addressing Barriers to Breast Cancer Care in California: The 2016-2017 Landscape for Policy Change | 1595 | | | UCLA fact sheets recommend changes to help patients and survivors – particularly low-income women – who face serious obstacles to care | | More than 29,000 women in California will be diagnosed with breast cancer in 2018. Many of them — especially low-income women, who suffer the worst survival rates — will face economic, emotional and structural obstacles to getting treatment and follow-up care.
“Breast cancer is one of the most common diseases, so why is it still so hard for women to get adequate care?” asked Ninez Ponce, associate director of the UCLA Center for Health Policy Research and co-author of a two-year study of breast cancer barriers in California. “Women who face the hardship of illness should not also have to face the additional hardship of not being able to find a doctor, or inadequate health coverage or time limits on treatment.”
New fact sheets based on the previously released study recommend that California policymakers address three main issues that are preventing women from receiving life-saving, life-extending treatment for breast cancer.
The study found low-income women covered by Medi-Cal and other public health programs, face the biggest hurdles to getting care. Medi-Cal’s provider networks include fewer cancer doctors: While 60 percent of specialists say they will take new Medi-Cal patients with breast cancer, only 42 percent actually do. The Breast and Cervical Cancer Treatment Program, a program for eligible low-income Californians, also restricts the amount of time doctors can spend treating a breast cancer patient. As a result, low-income women wait longer before a doctor is available and have less time to finish treatment, which reduces the chances for them to overcome the disease.
The survival rate for women who are eligible for both Medicare and Medi-Cal is 59.4 percent, compared to 80.3 percent for women with private insurance.
“It is unconscionable that a woman’s survival rate is dictated by her type of insurance,” said AJ Scheitler, lead author of the fact sheets. “Giving patients in public programs better access to care, as well as protecting ongoing treatment for all women with breast cancer, will not only save their lives; it will enhance their future quality of life.”
The fact sheet recommends that Medi-Cal improve its payment rates to providers to expand the pool of doctors who treat low-income patients, and that Medi-Cal cover breast cancer treatment for longer than the program’s current limit of 18 months.
Many women fighting breast cancer face a daunting task navigating a fragmented health care system. They must see multiple doctors, deal with insurance requirements and restrictions, and need support services they have never used before.
To help women work through the bureaucracy, and understand and find the health services they need — especially when language or cultural differences are an issue — the study’s authors recommend that women have access to health care advocates, or patient navigators, and that the state or health care providers adopt quality standards for those services.
“A woman battling breast cancer should have one task: Beating the disease,” Scheitler said. “Patients benefit tremendously from having a guide help them through the complexities of multiple doctor appointments and a treatment schedule, as well as connections to organizations that provide wigs or mastectomy bras for women who have undergone treatment.”
Another barrier to care is that women sometimes are unable to continue seeing the doctor they know and trust. Among the reasons: Rising premiums that force patients to drop health coverage, a job switch that leads to a change in insurers, or a doctor being dropped from a list of approved providers. Although women with private coverage who are undergoing treatment can usually keep their doctors after a change in insurers, many women are unaware of this protection and have gaps in care while they seek a new provider.
The authors recommend that patients be allowed to continue seeing their doctors until treatment is completed, regardless of insurance status changes; and they call for health providers and insurers to be required to inform patients of their rights if their insurance status changes.
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
| | 2/28/2018 | 291 | | Approved | 2/9/2018 3:50 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 2/27/2018 10:40 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Latino Immigrants Have Higher Rates of Health Insurance in States with Inclusive Policies | 1726 | | | Granting more rights and protections to Latino noncitizens may help improve their access to health | | Non-citizen Latinos living in states that have policies that include and protect them are more likely to have health insurance compared to those living in states that lack such policies, according to a new fact sheet from the UCLA Center for Health Policy Research.
However, their overall chance of having health insurance is still far below that of naturalized Latino immigrants and Latino citizens. ''Immigrants are likely to be healthier in states with friendly policies,'' said Maria-Elena Young, author of the fact sheet. ''But they still lag far behind naturalized Latinos and even farther behind citizens generally.'' Building on findings from a recent study, Young found that adult noncitizen Latinos living in states that give noncitizens greater access to higher education, workplace and other policy protections, such as California and Washington, are nearly 10 percent more likely to have health insurance compared to states that have restricted policies, such as Ohio and Alabama.
Yet, the probability of noncitizen Latinos having insurance still lags far behind that of naturalized and U.S.-born Latinos.
''There are health benefits not only from health care policies, but from policies that expand rights and opportunities where Latino immigrants study, work, and seek services,'' Young said. ''However, many states still lack these policies. What we need are leaps in policy improvements to improve the health environment for noncitizens.''
| | 1/25/2018 | 282 | | Approved | 8/29/2017 1:52 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 2/5/2018 10:30 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | Mental and Emotional Health; Elderly | Publication | Older Californians and the Mental Health Services Act: Is an Older Adult System of Care Supported? | 1708 | | | Study calls for standardized data reporting and geriatric training, outreach and more integrated services | | California's older adult population will increase 64 percent by 2035, and with it the need for more mental health services. Yet the state's public mental health system lacks adequate services specifically tailored to older adults, according to a study and other documents released today by the UCLA Center for Health Policy Research.
Notably, the state has no systematic record of which local agencies used state mental health care funds to provide services for older adults or data to measure whether treatments worked.
This is the state's first evaluation of mental health services for adults 60 and older in the public mental health system. In the study, authors report that the mental health needs of older adults are often ''lumped in'' with those of all adults, although older adults’ needs can be very different based on their stage of life.
''California's older adults have unique needs but are often treated generically,'' said Janet Frank, faculty associate at the center and leader of the evaluation. ''Older adults often have multiple chronic illnesses which complicate mental health care.''
Funds not specifically mandated for elders’ mental health care
As of 2014, the Mental Health Services Act of 2004 generated $13 billion to fund delivery of public mental health services, according to documents reviewed in the study. However, no money is specifically earmarked to develop a system of care for older adults. In contrast, children's mental health programs do receive earmarked funding.
Mental health issues among older adults range from anxiety and depression to serious mental illness, and conditions can be complicated by dementia, the loss of thinking, remembering and reasoning skills that interfere with a person's daily life. Most older adults receiving public mental health services have ''aged into'' the older adult category after receiving decades of mental health services, the study found. The authors say more information is needed about older adults who develop late-onset mental health problems and how they find their way to public mental health services. Today, less than one-third of all older adults in the United States who need mental health care receive it, the study reports.
To analyze how and whether older adults in the public health system received mental health services, the researchers reviewed more than 100 publications and reports. They also conducted six focus groups and 72 interviews at the state level and across six counties — San Diego, Los Angeles, Tulare, Monterey, Alameda and Siskiyou. The counties represented designated mental health regions; California’s differences in geography, population size and density; ethnic and racial diversity; income level; and the range of programs being developed for older adult mental health care.
Recommendations
The study's authors make several recommendations to improve delivery of public mental health services to Californians who are 60 and older with mental illness:
Create an administrative structure dedicated to older adult mental health: Each county, as well as the state, should have at least one person who is the ''watchdog'' and departmental lead for older adult mental health services.
Require mandatory and standardized data reporting: Counties should document the unmet needs of older adults with mental illness in their area. They should better document the impact of treatment. Oversight at the state level would ensure program effectiveness.
Standardize geriatric training for providers: All mental health personnel — from professionals such as psychiatrists to case managers — should have appropriate geriatric training. Diversity training should also be included.
Conduct outreach: Do more to identify and reach older adults who are not getting services. Many older adults are already in the public health system, but it is unknown how many others are undiagnosed or going without treatment.
Increase integration of services: Older adults should be able to receive medical, behavioral health, aging and substance abuse services at one location.
''California will have more challenges in meeting the mental health needs of older adults than other states because we are more diverse and have more adults who are older,'' said Kathryn Kietzman, a research scientist at the center and study co-author.
''In addition to the broader issue of stigma that still surrounds mental health care, there are cultural, racial and language barriers to overcome that prevent people from seeking help for mental health problems.''
California Mental Health Services Oversight and Accountability Commission supported this study. The study team developed five documents published today detailing the state of mental health care services for older Californians and the need to support a system of care for older adults, including a publication that introduces statewide indicators to assess mental health in seniors.
Read the study: Older Californians and the Mental Health Services Act: Is an Older Adult System of Care Supported?
Watch the related Jan. 25 seminar Center Health Policy Seminar here.
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 12/13/2017 | 288 | | Approved | 12/7/2017 10:35 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/15/2017 1:27 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Rachel Dowd | dowd@law.ucla.edu | The Williams Institute | 310-206-8982 | | | UCLA Center for Health Policy Research | | 1501 | | Y | | | | Publication | Characteristics and Mental Health of Gender Nonconforming Adolescents in California | 1706 | | | The survey measures youths’ perceptions of how they are seen by their student peers | | A new UCLA study finds that 27 percent, or 796,000, of California’s youth, ages 12 to 17, report they are viewed by others as gender nonconforming at school.
The study also assessed differences in mental health among gender nonconforming youth and gender conforming youth in the state, and found no significant difference in the rates of lifetime suicidal thoughts and suicide attempts between gender nonconforming youth and their gender conforming peers. However, gender nonconforming youth were more than twice as likely to have experienced psychological distress in the past year.
“The data show that more than one in four California youth express their gender in ways that go against the dominant stereotypes,” said lead author Bianca D.M. Wilson, the Rabbi Barbara Zacky Senior Scholar of Public Policy at The Williams Institute. “However, the heightened psychological distress we see among gender nonconforming youth indicates that we must continue to educate parents, schools and communities on the mental health needs of these young people and reduce known risk factors, such as bullying and bias.”
The study, released by The Williams Institute at UCLA School of Law and the UCLA Center for Health Policy Research, analyzed data collected from nearly 1,600 California households in the 2015-2016 California Health Interview Survey. It is the first time this survey has included questions about gender expression among teens.
Gender nonconforming refers to people whose behaviors and appearance defy the dominant cultural and societal stereotypes of their gender. The health interview survey measured gender expression by asking adolescents how they thought people at school viewed their physical expressions of femininity and masculinity. Youth who reported that people at school saw them as equally masculine and feminine were categorized as “androgynous.” Girls who thought they were seen as mostly or very masculine and boys who thought they were seen as mostly or very feminine were categorized as “highly gender nonconforming.”
Key findings of the study include:
• 27 percent, or 796,000, of California’s youth, ages 12 to 17, report they are viewed by others as gender nonconforming at school, including 6.2 percent who are highly gender nonconforming and 20.8 percent who are androgynous.
• Highly gender nonconforming, androgynous and gender conforming youth do not statistically differ in rates of lifetime suicidal thoughts and suicide attempts.
• As a group, both highly gender nonconforming and androgynous youth reported higher levels of psychological distress compared to their gender-conforming peers.
The finding that gender nonconforming youth in California do not have higher rates of suicide differs from the findings of some previous research. The study co-authors suggest that the variation in findings may be due to sample-size limitations of this study or possibly to the state’s supportive policies for gender nonconforming people. California is one of several states that expressly prohibit bullying and discrimination against gender nonconforming people in schools and public accommodations, among other arenas.
“It’s possible California’s policy environment has made it safer for adolescents to be gender nonconforming,” said Tara Becker, a co-author and statistician for the health survey, which is conducted by the UCLA Center for Health Policy Research. “But given events at the national level, we should by no means relax our stance. California can and should strive to be an ongoing model of acceptance and inclusion.”
The Williams Institute, a think tank on sexual orientation and gender identity law and public policy, is dedicated to conducting rigorous, independent research with real-world relevance.
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
| | 12/13/2017 | 289 | | Approved | 12/8/2017 11:39 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/21/2017 9:28 AM | i:0#.f|uclachissqlmembershipprovider|venetia | | | | | | | | | | | | | | | Publication | | | | | | | 
In divisive times, we thank you for your continued support of our mission to improve everyone’s health through high-quality, objective, and evidence-based research and data that inform effective policymaking!
Please note the Center will close starting Monday, December 25, 2017, and reopen Tuesday, January 2, 2018. For media needs, please contact Gwendolyn Driscoll, director of communications, at 310-794-0930 or gdriscoll@ucla.edu.
We wish you happy holidays and a peaceful and inclusive new year!
| | 10/31/2017 | 285 | | Approved | 10/18/2017 1:50 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 10/31/2017 12:11 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | UCLA Center for Health Policy Research | 310-794-6963 | Rachel Dowd | dowd@law.ucla.edu | | 310-206-8982 | 1092 | 1501 | Y | Y | | | Publication | Demographic and Health Characteristics of Transgender Adults in California: Findings from the 2015-2016 California Health Interview Survey | 1695 | | | Data also show another year of statewide health insurance gains, now at risk under potential federal funding changes | | The first release of transgender data from the California Health Interview Survey, the nation’s largest state survey, reveals the demographic characteristics of transgender adults in the state — such as population size, racial makeup and marital status — as well as sobering disparities in their health status. For example, one in five transgender adults in California has attempted suicide — a rate six times that of the state’s adult cisgender population.
The health data used in a new policy brief by The Williams Institute and the UCLA Center for Health Policy Research are among hundreds of new California Health Interview Survey (CHIS) estimates released today. Included are updated statistics on health insurance that show the number of uninsured Californians at record lows in 2016, primarily as a result of Medi-Cal expansion under the Affordable Care Act. A webinar on findings from the policy brief and the survey is today from noon to 1 p.m.
The policy brief on gender identity, which uses pooled 2015-2016 California Health Interview Survey data for greater stability, reports that 92,000 transgender adults between the ages of 18 and 70 make up 0.35 percent of California’s adult non-institutionalized population. According to the report, transgender adults have general health status, insurance and health access similar to cisgender adults, or adults who identify with their sex assigned at birth.
However, 22 percent of transgender adults have ever attempted suicide, compared to 4 percent of cisgender adults. Transgender adults are about three times more likely to have had lifetime suicidal thoughts, 34 percent to 10 percent, and nearly four times more likely to have experienced serious psychological distress in the past year, 33 percent compared to 9 percent, according to the brief. They are significantly more likely to report having a disability due to a physical, mental or emotional condition, 60 percent to 27 percent. They are more likely to delay or not get needed doctor-prescribed medicine compared to cisgender adults, 32 percent compared to 11 percent, according to the brief.
“In many ways, transgender adults in California are similar in characteristics and experiences to cisgender adults,” said Jody Herman, Scholar of Public Policy at the Williams Institute and lead author of the brief. “Yet, this study points out that there’s still much that needs to be done in California to address health disparities for the transgender population.”
Diverse survey participants
Because it reflects California’s diversity, CHIS is used nationally and even internationally for its wealth of data on many under-surveyed racial, ethnic and gender minority groups. In 2016, 21,269 California households participated in the survey, and 21,444 responded in 2015. Those who were surveyed answered questions on health topics such as mental, dental and physical health issues; insurance coverage; internet usage; and baby bottle-feeding practices.
Trends and new topics
The proportion of uninsured Californians from birth to age 64 declined from 15.5 percent in 2013 — the year before the Affordable Care Act was expanded — to 9.5 percent in 2015 and to 8.5 percent, or 2.8 million people, in 2016. Residents who are undocumented make up 37.4 percent of those who are uninsured and ineligible for Medi-Cal, the public program for low-income and disabled Californians.
“More than 60 percent of the uninsured are Latino,” said Ninez Ponce, principal investigator for CHIS and associate director of the Center. “They have remained at the bottom of the health care pyramid.”
Although the proportion of nonelderly Latinos who were uninsured was cut almost in half, from 21.4 percent in 2013 to 12.3 percent in 2016, they remain more likely to be uninsured than members of other racial groups and account for the highest percentage of the state’s overall uninsured population, according to the survey.
Continuing uncertainties over federal funding of health programs cast a pall on gains in health insurance coverage, particularly for the one in three Californians covered by Medi-Cal. Fresno, Siskiyou, Tehama and Tulare, all rural counties, had among the highest growth in post-Affordable Care Act adult Medi-Cal enrollment — from 25.7 to 29.4 percent, according to the survey estimates. The state’s safety-net health program now covers 33.3 percent to 45 percent of the population in those counties.
“Many children and adults newly insured by the ACA’s expansion of Medi-Cal are at risk of losing health care if health program funding is cut back or allowed to languish,” said Todd Hughes, director of CHIS. “Rural communities will suffer significantly.”
Other noteworthy 2016 health data and trends on Californians:
Transgender demographics: California’s transgender adults ages 18 to 70 are more likely to be white compared with cisgender adults, 65 percent to 39 percent, respectively, and less likely to be Latino, 13 percent to 38 percent. When asked how they currently describe themselves, 7 percent of transgender adults said male, 32 percent female, 46 percent as transgender and 15 percent as a different gender identity.
Disparities in medical care discrimination. African-American adults have the highest rate of reporting medical care discrimination due to race or ethnicity, 14.2 percent. Rates for other racial groups: whites, 2.6 percent; Asians, 5 percent; Latinos, 6.4 percent; other and multiple races, 8.7 percent. However, whites and multiple-race respondents had the highest rates of medical discrimination based on mental health, sexual orientation or gender identity, 4.5 percent and 5.1 percent, respectively.
Marriage inching down. The proportion of married adults dropped below the halfway mark in 2015 to 48.4 percent and hit 47.4 percent in 2016. The share of never-married singles is increasing gradually, reaching 27.7 percent in 2016.
Fewer married couples with children. The proportion of married adults with children has gradually declined to 22.7 percent in 2016, a 9-percentage-point drop since 2005. The proportion of married couples without children remains fairly constant at 25.8 percent. In 2016, 4.7 percent of women ages 18 to 44 said they were pregnant.
Teen facts. In 2016, 22.5 percent of teens ages 12 to 17 said they had tried an alcoholic beverage, a 14-percentage-point decline since 2003. About 1 in 10 teens have used an e-cigarette; 15.5 percent reported they have had sex; and 23 percent described themselves as obese.
Overall adult health status. Nearly four in five adult Californians report being in good/very good/excellent health. But measuring by race shows disparities: While 85.9 percent of whites reported they were in good-to-excellent health, 69.9 percent of Latinos and 77.5 percent of African-Americans said the same. Latinos make up the largest racial/ethnic group in the state, 39.2 percent, according to the state Department of Finance.
Dental health. Nearly 71 percent of adults report they have excellent/very good/good teeth, and 61 percent have dental insurance. Two percent said they don’t have their own teeth. Among all children, nearly 70 percent had a dental check within the past 6 months in 2016, a 9-percentage-point increase compared to 2013. The number who had never been to a dentist was 12.5 percent — an almost 7-percentage-point decline over the same time period.
Housing crunch. Homeownership has steadily declined statewide over the past decade, from 62 percent in 2007 to 55.2 percent in 2016, although it varies from county to county. In San Francisco County, the rate is 38.6 percent and in Los Angeles County, it is 48.7 percent. Of adult survey respondents under 30, nearly half — 48.9 percent — still live with their parents.
Six years of annual information — 2011 to 2016 — are now available to the public for free through the center’s easy-to-use web tool AskCHIS, which allows users to customize their queries.
The 2016 survey spans 16 broad topic categories, including: general health; health conditions (such as chronic conditions like diabetes, asthma, high blood pressure and obesity); mental health; dental health; health behaviors (such as diet, activity, alcohol and cigarette use, sexual behaviors); neighborhood and housing (such as social cohesion); health insurance coverage and child and adolescent health insurance; access to health care; employment (status, hours, industry and occupation); child care; respondents’ characteristics (such as race, sexual orientation, gender identity and gender expression, and citizenship).
Read the transgender report: Demographic and Health Characteristics of Transgender Adults in California: Findings from the 2015-201 California Health Interview Survey
Find 2016 California Health Interview Survey data: AskCHIS.com
Read the insurance policy note: Number of Uninsured in California Remained at Record Low in 2016
The California Health Interview Survey is conducted by the UCLA Center for Health Policy Research in collaboration with the California Department of Public Health and the California Department of Health Care Services and is supported by several public and private funders committed to improving the health of Californians.
| | 10/31/2017 | 287 | | Approved | 10/23/2017 10:04 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 10/24/2017 10:22 AM | i:0#.f|uclachissqlmembershipprovider|celeste | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | The National Institute on Minority Health and Health Disparities awarded the UCLA Center for Health Policy Research a $2.5 million grant to study in which ways state policies help Latino and Asian immigrants in California integrate into the health care system or ways policies prevent access to health care and contribute to immigrants' persistent inequities in health.
The project will be led by Associate Center Director Steven P. Wallace. Other members of the research team are Center Director of Research Nadereh Pourat, Faculty Associate Michael Rodirugez, and Graduate Student Researcher Maria-Elena Young.
The grant will fund a survey that builds on the 2018-19 California Health Interview Survey, the nation's largest state health survey, about respondents' experiences of health care, social services, education, employment, and law enforcement. The study will include 2,000 Latino and Asian immigrants statewide, as well as in-depth qualitative interviews with immigrants in Fresno and Los Angeles County.
"California has many policies that help immigrants and their families become active and healthy members of our state. Given the increasingly restrictive nature of federal immigration policies, it's critical that we know how immigrants experience California's polices in their daily lives and the extent to which they impact access to health care and health itself," said Wallace. "Our goal is to better understand the mechanism that links policies to immigrant health, and identify ways that policies and education might contribute to healthier communities."
| | 9/27/2017 | 283 | | Approved | 9/11/2017 9:57 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 9/27/2017 3:20 AM | i:0#.f|uclachissqlmembershipprovider|celeste | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Cal MediConnect Enrollment: Why Are Dual-Eligible Consumers in Los Angeles County Opting Out? | 1661 | | | Confusion over new benefits, preference for 'tried and true,' drive opt-outs | | Three in five of the poorest, sickest residents in Los Angeles County have rejected a managed health care program meant to improve their access to health services, according to a policy brief by the UCLA Center for Health Policy Research. As a result, the county’s opt-out rate for the program is the highest in California, pushing overall enrollment far lower than expected.
The managed care program, called Cal MediConnect, was designed to integrate financing and delivery of medical, mental health and other health care services for 415,000 medically frail elderly or severely disabled young Californians who qualify for both Medicare and Medi-Cal benefits in the seven-county pilot program area. Eventually, 1.1 million Californians could be enrolled.
The main goal of Cal MediConnect is to have one entity coordinate care for this high-need, high-cost group, which eliminates fragmentation of health services and subsequent gaps in care, according to the policy brief. The new program also provides extra benefits, such as unlimited transportation and more vision and dental care.
However, as of July 1, just 19 percent of eligible people in L.A. County were enrolled — 38,020 people out of about 200,100. Although the California Department of Health Care Services in 2014 projected a enrollment rate of more than 60 percent in the seven participating counties in the state, the rate is less than half that at 28 percent, the brief reports.
Factors that contributed to opt-outs in L.A. County
According to the UCLA study, the possibility of losing a trusted doctor is enough to prompt many in L.A. County to opt out of the new program, which automatically enrolled people who were eligible.
"These are very vulnerable people who have worked long and hard to cobble together a network of doctors and specialists they trust,” said Kathryn Kietzman, a research scientist at the UCLA Center for Health Policy Research and co-author of the policy brief. "They don’t want to lose that."
Kietzman and co-authors conducted 53 one-on-one interviews and six focus groups with an additional three dozen L.A. County residents who are eligible for both Medicare and Medi-Cal.
They found that many consumers were confused about whether benefits under the new program were better or worse than what their two current programs offered, contributing to the growing rejection rate, according to the brief. Some consumers — including those with significant language barriers — were overwhelmed by an avalanche of information they didn’t understand. Certain ethnic and racial groups had especially high opt-out rates, including 94 percent of Russian speakers, 79 percent of Koreans, and 72 percent of Amerasians, Chinese and whites.
Latinos/Hispanics were among the least likely to opt out (45 percent), second only to Samoans (36 percent).
"People often went by word of mouth — from friends, family, their current doctors — to decide whether to remain enrolled," said Kate McBride, graduate student researcher at the center and lead author of the policy brief. "But the information from those sources wasn't always accurate."
Recommendations
Authors of the brief suggest policies to ensure these vulnerable consumers and their families make informed decisions about their health care, including:
Have people help review and disseminate the health care information. Current consumers and their families can help make sure future informational materials are in simple, understandable language and translated into multiple languages and formats — print, in-person talks and web-based materials. Also, consumers’ families, doctors, community advocates and others could be trained as health information navigators for those with limited health literacy, similar to Covered California’s Navigator Program. Avoid disruption of a someone’s existing network of health care. Losing access to trusted health providers is the biggest concern of consumers who are eligible for both Medicare and Medi-Cal. State policymakers and planners could propose a new model that coordinates care across existing programs. Then consumers could choose to keep their existing Medicare and Medi-Cal providers if they wish but also access new program services they lack. Washington State’s managed fee-for-service program is an example of this type of model. Recognize and respond to consumer diversity. Language proficiency, education, immigration status and other factors complicate decision-making about new health care plans. Community organizations must identify and address the different needs and challenges facing these people in L.A. County and help them through the decision-making process
This policy brief is based on findings from a two-year study of how L.A. County residents eligible for Cal MediConnect made their decisions, conducted by the UCLA Center for Health Policy Research in partnership with the Westside Center for Independent Living and a community advisory group of five consumers and five stakeholders. The policy brief was developed with support from the Robert Wood Johnson Foundation.
Read the policy brief: Cal MediConnect Enrollment: Why Are Dual-Eligible Consumers in Los Angeles County Opting Out?
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
| | 9/27/2017 | 284 | | Approved | 9/25/2017 9:49 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 9/26/2017 2:35 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | Are discrimination, citizenship, and immigrant status linked in the states? How does state policy affect immigrant health? How is nonresponse to citizenship and immigrant questions addressed in surveys?
 Center researchers will address these immigrant-focused questions during a special session on measuring immigration status at APHA 2017. The presentations are among three dozen APHA offerings that feature Center researchers or California Health Interview Survey data. More than 12,000 public health professionals, medical providers, media and others from across the nation are expected to attend the Nov. 4-8 event in Atlanta, Georgia. Other topics covered by Center sessions include measuring child mental health, how outreach strategies affected ACA enrollment in California, aging in communities of color, tobacco cessation and more.
Visit us at Booth #726 to pick up publications, get an AskCHIS demonstration, or pick up one of our adorable stress bears!
Find the list of our APHA sessions here.
| | 8/24/2017 | 280 | | Approved | 7/10/2017 9:41 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 8/23/2017 7:18 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Parks After Dark Evaluation Brief | 1657 | | | UCLA study finds nighttime recreation and wellness programs reduced policing and health care costs | | A Los Angeles County recreational program created stronger ties within communities, improved relations between the community and law enforcement officers, and decreased crime, according to a report by the UCLA Center for Health Policy Research. The study also found that the program, called Parks After Dark, saved millions of dollars in policing and health care costs.
The program was intended to make specific Los Angeles County parks safer through positive community engagement by the Los Angeles County Sheriff’s Department, while providing wider access to free recreation, health and wellness programs. The effort, which was launched in 2010 as an anti-gang initiative by the county’s Department of Parks and Recreation, has focused on neighborhoods with high levels of gang activity and crime.
The program provides recreational sports, classes on healthy eating and exercise, computer courses, concerts and movies, as well as health care and social services — including registration for the CalFresh food stamps program, mammograms, mental health assessments and other health screenings — on Thursday, Friday and Saturday evenings from June through August.
Parks After Dark expanded from three parks in its first year to 23 this summer, including in unincorporated communities of South Los Angeles, East Los Angeles, Altadena, La Puente, Sylmar, Val Verde, Lake Los Angeles and Whittier.
The UCLA report found that about 95 percent of people who participated in Parks After Dark programs in 2016 said they felt the program improved their community’s relationship with the deputy sheriffs, and of participants who described their own neighborhoods as ''unsafe,'' 7 in 10 said they felt safe while they attended park programs. About 95 percent said it helped improve their relationships with neighbors.
''The evaluation revealed evidence of multiple benefits,'' said Nadereh Pourat, director of the Health Economics and Evaluation Research Program at the center and the report’s lead author. “The data show the program achieved its goals of promoting healthy behavior and safer communities.''
The program’s budget for 2016 was $2.3 million, but the UCLA report estimates that by reducing crime, it saved the county about $5.87 million in law enforcement costs last year. The researchers also estimated that wellness programs, including Zumba and other physical activity classes, ultimately saved the participants and the county more than $500,000 in health care expenditures.
In 2016, Parks After Dark programs received about 178,000 visits, according to the report.
''Families who are involved in the evening park programs want PAD to continue, and they say these programs have brought their families — and the community — together,'' said Faith Parducho, special assistant at the Department of Parks and Recreation.
The report includes recommendations for strengthening Parks After Dark, such as finding ways to encourage participants to be physically active year-round, identifying a sustainable source of funding and encouraging deputy sheriffs to increase their engagement with residents throughout the year to further build trust — especially through more organized activities with teens.
The program was implemented in partnership with the Los Angeles County Board of Supervisors; several county agencies, including the chief executive’s office, department of public health, sheriff’s department and probation department; and local community-based organizations.
Read the policy brief: Parks After Dark: Evaluation Brief
Read the related interview: Three Questions for the Expert
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 8/4/2017 | 281 | | Approved | 7/28/2017 7:05 AM | i:0#.f|uclachissqlmembershipprovider|celeste | 7/29/2017 9:07 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | | | | | | | | | | | | | | | Publication | | | | | | |
In connection with our review of
the 2016 CHIS data, we are releasing revised weights for the 2015 CHIS
data. We have removed the CHIS 2015 data from our
online dissemination platforms while we make these updates, and expect to
release the revised data in mid-August. The survey
weight revisions should not measurably affect the percentage distributions of
most CHIS indicators and is only applicable to the CHIS 2015 data, with higher
impacts on teen and child estimates compared to adult estimates. More
information on the revisions can be found in the CHIS forum.
CHIS will rerun all affected
projects produced with CHIS 2015 data through our Data Access Center, at no
cost to the researcher. Please feel free to contact the Data Access Center (dacchpr@ucla.edu) to obtain additional
information about the change in the 2015 weighted population estimates.
| | 7/31/2017 | 278 | | Approved | 6/15/2017 10:49 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 7/30/2017 9:28 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Partnership Strategies of Community Health Centers: Building Capacity in Good Times and Bad | 1650 | | | Policy brief looks at centers in four U.S. regions, including Los Angeles | | Community health centers, the leading providers of primary health care to the nation’s poor and uninsured populations, need strong partnerships and effective strategies to strengthen the current health care safety net, and to prepare for what may happen in the future, according to a new policy brief by the UCLA Center for Health Policy Research.The brief looks at a selection of Federally Qualified Health Centers, referred to as community health centers, in Atlanta, Houston, Los Angeles and New York state that collaborate with other regional centers, local hospitals and health departments to improve and expand care, or work with legislators and advocacy groups to push for changes in health policy.Their proactive strategy is a blueprint for community health centers nationwide, given the current administration’s proposed plans to cut billions of dollars in federal Medicaid benefits to vulnerable Americans, said Steven P. Wallace, associate director at the UCLA Center for Health Policy Research and co-author of the report.“These centers are working to do their best in the current environment,” Wallace said. “But all centers will also need a robust Plan B if resources provided by the Affordable Care Act are stripped away.”The brief, based on findings from UCLA’s REmaining Uninsured Access to Community Health Centers project, looks at specific strategies community health centers in the four regions undertook to increase capacity and improve service after the Affordable Care Act was enacted. Among the findings:Streamlining referrals in Atlanta: One center set up a shared electronic medical records system with a local public hospital to more easily admit patients to the hospital and improve post-hospital care; the hospital granted admitting privileges to the center’s physicians.Pooling regional resources in Houston: Four centers collaborated to strengthen regional service, with center directors regularly meeting to share ideas and resources. The centers’ partners set up and funded shared pharmacy services and a position for a shared psychiatrist that no single center could support alone.Collaborating with Los Angeles County policymakers: The Los Angeles County Board of Supervisors in 2014 signed a contract with 204 centers in the county to establish a no-cost, primary care program for low-income uninsured county residents who did not qualify for other public health insurance, without regard to citizenship status. Supervisors authorized a $61 million annual budget for the centers to serve as many as 146,000 people.Advocating for health policy change in New York state: Community health centers in New York state speak out on behalf of their patients both directly and indirectly. Examples include having leadership staff participate in local councils and committees, encouraging patients to attend local government meetings, and engaging with law enforcement agencies to change practices to protect center patients. Center leaders in the state said they maintain contact with local, state and federal policymakers as well as stakeholders involved in transportation, immigration, housing and other policy areas that have health implications.“We found community health centers are being more than just practical when forming new partnerships,” said Maria-Elena Young, graduate student researcher at the UCLA Center for Health Policy Research and lead author of the brief. “They’re taking creative and innovative steps and thinking outside of the box to improve the safety net.”Having a shared mission, understanding the political environment, incubating partnerships, and highlighting the benefits of aligning with community health centers were all factors that led to the success of each partnership strategy, according to the policy brief.Authors recommend a series of steps that other community health centers can take to develop partnerships, such as having the centers include partnership-fostering as part of their long-term strategic plan; formalizing such partnerships; asking foundations to provide small grants to centers to build new collaborations; educating local hospitals on the value centers’ primary care services bring in lowering hospital readmission rates; and providing funding for staff dedicated to developing community partnerships and advancing advocacy efforts.The policy brief is supported by the Commonwealth Fund.Read the study: Partnership Strategies of Community Health Center: building Capacity in Good Times and Bad
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 6/28/2017 | 276 | | Approved | 6/8/2017 9:45 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 6/27/2017 9:40 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | California Public Hospitals Improved Quality of Care Under Medicaid Waiver Program | 1622 | | | Results UCLA report are the first from a national effort to reform public hospitals | | A five-year Medicaid waiver program that infused billions of dollars into public hospitals prompted significant improvements in health care to California’s neediest population — the poor and uninsured, according to an extensive evaluation by the UCLA Center for Health Policy Research.
Seventeen designated public hospitals participated in the $3.3 billion “pay-for-performance” experiment, including five University of California hospital systems and 12 county‐owned-and‐operated hospital systems. Collectively, these facilities serve more than 2 million patients every year, including most of the state’s Medi-Cal patients. Medi-Cal is California’s version of Medicaid.
Participating hospitals saw increased rates of mammogram screenings, flu vaccinations, child weight screenings, and tobacco cessation, according to the evaluation. A higher proportion of patients received timely appointments and controlled their cholesterol and blood glucose levels in participating hospitals compared to patients at hospitals that did not participate in the program.
Among people with HIV, the rate of mental health screenings increased dramatically, from 3 percent to 67 percent, according to the evaluation. There was also a dramatic increase in the rate of Hepatitis B vaccinations, which rose from 11 percent to 58 percent.
California is the first of nine states in the program to report on participating hospitals’ efforts to transform their systems and improve quality of care for low-income patients.
“California’s health system reforms are a beacon for the rest of the nation,” said Nadereh Pourat, the director of research of the UCLA Center for Health Policy Research and leader of the evaluation project. “These strong results are significant, because they show how national reform can be successfully implemented. The waiver program illustrates that with an adequate supply of funds, California has improved the health of its population by strengthening its health care delivery system under Medicaid.”
Waiver established as part of the Affordable Care Act’s “Bridge to reform”
California established the Medicaid waiver, called the Delivery System Reform Incentive Payment program, in 2010. The program incentivized participating hospitals to test innovative strategies to improve care by rewarding them if they met specific milestones.
The UCLA Center for Health Policy Research’s evaluation found that hospitals met 97 percent of the 3,764 milestones related to 44 projects organized under five broad categories:
Category 1: Develop ambulatory care infrastructure. Example: Increase primary care providers and clinics.
Category 2: Redesign of care delivery. Example: Measure and improve patient experience of care.
Category 3: Track population health measures. Example: Track proportion of diabetic patients with controlled blood glucose levels.
Category 4: Improve urgent care. Example: Reduce stroke mortality and infections from surgery during hospitalization.
Category 5: Improve quality of care for patients with HIV. Example: Increase number of patients on antiretroviral therapy.
Hospitals exceeded the challenge of implementing these projects. For example, UC San Francisco Medical Center exceeded its milestone for the number of elderly and disabled patients assigned to a medical home by 2,666 percentage points. UCLA hospitals reduced the proportion of patients with pressure sores from 3.92 percent to 1.75 percent. Ventura County Medical Center increased the percentage of HIV patients receiving antiretroviral therapy from 82 percent to 93 percent.
The evaluation reported that additional federal funding through the subsequent Public Hospital Redesign and Incentives in Medi-Cal Program allowed many of the hospitals to continue projects that began under the Delivery System Reform Incentive Payment program.
| | 6/28/2017 | 277 | | Approved | 6/15/2017 10:43 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 6/27/2017 9:40 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Podiatric Services Could Reduce Costs of Treating Diabetes Complications in California by up to $97 Million | 1627 | | | | | Allowing podiatrists to give diabetic patients regular foot health screenings — which are usually done by primary care doctors — could save limbs, lives and money, according to a new policy brief from the UCLA Center for Health Policy Research.
As many as 1 in 4 diabetic Californians develop damaging toe, foot and leg ulcers which could lead to amputation and elevated risk of death, according to the study. The cost of treatment statewide reached $565 million in 2014.
Using admissions data from the California Office of Statewide Health Planning and Development, authors of the study found that podiatry services provided to diabetic patients could have saved between $29 million and $97 million in 2014, even given the limited number of diabetics who received foot screenings — between 11 percent and 30 percent of patients, depending on age.
Role of podiatrist
A medical doctor who provides podiatric services to a Medi-Cal patient is reimbursed for treatments, which could include screening for foot health or treating wounds that could lead to infection. But a podiatrist who performs the same services in his or her office to that patient is typically denied reimbursement because his or her services are considered "optional."
"Foot screening should not be optional, unless you consider lower limbs optional," said Jonathan Labovitz, Medical Director of the Foot & Ankle Center at Western University of Health Sciences and lead author of the report. "An amputation does not just result in a reduced quality of life but in a significantly increased risk of death."
Foot ulcers are one of the most common complications of diabetes. Treatment for advanced cases involves hospitalization and amputation, making management of foot ulcers extremely expensive — about $17 billion a year nationwide, according to figures cited in the report. More than 80 percent of toe, foot or leg amputations among diabetic patients are preceded by foot ulcers, and as many as three-quarters of those amputees die within five years, according to the report.
It costs between $7,500 and $20,600 each time a diabetic foot ulcer is treated, according to the American Podiatric Medical Association (APMA). In comparison, the APMA says a limb amputation resulting from a foot ulcer costs $70,400 and as much as a half-million dollars over a patient's lifetime. The study's authors estimate that California would save between $7.5 and $16.9 million for Medi-Cal patients alone by providing foot screening and preventing amputation.
California Health Interview Survey data cited in the study estimates diabetes rates among California residents rose from 8.4 percent in 2011 to 8.9 percent in 2014. Among seniors, the rates were even higher: from 18.6 percent to 20.6 percent, possibly presaging a rise in diabetes-related complications — and costs.
"Getting diabetic patients checked regularly before foot problems escalate significantly brings down health care costs," said Gerald Kominski, Center director and co-author of the report. "Diabetes is not going away and California is aging. From a policy perspective, podiatric foot screenings are key to combatting the economic toll of this disease."
Read the policy brief: Podiatric Services Could Reduce the Cost of Treating Diabetes Complications in California by up to $97 Million
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
| | 6/22/2017 | 279 | | Approved | 6/22/2017 8:06 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 6/22/2017 8:21 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | What proportion of children in San Bernardino County missed school because of asthma compared with children in rest of the state? What share of residents in downtown Anaheim (92805) are uninsured compared with those in Anaheim Hills (92807)? How can you get easy access to these and many other health questions?
Introduction to AskCHIS
Monday, June 26, 10 a.m.-11:30 a.m. (PST)
In this introductory class, participants will learn to access health data estimates for children, teens, and adults at the state and county level using AskCHIS. They will also learn how to export their findings and turn them into understandable charts. RSVP.
Advanced AskCHIS
Monday, June 26, 1:30pm-3 p.m. (PST)
Builds on basic AskCHIS skills. Participants will learn how to work with multiple CHIS variables, generate bivariate tables, and export data tables and graphs. RSVP.
AskCHIS Neighborhood Edition
Tuesday, June 27, 10 a.m.-11:30 a.m. (PST)Narrowing the geographic focus, users will find health data by legislative district, city, and ZIP Code on AskCHIS NE. They will learn how to export excel data and visualizations generated on AskCHIS NE to use in online and printed reports. RSVP.
Dhannya V. Sasi, the workshop trainer, will answer questions and help participants with data searches during the class. Workshops are supported by Kaiser Permanente.
Please note: Google Chrome is not compatible with this seminar. Participants should use another browser. | | 5/31/2017 | 275 | | Approved | 5/23/2017 8:43 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 5/31/2017 9:38 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Families with Young Children in California: Findings from the California Health Interview Survey, 2011-2014, by Geography and Home Language | 1619 | | | | | Almost 60 percent of households with children ages 0-5 in California speak a language other than or in addition to English. This reflects the growing cultural diversity of the state, according to new study by the UCLA Center for Health Policy Research.
The study focuses on families with children ages 0-5 and factors that influence a child's well-being and readiness for school. Overall, the report shows that nearly 9 in 10 parents of young children are married or in long-term relationships; 6 in 10 have more than a high school education; and a majority has fairly strong neighborhood ties.
But there are significant disparities in income, parent educational achievement, and perceived English language skills. Nearly half of young families are poor enough to qualify for public aid, and poor families are concentrated in California's urban centers.
Multilingual, but not always proficient
Forty-two percent of households with young children speak only English at home; 40 percent speak both English and another language at home (primarily Spanish); and more than 20 percent speak no English
. Other research has shown that children who enter school without strong skills in their primary language often have more difficulty becoming proficient in English. This can put them at a disadvantage as they advance through school and enter the labor force, said Susan Holtby, program director at Public Health Institute and lead author of the report.
"Being multilingual is an incredible asset, but our challenge is to ensure that children become proficient in English early on so they reach high school with the skills to do well so that the benefits of being multilingual can be optimized," said Holtby.
The study, based on 2011-2012 and 2013-2014 California Health Interview Survey data, reports 60 percent of young children's parents had more than a high school education — including nearly 38 percent with a bachelor's degree or higher — but 20 percent had less than a high school education. For many, the lack of education is compounded by a language barrier: 37 percent said they speak English "not well" or "not at all," which other research suggests can complicate their children's path to success.
Role of cities, suburbs and rural location
Living in an urban, suburban or rural setting is an important factor in young families' lives. Some study findings based on the family's community setting:
Urban areas: Three-quarters of young families are urban residents, and half of those are Latino parents; about 30 percent are non-citizens; and about a quarter are enrolled in Medi-Cal and/or WIC. Rural areas: Ten percent of young families live in rural areas. They have the highest proportion of U.S.-born parents -- 66 percent with at least one parent born in the U.S. Rural areas also have a higher proportion of young White families. These areas also have the highest level of feeling safe in their neighborhoods "all of the time" at 55 percent. Suburbs: Less than 15 percent of young families live in the suburbs. Suburban parents have the highest educational attainment — 72 percent report more than 12 years of education. The area has higher proportions of White and Asian young families, and higher incomes — 70 percent are at or above 200 percent of FPL — compared to 51 percent of urban families and 46 percent of rural families.
The study, supported by First 5 California, recommends that parents and caregivers engage with young children through reading, singing and conversation to enhance school readiness for both multilingual and English-only speakers.
| | 5/3/2017 | 274 | | Approved | 5/3/2017 9:13 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 5/3/2017 9:42 AM | i:0#.f|uclachissqlmembershipprovider|celeste | | | | | | | | | | | | | | Diabetes; Diet and Nutrition; Obesity/Overweight | Publication | | | | | Leading experts from across the country convene in Los Angeles today to discuss how to remove added sugar from foods | | Leading experts from across the country will convene in Los Angeles today for the "Kaiser Permanente/American Heart Association Expert Roundtable on Added/Free Sugar Consumption," organized by the UCLA Center for Health Policy Research.
Researchers and experts from the Harvard School of Public Health, Dannon, Partnership for a Healthier America, multiple University of California campuses, Duke University School of Public Policy and others will discuss policy options for reducing added sugar in foods as well as the most vulnerable communities and highest priority research areas.
| | 4/27/2017 | 272 | | Approved | 4/12/2017 3:05 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 4/25/2017 9:52 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | A "Cap" on Medicaid: How Block Grants, Per Capita Caps, and Capped Allotments Might Fundamentally Change the Safety Net | 1618 | | | UCLA report finds that big cuts to health care benefits would hurt the disabled, children and elderly Americans | | The Trump administration’s intent to reform Medicaid includes financing changes that would save hundreds of billions in federal dollars over time, but at the expense of cutting significant health care benefits to tens of millions of the program’s most vulnerable recipients — the disabled, children and elderly Americans, according to a new report from the UCLA Center for Health Policy Research.
None of three “capped” financing systems — block grants, capped allotments and per capita caps —discussed in previous health proposals guarantees benefits for those who qualify for the low-income health program. All of them shrink real funding over time because the proposed growth formulas set the growth to a lower rate than what would be expected under current law. In contrast, the current Medicaid system guarantees benefits to all eligible enrollees and grows in response to increases in enrollment and health care costs.
As a result of capping, states would have to choose whether to bear an increasingly larger share of Medicaid costs, cut patient benefits, create waiting lists, or institute other stricter requirements to limit enrollment, according to the study’s authors.
“These are great plans for federal accountants. It’s a terrible plan for everyone else,” said center Director Gerald Kominski, co-author of the policy brief. “The decrease in funding will profoundly damage the ability of California – and other states – to cover beneficiaries as time goes on.”
Disabled, elderly account for disproportionately large proportions of care
The Medicaid program is jointly financed by the federal and state governments. The federal government currently pays about 63 percent of the cost, and states the remaining 37 percent, although the proportion varies by state, according to the study. As a provision of the Patient Protection and Affordable Care Act, Medicaid eligibility was expanded to include poor single, childless, low-income adults, which vastly expanded the number of people gaining health insurance. In 2015, Medicaid covered 62.4 million Americans at a cost of $552 billion, according to the report.
Benefits vary widely by population group, with the disabled and those 65 years and older making up about 25 percent of enrollees in 2011, but accounting for 64 percent of Medicaid spending.
“It obviously costs more to provide care for certain populations, such as the severely disabled,” said Haleigh Mager-Mardeusz, a graduate student at the UCLA Fielding School of Public Health and co-author of the report. “Capped funding will force states to make hard choices about who ‘deserves’ health care coverage.”
How three “capped” funding systems would change benefits
Each proposed capped financing system would change — and decrease — Medicaid funding to states as well as fundamentally alter the structure of the Medicaid program from an entitlement program, in which any person who qualifies can receive health benefits:
Block grant: Changes Medicaid to a fixed-grant program that stays constant over time, regardless of whether an economic downturn leaves more people uninsured or a population spike increases demand for enrollment. The report authors say funding for block grant programs are often targeted during federal budget cuts.
In California, spending per enrollee in one proposed version of a block grant would drop from $4,500 a year currently to $3,200 a year within the first year of a block grant conversion, according to the study.
Capped allotment: Requires the state to spend money in order to receive matching federal funds, up to a limit. A state that spends less than anticipated would have its federal match reduced. Funding under this system is expected to be lower than current funding.
Per capita caps: Limits how much can be spent on health care per enrollee. The state would be responsible for any amount that exceeds the limit, which would be a problem with sicker, older patients, who require more care, or in the event of a natural or man-made disaster. Geographic variation in health costs could be a problem for many states, if the federal government uses a uniform cost measure. Per capita caps were the proposed funding system in the American Health Care Act.
In California, estimated benefits would drop significantly in the first year under one proposed version of a per capita cap system for almost all population groups except adults, from $21,775 to $15,100 for a disabled beneficiary; from $12,725 to $5,580 for an elder; and from $2,500 to $1,820 for a child. Adult beneficiaries are an exception: Their benefits would increase from $1,715 to $2,271 under a per capita cap funding system.
According to the report, proponents of capped funding systems say those systems will encourage states to become more efficient and innovative and to find ways to provide health services for less money. However, the authors note that state Medicaid programs are already very efficient and most states would end up bearing increased costs as the real value of federal funding diminishes over time.
“Under these caps, many Medicaid patients will see retraction of their health care,” said Cosima Lenz, a graduate student at the UCLA Fielding School of Public Health and co-author of the report. “It’s the opposite of what we saw with Medicaid expansion under the Affordable Care Act.”
| | 4/27/2017 | 273 | | Approved | 4/17/2017 9:17 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 4/19/2017 9:20 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | What’s the teen smoking rate in California’s Sierra counties compared to the Bay Area? What share of residents in downtown Anaheim (92805) are uninsured compared to Anaheim Hills (92807)? How can you get easy access to these and many other health questions?
Introduction to AskCHIS
April 26, 1:30pm – 3:00pm (PST)
In this introductory class, participants will learn to access health data estimates for children, teens, and adults at the state and county level using AskCHIS. They will also learn how to export their findings and turn them into understandable charts. RSVP.
Advanced AskCHIS
May 10, 1:30pm – 3:00pm (PST)
Builds on basic AskCHIS skills. Participants will learn how to work with multiple CHIS variables, generate bivariate tables, and export data tables and graphs. RSVP.
AskCHIS Neighborhood Edition
May 17, 1:30pm – 3:00pm (PST)Narrowing the geographic focus, users will find health data by legislative district, city, and ZIP Code on AskCHIS NE. They will learn how to export excel data and visualizations generated on AskCHIS NE to use in online and printed reports. RSVP.
Dhannya V. Sasi, the workshop trainer, will answer questions and help participants with data searches during the class. Workshops are supported by Kaiser Permanente.
Please note: Google Chrome is not compatible with this seminar. Participants should use another browser.
| | 3/30/2017 | 271 | | Approved | 3/16/2017 2:44 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 3/28/2017 9:58 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | | | | | | | | | | | | | | | Publication | Disaster Averted, For Now: How the American Health Care Act Would Have Affected Californians | 1614 | | | Ideas in the unsuccessful bill could be reintroduced in the future, authors say | | Although the American Health Care Act, or AHCA, failed to attract enough votes to advance last week, the ideas contained within the bill have long been popular with conservatives and will likely be introduced again in the future, according to the authors of a new policy brief on the proposed legislation from the according to a new policy brief from the UCLA Center for Health Policy Research.
In the study, the authors found that older and low-income Californians who buy insurance on the individual market would have shouldered drastically higher costs for health premiums under the new act. Conversely, young and wealthier groups would have benefited.
Census Bureau figures report that about 20 million Americans gained access to insurance under full implementation of the Affordable Care Act, or ACA, including 3.7 million in California, according to the National Health Interview Survey. However, passage of the Trump administration’s proposed law, which would have replaced the Affordable Care Act, was projected to increase the number of uninsured Americans from 26 million in 2017 to 41 million next year and 52 million by 2026, according to the Congressional Budget Office.
“The American Health Care Act was a public health disaster and its defeat is a victory for all Americans,” said Gerald Kominski, director of the UCLA Center for Health Policy Research and co-author of the policy brief. “But the fight is not over. Those opposed to the ACA will continue to try to kill it by regulatory and other means.”
The policy brief focuses on how the proposed law would have affected both Californians who buy insurance on the state health exchange, called Covered California, and those who buy private insurance without subsidies, totaling about 2.35 million people, according to 2015 data from the California Health Care Foundation.
The brief breaks down the financial winners and losers in California by age and income. Authors compared average 2020 tax credits for the Affordable Care Act and the American Health Care Act and found that a single 60-year-old with an annual income of $20,000 would lose more than $7,700 in tax credits — a 66 percent cut — under the proposed act, while a single peer earning $75,000 would get $4,000 more in tax credits. Young, poor singles would have a similar fate, although they would see a smaller reduction: A 27-year-old who makes $20,000 annually would have nearly $2,000 less to pay for insurance under the proposed act, while a peer who earns $75,000 would receive $2,000 more in tax credits.
The proposed health care act also hit older California couples hard: A 60-year-old couple with no dependents earning $20,000 a year would have lost more than $16,000 in benefits, a 67 percent drop. However, their peers who earn a combined $100,000 would have gained an $8,000 tax credit, and a 40-year-old couple with two young children and an income of $150,000 would have qualified for a $10,000 tax credit.
Although the bill was declared dead when a vote on the legislation was canceled, the authors note that the Trump administration has already begun to make fundamental changes to the current law outside of legislation, including proposed rule changes that would weaken patient protections and make it more difficult for people to enroll in coverage.
“This set of proposed rules is likely just the first of many that the administration will put forward to undermine the law,” said Petra Rasmussen, co-author of the brief and a Ph.D. student in Health Policy and Management at the UCLA Fielding School of Public Health. “The policy ideas that were included in the AHCA are ones that Republicans have been touting for many years, and they won’t go away with just one bill’s defeat.”
| | 3/7/2017 | 270 | | Approved | 3/7/2017 1:40 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 3/21/2017 9:18 AM | i:0#.f|uclachissqlmembershipprovider|celeste | | | | | | | | | | | | | | | Publication | | | | | Learn how to use AskCHIS© and AskCHIS Neighborhood Edition©, the free online health data tools of the California Health Interview Survey (CHIS) | | ACA repeal. Medi-Cal populations. Immigrant health. Diabetes and obesity. Learn how to quickly get free, comprehensive health data on these and other hot topics at this free introduction to the California Health Interview Survey (CHIS) and its user-friendly Web tools, AskCHIS and AskCHIS Neighborhood Edition.
In this training tailored to members of the California delegation, their staff and the legislative community, participants will learn how to access health data by legislative district, as well as by city, ZIP code, county, region and statewide. Learn how to compare data and to trend more than a decade's worth of health statistics to identify health problems in specific districts. Also, see how to easily map, chart and export data.
Hear from health policy experts, including Gerald Kominski, director of the UCLA Center for Health Policy Research, which conducts CHIS, as well as Ninez Ponce, CHIS principal investigator and professor at the UCLA Fielding School of Public Health, along with CHIS Director Todd Hughes. CHIS Project Coordinator Bogdan Rau will also present.
CHIS is the nation's largest state health survey and the definitive source of health data on California's children, teens, adults and elders. More than one million queries have been made using AskCHIS and tens of thousands of policymakers, researchers, advocates, media and others depend on CHIS data for answers to the most pressing health questions affecting Californians.
Please RSVP here.
What: AskCHIS legislative health data training, Sacramento
Date: Thursday, March 23, 2017
Time: 2:00-4:00 p.m., PST
Where: UC Center Sacramento, 1130 K St., Ste. LL22. Sacramento, CA 95814
Take elevator down to the Lower Level. Turn left outside the elevator. Conference Room A is down the hall and on the right. The official name is LL3.
See parking information here.
For more information, please email gdriscoll@ucla.edu or call 310-794-0930.
CHIS is conducted by the UCLA Center for Health Policy Research incollaboration with the California Department of Public Health and the Department of Health Care Services.
| | 1/31/2017 | 268 | | Approved | 1/25/2017 6:18 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 1/31/2017 9:22 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | The State of Health Insurance in California: Findings from the 2014 California Health Interview Survey | 1603 | | | Report on ACA impact is benchmark against which ACA repeal can be measured | | The number of uninsured Californians ages 64 and under fell from 5.32 million in 2012 to 4.46 million in 2014 ― a decline of 16 percent, according to The State of Health Insurance in California: Findings from the 2014 California Health Interview Survey, a new report from the UCLA Center for Health Policy Research.
Since that time, the number of uninsured has fallen further ― effectively halving the number of uninsured in the state since the inception of the Patient Protection and Affordable Care Act (ACA).
Findings from the Center's report ― which uses data after full implementation of the Patient Protection and Affordable Care Act (ACA) ― show how even one year into ACA implementation the law had made significant impact on access to health insurance and to health care services across multiple vulnerable population groups.
"The drop in the uninsured population shows the ACA was a success," said Shana Alex Charles, Center faculty associate and lead author of the report. "But it is bittersweet, given that the current administration is focused on repealing the law."
The State of Health Insurance in California is the Center's signature publication, released every two years following analysis of comprehensive data from the California Health Interview Survey (CHIS), the nation's largest state health survey.
"This report will be the benchmark against which Republican plans to repeal the ACA will be measured," said Gerald Kominski, a co-author of the report and the director of the UCLA Center for Health Policy Research. "If the current administration is not able to maintain or exceed the ACA's track record, they will be judged ― and judged harshly."
Many Gains Overall, but Disparities PersistThe report shows the expansion of health care under the ACA played a significant role reducing the population of uninsured Californians due to two main factors: Expansion of Medi-Cal to previously excluded groups and provision of federal subsidies that helped people afford to buy private insurance on Covered California. The uninsured population for those 64 and under dropped from 21 percent in 2012 to 17 percent in 2014.
Other statewide 'before and after reform' findings:
Employer-based insurance unaffected: The ACA had a relatively negligible effect on overall employment-based insurance (EBI) coverage in the state, despite ACA critics' speculating that employers would cut back on insurance benefits if Californians were able to access coverage elsewhere. EBI rates declined slightly from 54.9 percent in 2012 to 53.4 percent in 2014. However, findings showed only 44.7 percent of Latino workers have health coverage through an employer, compared to nearly 75 percent of white workers.
More individually purchased health plans: With the elimination of pre-existing conditions as a factor for denying coverage and the provision of federal subsidies under the ACA, the number of people 64 and under who bought individual health plans increased from 1.9 million in 2012 to 2.4 million in 2014. Self-employed Californians saw a nearly 9 percentage point reduction in uninsurance.
"This group, those who were self-employed or wanted the flexibility to leave an employer and start their own business, was a focus of health reform," said Kominski.
Insurance gender gap: More women than men gained coverage through Medi-Cal expansion. Uninsurance rates for women ages 19-64 dropped from 19 percent to 13 percent, while the rate for men in the same age category declined slightly from 23 percent to 22 percent.
Increased access to care: Ability to see a doctor increased for nonelderly adults with employer-provided insurance, but declined among those with public health coverage. Delayed or foregone care was lowest among children and the elderly and highest among Medi-Cal adults 64 and under. The latter group saw an increase in delays in care, from 11 percent in 2012 to 32 percent in 2014. Racial and ethnic disparities in access to care persist.
Policy recommendations include outreach efforts by the state and/or private foundations in counties with high populations of uninsured ― the result of factors such as limited education and citizenship status ― and monitoring Medi-Cal patients' access to care and ensure they know how to use their coverage.
"Although the report’s findings show the state has significantly cut the number of its uninsured population, we now face challenges on two fronts," said Robert K. Ross, MD, president and CEO of The California Endowment, which supported the report. "We must work hard to protect the gains made in health reform, while we continue to reach out to Californians who remain uninsured."
Read the report: The State of Health Insurance in California: Findings from the 2014 California Health Interview Survey
The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health policy information for California. The Center improves the public's health through high-quality, objective and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
The California Health Interview Survey (CHIS) is the nation's largest state-based health survey and one of the largest health surveys in the United States.
The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians. | | 1/31/2017 | 269 | | Approved | 1/26/2017 12:44 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 3/17/2017 3:20 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | The UCLA Center for Health Policy Research has received a five-year contract from The California Department of Health Care Services (DHCS) to evaluate the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program. Nadereh Pourat, Director of Research at the Center, will lead the evaluation project.
PRIME is a five-year, $3.7 billion demonstration project under the Medi-Cal 2020 Section 1115 Waiver aimed at promoting access to and improving the health of patients at public, municipal and district hospitals in California. These hospitals will put in place health improvement projects such as integration of physical and behavioral health care, transition from hospitalization to home health and other post-acute services, obesity prevention, cancer screening and follow-up care. Medi-Cal is California's version of Medicaid.
The evaluation will assess the impact of PRIME on quality of care, health outcomes and costs under Medi-Cal as well as the impact of value-based payment models and sustainability of the health delivery redesign achieved by PRIME projects. Evaluation activities include interviews and surveys with participating hospitals as well as analyses of available data.
PRIME follows a previous demonstration called Delivery System Reform Incentive Payment (DSRIP) under the Bridge to Reform Section 1115 Waiver, which was also evaluated by the Center with Pourat as the lead evaluator.
"These demonstrations have and continue to play a pivotal role in improving the capacity of crucial safety net providers that provide care to populations who are threatened with loss of coverage if ACA is repealed," said Pourat. "The ability of Medi-Cal to continue to provide care to those insured under the ACA depends on improvements in care delivery." The PRIME demonstration runs through December 31, 2020.
| | 1/17/2017 | 267 | | Approved | 1/13/2017 7:45 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 2/27/2017 9:54 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | Miranda Dietz | miranda.dietz@berkeley.edu | UC Berkeley Center for Labor Research and Education | 510-642-1583 | 1092 | 945 | Y | N | | | Publication | ACA Repeal in California: Who Stands to Lose? | 1597 | | | | | Up to 3.7 million insured in California’s Medicaid expansion and a further 1.2 million Californians receiving subsidies to buy affordable health insurance in Covered California are at risk if current Republican plans to repeal the Affordable Care Act are enacted, according to a set of new studies and county fact sheets from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research. Millions of Californians stand to lose from ACA repeal in some way -- either through lost access to affordable coverage or to jobs created by health insurance expansion. In particular, low-income earners, young adults, part-time workers, and people of color in California gained the most between 2013 and 2015. Now, with the impending repeal and replacement of the ACA, people in these and other groups have the most to lose and risk sliding back into the ranks of the uninsured, according to "ACA Repeal in California: Who Stands to Lose?," one of the two policy briefs. And according to brief's authors, these could be underestimates. "Fallout from Republican changes to the health care system could be even more harmful if the administration changes the way Medi-Cal benefits are calculated or if coverage features are reduced," said Miranda Dietz, researcher at the UC Berkeley Labor Center and lead author of the study. Under the ACA, California cut the number of its uninsured residents in half, from 6.5 million in 2013 to 3.3 million in 2015 - the largest decline in the uninsured rate of any state. Statewide, 9.4 percent of the population enrolled in the expanded Medi-Cal, and 3.1 percent enrolled in Covered California, with subsidies. Medi-Cal accounts for most of the drop in uninsured populationMedi-Cal expansion drove much of the drop in uninsurance rates, enabling 3.7 million adults to become newly eligible for coverage. If this aspect of the ACA were repealed, these Californians would immediately lose their insurance or face significantly higher costs to purchase coverage. People of color made up 71 percent of this expansion group, with 42 percent identifying as Latinos. The 1.2 million subsidized enrollees received an average of $309 per month in federal premium subsidies, and many (60% of subsidized enrollees) received additional funds to reduce their out-of-pocket costs. For some, these subsidies kept them from being uninsured; others may have had coverage before 2014, but the coverage that became available to them under the ACA was more comprehensive and/or more affordable, the study reports. More than half of this group had incomes below 200 percent above the federal poverty level - the group that had the highest uninsurance rates prior to ACA enactment. State-wide reach of repeal of Medi-Cal expansionRepeal of the ACA should put all counties on alert, especially those with high enrollment under Medi-Cal expansion, the study reports. As of July 2016, counties that had the highest share of adults who joined Medi-Cal during ACA expansion were in the northern and central regions of the state, including Humboldt, Mendocino (both 13.9 percent), Trinity (13.6 percent), Fresno (12 percent), and Stanislaus (11.6 percent) counties. Sister paper on economic effects of the repealA related paper from UC Berkeley reports the economic impacts of repeal of the ACA would result in an estimated $20.5 billion annual loss in funding for Medi-Cal expansion and federal subsidies, $1.5 billion lost in state and local tax revenue, and 209,000 lost jobs, primarily in the healthcare industry. The study reports counties that could face the biggest job losses already have high rates of unemployment: Fresno, Kern, Los Angeles, San Bernardino, San Joaquin, Stanislaus and Tulare. Data sheets for selected counties outline the potential number of people who would lose insurance coverage and potential number of jobs that would be lost under ACA repeal. In sheer numbers, Los Angeles could see 970,000 people lose their health insurance and 63,000 losing jobs. "Californians benefited significantly from the economic stimulus of health care jobs and other job related to implementation of the ACA," said Laurel Lucia, a manager of the health program at the UC Berkeley Labor Center and lead author of the second study. "Ultimately, we could face a complete reversal for the state if the ACA is repealed." Read the report: ACA Repeal in California: Who Stands to Lose?Read the related data brief: California's Projected Economic Losses under ACA RepealRead fact sheets for selected counties on the potential number of job losses and estimated number of people who could go back to being uninsured.
| | 1/12/2017 | 265 | | Approved | 12/20/2016 2:21 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 1/12/2017 7:35 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Addressing Barriers to Breast Cancer Care in California: The 2016-2017 Landscape for Policy Change | 1595 | | | California State Senate will discuss barriers and possible solutions Jan. 12 | | In 2016, more than 26,700 California women were diagnosed with breast cancer, and an estimated 4,000 died from the disease. For women with breast cancer, the path from diagnosis to treatment to continued care is riddled with obstacles, according to a new analysis by the UCLA Center for Health Policy Research.
''While we are making great progress in the diagnosis and treatment of breast cancer, the disease continues to disproportionately hurt women and families with the fewest resources, such as those on Medi-Cal,'' Pan said. ''All women facing breast cancer deserve an equal chance at hope.''
The report reveals tiers of persistent roadblocks women face while seeking treatment, including a difficult-to-navigate health system, inadequate insurance, high costs, individual and cultural misconceptions, and language barriers. All people face access problems, regardless of income and race, but women who are uninsured, underinsured and have health coverage through public programs persistently face more obstacles, which leads to difficulty completing a treatment program.
In the briefing, the authors will focus on three key barriers from the report that impede breast cancer treatment:
Narrow Networks: Insurance companies that limit access to providers create narrow networks, which are a "system" barrier to timely breast cancer care. While a number of recent reports cite the tightening of provider networks for different health insurance plans, it even more strongly limits access to care for women with breast cancer in California. Timely Care: Insurance status affects how quickly care can be obtained. Time spent waiting for authorizations often impacts continuity of care. Cultural barriers: Women are often challenged to find breast cancer treatment providers who speak their language or understand their culture. Also, women appear to commonly hesitate to seek care because of cultural beliefs.
''Imagine you are diagnosed with breast cancer, but for whatever reason — lack of transportation, a language barrier, uncertainty over health insurance coverage — you can’t get the timely care that gives you the best chance of beating the cancer,'' said Ponce, associate director at UCLA Center for Health Policy Research.
Policy recommendations to address each barrier include making sure health insurance networks are adequate by setting a minimum number of breast cancer specialists (plans do not require a minimum number of providers); extending period of treatment coverage by removing time limits, such as those in public programs; and developing culturally sensitive interventions that address cultural barriers to seeking care. The report also recommends that the care process includes interpretation/translation services beyond just medical visits to include tasks such as making appointments and educating patients on self-care.
''There are many locked doors that can prevent full treatment to women with breast cancer,'' said de Guia of CPEHN. ''We need to unlock the doors to help women get the care they need to live longer, healthier lives.''
Join us at the public legislative briefing:
What: ''Breaking the Barriers to Breast Cancer Care: Exploring Policy Options''
When: Thursday, Jan. 12
Time: 12:30 p.m. registration; 1-2 p.m. briefing
Where: Room 4203, State Capitol Building, 1315 10th S. Sacramento, CA 95814 ( Map)
| | 1/5/2017 | 266 | | Approved | 1/5/2017 11:51 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 1/12/2017 11:15 AM | i:0#.f|uclachissqlmembershipprovider|celeste | | | | | | | | | | | | | | | Publication | | | | | ''Breaking the Barriers to Breast Cancer Care: Exploring Policy Options'' | | One in eight women will develop breast cancer. Yet from narrow provider networks to cultural and linguistic obstacles, serious barriers exist for women seeking breast cancer treatment in California.
At this January 12 legislative briefing in Sacramento, co-sponsored by the California Latino Legislative Caucus, California Asian Pacific Islander Legislative Caucus, the California Legislative Lesbian, Bisexual and Transgender Caucus, and researchers from the UCLA Center for Health Policy Research will present findings from a new statewide study on obstacles to breast cancer care.
What: ''Breaking the Barriers to Breast Cancer Care: Exploring Policy Options'' When: Thursday, Jan. 12, 2017 Time: 12:30 pm registration; 1-2 pm briefing Where: Room 4203, State Capitol Building 1315 10th St, Sacramento, CA 95814 [Map]
Speakers:
The UCLA Center for Health Policy Research and the UCLA Center for Cancer Prevention & Control Research partnered on the study, funded by the California Breast Cancer Research Program.
Please join us to learn how we can tear down the barriers to high-quality breast cancer care in California.
Open to the public. Please contact AJ Scheitler for more information: ajscheitler@ucla.edu.
| | 12/22/2016 | 264 | | Approved | 12/19/2016 10:11 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/22/2016 9:25 AM | i:0#.f|uclachissqlmembershipprovider|venetia | | | | | | | | | | | | | | | Publication | | | | | | | The researchers and staff at the UCLA Center for Health Policy Research thank you for your support this year and wish you a very happy holiday season! The Center closes Thursday afternoon, Dec. 22, and reopens Tuesday, Jan. 3. Media who wish to contact Center personnel during this time may reach Gwen Driscoll, director of communications, at: 310-720-4441.
| | 12/14/2016 | 261 | | Approved | 12/2/2016 12:55 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 2/8/2017 2:13 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Growth in Medi-Cal in 2015 Fueled Unprecedented Drop in California’s Uninsured Rate | 1593 | | | Findings part of release of wide range of new data on the health of Californians | | Californians who were historically unable to afford health insurance — those with low incomes and people of color — benefited significantly from health coverage expansion policies under the Patient Protection and Affordable Care Act, according to new 2015 California Health Interview Survey data released today.
The new CHIS data, which are accompanied by a fact sheet on insurance trends, show the overall rate of uninsured Californians fell to a new low in 2015: 9.5 percent — the first time the rate has dropped to less than 10 percent since data have been collected.
And declines in rates of those who are uninsured were most pronounced among the state’s poorest residents ages 0 to 64, dropping by nearly 10 percentage points between 2013 and 2015, to 12.8 percent. Declines were also more pronounced for most racial and ethnic groups, with rates of those who are uninsured falling nearly 7 percentage points among Asian-Americans and African-Americans, and 6.5 percentage points among Latinos.
“The evidence shows that the Affordable Care Act has opened the doors to groups who have been historically shut out from health insurance coverage,” said Ninez Ponce, associate director of the UCLA Center for Health Policy Research and principal investigator at CHIS. “It is likely that the ACA’s expansion of Medi-Cal and income subsidies for Covered California have been instrumental in expanding the safety net for poor and traditionally disadvantaged groups.”
CHIS, the nation’s largest state health survey, surveyed 21,444 households in 2015, including 21,034 adults, 754 teens and 2,157 children.
Medi-Cal expansion drives coverage
The related fact sheet published in conjunction with the 2015 CHIS data release reports that the number of Californians ages 0 to 64 with Medi-Cal health coverage climbed to 32.2 percent of people in 2015 — an increase of 11 percentage points since 2013. Medi-Cal is the state’s version of Medicaid.
However, progress made in expanding health care coverage in the state may be in danger, said Shana Alex Charles, faculty associate at the Center and author of the fact sheet.
“Both our data and national data show Americans have clearly benefited from Medicaid’s expansion under the Affordable Care Act, and this is the benchmark against which any future policies will be measured,” Charles said. “We can’t go back to 2013, when millions more Californians were uninsured.”
The share of Californians with individual insurance remained fairly constant at 7 percent, or 1.2 million people, according to the fact sheet.
Rising affordability
The new data reveal large declines across all income levels of those who said they are currently uninsured because they “can’t afford” health care, from a 26 percentage point drop for the lowest income earners to a 20 percentage point decline for highest.
Fewer Californians cited cost as a reason to go without needed medical care in 2015. With the exception of African-Americans, all other racial and ethnic groups reported 6 to nearly 14 percentage point drops in cost being a reason to forgo care.
Despite the gains, American Indian/Alaska Native and Latino residents have the highest rates of not being insured, 17.5 percent and 15 percent, respectively. And there was a 3.3 percentage point increase from 2013 to 2015 in African-Americans citing cost as a barrier to care.
New topics and updated variables
In addition to updated insurance estimates, respondents answered questions on hundreds of new and updated health topics ranging from discrimination in getting medical care to chronic disease management, to resiliency among teens.
Some findings from 2015:
• Gender identity measurement: For the first time, CHIS, in partnership with the Williams Institute at UCLA School of Law, measured the size of the transgender and gender-nonconforming population in California, making it one of the few state-level health surveys featuring this population. In 2015, about 64,000 adults ages 18 to 70 (0.25 percent of the population) were estimated to be transgender or gender non-conforming, and about 133,000 Californian youth ages 12 to 17 (about 4.5 percent of the youth population) were estimated to express their gender in a “non-conforming” way (e.g., boys who act or dress mostly or very feminine, and girls who act or dress mostly or very masculine). Researchers can request more detailed data on both adults and teens through the Data Access Center.
• More adult Californians had routine primary care checkups in 2015: The proportion of those with coverage who had a primary care checkup rose nearly 4 percentage points between 2013 and 2015 to 73 percent.
• Discrimination in a health care setting: Another new question showed 15 percent of African-Americans and the same percentage of a group that includes multi-racial and small groups of single-race adults said they felt they had sometimes or often been treated unfairly while getting medical care. In comparison, 14 percent of Latinos, 10 percent of whites and 7 percent of Asian-Americans said they felt discriminated against. In a related question, nearly 14 percent of African-Americans said they felt they would have received better care if they were a different race or ethnicity, compared to 2 percent of whites.
• “Teledoctor” makes house calls: A new survey question on telemedicine revealed nearly 10 percent of adult Californians received health care from their provider by video or phone.
• Prediabetes rate: More than 12 percent of adult respondents said they were identified as having prediabetes, which can develop into type 2 diabetes, a jump of nearly 3.5 percentage points.
Other new and updated topics in CHIS 2015 include estimates of delays in dental care and emergency room dental care among children, breast feeding and bottle feeding, and mammography screenings.
“We’re excited about the latest data on the broad set of topics included in the CHIS, and how they can help researchers, policymakers, and local organizations address emerging health needs,” said Todd Hughes, director of the California Health Interview Survey. “But the insurance data is significant — it gives us a measure of how the ACA improved access and affordability of health care for millions of people who had gone without.”
CHIS 2015 data can be accessed directly through AskCHIS, a user-friendly online tool, or by downloading a Public Use File. Learn more about how to Get CHIS Data.
Related: Noon seminar on “CHIS 2015: What’s new in the nation’s largest health survey.”
The California Health Interview Survey is conducted by the UCLA Center for Health Policy Research in collaboration with the California Department of Public Health and the California Department of Health Care Services and is supported by several public and private funders committed to improving the health of Californians.
| | 12/8/2016 | 262 | | Approved | 12/6/2016 11:14 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 3/7/2019 11:28 AM | i:0#.f|uclachissqlmembershipprovider|celeste | Brianna Aldrich | baldrich@dentistry.ucla.edu | | (310) 206-0835 | | | | | 1408 | | N | | | | Publication | | | | | UCLA experts make policy recommendations based on UCLA-First 5 LA program achievements | | Despite efforts to increase dental visits at federally qualified health centers, only 21 percent of people who use those facilities received dental services in 2015, according to an article by UCLA researchers from the UCLA School of Dentistry and UCLA Fielding School of Public Health and their colleagues.
The article, published in the December issue of the journal Health Affairs, outlines recommendations for closing the gap in oral health services. Strategies for expanding oral health care capacity include adding dental clinics at federally qualified health centers that currently do not provide dental services (co-locating medical and dental services) and providing support for infrastructure enhancements and quality improvement, said Dr. James Crall, lead author of the article and a professor of the division of public health and community dentistry at the UCLA School of Dentistry.
A model of how these strategies can achieve success in improving access and quality of care for young children is the UCLA-First 5 LA Oral Health Program, led by Crall and funded by First 5 LA — an early childhood advocacy organization in Los Angeles County. Data from the oral health program show that the average number of children, ages zero to 5, receiving dental services each month at 12 participating clinics increased by nearly 85 percent in the first two years of the project. Eight additional clinics are now participating in a second phase of the program.
Crall credits this jump in dental services to the program’s support for new oral health care workers known as community dental home coordinators, training clinicians and support staff to provide oral health care for young children, and a quality improvement learning collaborative that teaches clinic teams how to deliver care more effectively by integrating the efforts of dental and medical providers.
“We are very pleased with the results thus far of our oral health program,” Crall said. “The data show that our model is working. The strategies we’ve implemented could serve as a model for oral health care programs across the country.”
The model is outlined in the Health Affairs article and in a related policy brief released earlier this year by the UCLA Center for Health Policy Research. The issue marks the journal’s first comprehensive look at oral health and today Crall presented the paper at a forum in Washington, D.C.
“Young children are our greatest asset and we cannot improve their overall health without improving their oral health,” said Nadereh Pourat, co-author on the study and the director of research at the UCLA Center for Health Policy Research. “Our study identifies an effective strategy to integrate oral and medical care to improve the health of the most socially vulnerable children, but this strategy can also work for all young children.”
Crall and Pourat, who is also a professor at the UCLA Fielding School of Public Health and the UCLA School of Dentistry, along with fellow researchers, Moira Inkelas, an assistant professor at the Fielding School, and quality improvement advisors Colleen Lampron and Richard Scoville, made the following recommendations for policy makers and program officials to increase access to high-quality primary oral health care services for underserved people:
• Policies could be updated to define oral health care as an essential, integral part of health centers’ primary health care services, with a clear expectation that comprehensive primary health care services be provided in all federally qualified health centers.
• Congress and the Health Resources and Services Administration could give greater priority to expanding dental care service delivery within existing federally qualified health centers by providing additional funding for facilities, personnel and critical infrastructure elements to address obstacles.
• Government agencies could help develop more effective strategies for expanding access to dental services through partnerships among eligible health centers and community-based dental providers, especially in clinics that do not provide co-located medical and dental services.
• The Health Resources and Services Administration could expand the use of quality improvement methods and collaboratives to redesign the care delivery processes at federally qualified health centers to achieve greater medical and dental integration within health center delivery systems and improve oral health care access, quality and performance.
A related brief, focused on California, will be issued Dec. 8 by Children Now, First 5 LA and the UCLA School of Dentistry.
This research and the Los Angeles-based oral health program featured in the Health Affairs article was supported by First 5 LA.
| | 12/1/2016 | 260 | | Approved | 12/2/2016 11:15 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/2/2016 11:55 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | New rules enforce smoke-free public housing | |  Renters living in approximately 780,000 privately owned rental units remain unprotected from secondhand smoke in the city of Los Angeles, despite the U.S. Housing and Urban Development (HUD) announcement that public housing developments in the U.S. will be required to provide a smoke-free environment for their residents. ''Thi s is terrific news ,'' said Peggy Toy, director of UCLA-Smokefree Air For Everyone (UCLA-SAFE). ''But in the city of Los Angeles, public housing is only a small share of the housing stock. We need to make sure all residents in the re st of the city’s multi-unit rentals also have protection from secondhand smoke.'' More than 3,100 public housing agencies (PHAs) across the nation can now put in place required smoke-free policies over the next 18 months. The federal ruling prohibits lit tobacco products (cigarettes, cigars or pipes) in all living units, indoor common areas, administrative offices and all outdoor areas within 25 feet of housing and administrative office buildings. There are only 6,500 public housing units in the city, according to the Housing Authority of the City of Los Angeles. In comparison, there are 780,000 privately owned rental units in the city, of which approximately 624,000 of them (80 percent) are under rent-control, according to The Los Angeles Housing Department. None of these privately-owned units will benefit from the new HUD protections. UCLA-SAFE launched a smoke-free housing initiative in Los Angeles in April 2016 that encourages owners of market-rate multi-unit apartments in densely populated areas of the city to voluntarily put in place smoke-free policies to reduce residents’ exposure to secondhand smoke. UCLA-SAFE, supported by a $3 million grant from the U.S. Centers for Disease Control, focuses its efforts on densely populated neighborhoods in the city of Los Angeles where a high proportion of Latinos and African-Americans live. The two groups have among the highest rates of chronic disease, including diabetes, heart disease and cancer. In conjunction with the campaign kickoff, UCLA Center for Health Policy Research released a study that showed a majority of tenants favored smoke-free apartments, but 80 percent of units did not have smoke-free policies. The CDC estimates cigarette smoking kills 480,000 Americans each year, making it the leading preventable cause of death in the United States, according to the HUD press release. In addition, smoking is the leading cause of fire-related deaths in multifamily buildings. The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 11/29/2016 | 237 | | Approved | 12/17/2015 10:20 AM | i:0#.f|uclachissqlmembershipprovider|bhan | 12/6/2016 9:49 AM | i:0#.f|uclachissqlmembershipprovider|sabinali | F. Lurmann | | UCLA Center for Health Policy Research | | | | | | 756 | | N | | | | Publication | | | http://healthpolicy.ucla.edu/PublishingImages/Members%20Images/StevenPWallace.jpg | | | |
The Center is pleased to host leading health policy experts at our lunchtime seminar series.
Dec. 14 Seminar: "CHIS 2015: What's new from the nation's largest state health survey"
 
In conjunction with the release of new
California Health Interview Survey (CHIS) 2015 data, the Center will be hosting its final seminar of the year on Dec. 14 featuring CHIS Principal Investigator Ninez Ponce and CHIS Director Todd Hughes. Join us to hear all about what's new in the nation's largest state health survey, including new and updated variables on health insurance status, discrimination in a health care setting, gender identity and gender expression, and more!
Join us via live-streaming webinar here:
What: |
"CHIS 2015: What's new from the nation's largest state health survey"
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Who: |
Ninez Ponce, Associate Center Director and Principal Investigator of the California Health Interview Survey; Director, UCLA Center for Global and Immigrant Health; Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health
Todd Hughes, Director of the California Health Interview Survey
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When: |
Wednesday, Dec. 14, 2016
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Time: |
Noon - 1 pm, PST |
Where |
UCLA Center for Health Policy Research
10960 Wilshire Blvd., Suite 1550
Los Angeles, Calif. 90024 [Map] |
A recorded video will be posted on the Center's website shortly after the presentation. Recent seminars:
All seminars from the Center’s Health Policy Seminar Series can be viewed here.
November 29, 2016: "Race and Ethnicity Trends in California: What is the 'Landscape of Opportunity'?"
In a majority-minority state, what health challenges and trends face California's communities of color? The California Pan-Ethnic Health Network's recently released report, The Landscape of Opportunity, draws upon comprehensive Center research using the California Health Interview Survey and other data. This seminar will show how access to affordable housing, jobs, doctors and quality health care, insurance, safe neighborhoods and parks and much more varies depending on the color or your skin or your cultural community.Presented by Center Associate Director Ninez Ponce, a noted authority on health disparities, this seminar is a must for all interested in overcoming health inequities in California. Watch the video here.
October 26, 2016: "The ACA, FQHCs and the Remaining Uninsured"
Federally quailified health centers (FQHCs) are a key source of primary care for people without health insurance and are one of the only sources of low-cost care for undocumented immigrants. In this seminar, part of the Center's 2016 Health Policy Seminar Series, Center Associate Director Steven P. Wallace will discuss the findings from an upcoming joint study with The Commonwealth Fund on the national impact of the Affordable Care Act (ACA) on FQHCs. How did state decisions for and against the expansion of Medicaid impact the proportion of uninsured patients served by the FQHC safety-net? How well have FQHCs coped with the influx of newly-insured patients in terms of staffing and funding? Have FQHCs been able to meet the needs of the remaining uninsured, particularly the undocumented? Watch the video here.
September 27, 2016: "The Presidential Candidates and Their Health Plans"
What will health coverage look like under a President Trump? A President Clinton? In this Sept. 27 seminar, Center Director Gerald Kominski discusses the evolving visions of the presidential candidates' health plans. Specifically, Kominski describes Republican nominee Donald Trump's idea to replace the Affordable Care Act with block grants to states to provide health care to low-income people as well as to enable the sale of health insurance across state lines. Alternatively, Democrat nominee Hillary Clinton has vowed to expand Medicaid in every state as well as to undocumented workers and their families. She has also pledged to limit prescription drug costs. How feasible are these ideas in an age of extreme partisanship? Watch the video here.
June 13, 2016: "A Public Health Perspective to Improve the Juvenile Justice System"
Processing juvenile offenders in the traditional justice system can lead to a range of negative health and social consequences. However, health and public health perspectives are often absent in conversations about the juvenile justice system. In this June 13 seminar, Lauren Gase, chief of health and policy assessment in the Division of Chronic Disease and Injury Prevention at the Los Angeles County Department of Public Health, draws from her work with the Los Angeles County Department of Public Health to discuss results from a recently published study examining the impact of Teen Courts — a popular juvenile justice system diversion model in which youths are judged by their peers and given restorative sentences to complete during a period of supervision. Did this alternative justice solution prevent recidivism, which is linked to life-long negative health consequences? Watch the video here. May 19, 2016: "Implementing Physician Aid-in-Dying: What Can California Learn from Other States?"
California passed the End of Life Options Act (AB 15 ) in 2015, which allows residents to end their life through physician aid-in-dying (AID). In June of 2016, implementation of the law will begin. Yet there is little guidance as to how AID will be conducted. Drawing from lessons learned in other states that have already passed aid-in-dying laws, Cindy Cain, Center faculty associate and the author of an upcoming Center study on AID, will discuss the ethical and practical concerns of implementation and outline solutions that may help California policymakers, physicians and health workers sensitively and comprehensively respond to constituents and patients. Watch the video here.
April 16, 2016: "Towards a Smokefree LA: What Landlords and Tenants Think About Smokefree Housing in the City of Los Angeles"
On April 6, the Center presented findings from a first-ever survey of both landlords and tenants at an event in South LA, as well as launch an exciting new media and advertising campaign to encourage the adoption of smokefree policies citywide. In this seminar, Ying-Ying Meng, co-director of the Center's Chronic Disease Program, and Peggy Toy, director of the Center's Health DATA Program, will expand upon the survey's findings and discuss how we can achieve a healthier and more equitable Los Angeles. Watch the video here.
March 10, 2016: "On the Road to Diabetes? A Look at High Prediabetes Rates in California" Nearly ten percent of the adult population in California has diabetes but how many more have conditions that presage the onset of diabetes? How can the path towards diabetes be reversed? And what is the likely effect of the population with prediabetes on the future of California’s health and budget? In this seminar, Susan H. Babey, co-director of the Center’s Chronic Disease Program, discusses findings from a study on the prevalence of prediabetes in California. She also talks about what policymakers and health advocates can do to try to help prevent the progression from prediabetes to diabetes. Watch the video here.
| | 11/16/2016 | 259 | | Approved | 11/11/2016 8:23 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 11/15/2016 11:59 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | | | UCLA Center for Health Policy Research | | Lauren Paul | lauren.paul@rodale.com | Prevention Magazine | 212-297-1518 | | 1394 | | N | | | Publication | Prevention/UCLA Center for Health Policy Research Survey: American Attitudes about Health Insurance Survey Results | 1571 | | | UCLA Center for Health Policy Research collaborates with Prevention on study of attitudes about health insurance | |
Ninety-two percent of Americans ages 45 to 64 say they would keep their current health care plans unless premium prices increase significantly, according to a new nationwide poll by Prevention and the UCLA Center for Health Policy Research.
In addition, 90 percent of those surveyed said they were "very satisfied" or "somewhat satisfied" with their current health care.
"What the poll convincingly shows is that Americans do not perceive their health care system as 'broken,'" said Gerald Kominski, director of the center. "They are satisfied with the coverage they have, but they do worry about costs.”
The poll results were published just a week after the presidential election, in which a key issue was the possible repeal of the Patient Protection and Affordable Care Act. The repeal could result in the loss of coverage for up to 24 million people, according to a recent study by the Urban Institute and the Robert Wood Johnson Foundation.
The publication also comes in the midst of the nation’s open enrollment season, when people can choose or change health insurance plans for the following year.
In the study, more than 400 men and women who have health insurance were asked a variety of questions about where they get their insurance, how they shop for insurance, their estimated financial spending on health care and their attitudes toward their current insurance plan.
Among the key findings:
• More than 43 percent of respondents report being “very satisfied” with their current insurance plan, and more than 90 percent say they are at least “somewhat satisfied.”
• Ninety-two percent of respondents would keep their exact health plans if the cost stayed the same, but only 54 percent of respondents would do so if the price increased by 15 percent.
• Forty-one percent of respondents have spent more than $1,000 on medical expenses so far in 2016, including co-pays, deductibles, prescriptions, doctor visits and other medical bills not covered by insurance. Ten percent of respondents have spent $5,000 or more.
• Four in 10 respondents spend the same or more on health care expenses as they do on their rent or mortgage.
• One in five respondents report feeling nervous about going to the doctor or getting a test because their deductibles are high, and 17 percent have delayed seeking treatment or filling a prescription as a result.
"Finding the health insurance plan that’s right for you can seem incredibly overwhelming," said Barbara O’Dair, editor-in-chief of Prevention. "With this story and survey we try to break it down for readers in a way that will be empowering for them."
The survey was conducted during the last week of September. UCLA researchers weighted the results. Some of the study’s results appear in the December issue of Prevention magazine, on newsstands now, as part of an extensive guide to choosing a health insurance plan.
MEDIA: Please contact Gwen Driscoll at the UCLA Center for Health Policy Research for full results: gdriscoll@ucla.edu 310-794-0930.
About Prevention
Prevention is the world’s most established healthy lifestyle brand. For more than 60 years, it has delivered authoritative information, breaking news, and authentic lifestyle advice that inspires, challenges, and leads readers to love their whole life, from nutrition to food, medicine to mood, exercise to the environment. Prevention magazine is published 12 times a year by Rodale Inc, and the brand can also be found digitally at Prevention.com, a top online health destination leading the national conversation in health and wellness with daily breaking news coverage, perspective-shifting features, and practical strategies to enhance—and even save—lives. Prevention's Twitter handle is @PreventionMag and Prevention can be found on Facebook at http://www.facebook.com/preventionmagazine. Prevention magazine and its apps are available on the iPhone and iPad.
About The UCLA Center for Health Policy ResearchThe UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is affiliated with the UCLA Fielding School of Public Health.
| | 10/26/2016 | 257 | | Approved | 10/12/2016 9:27 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 10/26/2016 7:28 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Community Health Centers Play a Critical Role in Caring for the Remaining Uninsured in the Affordable Care Act Era | 1568 | | | Clinics see only a small drop in uninsured | |
What the future impact of the ACA would be on community health centers, which provide primary health care to vulnerable low-income, uninsured and undocumented populations, was unclear when the law was passed. Many experts thought newly insured patients would switch to private providers to use their new health benefits, costing community health centers patients and government funding.
However, this study reports that most community health centers are not only retaining previously uninsured people reluctant to leave existing doctor-patient relationships, but they’re also attracting newly insured people and treating a larger share of the remaining uninsured people as well.
“Some people felt the quality of care at their community health center was better than what a new, private provider offered,” said Steven P. Wallace, associate director of the center and lead author of the study. “They’re sticking with the tried and true.”
Study findings were based on interviews conducted from 2014–2016 with the staff of 31 community health centers (CHCs) in areas with high concentrations of uninsured and immigrant populations in New York and California, where Medicaid was expanded, and Georgia and Texas, where it was not.
High demand by people with insurance and those without
The number of insured people who used community health clinics nationwide increased 35 percent from 2010 to 2014, from 12 million to 16.5 million people, according to U.S. Health Resources and Services Administration data. That increase was reflected in the four case study states in the research. California had the highest jump, a 61 percent increase to 2.7 million patients; Georgia had the smallest, 26 percent, to 198,000.
The HRSA data also reported the number of uninsured people who used CHCs remained high at about 6 million people nationwide in 2014. States in the center’s study accounted for 2 million of them. In Georgia and Texas nearly half of the people who used CHCs were uninsured, followed by California and New York, with 27.5 and 18.6 percent, respectively. In sheer numbers, community health clinics in California — which serve nearly the same number of uninsured people as clinics in New York, Texas and Georgia combined — provided care to more than 1 million people without health insurance.
The number of immigrants seeking care at community health clinics grew 12 percent between 2010 and 2014, to 5.3 million, according to the study. The study reports that immigrants are an increasingly large share of the people using clinics, and many of them are not eligible for federal funding for health insurance coverage due to their legal status. This is especially consequential in California where about one-third of CHC users are immigrants. However, as the state and some counties provide certain categories of otherwise uninsured low-income immigrant residents with insurance or other coverage, this proportion may be lower than in states with no protections.
“Community health centers are a critical — and sometimes the only — source of care for residents of California who are undocumented,” said Maria-Elena Young, a graduate student researcher at the center and co-author of the study. “These centers play a vital role in ensuring the well-being of community members who are excluded from many services.”
Fears of a ‘fiscal cliff’
The study also reports that federal grants prompted by the ACA gave a much-needed infusion of funding to help serve the growing numbers of people using community health centers. This was particularly true in states that didn't expand Medicaid or take other measures to help low-income or uninsured patients gain coverage, which left the proportion of uninsured patients almost unchanged. Those funds also helped CHCs increase the availability of pharmacy, mental and dental health services.
But because much of the additional funding is temporary, clinics face significant financial challenges in the future and need stable revenue streams. Also, many clinics are unsure how changes in Medicaid reimbursement policies will affect their financial footing. The study notes that adult primary care receives the least federal funding and grants from foundations, putting continued services to that population at the most risk.
Staffing is another challenge. The ACA requires more specialized paperwork to track service quality, computerized patient record keeping, and other administrative tasks, and that cost is not reimbursed.
“The financial success of community health centers depends on their ability to successfully improve quality and coordinate care, and these improvements will require staff and resources,” said Nadereh Pourat, director of research at the UCLA Center for Health Policy Research. “When patients are high-need, CHCs have to hire more staff and use more resources to be successful. And that costs money.”
The study, supported by the Commonwealth Fund, also reports community health clinics in the study face difficulties recruiting and keeping registered nurses and doctors, because clinic salaries are less competitive than in private industry.
The authors of the study recommend both state and federal policy to permanently maintain and enhance core federal funding for community health clinics, insure the remaining uninsured in both expansion and non-expansion states, increase workforce availability by reimbursing CHCs for essential nonclinical services, and help CHCs prepare for changes in Medicaid reimbursement policies.
| | 10/26/2016 | 258 | | Approved | 10/22/2016 9:15 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 10/26/2016 12:33 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | Find data on the economic status of seniors in all 58 California counties using our new Elder IndexTM online dashboard. The Elder Index is a more accurate measure of how much it costs seniors to live in California than outdated federal poverty level (FPL) guidelines that ignore regional differences in living costs.
The user-friendly dashboard enables you to quickly find estimates on how much money it takes for California's elderly to make ends meet at the local level. The new format includes information on 6 new family types of senior households for a total of 12 different household arrangements, ranging from a single elder living alone to complex 3-generation households.
You can search, sort and compare data using simple pull-down menus for categories such as county of interest, household type (renter or owner), and whether adult children or grandchildren are part of the household.
The resulting visuals include an at-a-glance county snapshot, a bar chart that compares your county result to other counties in the state, and a thematic map to show regional cost trends. The information can be downloaded as a PDF or an Excel spreadsheet.
"This is the most comprehensive online collection of data on the economic well-being of California seniors," said D. Imelda Padilla-Frausto, Center graduate student researcher. "And this new tool makes it even easier to see how inadequate current poverty measures are in high-cost states like California."
Padilla-Frausto spearheaded the effort to make the Index more accessible in collaboration with California Health Interview Survey Project Coordinator Bogdan Rau.
Search the new Elder Index dashboard here.
The Elder Index is a tool developed by the UCLA Center for Health Policy Research and the Insight Center for Community Economic Development. The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health policy information for California. The Center improves the public's health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 9/27/2016 | 255 | | Approved | 9/12/2016 3:18 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 9/26/2016 3:52 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | | | UCLA Center for Health Policy Center | | | | | | | | | | | | Publication | | | | | | | 
Disparities in survey estimates of the uninsured. Lack of diverse scholars to study aging minority populations. Absence of smoke-free housing in low-income, densely-populated communities. Researchers from the UCLA Center for Health Policy Research are tackling these critical health policy topics and will share their knowledge in three special sessions at the 2016 American Public Health Association (APHA) annual meeting in Denver, Colorado.
These sessions are among 45 APHA presentations that feature Center staff or California Health Interview Survey data. More than 12,000 public health professionals, medical providers, media and others from across the nation are expected to attend the Oct. 29–Nov. 2 event to get a first look at new health research, emerging health issues, and strategies to promote health equity.
Center participants include Center Director Gerald Kominski, Associate Center directors Ninez Ponce and Steven P. Wallace, Director of Research Nadereh Pourat, new California Health Interview Survey Director Todd Hughes, Health DATA Director Peggy Toy, and other faculty associates, researchers, statisticians and support staff. FREE Center publications, pens, bears and other materials will be available at our APHA exhibit booth #720.
Among the roundtables, oral presentations, and posters featuring Center staff and data:
A special session on the reasons behind inconsistent figures in national and state surveys of the uninsured population A special symposium on ways to support research on health disparities among aging minority populations, particularly among diverse scholars A special session on national smoke-free housing efforts that features three presentations by Center staff on an ongoing campaign to encourage smoke-free housing in Los Angeles An oral presentation on why ACA-eligible populations remain uninsuredAn oral presentation identifying barriers to enrollment using consumer experiences with Covered California Discussions on educating lay health workers to increase cancer screenings among Asian ethnicities A poster presentation on developing questions that accurately measure gender identity
See a complete list of all Center and CHIS-related APHA presentations here. The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health policy information for California. The Center improves the public's health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 9/27/2016 | 256 | | Approved | 9/22/2016 12:17 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 9/27/2016 3:42 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | UCLA Center for Health Policy Center | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | The UCLA Center for Health Policy Research awarded $140,000 in grants to eight community organizations whose outreach pilot projects will increase use of community preventive services among low-income African-Americans and Latinos age 50 and older in South Los Angeles.
Getting simple preventative health care, such as flu shots and cholesterol tests, can save lives and money. Yet participation rates for underserved groups are far below ― sometimes half ― that of national goals for preventive health care, according to Center research.
The Center's Health Aging Partnerships in Preventative Initiative (HAPPI) awarded the grants with funding from the U.S. Department of Health and Human Services. Grant recipients will partner with Southside Coalition of Community Health Centers and other health providers, who will provide preventive care:
Recipients of $20,000 award/Participating clinic
Black Women for Wellness/To Help Everyone Clinic New Vision Christian Fellowship/ To Help Everyone Clinic Girls Club of Los Angeles/ To Help Everyone Clinic Worksite Wellness LA/ South Central Family Health Center Los Angeles Metropolitan Churches/South Central Family Health Center Esperanza Community Housing/St John's Well Child and Family Center
Recipients of $10,000 award (Participants choose their provider)
The pilot projects aim to improve awareness among older African-Americans and Latinos of the benefits in using clinical preventive services. Projects will also increase clinics' capacity for providing six types of those services ― mammograms, pap smears, colon cancer screenings, cholesterol tests, and flu and pneumococcal immunizations.
South LA seniors are at high risk of having easily-preventable health conditions and diseases," said Peggy Toy, director of the Center's Health DATA Program and HAPPI project director. "These grants will empower the groups that know their communities best to enable them to get the preventive care they need and which everyone should have access to."
According to a Center study that guided development of the pilot projects, national flu shot rates for African-Americans and Latinos 65 and older in 2012 were 52 percent and 58 percent, respectively. These rates are more than 30 percentage points below the national Healthy People 2020 goal of 90 percent.
Rates of colorectal screening for Latinos and African-Americans age 50-75, 47 percent and 55 percent, respectively, were also far below the Healthy People 2020 Goal of 71 percent. Center Faculty Associate Janet C. Frank and Kathryn Kietzman, evaluation director of HAPPI, co-authored the study.
| | 9/14/2016 | 254 | | Approved | 8/30/2016 9:41 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 9/13/2016 12:44 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | How much does the health of California workers compare from industry to industry? Which workers have the highest, or lowest, rates of health insurance? You can now search and easily compare health, demographic and insurance topics by industry and occupation on the free web query tool AskCHIS.
According to 2014 data, workers in education, health care and social assistance had high rates of excellent/good self-rated health and health coverage ― more than 90 percent of this group had insurance.
Conversely, nearly 40 percent of workers in agriculture, forestry, fishing, hunting, and mining lacked health insurance, the highest uninsurance rate of all industry groups.
AskCHIS now offers 14 industry and 13 occupation categories:
Industry categories:
• Agriculture, Forestry, Fishing, Hunting, Mining
• Construction
• Manufacturing
• Wholesale Trade
• Retail Trade
• Transportation, Warehousing, Utilities
• Information
• Finance and Insurance, Real Estate, Rental, Leasing
• Professional, Scientific, Management
• Educational Services, Health Care, Social Assistance
• Arts, Entertainment, Recreation, Accommodation, Food Services
• Other Services, Except Public Administration
• Public Administration
• Military
Occupation categories:
• Management, Business, and Financial
• Computer, Engineering, and Science
• Education, Legal, Community Service, Arts, and Media
• Healthcare Practitioners and Technical
• Service
• Sales and Related Occupations
• Office and Administrative Support
• Farming, Fishing, and Forestry
• Construction and Extraction
• Installation, Maintenance, and Repair
• Production
• Transportation and Material Moving
• Military Specific
The new industry and occupation (I & O) indicators in AskCHIS are coded with the help of the National Institute for Occupational Safety and Health's (NIOSH) Industry & Occupation Computerized Coding System (NIOCCS). NIOCCS is a web-based system that classifies industry and occupation responses into standardized codes that match the U.S. Census 2010 I & O classification scheme.
Log onto AskCHIS and search the sequence Topic>Select a category>Demographic>Employment to find indicators by industry and occupation.
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 8/31/2016 | 252 | | Approved | 7/20/2016 10:49 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 8/30/2016 11:07 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | | | | | | | | | | | | | | | Publication | Public Funds Account for Over 70 Percent of Health Care Spending In California | 1547 | | | | | Contrary to the notion that the country’s health care is primarily a privately funded system, 71 percent of health care expenditures in California are paid for with public funds, according to a new analysis by the UCLA Center for Health Policy Research.Nationally, federal and state taxpayer dollars directly paid for about 45 percent of health care expenditures in 2015 through insurance programs such as Medicaid, Medicare and programs for low-income children, according to a 2015 estimate from the Centers for Medicaid and Medicare Services.But that figure may be vastly underestimated, say the authors of a new UCLA policy brief, who used a more comprehensive framework to analyze public spending California. Their analysis found that if additional sources of public spending are factored in — such as county public health expenditures and new Affordable Care Act subsides — the public spending rate would be much higher. Add foregone revenue from tax subsidies for employer-based health insurance, and the share of public funds used to pay for health expenditures is approximately 71 percent, the study reports.“The public sector is the primary player in health care spending,” said Gerald Kominski, director of the UCLA Center for Health Policy Research who led the study. “But monies are disbursed in a fragmented way through numerous different entities, each of which has their own system and way of doing things. The question for policy makers is, ‘does this fragmented approach make sense?’”In California, public funds will pay for 71 percent ($260.9 billion) of a projected $367.5 billion spent on health care in 2016, according to the study. Medi-Cal/Healthy Families expenses take the biggest bite, 27 percent, followed by Medicare at 20 percent. Tax subsidies for employer-sponsored insurance (the foregone taxes) account for a significant 12 percent of public spending.Given the dominance of public spending in health care, the authors noted that a single-payer system might be more feasible than previously thought.
“For a majority of Californians, a public-run system is already the reality,” said Andrea Sorensen, a graduate student at the UCLA Fielding School of Public Health, who co-authored the study. “A single-payer system could unite all these various programs and expand them to the entire population, resulting in a more streamlined and cost-effective approach to health care spending.”The other publicly funded programs include: • Government spending on public employee insurance, 4 percent• County-level public health expenditures, 3 percent• Other government health programs such as VA expenditures, 3 percent• Affordable Care Act subsidies, 2 percentThe remaining 29 percent ($106.6 billion) of health care expenditures are paid out of private funds:• employer-sponsored group insurance, 16 percent• enrollee expenses for premiums, 6 percent• out-of-pocket expenses for covered benefits, 4 percent• individually purchased insurance, 3 percent
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
| | 8/31/2016 | 253 | | Approved | 8/24/2016 9:17 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 9/5/2016 11:30 AM | i:0#.f|uclachissqlmembershipprovider|venetia | | | | | | | | | | | | | | | Publication | | | | | | | Todd Hughes, a survey implementation expert and methodologist who helped lead national data collection efforts for the U.S. Census Bureau, will join UCLA on Sept. 12 as the new director of the California Health Interview Survey (CHIS), the nation’s largest state health survey. Conducted by the UCLA Center for Health Policy Research since 2001, CHIS interviews of thousands of Californians on a continuous basis to provide valuable health data to inform the efforts of organizations and policymakers at the local, state, national and international level.
Hughes started his career two decades ago knocking on doors as a Census Bureau field worker. He rose to become the assistant division chief of the American Community Survey, the largest ongoing household survey in the nation.
“Todd brings the kind of cradle-to-grave survey research experience CHIS needs to maintain its status as one of the nation’s leading health surveys,” said Ninez Ponce, CHIS principal investigator and professor in the UCLA Fielding School of Public Health. “And he also brings a strong track record of innovation in both research and methods that will be critical to our efforts to keep CHIS at the cutting edge.”
CHIS is particularly known for its large sample of many traditionally under-surveyed racial, ethnic and sexual minority groups. It is also nationally recognized for AskCHIS and AskCHIS Neighborhood Edition, which provide health experts, journalists and ordinary people with free, easy access to California health statistics, from the statewide level to individual ZIP codes.
“I’ve been very impressed by the way CHIS works to democratize data and make it possible for all Californians to understand their health and the health of their communities,” said Hughes. “And I’ve been impressed by the strong research mindset of the survey and their innovative efforts to improve data quality.”
Hughes was a junior at Brigham Young University in 1996 when he first worked for the Census Bureau conducting face-to-face interviews for various surveys.
“That experience was very helpful for me,” Hughes said. “In order to understand the quality of data a survey collects from households, you must understand the nature of the interactions that take place between a survey interviewer and the person being interviewed, and I’m glad I experienced that firsthand for two years.”
After graduating from college, Hughes moved into a supervisory position at the Census Bureau, overseeing a staff of up to 110 field representatives engaged in data collection for the Current Population Survey and other surveys in the 10-state Denver region.
He later moved to the American Community Survey (ACS), which at the time was a new survey, still in the demonstration stage and being conducted in just one-third of U.S. counties. Hughes, who first served as a Washington D.C.-based survey liaison for 12 regional ACS offices and later as a supervisory statistician in charge of nationwide face-to-face and telephone data collection, played a key role in implementing the ACS on a nationwide basis.
Hughes also successfully worked on the Census Bureau’s behalf to sustain federal resources for survey research during lean budgetary times. In 2011 he worked with the White House Office of Management and Budget and supported efforts with lawmakers on Capitol Hill to justify a $40 million increase of the ACS budget to expand the survey’s research sample and, consequently, the quality of the survey’s data.
"It was a big accomplishment for the survey, and I was proud to be a part of that effort,” Hughes said.
In 2008 he was promoted to assistant division chief for the ACS, a role in which he helped oversee a 3.5-million household survey with an annual program budget of as much as $250 million. During his tenure, he pioneered new efforts to increase survey response rates, including an internet response option that was estimated to save the survey $9 million in data-collection costs, as well as changes in ACS mail methodology and adaptive design principles on follow-up methods.
Hughes’ tenure at the ACS has been notable for its broad scope. In his most recent position, he served first as assistant division chief for data collection and then for survey methods and measures.
Hughes will be the fourth director of CHIS, which was started nearly 15 years ago by renowned UCLA scholar and Center founding director, E. Richard Brown.
“We were seeking someone who could provide operational excellence in every facet of survey work,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “Todd fits the bill. He has that very rare combination of a detailed understanding of survey research paired with the big picture skills that will help secure Rick Brown’s vision of CHIS as a state-based survey with national significance.”
Hughes holds a master's certificate in project management from the George Washington University School of Business and Public Management and a bachelor of science in statistics from Brigham Young University.
Originally from Utah, Hughes is happy to be returning to the West to his wife Tanya’s home state of California.
Edited by Judy Lin for UCLA Newsroom | | 7/27/2016 | 251 | | Approved | 7/20/2016 10:43 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 7/27/2016 12:48 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Persistent Racial and Ethnic Disparities in Flu Vaccination Coverage (American Journal of Infection Control) | 1538 | | | The immunization picture is improving statewide, say UCLA researchers, but it's still low | | More than 60 percent of all adults in California fail to get an annual flu shot, according to a new journal article by UCLA researchers that also found wide disparity in flu immunization rates among Asian subgroups.
Using California Health Interview Survey data for 2011-12, the article, which was published in the American Journal of Infection Control, reports immunization rates for two adult Asian ethnicities in the state — Koreans and Vietnamese — were the highest at 48.9 percent and 46.7 percent, respectively, compared to a 40.2 percent rate for whites. Rates for other ethnic groups studied — Latino, Japanese, Chinese, Filipino, South Asian, Asian other, and other — were not significantly different from whites. African-Americans had the lowest rate of the groups studied, 28.5 percent.
Statewide, the immunization picture improved, with 1 in 3 adults participating in 2011-2012 compared to 1 in 4 in 2005, according to the article. An advisory committee of public health and medical experts, which makes recommendations to the Centers for Disease Control and Prevention on vaccines and disease control, advocates an annual flu shot starting at the age of 6 months to reduce the chances of contracting a potentially debilitating flu virus.
“It’s important to get the word out,” said Ninez Ponce, associate director of the UCLA Center for Health Policy Research and one of the article’s co-authors. “Some public health groups and ethnic media are better at communicating the importance of getting a flu shot.”
For instance, Ponce said studies report more flu shots among Vietnamese in Santa Clara County, which has a strong public health infrastructure and community-based organizations that promote the importance of being immunized, and some Korean media regularly feature consumer stories on flu shot immunization.
According to previous studies, low household income and concern that getting a flu shot could result in a severe case of flu are factors in low immunization rates among African-Americans and other racial and ethnic groups.
“That means African-Americans are at high risk of being infected with the flu,” said Dr. Christopher Almario, assistant professor of medicine at Cedars-Sinai Medical Center and lead author of the study. “Knowing who isn’t participating can help us target those groups, encourage them to get flu shots, and keep them healthy during flu season.”
Read the study: Persistent racial and ethnic disparities in flu vaccination coverage: Results from a population-based studyThe UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 6/29/2016 | 248 | | Approved | 5/31/2016 2:21 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 6/28/2016 10:52 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | Updates to the Adult Health Profiles released today by the UCLA Center for Health Policy Research incorporates estimates from the 2013-2014 California Health Interview Survey (CHIS) that are accessed through a new interface that makes it easier and faster to view and understand authoritative health information.
Adult Health Profile contain key health and demographic estimates on California’s diverse population, available by region, county, Los Angeles Service Planning Area (SPA), and San Diego Health and Human Services Agency region. These profiles can now be accessed through a new, dynamic dashboard that provides quicker and easier access to data and visualizations.
“In addition to using the latest CHIS data, we’ve made some significant improvements to our interface, giving our users the option to either query health estimates for their county on our dashboard, or download the classic double-sided hard copy of the report,” said Bogdan Rau, CHIS project coordinator.
See the 2013-2014 Adult Health Profiles here.
| | 6/29/2016 | 249 | | Approved | 6/15/2016 11:38 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 6/28/2016 10:54 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | An Innovative Project Breaks Down Barriers to Oral Health Care for Vulnerable Young Children in Los Angeles County | 1535 | | | UCLA–First 5 LA initiative aims to improve California’s low rates of child dental services | | An innovative program that serves low-income and uninsured children in Los Angeles, the UCLA–First 5 LA 21st Century Dental Homes Project, has more than tripled preventive dental visits for children from birth to age 5, according to a new policy brief by the UCLA Center for Health Policy Research.
Some parents think that because their children’s primary teeth, or baby teeth, naturally fall out, they don’t need to be cleaned and checked. However, the American Academy of Pediatric Dentistry recommends a first dental exam between eruption of a child’s first tooth and age 1. Preschoolers’ teeth also need to be brushed daily with fluoride toothpaste, according to the academy.
Dentists and public health experts have long understood the need for improved dental care for children. About half of children in the U.S. have not seen a dentist in the past year, according to the Agency for Healthcare Research and Quality. Data from Denti-Cal, California’s dental Medicaid program, show that in Los Angeles County, more than 530,000 children from birth to age 5 covered by Medi-Cal had not seen a dentist in the past year. A recent statewide survey by the Dental Health Foundation reported that more than 50 percent of California children have tooth decay by the time they enter kindergarten. And, according to 2014 federal data, California ranks seventh-lowest in use of preventive dental services by children enrolled in Medi-Cal and Denti-Cal.
“The majority of young children aren’t receiving crucial preventive and oral health services that they need,” said Nadereh Pourat, director of research at the center and co-author of the study. “Avoiding cavities in primary teeth promotes healthy teeth for the rest of their lives.”
Number of preventive procedures triple
Over a two-year period, the 12 health centers participating in the project increased the number of preventive visits for procedures such as cleaning teeth and applying fluoride in children up to 5 years old from about 3,000 to more than 10,000. They also doubled the number of visits for child dental treatments, such as filling cavities, and diagnostic services, according to the study.
“Oral health is an essential part of a child’s development and this program is key to supporting health systems to better meet those needs,” said Kim Belshé, executive director of First 5 LA. “The learning from this program will help to address barriers that limit children’s access to necessary dental services.” The project, begun in 2012 and ending this year, was funded by a $9.3 million contract from First 5 LA and the program is being evaluated by the center.
Project strategies used to overcome barriers include outreach to parents; improvements in clinic infrastructure; and training of child care workers, dental professionals and medical professionals to deal with the very young, sometimes squirmy and apprehensive patients.
All health centers involved in the UCLA–First 5 LA 21st Century Dental Homes Project offer dental and primary care services, making it easier for parents to schedule both medical and dental visits.
“Although the project served children in low-income areas, the methods it used to overcome barriers to delivering dental care can be applied universally,” said Dr. Jim Crall, professor and chair of the public health and community dentistry division at the UCLA School of Dentistry and lead author of the brief.
Barriers to child dental care and solutions
The project also focused on other barriers that limit children’s access to dental services, such as a dearth of Medi-Cal dental providers and a lack of confidence among dental providers in how to deal with young patients.
The UCLA–First 5 LA 21st Century Dental Homes Project remedied those problems by providing technical expertise; developing infrastructure; training medical and dental providers on how to deliver care to young children; developing training for child care workers to train parents; and more.
The clinics’ successes were celebrated on June 17 at an awards ceremony in downtown Los Angeles. During a keynote address, Carole D’Elia, executive director of the Little Hoover Commission — which recently issued a report on fixing Denti-Cal — congratulated project participants for improving care for young children in Los Angeles’ underserved communities.
Co-author Pourat said, “Improving oral health of young children is a complex challenge and requires a comprehensive approach.”
See the policy brief: An Innovative Project Breaks Down Barriers to Oral Health Care for Vulnerable Young Children in Los Angeles County
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 5/31/2016 | 247 | | Approved | 5/16/2016 9:58 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 5/31/2016 6:49 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | California Health Interview Survey | Publication | | | | | | | Updates to AskCHIS Neighborhood Edition (NE)©, released today by the UCLA Center for Health Policy Research, include 2013-2014 estimates from the California Health Interview Survey (CHIS), new non-CHIS data, and changes that make finding quality, authoritative health information easier and faster.
To further the Center's mission of making critical health information available for all to use, AskCHIS NE now includes additional non-CHIS measures related to air quality and pollution burden from the California Office of Environmental Health Hazard Assessment and income inequality -- the GINI index -- from the American Community Survey (ACS).
Also, the dashboard now includes socio-demographic visualizations for each queried location, providing contextual information such as race/ethnicity groups, poverty level distribution, and population by age.
"The newest update to AskCHIS Neighborhood Edition brings valuable contextual information about communities across California," said Bogdan Rau, CHIS project coordinator. "From pollution burden, to ozone concentration, to contextual socio-demographic visualizations, these new data will help our users paint a better picture of California’s local communities."
| | 5/19/2016 | 245 | | Approved | 4/12/2016 2:53 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 5/19/2016 9:58 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | | | | | | | | | | | | | | | Publication | Implementing Aid in Dying in California: Experiences from Other States Indicates the Need for Strong Implementation Guidance | 1486 | | | Many – including doctors -- are unfamiliar with new physician-aided dying law | | As California nears implementation of a new law that will let terminally ill patients end their lives by taking a physician-prescribed lethal dose of medication, a new policy brief from the UCLA Center for Health Policy Research shows that health organizations, health care providers and the public have a critical gap in understanding how the law will work.
Though the End of Life Option Act, which applies only to people who are terminally ill and have fewer than six months to live, takes effect June 9, the study released today indicates that California health organizations lack vital information about aid in dying (AID) that could help doctors effectively and comfortably implement the new law. Families also lack information on end-of-life care or how to help loved ones who are considering end of life options.
According to the study, doctors and other health providers say they need more guidance on aid in dying. Among the primary questions doctors and other health professionals have: How do they properly prescribe medication? What does the law permit? Are they legally liable, if there are complications? Can they opt out of participating in AID and refer the patient elsewhere?
“Many people are unsure what the new law entails, and I hope this study can answer questions, and ultimately, help legislators take steps to improve all aspects of end-of-life care,” said Cindy Cain, faculty associate at the UCLA Center for Health Policy Research and author of the study, which also catalogs lessons learned from similar laws implemented in other states.
The passage of aid in dying laws has accelerated as baby boomers age and medical advances extend life, sometimes beyond comfort. California is the fifth state in the country to legalize or allow assisted death, joining Oregon (1994), Washington (2008), Montana (2009), and Vermont (2013), according to the Death with Dignity National Center.
However, the UCLA study reports the number of people who die each year from taking a doctor-prescribed dose of lethal medication is very low — 105 in Oregon in 2014, a rate of 31 physician-assisted deaths per 10,000 total deaths in the state, according to the Oregon Health Authority. The study notes a persistent gap between the number of people who request a prescription and those who die from a dose. For instance, in Oregon in 2014, 105 of the 155 people who were prescribed took the lethal dose. In Washington, 126 of 176 people did so.
“Having a choice in the matter may itself provide comfort to a terminally ill person,” Cain said. “Having that prescription in hand might give them a feeling of control, whether they ultimately use it or not.”
Patient protections
Ethical concerns over aid in dying methods have been raised, including the fear that physically disabled, uneducated, and underserved populations will be encouraged to choose it. However, the study reports that people who chose aid in dying in Oregon and Washington were primarily white, 65 or older, college educated, with private insurance. Another concern is the method will be used instead of palliative care — care that provides comfort, but is not intended to cure diseases — but the study reports palliative use in Oregon increased after the aid in dying law was passed.
The California law includes safeguards to prevent the possibility that a patient is being coerced into hastening death or has impaired thinking while making the decision: the attending doctor must confirm the patient has six months or fewer to live, is mentally stable, and is informed of other options; the patient must orally request aid in dying twice and provide a written request with signatures from witnesses. In addition, a consulting doctor must certify the patient’s diagnosis, prognosis and confirm the request for aid in dying.
Education, guidance for physicians, others needed
Cain said interdisciplinary groups with medical and legal expertise, professional organizations and formal and informal professional networks have an opportunity to provide more education and support on the aid-in-dying process to doctors and help address any of their concerns.
In addition, she recommends state policymakers make changes to refine data collection around aid in dying, and that professional organizations and health care provider groups improve and collect data for all forms of end-of-life care to ensure that it puts the terminally ill patient’s interests first.
The recommendations:
• Collect more complete data on aid in dying. Although the law requires that physicians complete a form recording prescriptions dispensed and a follow-up report after death, it should require more detailed data, such as asking the patient in advance their reason for requesting aid. Documentation should be requested at each step of the process, instead of just at the end. Finally, other data should be collected from patients, such as what disabilities they have besides the terminal illness.
• Improve data collection on all forms of end-of-life care. Life-ending practices, such as withdrawal of disease treatment and withholding of life-sustaining nourishment, do not require documentation, so little data exist on such practices. Having such data would help providers understand how families make decisions and what supports are necessary. An example of an area to be improved: the AID law also doesn’t require health care providers who prescribe the medication to give guidance or support to the family through decision-making or ingestion.
• Educate through outreach. Health organizations and professional organizations should offer outreach programs to inform state officials, the general public, and health providers about aid in dying. This will help state officials better understand and oversee the AID process, the public improve end-of-life decision-making, and providers become more competent and comfortable with discussing and being part of patients’ end-of-life concerns.
“The combined effort of legislators, doctors and the public is needed to ease the final days of what should be the focus of our attention, the critically ill patient,” Cain said.
| | 5/2/2016 | 246 | | Approved | 4/20/2016 11:02 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 5/9/2016 11:20 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Sue Ducat | | | 202-361-5115 | | | | | 652 | | N | | | | Publication | | | | | | | For more than a decade, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the world's largest AIDS assistance program, has allocated one-fifth of its budget, or $5.2 billion, strengthening health systems in poor countries that have high rates of AIDS.
Center Faculty Associate Corrina Moucheraud and coauthors analyze how much money each nation devotes to this segment of the program's investments in the May issue of Health Affairs, and found that the countries with the biggest PEPFAR budgets also had the smallest shares allocated to health systems -- and this relationship remained even controlling for a country's HIV burden.
The ambitious PEPFAR program was launched in 2003 in 15 AIDS-ravaged countries, now 35 countries. One goal was to strengthen the capacity of local public and private health systems to deliver AIDS and HIV services. Using PEPFAR budget data for 2004-2014, authors analyzed how PEPFAR funds were allocated in five program areas – prevention, care, treatment, management /operations, and governance/systems – focusing on the latter.
They found that budgets for countries in sub-Saharan Africa, primarily those with the biggest PEPFAR budgets, consistently had smaller allocations for health systems, which suggests a persisting gap in funds for health system strengthening in some of the countries where existing systems are weakest. The article reports a lack of consensus in what “strengthening a health system” means, which stymies effective assessment of the program.
Authors also discuss criticism that narrow disease-focused programs like PEPFAR have generally done too little for broad system strengthening in poor countries where donors substantially support the health sector -- so when a crisis like Ebola strikes, these chronically under-resourced health systems may struggle to respond effectively.
| | 4/27/2016 | 228 | | Approved | 9/1/2015 2:19 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 4/26/2016 10:37 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | UCLA Center for Health Policy Research | 310-794-6963 | | | | | 1092 | | Y | | | Mental and Emotional Health | Publication | The Mental Health Status of California Veterans | 1489 | | | UCLA study finds that percentage of ex-military who need care is roughly the same as that of general population | | Seventy-six percent of California veterans in need of mental health care from 2011 to 2013 either didn’t receive treatment or received inadequate care, according to a new study by the UCLA Center for Health Policy Research. But the share of veterans who needed mental health care was no greater than that of the general population, despite common perceptions that veterans are more likely than others to need care.
Using data from the California Health Interview Survey for 2011 to 2013, researchers found that 90,000 California veterans who had served in the military for at least a year, or 3.5 percent of the state’s veterans, needed mental health care. For nonveterans in California, the figure is 3.9 percent.
Linda Diem Tran, lead author of the policy brief, said the CHIS survey covers a broader swath of the veteran population than studies that draw their data from the U.S. Department of Veterans Affairs. Only about 40 percent of veterans are enrolled in VA programs, and VA data on mental health tends to include more severe cases.
“Much of the data that exists is not representative of the total population of veterans,” Tran said. “Our study is one of the few to make estimates based on all the veterans in California, and it finds that the stereotype that veterans have more mental health needs than everyone else may not be true.”
However, the UCLA study did find that veterans are more likely to contemplate suicide than nonveterans. The research found that 9.1 percent of California veterans had seriously considered suicide, compared to 5.6 percent of nonveterans. Thoughts of suicide and the need for mental health assistance are measured differently in the study’s methodology. (Veterans are also disproportionately likely to kill themselves; a previous study by the VA reported that more than 20 percent of suicides in the U.S. from 2009 to 2012 were veterans.)
Among those veterans with mental health needs, 68.8 percent reported visiting a health professional for their mental or emotional health. Among nonveterans who needed mental health care, 50.1 percent went without treatment.
But the study found that nearly 46 percent of all veterans with mental health needs did not receive adequate care, which the study authors defined as four or more visits with a health professional and use of prescription medication for mental health within the previous year.
California’s 2 million veterans made up an average of 7.2 percent of the state’s population between 2011 and 2013.
Veterans most in need of mental health care
The study uncovered which veterans tend to be most in need of mental health care. Among the findings:
3 in 5 veterans in need of mental health care are white. About 20 percent in need of care are Latino — a disproportionately high figure, considering that Latinos make up only 14.9 percent of the veteran population. Nearly 4 in 5 were disabled due to a physical or mental health condition. 1 in 4 with mental health conditions lived in poverty. 4 in 5 had less than a bachelor’s degree, and 1 in 5 reported an income below the federal poverty level.
The study recommends increasing California veterans’ access to mental health services and identifying strategies to help veterans sustain their treatment.
Other suggestions include standardizing mental health screenings by integrating them with physical health services, which would take advantage of the fact that 88 percent of veterans see a primary care doctor; reducing the stigma associated with mental health by educating veterans and their families about mental health; supporting long-term suicide prevention efforts; and continuously evaluating veterans’ mental health status throughout their lives, not just when emergencies arise.
Because of the small number of women veterans, women were not included in the study. The authors note that their mental health needs will need to be examined and addressed in future studies.
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 4/6/2016 | 243 | | Approved | 3/16/2016 10:56 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 4/6/2016 10:14 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Jonathan Bash | jonathan@brownmillerpr.com | | (925) 370-9777 | Terry Kanakri | | | 310-794-2172 | 1304 | 1202 | N | N | | | Publication | Unequal Protection: Secondhand Smoke Threatens Health of Tenants in Multi-Unit Housing in Los Angeles | 1484 | | | UCLA-led coalition launches citywide effort to promote smoke-free apartments | | Eight of 10 Los Angeles apartment dwellers are not protected from secondhand smoke, and an even bigger percentage — 82 percent — would support smoke-free policies in their buildings, according to a pair of new studies by the UCLA Center for Health Policy Research.
The research was released today to coincide with the kickoff of a new citywide campaign to reduce secondhand smoke in multi-unit apartment buildings. (Read the studies of tenants and landlords).
The two studies outline findings from nearly 1,000 door-to-door interviews with tenants in some of the most densely populated areas of the city of Los Angeles, as well as reports submitted to UCLA by 93 owners of apartment buildings, who collectively represented more than 5,400 units.
Significant support for smoke-free policies
Although just 20 percent of apartments are covered by smoke-free policies, 82 percent of tenants said they would prefer to live in a smoke-free apartment — and those who smoke were even more likely (85 percent) to support such a policy.
In addition, 55 percent of landlords expressed support for smoke-free policies, citing reasons that included the value of creating a healthy environment, lowering maintenance costs and increasing their properties’ marketability. Landlords with policies already in place unanimously reported that the guidelines have had no negative effect on vacancy rates.
“Our findings send a strong message to property owners that renters want healthy, smoke-free homes,” said Ying-Ying Meng, the lead author of both studies and co-director of the UCLA Center for Health Policy Research’s Chronic Disease Program. “Tenants want clean air in their homes and common areas. Landlords recognize that it literally pays to be smoke free due to the extra expense and liability of permitting smoking.”
Secondhand smoke is dangerous at any level and can lead to heart disease, lung cancer, stroke and asthma. Children and the chronically ill are particularly vulnerable.
Thirty-seven percent of apartment tenants in the study reported smoke drifting into their home from another apartment or a common area. Households where a child, someone who is chronically ill or a person of color lives were even more likely to be exposed. But there is currently no ordinance in the city of Los Angeles that prohibits indoor smoking in apartments and condominiums, even in common areas where children frequently play.
Confusion about implementation
With such strong support for smoke-free policies, why aren’t more tenants covered? According to the study, a majority of landlords either have never thought about the issue or weren’t aware that they could implement a smoking policy. Many landlords also assume that the city alone is responsible for smoking regulations, when in fact property owners have the right to make decisions regarding smoking on their properties.
“Landlords understand how expensive it can be to have someone smoke in one of their units,” said Joe Patel, president of the Apartment Association of Greater Los Angeles, the city’s largest organization representing owners and managers. “It can cost up to $15,000 to renovate a smoker’s unit, not including the immense health costs of secondhand smoke and the potential for liability if a neighbor gets sick. Unfortunately, this reality has yet to translate into smoke-free policies due to a lack of awareness. Our new campaign is going to change that.”
Smokefree Apartments Los Angeles campaignTo help tenants breathe easier, the Center for Health Policy Research, with funding from the Centers for Disease Control and Prevention, has partnered with the Apartment Association of Greater Los Angeles as well as CDTech, a nonprofit community development agency; FAME Corporations, a nonprofit that addresses social and economic inequalities in Los Angeles; SAFE, an advocacy group and registry of smoke-free apartments; the American Lung Association; the Los Angeles County Department of Public Health and other organizations, to launch Smokefree Apartments Los Angeles.The campaign will inform tenants about the risks of secondhand smoke and provide them with the tools they need to work with their landlords about voluntary smoke-free policies. The campaign will also offer assistance in implementing voluntary smoke-free policies for property owners and managers across the city. Billboards, bus shelters, print ads, social media ads and direct mail will carry the message, “It’s time for all L.A. to breathe easy,” and include a link to the campaign’s website, www.smokefreeaptsla.org.“We have an incredible opportunity to spark long overdue changes that will protect renters’ health and landlords’ bottom lines,” said Marlene Gomez, the campaign’s manager. “Together we’re going to ensure that all of L.A. can breathe easy in their own homes.”Read the policy brief: Unequal Protection: Secondhand Smoke Threatens Health of Tenants in Multi-Unit Housing in Los AngelesRead the fact sheet: Apartment Owers Support Nonsmoking Policies in Los Angeles
Smokefree Apartments Los Angeles is a community outreach program of the UCLA Center for Health Policy Research that aims to increase access to smoke-free apartments in low-income neighborhoods within the city of Los Angeles. The program is funded by the Centers for Disease Control and Prevention and executed in partnership with the Apartment Association of Greater Los Angeles, CDTech, FAME and a coalition of public health partners, including ChangeLab Solutions, the American Lung Association, Los Angeles County Department of Public Health, Los Angeles Unified School District Student Health and Human Services, USC Tobacco Center for Regulatory Sciences in Vulnerable Populations and the David Geffen School of Medicine at UCLA. | | 3/31/2016 | 244 | | Approved | 3/18/2016 8:49 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 3/30/2016 10:40 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Miranda Dietz | miranda.dietz@berkeley.edu | | 510-642-1583 | Nadereh Pourat, PhD | pourat@ucla.edu | | 310-794-2201 | 945 | 94 | N | Y | | | Publication | Affordability and Eligibility Barriers Remain for California's Uninsured | 1480 | | | UCLA–UC Berkeley research finds that many who were eligible for Medi-Cal in 2014 didn’t realize they could apply | | Two-thirds of the Californians who didn’t have health insurance in 2014 were actually eligible for coverage, but many did not enroll because of the high cost, according to a new study by the UCLA Center for Health Policy Research and the UC Berkeley Center for Labor Research and Education.
The researchers found that the other one-third of uninsured Californians were ineligible for coverage under the Affordable Care Act due to their immigration status.
Using California Health Interview Survey (CHIS) data, the study reports that California residents without health insurance fall into four groups:
• Undocumented residents: 32 percent. Residents who do not qualify for health coverage under the Affordable Care Act, they are predominantly low-income and Latino, and have limited English language proficiency.
• Those eligible for Medi-Cal: 28 percent. Adult citizens and lawfully present immigrants with incomes at or below 138 percent of the federal poverty level, and children at 266 percent of the poverty level.
• Those eligible to buy coverage on the state health exchange, Covered California, with a federal subsidy to help offset costs: 31 percent. Citizens and lawfully present immigrants with incomes from 139 percent to 400 percent of the poverty level.
• Those eligible to buy health coverage on Covered California, but not eligible for federal subsidy: 9 percent. Citizens and lawfully present immigrants with income above 400 percent of the poverty level, which disqualified them from federal subsidies.
Among reasons for not having insurance, the largest percentage of citizens and lawfully present immigrants, 46 percent, said cost was the main reason.
“We’re a relatively high cost-of-living state,” said Miranda Dietz, a researcher at UC Berkeley and the lead author of the study. “It’s no wonder some Californians, who may be unaware they qualify for health subsidies and other programs, still find the cost of health insurance out of reach. For people who are already stretched paying their rent, filling the car to get to work and feeding the kids, figuring out how to come up with more money for health care on top of that is a lot to handle.”
California has more than 1 million undocumented, uninsured residents who do not benefit from the Affordable Care Act because of their immigration status.
“Hundreds of thousands of men, women and children, not to mention the workers that power California’s economy, are one health emergency away from potential financial ruin because they lack insurance,” said Nadereh Pourat, a co-author of the study and the director of research for the UCLA center. “From an economic perspective, it’s bad business to rely on workers and then not offer them equal health protection. And from a humanitarian perspective, it’s just wrong.”
Young adults, men more likely to be uninsured
UCLA and UC Berkeley also collaborated on a related study examining CHIS data on low-income, adults under age 65 who were eligible for Medi-Cal in 2014. The report found that eligible but uninsured adults were more likely to be younger than 30 and male, compared to those who enrolled—meaning that health advocacy outreach should especially target men in that age bracket.
Reasons Californians gave for not being enrolled in Medi-Cal varied: About one-third of those who were eligible but uninsured said they thought they were ineligible or didn’t know if they were eligible. Another 20 percent said they were in process of getting insurance, reflecting a major backlog in processing applications during Medi-Cal during its first year. That backlog has since largely been resolved.
Both studies were funded by Blue Shield of California Foundation.
The year 2014 saw the implementation of the Affordable Care Act and was a time of major changes to the state’s health care system. The study notes that many previously uninsured Californians have enrolled in coverage, but fully covering those who are still uninsured will require changes in policy that improve affordability and expand eligibility.
Read the study: Affordability and Eligibility Barriers Remain for California's Uninsured
Read the study: Who Had Medi-Cal and Who Remained Uninsured in the First Year of Expansion?
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 3/10/2016 | 241 | | Approved | 3/2/2016 9:55 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 3/9/2016 11:32 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Susan H. Babey, PhD | sbabey@ucla.edu | UCLA Center for Health Policy Research | 310-794-6961 | Harold Goldstein | hg@publichealthadvocacy.org | California Center for Public Health Advocacy | (530) 400-9106 | 211 | 495 | Y | N | | | Publication | Prediabetes in California: Nearly Half of California Adults on Path to Diabetes | 1472 | | | And one-third of young adults are at risk of becoming diabetic | | Nearly half of California adults, including one out of every three young adults, have either prediabetes — a precursor to type 2 diabetes — or undiagnosed diabetes, according to a UCLA study released today. The research provides the first analysis and breakdown of California prediabetes rates by county, age and ethnicity, and offers alarming insights into the future of the nation’s diabetes epidemic.
The study estimates that some 13 million adults in California, or 46 percent, have prediabetes or undiagnosed diabetes, while another 2.5 million adults, or 9 percent, have already been diagnosed with diabetes. Combined, the two groups represent 15.5 million people — 55 percent of the state’s population. Because diabetes is more common among older adults, the study’s finding that 33 percent of young
adults aged 18 to 39 have prediabetes is of particular concern.
“This is the clearest indication to date that the diabetes epidemic is out of control and getting worse,” says Dr. Harold Goldstein, executive director of the health advocacy center. “With limited availability of healthy food in low-income communities, a preponderance of soda and junk food marketing, and urban neighborhoods lacking safe places to play, we have created a world where diabetes is the natural consequence. If there is any hope to keep health insurance costs from skyrocketing, health care providers from being overwhelmed and millions of Californians from suffering needlessly from amputations, blindness and kidney failure, the state of California must launch a major campaign to turn around the epidemic of type 2 diabetes.”
County-by-County Crisis
The study estimates prediabetes rates by county, finding major disparities across the state, particularly among those aged 18 to 39. For those young adults, prediabetes rates ranged from lows of 26 percent in Lake County and 28 percent in San Francisco County to a high of 40 percent in rural Kings County and Imperial County.
Racial and ethnic disparities are extremely pronounced. There are statistically higher prediabetes rates among young adult Pacific Islanders (43 percent), African Americans (38 percent), American Indians (38 percent), multiracial Californians (37 percent), Latinos (36 percent) and Asian Americans (31 percent) than among white young adults (29 percent), pointing to the need to focus additional prevention efforts in those communities. No demographic or region appeared to be free of the diabetes and prediabetes epidemics, as outlined in the policy brief.
Complicating matters is the fact that many people do not get tested for prediabetes because the test often is not covered by insurance, particularly for those under the age of 45. And although there are effective interventions to help people control their weight and adopt a healthier lifestyle, these programs are often not be covered by insurers.
“There are significant barriers not only to people knowing their status, but getting effective help,” said Dr. Susan Babey, lead author of the study and co-director of the UCLA Center for Health Policy Research’s Chronic Disease Program. “A simple blood test for diabetes should be covered by all insurers, as should the resources and programs that can make a real difference in stopping the progression of this terrible disease.”
Prevention is Possible
Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diabetes diagnosis. Up to 30 percent of people with prediabetes will develop type 2 diabetes within five years, and as many as 70 percent of them will develop the disease in their lifetime. Diabetes is associated with dramatically increased risk of amputation, nerve damage, blindness, kidney disease, heart disease, hospitalization and premature death.
Diabetes is one of America’s fastest-growing diseases and one of the most costly. Nationally, diabetes rates have tripled over the past 30 years. In California, the rate has increased by 35 percent since 2001. Nationally, annual medical spending for people with diabetes is almost twice that for people without diabetes. A person who is diagnosed with diabetes by age 40 will have lifetime medical spending that is $124,600 more than someone who is not.
Three-quarters of that care is paid through Medicare and Medi-Cal, including $254 million in annual hospital costs that are paid by Medi-Cal alone.
To avoid the progression from prediabetes to diabetes, the study’s authors recommend greater participation in the National Diabetes Prevention Program, as well as policy and other changes to increase screening and prevention and encourage healthy, active lifestyles.
“For most people, type 2 diabetes is entirely preventable,” Dr. Goldstein said. “If Medi-Cal covered diabetes prevention programs and every health provider screened for prediabetes, we could prevent a large proportion of cases. In exchange for a proactive investment today, we can save billions of dollars in health care costs over the next five years and beyond, and save thousands of lives.”
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
| | 3/10/2016 | 242 | | Approved | 3/9/2016 3:56 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 3/9/2016 11:37 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | | | | | | | | | | | | | | | Publication | | | | | Event will launch LA smokefree apartments awareness campaign | | The UCLA Center for Health Policy Research invites you attend the public launch of its “Smokefree Apartments Los Angeles” initiative from 10 – 11 a.m., Wednesday, April 6, 2016.
During this press conference – to be held at FAME Gardens Apartment Complex, 3730 West 27th Street, Los Angeles, CA 90018 – the Center will release findings from a first-ever survey of both landlords and tenants at an event in South LA, as well as launch an exciting new media and advertising campaign to encourage the adoption of smokefree policies citywide.
The Center’s Smokefree Apartments Los Angeles initiative is part of a national Centers for Disease Control and Prevention program to encourage voluntary smokefree policies in private, multi-unit rental buildings in the city of Los Angeles. The target area for the program includes apartment buildings in some of the most densely populated and disadvantaged neighborhoods of South Los Angeles.
Earlier this year, Los Angeles received an "F" grade from the American Lung Association in the category of smokefree housing. At the April 6 event, tenants, health experts and other distinguished guests will discuss the need for greater awareness and implementation of smokefree apartment policies in Los Angeles, in an effort to promote public health and combat chronic disease caused by exposure to secondhand smoke.
Please RSVP by Friday, March 25, by emailing: dhanaya@ucla.edu.
| When: |
Wednesday, April 6, 2016 |
|---|
| Time: |
10 - 11 a.m. |
|---|
| Where: |
FAME Gardens Apartment Complex, 3730 West 27th Street, Los Angeles, CA 90018 [Map] |
|---|
| | 2/29/2016 | 240 | | Approved | 2/16/2016 12:48 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 2/28/2016 10:38 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Hidden Health Problems Among California's "Hidden Poor" | 1471 | | | Low-income seniors report worse health, more depression and less access to care than their wealthier peers, UCLA fact sheet shows | | Single or partnered elderly Californians whose income is above the official poverty level but below what is required to maintain a basic quality of life are almost twice as likely to say they are in poor or fair health; feel depressed; and cannot get timely health care as their wealthier counterparts, according to a new fact sheet by the UCLA Center for Health Policy Research.There are almost two and a half times as many "hidden poor" Californians age 65 and older as there are in that age group who live below the federal poverty level — 655,000 compared to 259,000. Unlike seniors living below the poverty line, they often don’t qualify for safety-net services that would help ease financial burdens such as health care expenses.The authors used the Elder Index, a measure of poverty that factors in the true cost of living in each county in the state, to identify the vulnerable population.
"There are far more 'under-the-radar' poor than 'officially' poor people in California and throughout the nation," said Steven P. Wallace, lead author of the fact sheet and associate director of the Center. "They have financial troubles and health issues that may be related to their economic situation, but outdated poverty measurements keep them in the blind spot of planners and policymakers."Currently, the federal poverty level counts a single person as poor if their annual income is under $11,770. However, in high-cost areas of California, people with incomes much higher than that may still struggle to make ends meet. In 2011, the average cost of basic living expenses in California as measured by the Elder Index was $23,364 for single older renters.Health takes a back seat for vulnerable groupOne in four elders living alone or with only a spouse or partner in California has an income above the poverty level but beneath the cost of living as measured by the Elder Index, the fact sheet reports. Using 2013-2014 California Health Interview Survey data, authors assessed the health of people in that group and found substantial disparities between the haves and have-nots.Although 47.3 percent of elderly seniors living below the federal poverty level self-identified as being in fair or poor health, 34 percent of the hidden poor also did, compared with 17.5 percent of those with incomes above the Elder Index. Hidden poor seniors said they felt depressed "some, most or all of the time" at a rate of 10.6 percent, compared to 3.4 percent of those above the Elder Index. And almost twice as many had difficulty obtaining timely medical care — 22.2 percent compared with 11.9 percent.Latino, African-American and Asian-American older adults who live alone or only with a spouse/partner have the highest rates of being among the hidden poor, at 35.4, 30.6 and 29.2 percent, respectively; about half of the people in each group have incomes under the Elder Index.
While a lower percentage of non-Latino white seniors have incomes under the Elder Index, at 29.6 percent, the number of hidden poor among older non-Latino white singles and older couples at 21.5 percent is almost three times the official poverty rate of 8.1 percent.
"It is time for state and federal policymakers to address the needs of this vulnerable group and have programs that help them obtain basic necessities," Wallace said.
Research for this fact sheet was funded by the California Wellness Foundation.The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health policy information for California. The Center improves the public's health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 1/28/2016 | 238 | | Approved | 1/20/2016 2:54 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 1/24/2016 11:37 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Impact of a Pediatric Palliative Care Program on the Caregiver Experience (Journal of Hospice & Palliative Nursing) | 1455 | | | | | When a child undergoes medical care for a life-limiting condition ― such as cancer or certain neurological or cardiac conditions ― receiving in-home palliative care at the same time improves the quality of life for both the child and the family by reducing worry and stress, according to an article by researchers from the UCLA Center for Health Policy Research published in the Journal of Hospice & Palliative Nursing.
In 2010, the Affordable Care Act (ACA) cemented the right of severely ill children to undergo concurrent curative care and palliative care, known as "comfort" care, in the last six months of life, the study reports. Prior to the ACA, parents of severely sick children had to forgo the first to qualify for the latter.
The UCLA researchers followed a three-year California Department of Health Care Services pilot program for qualifying Medi-Cal children in nine California counties called Partners for Children (PFC). The program gave palliative care to children ages one to 20 for much longer than the "last six months of life" limit under the federal law and regardless of life expectancy.
Palliative care included home-based services such as pain and symptom management for the child and art/music therapies to help him or her cope with illness, family education on how to operate medical equipment or navigate the health care system, 24-hour access to on-call hospice or a health agency nurse, respite care, and counseling and bereavement services, according to the article.
Reduction of caregiver stress and worry
Based on surveys of PFC participants' parents taken before and during the program, authors of the article found that palliative care reduced family stress and worry. They also found that family support (from spouses, grandparents, friends, etc.) further helped decrease caregivers' stress and worry. Earlier studies showed palliative care also lowered costs, according to the article.
"The PFC program is a promising tool that can enhance care for children with life-limiting illnesses and alleviate some caregiver stress and worry," said Daphna Gans, a Center faculty associate and lead author of the study. "It also saves money by reducing the number of days a child spends in the hospital ― a win-win situation."
The authors also found that the family-centered palliative program is effective for children in less severe stages of the disease and families would benefit by early referrals to reduce stress before the disease reached an advanced stage.
"Child palliative care is a program worth growing, but should not be limited to the most severely sick children," Gans said. "Early access to palliative treatment showed that despite their child's deteriorating health, caregivers reported feeling less stress as the disease progressed rather than greater stress ― that is a measure of success."
The PFC program ran from January 2010 to December 2012 and was extended for five more years to 2017.
Read the study: Impact of a Pediatric Palliative Care Program on the Caregiver Experience | | 1/28/2016 | 239 | | Approved | 1/22/2016 1:42 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 1/29/2016 10:41 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | The California Health Interview Survey (CHIS) has released statewide one-year public use data files for 2011 and 2012. Researchers can now analyze and compare comprehensive health data for adults, adolescents and children in California on hundreds of health topics ranging from health insurance coverage to diabetes prevalence to fast food consumption over four consecutive years: 2011, 2012, 2013 and 2014. The 2013 and 2014 one-year files were released in September 2015.
 Previously released as a combined two-year file, the unbundling of 2011 and 2012 annual data lets researchers and other users with statistical analysis software compare statewide health variables from year to year, such as comparing rates of health insurance before and after full implementation of the Affordable Care Act.
One-year estimates are also available through the award-winning, simple-to-use online query tool, AskCHIS©.
For those who prefer to use two-year data, the 2013-2014 dataset is available on request as a Special Use Research File (SURF). These two-year SURFs are available for 2011-2012 and 2013-2014. Access to the files can be obtained by a SURF application.
Coming Soon: The estimates available on AskCHIS Neighborhood Edition© (NE), which provides health estimates at the ZIP code, city and legislative level, will be updated using new CHIS 2013-2014 data. NE will also launch a subscription-based application program interface (API) to expand access to the unique local population health estimates it provides.
CHIS is conducted by the UCLA Center for Health Policy Research and is the largest state health survey in the nation. It surveys more than 20,000 households each year and covers hundreds of health topics, including health status, health conditions, health behaviors, mental health, health insurance coverage, and health care access and utilization by race/ethnicity, gender, income and more. | | 12/21/2015 | 235 | | Approved | 12/15/2015 7:56 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/18/2015 2:41 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | - Informing legislation on health reform for the state's undocumented.
- Assessing mental health needs of the state's schoolchildren.
- Guiding an OMB-led workgroup on LGBT survey methodology.
- Providing data for research cited in numerous amicus briefs in support of same-sex marriage submitted to the U.S. Supreme Court.
Conducted by the UCLA Center for Health Policy Research, CHIS surveys more than 20,000 California households each year on their health issues, status and behaviors ranging from access to care to chronic disease to soda consumption and exercise. Used by legislators, community advocates, academic researchers, media and others, CHIS data have proved an invaluable, free resource to help promote improvements in health for all populations ― including children, low-income families, racial and sexual minorities, and vulnerable elders ― in the state and beyond.
| | 12/21/2015 | 236 | | Approved | 12/15/2015 12:48 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/17/2015 8:17 AM | i:0#.f|uclachissqlmembershipprovider|venetia | | | | | | | | | | | | | | | Publication | | | | | | | The researchers and staff of the UCLA Center for Health Policy Research wish you a healthy and happy 2016!
Please note the Center will be closed starting Dec. 24, 2015 and will reopen Jan. 4, 2016. Media who wish to contact Center personnel during this time may reach Gwen Driscoll, director of communications, at: 310-720-4441.
| | 12/15/2015 | 234 | | Approved | 12/10/2015 9:53 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 12/16/2015 2:22 PM | i:0#.f|uclachissqlmembershipprovider|venetia | | | | | | | | | | | | | | | Publication | | | | | | | 
Effective and evidence-based. From health insurance to diabetes and obesity to the health and well-being of our vulnerable seniors, the UCLA Center for Health Policy Research is one of the most effective non-profit organizations in the nation in using data and evidence-based research to raise awareness of critical health issues.
Free. We give our data and research at no cost because we believe that positive change happens when everyone has access to the most current and accurate information.
We need your help. Your contribution helps us to provide policymakers, researchers, the media, activists, advocates and others with evidence-based data and research that leads to real change.
Please consider making a tax-deductible contribution here.
Our impact includes:
• Helping California prepare for and implement the Affordable Care Act.
• Supreme Court amicus briefs in defense of health care reform and same-sex marriage.
• New laws that expand our understanding of senior citizens and poverty.
• Community-led efforts to improve air quality in heavily-polluted areas of Los Angeles and Long Beach.
• Expanded access to food stamps for California's children.
     
| | 11/30/2015 | 232 | | Approved | 11/17/2015 11:09 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 11/30/2015 7:29 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | Why
are hundreds of thousands of the state's ''dual eligibles'' — fragile
older seniors and disabled young people who receive both Medi-Cal and
Medicare benefits — rejecting the new state-managed health care pilot
program?
That's the question being posed by researchers at the UCLA Center for Health Policy Research, who have received a $400,000 grant from the Robert Wood Johnson Foundation and are working with community advocates, managed health care providers and health insurers to study the issue.
According to recent enrollment data from the state, the overall opt-out rate for the pilot program, Cal MediConnect, is high — 45 percent. An additional 10 percent have actively dis-enrolled after having been passively enrolled. The program was designed to better coordinate medical care and long-term support services for this vulnerable population and eliminate potential overlaps in service under Medi-Cal and Medicare.
''It’s been a rocky start for Cal MediConnect, and the only way to find out why these consumers are opting out of the program is to ask them,'' said Kathryn Kietzman, a research scientist at the center and principal investigator of a new joint project, Consumer Healthcare Options Investigating Cal MediConnect Enrollment (CHOICE).
The state Department of Health Care Services (DHCS) estimated before the program's debut that one-third of the ''duals'' at most would opt out. But the most recent enrollment report showed the rate was significantly higher (45 percent) than expected and outpaced the enrollment rate (31 percent). About 450,000 people in seven counties were eligible to begin transitioning to Cal MediConnect starting April 2014.
The 'herd' instinct
Opt-out rates vary significantly by county, according to October's DHCS figures. Orange County, which began enrollment in August, has the highest rate, 69 percent (including 83 percent of all Vietnamese who are eligible), and San Mateo the lowest, 13 percent. In general, older consumers are opting out at higher rates than younger. For example, 63 percent of Los Angeles County consumers, ages 90 and older, opted out, compared to 48 percent ages 21 to 64.
Besides racial and ethnic variations, another factor was language. The data show that Russian-speaking eligibles had the highest opt-out rates in Los Angeles, San Diego and Santa Clara counties — 92 percent, 79 percent and 72 percent respectively — along with Armenian speakers in San Bernardino (90 percent) and Los Angeles (80 percent) counties.
Conversely, Spanish speakers in most counties had among the lowest opt-out rates, from 26 to 29 percent in each county, except for Orange and Los Angeles counties, which had the highest opt-out rate, 48 percent and 39 percent, respectively.
''It’s almost as if once a cluster of people made the decision to opt-out in a certain community, word spread and the rest followed suit,'' Kietzman said. ''It will be helpful to determine their source of information on managed care, how reliable it is and how it influences their decision to join or not join.''
Researchers will conduct 50 individual interviews and six group sessions with dual-eligible consumers and caregivers in Los Angeles County to determine their health care preferences and what could be done to better inform their decision-making. Los Angeles County consumers were chosen because they make up half of the eligible pilot program population (200,000).
Westside Center for Independent Living is the lead community partner on the project. Supporting community partners include Personal Assistance Services Council of Los Angeles County, Care 1st Health Plan, Justice in Aging, L.A. Care Health Plan, Center for Health Care Rights and Anthem Blue Cross.
See opt-out rates as of Oct. 1 by language, ethnicity and age for each of the pilot counties here.
The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. | | 11/30/2015 | 233 | | Approved | 11/17/2015 11:12 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 2/1/2016 10:55 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | • 60,000 geographic location requests• 30,000 questions asked• 1,600 users
Granular dataAskCHIS Neighborhood Edition© (NE) was created in response to demand for micro-level data. Nearly 90 percent of NE queries looked at either ZIP-code-level or city-level data, with ZIP codes being by far the most popular search (67 percent of all queries). The tool can also look at health data by legislative district. An existing companion Web tool, AskCHIS©, allows users to find health data at the county, region and state levels.
Most requested: Chronic disease, insurance status
AskCHIS NE© has helped users search topics ranging from children's physical activity to chronic disease to rates of insurance and more. The most popular topics over the past year include adult diabetes, adult obesity, child/teen asthma, food insecurity and adult uninsured rates.
Big impact
Numerous county agencies and cities, such as Los Angeles County Department of Public Health, Sacramento County and the City of Long Beach, now incorporate AskCHIS NE© ZIP-code-level data into their community health dashboards. AskCHIS NE© has also been used as a source for health information in transportation programs administered by the California Department of Transportation.
Happy birthday, AskCHIS NE©!
| | 10/29/2015 | 231 | | Approved | 10/22/2015 11:52 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 10/28/2015 9:39 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | | | | | | | | | | | | | | | Publication | | | | | | | Health disparities persist for California's 9.8 million Latino adults, whose rates for obesity, fair or poor health, food insecurity and uninsurance are much higher than the state average, according to updated Race and Ethnicity Health Profiles that use 2012-2013 California Health Interview Survey data. African-Americans have the highest rates of high blood pressure, obesity and current smoking, the data show. The profiles, published by the UCLA Center for Health Policy Research, also reveal wide gaps in health between Latino ethnic groups. For example, nearly 40 percent of Salvadorans report fair or poor health, compared to 12.8 percent of South Americans and 30.8 percent of Latinos overall. Similar disparities are seen between Asian ethnic groups, although rates for Asians overall are generally equal to or better than the state average.
Health Profiles provide key health estimates for four major racial groups in the state – white, Latino, African-American and Asian. Health topics range from access to care to health outcomes (such as diabetes and obesity) and health behaviors (such as soda consumption and smoking).
The easy-to-read, one-sheet profiles are also available for individual Latino and Asian ethnic groups, including Mexican (U.S. & non-U.S. born), Salvadoran, Guatemalan, South American, Chinese, Filipino, Japanese, Korean, Vietnamese and South Asian adults.
Among the findings for California’s estimated 28.2 million adults:
Latinos and food insecurity
Among all California adults, 16 percent, or nearly 8 million adults, have difficulty reliably putting food on the table in the past year. Salvadoran and non-U.S.-born adult Mexicans have the highest rate, 46.6 percent and 37.2 percent respectively. An estimated 2.7 million adult Latinos overall are food insecure.
Latinos and soda consumption
Eleven percent of adults drink at least 1 soda per day statewide; Latinos have the highest rate, nearly 17 percent. U.S.-born Mexicans are the biggest consumers among individual ethnic groups, with 1 of 5 downing at least one soda every day.
African-Americans and obesity, smoking
Compared to any other single group, African-Americans have the highest rates of high blood pressure (36.9 percent), obesity (36.9 percent), and current smokers (19.5 percent) in the state.
Filipinos and Koreans and high blood pressure
The diabetes rate of all Asian adults (8.5 percent) is nearly identical to the state (8.6 percent). However, Vietnamese adults have a significantly higher rate than Asians overall, 14 percent. Similarly, Filipino and Korean adults have higher rates of high blood pressure, 35 percent and 30.7 percent respectively, when compared to all Asians and all Californians, 22.8 percent and 27.6 percent.
Whites and binge drinking
Whites have second-highest rates of high blood pressure and smoking (30.1 percent and 14.3 percent, respectively) and the highest rate of binge drinking (33.6 percent).
| | 10/26/2015 | 213 | | Approved | 3/24/2015 2:33 PM | i:0#.f|uclachissqlmembershipprovider|celeste | 12/17/2015 10:58 AM | i:0#.f|uclachissqlmembershipprovider|venetia | | | UCLA Center for Health Policy Research | | | | | | | | | | | | Publication | | | http://healthpolicy.ucla.edu/PublishingImages/Members%20Images/StevenPWallace.jpg | | | | The Center is pleased to host leading health policy experts at our lunchtime seminar series. Our next seminar will be:
November 19: "Why Don't More Community Clinics Provide On-Site Dental Care?"   Low-income adults and children who are able to see a dentist at the same location as their primary care doctor are more likely to get dental care, yet almost three out of five community health clinics in California either don’t offer oral health services or, if they do, the nearest facility is sometimes too far for many patients to reach, according to a recent Center study. In this November 19 seminar, part of the Center’s ongoing Health Policy Seminar Series, the study’s authors, Dr. James Crall and Dr. Nadereh Pourat, review the data on the number of California community health centers that provide on-site dental care versus those that do not and takes a specific look at the county that “co-locates” oral and primary care the least: Los Angeles. The presentation will also make the case that providing both dental and primary care in the same location is good not just for patients but for clinics’ bottom line.
What: |
“Why Don’t More Community Clinics Provide On-Site Dental Care?” |
Who: |
Dr. James Crall, professor and chair of the public health and community dentistry division at UCLA School of Dentistry, and Dr. Nadereh Pourat, director of research at the UCLA Center for Health Policy Research |
When: |
Thursday, Nov. 19, 2015 |
Time: |
Noon - 1.pm. |
Where |
UCLA Center for Health Policy Research
10960 Wilshire Blvd., Suite 1550
Los Angeles, Calif. 90024 [Map] |
A recorded video will be posted on the Center's website shortly after the presentation.
Recent seminars:
All seminars from the Center’s Health Policy Seminar Series can be viewed here. 
October 28: "Narrow Networks: Do We Know When Networks Have Become Too Narrow?"
The Affordable Care Act (ACA) has created a greater degree of standardization of health insurance plans than has ever existed in the individual (non-group) health insurance market. All policies are required to have Essential Health Benefits, as well as four metal tiers based on plan actuarial values and standard limits on maximum annual out-of-pocket spending. As a result, one of the most significant remaining features of health plans that can vary considerably is the number of doctors and hospitals contracting with each health plan. The fact that many health insurers offered plans through ACA Exchanges in 2014 and 2015 with so-called “narrow networks” has led to some concern that those buying health insurance in the individual market, both inside and outside the Exchanges, now face more restricted access to doctors and hospitals in their immediate geographic area. Furthermore, this restricted access has raised concerns about possible adverse health consequences.
This October 28 webinar presents an overview of the impacts of “narrow networks.” In it, Gerald Kominski, the Center’s director, summarizes what is known about narrow networks from the research literature; discusses challenges in defining and measuring network adequacy; and proposes further research to determine whether narrow networks are necessarily associated with lower quality care. Watch the video here.
September 22: "Promoting Preventive Health Care in the Community: The Healthy Aging Partnerships in Prevention Initiative"
Center researcher Kathryn Kietzman and O. Kenrik Duru from the David Geffen School of Medicine at UCLA present early findings from a new project to increase the use of clinical preventive services, such as flu shots and mammograms, among older residents of South Los Angeles. Watch the video here.
July 15: "Environmental Factors Driving Rising Obesity in California"
More than seven million Californians are obese, and obesity rates have risen over the past decade to encompass one-quarter of the adult population. The cost to Californians -- in terms of health and medical care -- is rising as well. What can the state do to stem the epidemic?
In this seminar, part of the Center's 2015 Health Policy Seminar Series, Center Research Scientist Joelle Wolstein and Senior Center Research Scientist Susan H. Babey will discuss findings from their 10-year study, Obesity in California. In particular, the authors will describe the structural challenges to fighting obesity in California, including the built environment, neighborhood safety, as well as economic access issues that prevent Californians from practicing healthy behaviors. Watch the video here. June 17: "The Importance of CHIS in LGBT Research and Data Collection" The California Health Interview Survey (CHIS) represents one of the largest ongoing population-based data collection efforts in the country that has included measurement of sexual orientation for more than a decade. In this seminar, Gary Gates, the Blachford-Cooper Distinguished Scholar and research director at the UCLA Williams Institute, demonstrates how CHIS has been used in research about the lesbian, gay, bisexual and (as of CHIS 2015) transgender community and the role it has p layed in helping to inform important policy debates about LGBT rights. He highlights new ways that CHIS is expanding its efforts to identity the LGBT population and provide leadership in advancing efforts to improve LGBT data collection. Watch the video here.
Past speakers in the UCLA Center for Health Policy Research’s Seminar Series include:
• Nadereh Pourat, Director of Research, UCLA Center for Health Policy Research Director, Health Economics and Evaluation Research Program Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health Adjunct Professor, UCLA School of Dentistry
• Gerald Kominski, director of the UCLA Center for Health Policy Research and professor in the UCLA Fielding School of Public Health
• Lené Levy-Storms, faculty associate, UCLA Center for Health Policy Research; associate director, UCLA Borun Center for Gerontological Research; associate professor, Depts. of Social Welfare and Medicine/Geriatrics, Luskin School of Public Affairs & David Geffen School of Medicine at UCLA
• Elisa F. Long, assistant professor in Decisions, Operations & Technology Management at the UCLA Anderson School of Management
• Kathryn Kietzman, research scientist, UCLA Center for Health Policy Research
• Steven P. Wallace, Center associate director and professor in the UCLA School of Public Health
• John Øvretveit, director of research and professor of health innovation and evaluation at the Karolinska Institute
• Dylan H. Roby, senior research scientist, UCLA Center for Health Policy Research; assistant professor of Health Policy and Management, UCLA Fielding School of Public Health
| | 9/30/2015 | 229 | | Approved | 9/14/2015 3:23 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 9/30/2015 10:15 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | UCLA Center for Health Policy Research | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Better Together: Co-Location of Dental and Primary Care Provides Opportunities to Improve Oral Health | 1423 | | | Many people are forced to travel miles to get oral care — or forgo it — when it’s not available on-site | | Low-income adults and children who are able to see a dentist at the same location as their primary care doctor are more likely to get dental care, yet almost three out of five community health clinics in California either don’t offer oral health services or, if they do, the nearest facility is sometimes too far for many patients to reach, according to a new study by the UCLA Center for Health Policy Research.
The study also showed that of the remaining clinics offering on-site dental care, nearly a quarter lack full-time dentists or dental hygienists and see less than half the number of dental patients they could be serving. The study, funded by the First Five L.A. 21st-Century Community Dental Homes Project, includes nearly 900 community health centers, where about 4.9 million low-income people receive primary care.
Dental and primary care health issues are often linked. For example, gum infections can affect other parts of the body, and dentist-prescribed painkillers or antibiotics could react with another medication prescribed by a physician, Crall said. Having doctors and dentists share a patient’s health history and treatment records would help streamline and improve overall care, according to the study.
Barriers for patients with little time, money and few resources
Though federally qualified health centers, which receive federal funding, are required to provide health care regardless of ability to pay, they don’t always include on-site oral health services.
Low-income patients in California face many challenges when seeking care — scheduling time off from work, arranging child care and trying to get to and from clinics, often navigating multiple bus routes to reach a health center. Seeking dental care at a separate location adds to that burden, the study reports.
Of the 310 clinics that offered off-site dental care, the researchers found:
•25 had dental sites within easy walking distance (up to 1/10 of a mile, or a city block).
•50 had sites from 1/10 of a mile to a mile away.
•127 required patients to travel 1 to 5 miles.
•108 had dental sites more than 5 miles away.
Additional travel and time commitments could be a significant barrier to dental care — and make many patients forgo care, said Nadereh Pourat, director of research at the UCLA Center for Health Policy Research and lead author of the study.
“It’s a missed opportunity not to put doctors and dentists together,” Pourat said. “Think of the problems faced by a mother of three small kids with no childcare and no transportation who has to get to doctor and dentist appointments in separate locations. Being able to get her family’s medical and oral health care on the same day and in the same location would make a significant difference to someone like her.”
Rural clinics provide better access to co-located dental care
Los Angeles County has the smallest proportion of clinics that offer on-site dental and medical care (23 percent), while Northern/Sierra region counties had the largest (51 percent), according to the study. Pourat said that community clinics in rural areas have more comprehensive services because they know there are fewer health care choices for their patients. Clinics in those areas “are more attuned to the benefits of co-locating medical and dental services,” Pourat said.
Los Angeles also had the highest proportion of clinics that didn't offer any dental care (46 percent) followed by Sacramento County at 42 percent.
Improving dental ‘capacity’
Even though the study showed that a third of clinics offer on-site dental care, many of those could serve additional patients if they employed full-time dentists and hygienists instead being limited to a part-time staff, said Crall, who is also principal investigator of the Dental Home Project. While new community health clinics and those that want to expand are now required to provide oral health care as part of their services, smaller, existing clinics have not followed suit, he added.
“With limited access, patients turn up with advanced cases of dental disease that could have been prevented. We need to make sure preventive dental care is more than a luxury,” Pourat said. “Co-location of dental care would contribute to the triple aim of health reform: better care, better health and lower costs.”
To encourage co-location of dental and primary care services, the authors recommend promoting on-site availability of dental services in community health centers. They also recommend providing federal and other grants to build and equip dental facilities, having better reimbursement policies for health centers that provide dental services to high-risk populations, and forgiving dentists’ student loans in exchange for working at community health centers.
“When services are co-located, care can be more coordinated and efficient by addressing the medical and oral health needs of patients in one place. For example, medical providers can screen patients for oral health needs and then refer higher risk patients to dental providers who are willing to see them, and vice versa,” said Kim Belshé, Executive Director of First 5 LA. “When this interaction takes place, oral health and medical providers can jointly manage patient care and tap into each other’s expertise to the benefit of their patients.”
First 5 LA, in partnership with others, strengthens families, communities, and systems of services and upports so all children in L.A. County enter kindergarten ready to succeed in school and life.
| | 9/30/2015 | 230 | | Approved | 9/24/2015 2:19 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 10/24/2015 11:22 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | | | | | | | 
Associate Center Director Steven P. Wallace, Center Research Scientist Kathryn Kietzman, faculty associates, and a cast of statisticians and graduate student researchers will present more than 40 lectures, roundtables and poster sessions at the American Public Health Association Annual Meeting in the Windy City October 31-November 4.
Health topics presented by Center associates will include:
• Racial and ethnic disparities in health care access, health care use, and health outcomes (multiple presentations)
• Obesity and weight issues among preschoolers in Los Angeles
• The effect of federal immigration policy on the nation's undocumented immigrants
• Adolescent behavior and exposure to crime
• Alzheimer's Disease and caregiver burden
• "Young invincibles" and health care spending
• Pediatric palliative care; end-of-life care
• Research on minority aging from RCMAR
• Making meaningful community health data available
• And many more!
Need Center publications? Find us at Booth #848
Come visit Community Relations Manager and RCMAR Program Administrator Porsche McGinnis and other staff at Booth #848 and pick up Center publications, fact sheets and more.
See a complete list of Center presentations here.
| | 8/31/2015 | 227 | | Approved | 8/6/2015 9:34 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 8/30/2015 11:54 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | The Hidden Poor: Over Three-Quarters of a Million Older Californians Overlooked by Official Poverty Line | 1417 | | | | | Nearly 1 in 5 adults over 65 in California — more than three-quarters of a million people — live in an economic no-man’s land, unable to afford basic needs but often ineligible for government assistance, according to a new study by the UCLA Center for Health Policy Research.
The study, funded by the California Wellness Foundation, highlights the plight of the “hidden poor” — those who live in the gap between the federal poverty level and the Elder Index's poverty measure, which is considered a more accurate estimate of what it takes to have a decent standard of living. The Elder Index accounts for geographic differences in costs for housing, medical care, food and transportation. The national federal poverty level guidelines say a single elderly adult living alone should be able to live on $10,890 a year, while the Elder Index estimates that person in California on average requires $23,364.
“Many of our older adults are forced to choose between eating, taking their medications or paying rent,” said D. Imelda Padilla-Frausto, a UCLA graduate student researcher at the center and lead author of the study. “The state might be emerging from a recession, but for many of our elder households, the downturn seems permanent.”
According to the study, about 772,000 elderly adults in California who are heads of households belong to this group of hidden poor, which is more than double the number of elderly (342,000) who meet federal poverty level guidelines. Unlike the “official” poor, the hidden poor often do not qualify for public assistance.
The study, which used 2009-2011 American Community Survey data and the 2011 Elder Index data, showed that in terms of sheer numbers, whites make up more than half of elders in the financially pinched group (482,000). Proportionately, grandparents raising grandchildren, older adults who rent, Latinos, women, and the oldest age group (75 and over) were the groups most affected.
The invisible poor are throughout California
Geographically, the researchers found that in all counties, between 30 and 40 percent of elderly adults who are single and 20 to 30 percent of older couples are among the hidden poor.
The county groups with the highest proportion (40 percent or more) of hidden poor among households headed by single elders are rural: Nevada/Plumas/Sierra, Mendocino/Lake andColusa/Glenn/Tehama/Trinity. Counties with smaller populations were pooled to create larger samples. Among households headed by couples, Imperial County is the only county with more than 40 percent hidden poor. Among older couples, Imperial County had a significantly higher rate than any other county — 43.4 percent of older couples did not have enough income to make ends meet, according to the study. According to federal poverty level guidelines, only 11.9 percent of older couples in the county were “poor.”
See a county-by-county chart of “poor” and “hidden poor.”
Groups with large proportions and populations of hidden poor:
• Grandparents raising grandchildren. Although a small subset of elder households, grandparents raising grandchildren are a particularly vulnerable group as neither the grandparents nor child is able to generate additional income to cover basic living expenses. Of the 16,000 households in California in which grandparents have primary responsibility for their grandchildren, more than half (9,000) have incomes below what the Elder Index defines as adequate for basic living. And more than half of those (5,000) are among the hidden poor.
• Older adults housing adult children. Older couples whose adult children live with them were six times more likely to qualify as being among the hidden poor according to the Elder Index than those considered poor according to the federal poverty level (25.7 percent vs. 4.1 percent, respectively). Similarly, single elders housing adult children were four times more likely to qualify as among the hidden poor by the Elder Index than those considered poor according to the federal poverty level guidelines (35.7 percent vs. 9 percent, respectively).
“Older adults raising grandchildren or housing adult children have taken on more financial burdens with limited earning capacity and are living right on the edge of a cliff,” said Steven P. Wallace, associate director of the UCLA Center for Health Policy Research and co-author of the report. “They have few options, and one unexpected expense can put them right over.”
• Single women who head households: Nearly 466,000 have incomes below the Elder Index, and more than half of those (286,000) are among the hidden poor.
• Single elders head of households, age 75 and older: Of the 359,000 households with incomes under the Elder Index, almost two-thirds (224,000) are among the hidden poor and unable to cover basic living expenses.
• Single elders who are renters or homeowners: Housing is one of the biggest drivers of economic insecurity, particularly for single elders. Almost 70 percent of single older renters have incomes below the Elder Index and more than half of those are among the hidden poor. Among single older homeowners paying a mortgage, nearly half (49.7 percent) have incomes below the Elder Index, and, among this group, 4 out of 5 struggle to make ends meet.
In comparing race and ethnicity, among the older population of African-Americans in California, couples who head households were five times more likely to be among the Elder Index hidden poor than to qualify as poor, according to the federal poverty level guidelines (21.2 percent vs. 4.2 percent, respectively). Similarly, older white couples were five times more likely to be among the hidden poor than among the poor (16.3 percent vs. 3.8 percent, respectively.) The highest proportion of hidden poor among single elders who head households was found among African-Americans and Latinos (37.4 percent and 36.8 percent, respectively).
See in-depth charts showing the “hidden poor” by gender, race, age and federal poverty level and other categories.
The authors have recommended ways to address the needs of those living in the gap between the federal poverty level and the Elder Index, including: increasing and protecting income as is proposed in Assembly Bill 474 and the Supplemental Security Income Restoration Act; raising income eligibility limits for housing assistance and using former redevelopment funds for construction of affordable housing; helping seniors with the cost of health care by raising income eligibility to 200 percent of the federal poverty level, from 100 percent; and expanding and updating food benefits.
“It’s very clear that income level is a major predictor of health outcomes — at any age. This research underscores that elders’ economic security is a health equity issue,” said Judy Belk, president and CEO of the California Wellness Foundation.
Read the policy brief: The Hidden Poor: Over Three-Quarters of a Million Older Californians Overlooked by Official Poverty Line
Read a related interview with the lead author, D. Imelda Padilla-Frausto.
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
The mission of The California Wellness Foundation is to improve the health of the people of California by making grants for health promotion, wellness education and disease prevention.
The Elder Economic Security Standard™ Index for California was developed as part of the Elder Economic Security Initiative™ at Wider Opportunities for Women (WOW).
The Insight Center for Community Economic Development leads the Elder Economic Security Initiative™ program for California, an affiliate of the national Elder Economic Security Initiative™ (Initiative) at Wider Opportunities for Women. The Initiative provides tools, including the Elder Economic Security Standard™ Index. For more information, see www.wowonline.org or call (202) 464-1596.
| | 8/18/2015 | 226 | | Approved | 8/4/2015 3:27 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 8/21/2015 1:51 PM | i:0#.f|uclachissqlmembershipprovider|celeste | | | UCLA Center for Health Policy Research | | | | | | | | | | | | Publication | | | | | Comparing the 2013 and 2014 California Health Interview Surveys shows that the Affordable Care Act is working to insure more adults in California | | From 2013 to 2014, the number of Californians ages 19 to 64 without health insurance declined by 15.5 percent — more than 655,000 people — after full implementation of the Affordable Care Act, according to new California Health Interview Survey data released today by the UCLA Center for Health Policy Research.
The Center also released a fact sheet on health insurance using the new data, which estimates Medi-Cal enrollment among the same age group rose from 12.9 percent in 2013 to 19.2 percent in 2014. The uninsured rate dropped from 20.6 percent to 17.4 percent during the same time period. This is the first time the rate of people receiving Medi-Cal exceeded the rate of people without insurance.
The decline is in line with national estimates and is good news for the people of California, said Ninez Ponce, principal investigator for the survey and associate director of the UCLA Center for Health Policy Research.
“The number of people without insurance, especially among low-income families and the middle class, is going in the right direction — down,” Ponce said. “But with 4.5 million still uninsured in the state, our job is not over yet.”
The new health insurance data is part of a broad release of comprehensive new health information by the California Health Interview Survey. CHIS is the nation’s largest state health survey. In 2014, 23,160 Californians participated in the survey, and 24,845 participated in the 2013 survey. Respondents answered questions on hundreds of health topics ranging from asthma and diabetes to public program participation.
Demand for data prompts annual release
And beginning now CHIS will release data annually; previously data were released every two years.
“This is a significant development that will provide policymakers and others with much more timely data on the health of Californians,” said David Grant, director of CHIS.
Releasing data every year will allow researchers and others the flexibility to analyze data for shorter time periods, for example, assessing the impact of important policies like the Affordable Care Act. New information collected during CHIS 2013-2014 includes pre- and post-ACA health insurance coverage rates and the proportion of those who bought plans through the health insurance exchange, Covered California.
CHIS 2011 and 2012 public use files, which allow researchers with statistical analysis software to crunch the data themselves, will be re-released as one-year data sets with an anticipated release this fall. Four years of annual information — 2011 to 2014 — are now available to the public for free through the Center’s easy-to-use web tool AskCHIS, which allows users to customize their queries. The new CHIS 2013 and 2014 data will be used to update the small area estimates displayed on AskCHIS Neighborhood Edition with an anticipated release in early 2016.
New topics outside of insurance
Other new information released for 2014 revealed noteworthy health behaviors and trends among different age groups of Californians, including:
Children and sedentary time. On a typical weekday, nearly half (46.5 percent) of children ages 2 to 11 spend 2 or more hours a day watching TV, playing computer games or talking with friends, and that increases on the weekend to more than 7 in 10 children (71.7 percent).
Teens and smoking. Roughly 1 in 10 teens reported “vaping,” smoking e-cigarettes.
High school students and community. Nearly 90 percent of adolescents feel they can make a difference in their community, a positive attitude that spanned disparate incomes and races/ethnicities.
Women and family planning. Birth control pills still reign as the most popular method of family planning among women. Of nearly 2 million women ages 18 to 44 who received birth control from a doctor, 56.6 percent were on the pill. Nearly 34 percent used IUDs, implants and other hormonal methods.
Adults and smoking. Nearly 12 percent of adults 18 and older are current smokers, but 7 in 10 of those smokers have thought about quitting in the next 6 months.
The 2013-2014 survey spans 14 broad topic categories, including:
• Demographics (three sections)
• Health conditions, including chronic conditions such as diabetes, asthma, high blood pressure and obesity
• Health behaviors
• General and sexual health
• Mental health
• Housing/social cohesion
• Health insurance and child and adolescent health insurance (nearly 50 subcategories)
• Health utilization and access
• Employment/income/food security
As the one-year data files contain smaller sample sizes, the change to an annual data release required collapsing some variables — such as age — into larger groups for public use files. For researchers interested in analyzing data with more detailed categories or on sensitive information not included in the one-year public use files, CHIS data can be requested via the UCLA Center for Health Policy Research Data Access Center.
CHIS is conducted by the UCLA Center for Health Policy Research in collaboration with the California Department of Public Health and the California Department of Health Care Services and is supported by several public and private funders committed to improving the health of Californians. | | 7/29/2015 | 221 | | Approved | 6/2/2015 1:02 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 7/29/2015 9:27 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Role Models and Social Supports Related to Adolescent Physical Activity and Overweight/Obesity | 1412 | | | | | Adolescents and teens who have positive role models and who participate in after-school clubs tend to be more physically active and are less likely to be overweight, according to a study by the UCLA Center for Health Policy Research.
However, the research also found that low-income teens and teens of color are less likely to have this kind of positive support.
Using data from the 2011–12 California Health Interview Survey, the study’s authors analyzed the presence of role models, adult mentors at school, and participation in volunteer and extracurricular activities among California 12- to 17-year-olds. The researchers then determined how those three “protective social factors” are tied to children’s levels of physical activity and their propensity to be overweight or obese.
The study cites other research that has shown that the presence of protective factors in a teen’s life lead to more positive socialization, greater confidence and opportunities to engage in healthy behaviors.
Whether the protective factors were a part of the teens’ lives varied significantly by their race, ethnicity and household income. For example, only 42 percent of the lowest-income teens and roughly the same percentage of Asian-American teens felt they had a high level of support at school, compared to 60 percent overall. Thirty-one percent of the population participated in clubs outside of school, but just 19 percent of lowest-income and 23 percent of Latino teens did so. Seven of 10 affluent teens said they had a role model, compared to just about half of low-income teens and Latino teens.
While 60 percent of the group overall had a role model, 38 percent said they did not.
“It’s a sad fact that not all teens have a parent or adult to guide them in a positive way,” said Susan Babey, a senior research scientist at the Center and the report’s co-author. “If the teen also lacks adult support at school and support from a positive peer group, they sometimes emulate unhealthy characters they see in movies or on TV — which are not the best places to find role models.”
Physical activity, BMI and social connection
The study, supported by The California Endowment, found that 70 percent of teens who have social protective factors had a healthy body mass index, while just 60 percent of those who did not have those factors had a healthy BMI.
The research also revealed that the proportion of teens who are physically active for 60 minutes or more per day at least five days a week was significantly higher among those who:
• Volunteered (42 percent), compared to those who didn’t (34 percent)
• Participated in extracurricular clubs (46 percent), compared to those who didn’t (35 percent)
• Had strong support from adults at school (42 percent), compared to those who didn’t (33 percent)
• Said they had a role model (41 percent), compared to those who said they didn’t (34 percent)
Role models
Although 11 percent named an entertainer as a role model and 15 percent named an athlete, more teens (22 percent) named family members as their role models. Four percent identified teachers and another four percent said friends were their role models.
“Many teens seek role models who look like them, who they can identify with, who share similar backgrounds,” Babey said. “But the other places they may look for a role model, such as the entertainment industry, have not historically featured faces and stories that reflect the racial and socioeconomic diversity of teens in California.
“So there needs to be diversity of role models — not just in what they look like but in their backgrounds and professions,” Babey said.
The authors recommend that school policies strengthen adult support among teachers and school staff, especially for teens of color and from low-income families; teens and parents help develop school policies and activities; community organizations and schools increase opportunities for social participation outside of school, particularly in underserved areas; and that subsidies be offered to make such programs more affordable.
“Children living in poverty are severely lacking the social supports they need to thrive, which often results in the cycle of intergenerational poverty and poor health outcomes,” said Dr. Robert Ross, president and CEO at The California Endowment. “At The Endowment, we are strong proponents of folding youth development into all of our work. They are our future leaders. Kids need and want to be heard. As adults, it’s our job to make sure we listen and respond.”
Read the policy brief: Role Models and Social Supports Related to Adolescent Physical Activity and Overweight/Obesity
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians.
| | 7/28/2015 | 225 | | Approved | 7/28/2015 8:43 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 7/29/2015 11:48 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | Janet C. Frank, DrPH | jcfrank@ucla.edu | | 310-709-5101 | 1092 | 40 | Y | Y | | | Publication | | | | | | | Center Faculty Associate Janet C. Frank was awarded a $400,000 grant by the state Mental Health Services Oversight and Accountability Commission (MHSOAC) to assess progress made statewide in setting up a system of care for older adults with serious mental illness since the passage of California’s Mental Health Services Act (Proposition 63) in 2004. Frank will also identify methods to improve progress in this area.
"Research has shown that the proportion of older adults suffering with mental illness is higher than that of the general population, but that many who could benefit are not receiving treatment," said Frank.
As principal investigator of the two-year project, Frank will work with Research Scientist Kathryn Kietzman and other colleagues at the Center to gauge how well a sampling of counties have developed and used services tailored to meet the needs of the older adult population, including the unique needs of unserved and underserved diverse seniors. The project will also measure how well the Mental Health Services Act (MHSA) has helped put in place or supported a system of care for older adults.
In order to bolster the State’s ability to promote improvements in the quality of services for older adults, Frank has assembled national experts to help develop indicators focused specifically on older adults with mental health issues. The Commission’s intention is to incorporate them into future MHSOAC data-strengthening efforts to monitor performance.
"The Commission looks forward to working with UCLA to assess statewide progress made in implementing a system of care for older adults with mental illness so that methods to further progress in this area can be identified," said Renay Bradley, Director of Research and Evaluation at the Commission.
| | 7/25/2015 | 224 | | Approved | 7/25/2015 9:58 AM | i:0#.f|uclachissqlmembershipprovider|venetia | 7/25/2015 10:31 AM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | Medicaid/Medi-Cal; 2012 California Health Interview Survey (CHIS 2012); 2013 California Health Interview Survey (CHIS 2013); Barriers to/Disparities in Health Care | Publication | Medi-Cal Versus Employer-Based Coverage: Comparing Access to Care | 1410 | http://healthpolicy.ucla.edu/PublishingImages/Spotlight/medical_CHCF_art.jpg | | | | A new California Healthcare Foundation report based on California Health Interview Survey (CHIS) data found Medi-Cal patients face significant gaps in access to care compared with those who have employer-sponsored health insurance. Even within the Medi-Cal group, subgroups face access gaps depending on where they live, the language they speak, or their physical limitations. According to the report, the ranks of Medi-Cal patients grew 50 percent, from 8 million in 2012-2013 to 12 million in 2014-2015. Researchers at the UCLA Center for Health Policy Research compared health access of Medi-Cal patients to that of patients with employer-sponsored insurance (ESI) and examined 45 measures of health access data for non-elderly adults and 28 measures for children from the 2012 and 2013 CHIS. “It will take a lot of improvement for adults covered by Medi-Cal to have the same access to care as adults with job-based coverage,” said Shana Alex Charles, director of the Health Insurance Studies program at the Center. “Fortunately, children with Medi-Cal have access to care that’s very comparable to kids who are covered by a parent’s employer plan.” Some findings from the report: Differences between Medi-Cal patient and ESI patient characteristics: Half the adult Medi-Cal adult patients were in worse health than counterparts covered by ESI – 31 percent of Medi-Cal patients said they were in excellent/very good health compared to 61 percent of patients with ESI. Medi-Cal adults also are more likely to be Latino, non-citizens or without a green card. Gaps in access between Medi-Cal and ESI patients: Medi-Cal adults fared worse than ESI patients on 29 of 45 measures. For example, adult Medi-Cal patients were more than twice as likely as those with ESI to report they do not have a usual source of care other than the ER (18 percent and 8 percent, respectively), and three times more likely to have trouble finding a general doctor (6 percent and 2 percent, respectively). In contrast, access measures for Medi-Cal children were equal to those of children covered by ESI in 20 of 28 categories. Large gaps in access exist among subgroups of the Medi-Cal population: There were significant differences among Medi-Cal adults, depending upon whether they lived in a rural area or an urban area, their race or ethnicity, or their native language. For example, 26 percent of Medi-Cal patients in rural areas said they did not have a usual source of care besides the ER compared with 16 percent of their urban counterparts. For Spanish-speaking Medi-Cal patients and patients with any physical limitation, 36 percent of each were told a doctor would not take them as a new patient compared to 7 percent of all Medi-Cal patients. Read the study: Medi-Cal Versus Employer-Based Coverage: Comparing Access to CareRead the companion paper by the Urban Institute: MediCal Versus Medicaid: Comparing Access to Care The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu. The California Healthcare Foundation is leading the way to better health care for all Californians, particularly those whose needs are not well served by the status quo. CHCF informs policymakers and industry leaders, invests in ideas and innovations, and connects with changemakers to create a more responsive, patient-centered health care system. | | 6/25/2015 | 222 | | Approved | 6/2/2015 2:47 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 6/25/2015 2:09 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | UCLA Center for Health Policy Research | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Obesity in California | 1395 | | | Rate is up from 19.3% in 2001 | |
The study found that 24.8 percent of adults were obese in 2011–2012, compared to 19.3 percent a decade earlier. Nearly 18 million California adults and adolescents are considered overweight or obese, and about 7.4 million of them can be classified as obese. Data for the research was drawn from California Health Interview Survey results starting in 2001. Adults with a body mass index of 25 or greater are considered overweight; those with a BMI of 30 or more are considered obese.
The authors also found that 16 percent of Californians ages 12 to 17 were overweight and 17 percent were obese — both figures were relatively unchanged from 2001. Nearly 1 million California adolescents were overweight or obese in 2011–2012.
Nationally, 28 percent of adults are obese, according to Behavioral Risk Factor Surveillance System data. Although the California average is slightly below that figure, the UCLA study found that obesity rates in 17 of 41 California counties or county groups are at or above the national level. (The researchers grouped some smaller counties into groups in order to make data sample more robust.)
“Healthy eating requires a combination of money, time and resources, which not everyone has,” said Joelle Wolstein, a research scientist at the center and lead author of the study. “Obesity results from a complex web of factors. Can you get fresh vegetables nearby? If not, can you get to the store? Is there a safe place to exercise nearby?”
The study, funded by The California Endowment, found obesity rates had increased in every major region of the state since 2001. But current adult obesity rates varied widely by county: San Francisco County had the lowest rate (11.3 percent), while Imperial County had the highest (41.7 percent).
Counties and county groups with the highest and lowest adult obesity rates in 2011–2012:
Lowest
San Francisco: 11.3
San Luis Obispo: 12.6
Marin: 13.9
San Mateo: 16.6
Yolo: 17.9
Highest
Imperial: 41.7
Tehama/Glenn/Colusa*: 38.2
Tulare: 38.0
Kings: 36.6
Solano: 35.9
*Smaller counties were pooled to create a larger sample.
“It’s a bit ironic that the counties with the highest obesity rates tend to be rural,” said Susan Babey, a senior research scientist at the center and co-author of the study. “We associate the countryside with fresh fruits and vegetables, but these may be the places where it’s hardest to access a healthy diet.”
Most vulnerable more likely to be obese
Lower-income Californians and those belonging to certain racial and ethnic groups had disproportionately high rates of obesity, the report found. Obesity rates among the poorest adults —those with household incomes below 200 percent of the federal poverty level — jumped during the past decade from 24.4 percent to 30.5 percent, a rate 10 points higher than that of higher-income Californians (those whose income was at least 400 percent of the poverty level).
Obesity rates also varied considerably by race, although the figures for all racial and ethnic groups increased during the decade. Groups with the highest obesity rates in 2011–2012 were Pacific Islanders (37.1 percent), American Indians (36.2 percent), African-Americans (36.1 percent) and Latinos (32.6 percent) — all markedly higher than the rate for whites (21.9 percent). Asians had the lowest obesity rate, 9.7 percent, but even that figure represented a jump from 5.3 percent in 2001.
Rates within racial groups varied significantly, as well. Among Asian subgroups, for example, 2.1 percent of Koreans were obese versus 20 percent of Southeast Asians.
Contributing factors
Predictably, those with unhealthy dietary behaviors — a limited diet of fresh produce and high consumption of sugary beverages and fast food — had higher rates of overweight and obesity. But the study found that other social, demographic, economic and environmental factors played important roles, too. Some examples:
• Access to fresh produce: 22 percent of adults who said fresh produce was always affordable in their neighborhood were obese, compared with 31 percent of those who said fresh produce was never affordable. Only three-quarters of Latinos and African-Americans said fresh produce was affordable, compared to 86 percent of whites.
• Neighborhood safety: Among low-income adults, 28 percent felt their neighborhood was unsafe compared to 5 percent of higher-income adults. Twenty-two percent of Latinos and 18 percent of African-Americans reported their neighborhoods were unsafe compared to 7 percent of whites.
• Park safety and exercise: Among adolescents, 27.4 percent of those who felt their neighborhood park was safe were obese; the obesity rate among adolescents who felt their park was unsafe was 42.3 percent.
• Social connection: 26 percent of those who felt little connection with neighbors were obese, compared with 22 percent of those in high-connection neighborhoods.
The authors write that local governments should address these barriers by bringing more farmers’ markets to underserved areas or by offering incentives to storefront markets to add fresh produce; improving safety at existing parks through better maintenance; developing crime prevention programs to encourage leisure walking; making neighborhoods more walkable and pedestrian-oriented; and encouraging development projects that include recreation space.
“Low-income communities lack resources such as parks, grocery stores, health clubs and, even in many instances, sidewalks, of which wealthier communities have an abundance,” said Dr. Robert Ross, president and CEO of The California Endowment. “It’s the lack of equity between low-income communities and their wealthier counterparts that is helping to drive the disparities in obesity rates in California and across the nation, and this report confirms that.”
The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians.
| | 5/28/2015 | 209 | | Approved | 2/24/2015 2:44 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 5/27/2015 11:03 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | Barriers to/Disparities in Health Care; Racial and Ethnic Groups; Women | Publication | Missed Opportunity? Twenty Percent of Breast Cancer Patients Don't Know Their Recurrence Risk Status | 1393 | | | UCLA-led study finds that Hispanic women are twice as likely to have unnecessary treatment | | Although 90 percent of women with early-stage breast cancer said they were aware they took a genomic test that identified their level of risk for a recurrence of the disease, 1 in 5 didn’t know the results of that analysis, according to a new fact sheet by the UCLA Center for Health Policy Research.
The test, called gene expression profiling, or GEP, is used by physicians to help guide treatment decisions and can potentially help people avoid unnecessary chemotherapy. One of a number of emerging “precision medicine” genomic technologies, the GEP estimates the activity of specific genes in breast cancer cells, which can help predict whether there is a greater chance for breast cancer to return. Those with a high risk for cancer growth benefit by having chemotherapy as part of their treatment, the authors write, but chemo has no added value for those with a low risk.
The report is based on a national study of nearly 900 women younger than 65 who were diagnosed with early stage estrogen-receptor–positive, lymph-node–negative breast cancer. The Center collaborated with researchers from Harvard University’s Brigham and Women’s Hospital and Aetna.
The study also found that 15 percent of Hispanic women with a low risk for recurrence of breast cancer had unnecessary chemotherapy as part of their treatment, more than double the rate for the group as a whole (7 percent).
“No one should have to go through the stress and discomfort of chemo without understanding the personal risks and benefits,” said Ninez Ponce, the Center’s associate director and senior author of the study. “At the very least, patients should know their options. Right now, some women may be making treatment decisions based on incomplete information.”
Information gap wider for Hispanics and African-Americans
Although 9 in 10 women surveyed said they were aware that they had taken a test that would determine their risk profile, the percentage who knew about the test varied significantly by racial and ethnic group. Only 78 percent of Hispanic women and 85 percent of African-American women were aware of the test, compared with 94 percent of white women and 98 percent of Asian-American women.
Additionally, approximately 20 percent of those surveyed said they still did not know whether the test result indicated a high or low risk for recurrence of cancer — a significant information gap. Nearly 10 percent of Hispanics and 6 percent of African-Americans said their doctors did not discuss the test or test results with them, compared to just 3 percent of whites and 2 percent of Asian-Americans.
High-risk patients opt for chemo, but so do some low-risk
Among the high-risk patients, all of the Hispanic and Asian-American women and 81 percent of African-American and whites had chemotherapy, according to the report.
One in eight women will be diagnosed with breast cancer in her lifetime. The authors write that women who know they have a low risk for recurrence have the opportunity to avoid overtreatment and the side effects of chemotherapy, which include fatigue, hair loss, nausea, vomiting, diarrhea, bruising and bleeding.
The research was funded by Aetna.
Read the fact sheet: Missed Opportunity? Twenty Percent of Breast Cancer Patients Don’t Know Their Recurrence Risk Status
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit www.healthpolicy.ucla.edu.
Aetna is committed to providing individuals, employers, health care professionals, producers and others with innovative benefits, products and services. Discover more at www.aetna.com
| | 5/28/2015 | 219 | | Approved | 5/27/2015 12:52 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 5/27/2015 2:44 PM | i:0#.f|uclachissqlmembershipprovider|venetia | Venetia Lai | venetialai@ucla.edu | | 310-794-6963 | | | | | 1092 | | Y | | | Barriers to/Disparities in Health Care; Screening for Early Disease Detection; 2009 California Health Interview Survey (CHIS 2009); Adult; Racial and Ethnic Groups | Publication | Racial Minorities Are More Likely Than Whites to Report Lack of Provider Recommendation for Colon Cancer Screening (American Journal of Gastroenterology) | 1392 | | | | | Colorectal cancer strikes – and kills – African-Americans at rates higher than any other racial group in the nation, according to the Centers for Disease Control. Yet, 25 percent of older African-Americans who had gone without a timely colorectal cancer screening said doctors failed during a regular checkup to recommend it compared to 17 percent of older whites, according to a new study in the Journal of Gastroenterology.
Although there were other reasons people gave for not getting screened for colorectal cancer (CRC), a larger share of older unscreened African-Americans and Asian-Americans said their main reason was their doctor did not recommend the test, the study found. Among all unscreened people, 1 in 5 cited the same reason for not getting screened. The test is recommended for people ages 50 to 75.
The study found rates of doctor non-recommendation for CRC screening among Asian-Americans and Latinos were 22 percent and 21 percent, respectively. English proficiency and whether a patient was treated at a clinic also created variations in doctor recommendation. Nearly 3 in 5 Californians ages 50 to 75 were up to date for a CRC check, authors said.
"Doctor recommendation is the biggest driver in people getting screened for colorectal cancer, the second most common cause of cancer-related deaths in the country," said Ponce. "It is part of the provider's job to eliminate disparities like this and save lives."
| | 5/28/2015 | 220 | | Approved | 5/27/2015 2:55 PM | i:0#.f|uclachissqlmembershipprovider|venetia | 5/27/2015 7:58 PM | i:0#.f|uclachissqlmembershipprovider|venetia | | | | | | | | | | | | | | | Publication | | | | | | |  The UCLA Fielding Health Policy and Management Student Association interviewed Gerald Kominski for its May newsletter. Above, Jerry with his family at Centre Court, Wimbledon, July 2013.
Name: Gerald (Jerry) Kominski
Title: Professor, Department of HPM, and Director, UCLA Center for Health Policy Research
Favorite Activities: Tennis, travel, photography
Favorite Ways to Relax: Reading, mostly history and biographies; watching TV; listening to my vast music collection
If you could have any other job what would it be: I have the best job in the world, so I don’t even know what else I would do!
What Motivates you: I was very moved by the civil rights movement growing up in the 60s, and it inspired me to join the fight for equality. I’ve wanted to make the world a better place, and I feel I’ve done that in my professional and personal lives.
Advice You would give to a HPM student: Whatever career path you choose, make sure you feel passionate about it! Life is so much more rewarding when you have an avocation rather than just a job.
Hero: As a kid, John Kennedy; as an adolescent, John Lennon; as an adult, my father.
Summer Plans: Travel to Lisbon
Fun Fact: I have over 20,000 songs on the iPod Classic I carry in my briefcase!
| | 5/21/2015 | 218 | | Approved | 5/12/2015 11:10 AM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | 5/20/2015 10:56 PM | i:0#.f|uclachissqlmembershipprovider|gwendolyn | Venetia Lai | venetialai@ucla.edu | UCLA Center for Health Policy Research | 310-794-6963 | | | | | 1092 | | Y | | | | Publication | Ten-Year Trends in the Health of Young Children in California: 2003 to 2011-2012 | 1391 | | | UCLA research shows significant gains over the past decade, but disparities persist | | An impressive 3 in 4 California children ages 2 to 5 had a regular dental checkup in 2012, including those from poorer households, according to a new |
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