Association of California Immigrants' Avoidance of Public Programs Due to Immigration Concerns With Delayed Access to Health Care.

This cross-sectional study examines the association of avoidance of public programs among California immigrants with delayed access to health care services and prescriptions owing to concerns about how their interaction with these services may affect their immigration status.

How Has Access to Care for Medi-Cal Enrollees Fared Relative to Employer-Sponsored Insurance 4 Years After the Affordable Care Act Expansion?

BACKGROUND: The number of Californians covered by Medi-Cal increased more than 50% between 2013 and 2018, largely due to expansion under the Affordable Care Act (ACA). This rapid expansion of Medicaid rolls prompted concerns that Medi-Cal enrollees would face greater difficulty accessing health care. OBJECTIVE: Examine whether gaps in access to care between Medi-Cal and employer-sponsored insurance (ESI) present in 2013 (prior to ACA implementation) had changed by 2018 (several years post implementation). DESIGN: Secondary analysis of data from the 2013 and 2018 California Health Interview Survey. The sample included adults of ages 18-64 insured all year and covered by ESI or Medi-Cal at time of interview. Logistic regressions were used to examine variation across years in the association between access to care and insurance type. MAIN MEASURES: Five access to care outcomes were assessed: no usual source of care, not accepted as new patient in past year, insurance not accepted in past year, delayed medical care in past year, and difficulty getting timely appointment. The main predictors of interest were type of insurance (Medi-Cal or ESI) and survey year (2013 or 2018). KEY RESULTS: The association between insurance type and access to care changed significantly over time for three outcomes: not accepted as new patient in past year (OR = 0.55, 95% CI = 0.32-0.97), delayed medical care in past year (OR = 1.55, 95% CI = 1.06-2.25), and difficulty getting timely appointment (OR = 0.41, 95% CI = 0.23-0.74). Predicted probabilities indicate gaps between Medi-Cal and ESI narrowed for not accepted as new patient in past year and difficulty getting timely appointment, but widened for delayed medical care. CONCLUSIONS: Despite the rapid expansion in the number of Californians covered by Medi-Cal, most gaps in access to care between Medi-Cal and ESI enrollees improved or did not significantly change between 2013 and 2018.

Using a Twitter Chat to Rapidly Identify Barriers and Policy Solutions for Metastatic Breast Cancer Care: Qualitative Study.

BACKGROUND: Real-time, rapid assessment of barriers to care experienced by patients can be used to inform relevant health care legislation. In recent years, online communities have become a source of support for patients as well as a vehicle for discussion and collaboration among patients, clinicians, advocates, and researchers. The Breast Cancer Social Media (#BCSM) community has hosted weekly Twitter chats since 2011. Topics vary each week, and chats draw a diverse group of participants. Partnering with the #BCSM community, we used Twitter to gather data on barriers to care for patients with metastatic breast cancer and potential policy solutions. Metastatic breast cancer survival rates are low and in large part conditioned by time-sensitive access to care factors that might be improved through policy changes. OBJECTIVE: This study was part of an assessment of the barriers to care for metastatic breast cancer with the goal of offering policy solutions for the legislative session in California. METHODS: We provided 5 questions for a chat specific to metastatic breast cancer care barriers and potential policy solutions. These were discussed during the course of a #BCSM chat on November 18, 2019. We used Symplur (Symplur LLC) analytics to generate a transcript of tweets and a profile of participants. Responses to the questions are presented in this paper. RESULTS: There were 288 tweets from 42 users, generating 2.1 million impressions during the 1-hour chat. Participants included 23 patient advocates (most of whom were patients themselves), 7 doctors, 6 researchers or academics, 3 health care providers (2 nurses, 1 clinical psychologist), and 2 advocacy organizations. Participants noted communication gaps between patient and provider especially as related to the need for individualized medication dosing to minimize side effects and maximize quality of life. Timeliness of insurance company response, for example, to authorize treatments, was also a concern. Chat participants noted that palliative care is not well integrated into metastatic breast cancer care and that insurance company denials of coverage for these services were common. Regarding financial challenges, chat participants mentioned unexpected copays, changes in insurance drug formularies that made it difficult to anticipate drug costs, and limits on the number of physical therapy visits covered by insurance. Last, on the topic of disability benefits, participants expressed frustration about how to access disability benefits. When prompted for input regarding what health system and policy changes are necessary, participants suggested a number of ideas, including expanding the availability of nurse navigation for metastatic breast cancer, developing and offering a guide for the range of treatment and support resources patients with metastatic breast cancer, and improving access to clinical trials. CONCLUSIONS: Rapid assessments drawing from online community insights may be a critical source of data that can be used to ensure more responsive policy action to improve patient care.

Disparities in Health Care Access and Health Among Lesbians, Gay Men, and Bisexuals in California.

This policy brief examines differences in health care access, health behaviors, and health outcomes by sexual orientation among California adults. Using data from the California Health Interview Survey, the study finds that although lesbian, gay, and bisexual women and men have similar or better rates of insurance coverage compared to straight women and men, they are more likely to experience delays in getting needed health care. Lesbians, bisexual women, and bisexual men have higher rates of smoking and binge drinking than straight women and men; however, gay men are less likely to consume sugary beverages and to be physically inactive. Lesbians and bisexuals had poorer health status and higher rates of disability than straight adults. Future research is needed to explain these disparities, as well as to identify health care and structural interventions that will improve access to care and health outcomes for this population.

Few California Children and Adolescents Meet Physical Activity Guidelines.

This policy brief describes physical activity among California children and adolescents. Using data from the California Health Interview Survey (CHIS), the study found that only 31 percent of children ages 5-11 and 18 percent of adolescents ages 12-17 meet the physical activity guidelines of engaging in at least one hour of physical activity every day. Neighborhood characteristics, including safety and proximity to parks, are related to physical activity levels among youth. Also, among older children, boys are more active than girls. Additional efforts by state and local policymakers, as well as communities, are needed to promote physical activity to increase the proportion of children and adolescents achieving recommended amounts of physical activity.

Walking Among California Adults.

This policy brief describes two types of walking among California adults: walking for transportation and walking for leisure. Using data from the 2013-14 California Health Interview Survey, the study found that the prevalence of both types of walking has increased since 2003. The prevalence of walking for both transportation and leisure varies with age, income, race/ethnicity, and neighborhood safety and cohesion. Additional efforts by state and local policymakers, as well as by communities, are needed to reduce disparities and promote walking among adults.

Sugary Beverage Consumption Among California Children and Adolescents.

This policy brief examines patterns of sugary beverage consumption among children and adolescents in California. Using data from the California Health Interview Survey (CHIS), this study found that while sugary beverage consumption decreased among adolescents ages 12-17 between 2011-12 and 2013-14, it increased among children under age 12 between 2009 and 2013-14. The trend among children under age 12 may be attributed to a shift in sugary beverage consumption from soda to sports and energy drinks. Establishing and strengthening policies that focus on reducing consumption of sugary beverages could counter the increasing consumption trend among younger children as well as result in further reductions in consumption among teens.

Civic Engagement Among California High School Teens.

This policy brief describes civic engagement among California adolescents in high school. Using data from the California Health Interview Survey (CHIS), the study found that the most common civic engagement activity among California high school teens is volunteering. Latino teens and those from low-income families have lower rates of civic engagement. Higher rates of civic engagement are associated with better health status, fewer days of missed school due to health, better grades, and greater perceived likelihood of attending college. Strategies to increase adolescent civic engagement could help promote healthy development. Policymakers, schools, and community organizations can promote civic engagement among all youth by expanding programs, encouraging youth participation in school and community organizations, and engaging youth who have not traditionally been included in civic activities.

Exploring the differences between pet and non-pet owners: Implications for human-animal interaction research and policy.

There is conflicting evidence about whether living with pets results in better mental and physical health outcomes, with the majority of the empirical research evidence being inconclusive due to methodological limitations. We briefly review the research evidence, including the hypothesized mechanisms through which pet ownership may influence health outcomes. This study examines how pet and non-pet owners differ across a variety of socio-demographic and health measures, which has implications for the proper interpretation of a large number of correlational studies that attempt to draw causal attributions. We use a large, population-based survey from California administered in 2003 (n = 42,044) and find that pet owners and non-pet owners differ across many traits, including gender, age, race/ethnicity, living arrangements, and income. We include a discussion about how the factors associated with the selection into the pet ownership group are related to a range of mental and physical health outcomes. Finally, we provide guidance on how to properly model the effects of pet ownership on health to accurately estimate this relationship in the general population.

Prediabetes in California: Nearly Half of California Adults on Path to Diabetes.

In California, more than 13 million adults (46 percent of all adults in the state) are estimated to have prediabetes or undiagnosed diabetes. An additional 2.5 million adults have diagnosed diabetes. Altogether, 15.5 million adults (55 percent of all California adults) have prediabetes or diabetes. Although rates of prediabetes increase with age, rates are also high among young adults, with one-third of those ages 18-39 having prediabetes. In addition, rates of prediabetes are disproportionately high among young adults of color, with more than one-third of Latino, Pacific Islander, American Indian, African-American, and multiracial Californians ages 18-39 estimated to have prediabetes. Policy efforts should focus on reducing the burden of prediabetes and diabetes through support for prevention and treatment.

Lunchtime School Water Availability and Water Consumption Among California Adolescents.

PURPOSE: To examine the potential impact of California SB 1413, which required school districts to provide free, fresh drinking water during mealtimes in food service areas by July 1, 2011, on greater water consumption among California adolescents. METHODS: Data were drawn from the 2012 and 2013 state-representative California Health Interview Survey. A total of 2,665 adolescents aged 12-17 years were interviewed regarding their water consumption and availability of free water during lunchtime at their school. RESULTS: Three-fourths reported that their school provided free water at lunchtime, mainly via fountains. In a multivariate model that controlled for age, gender, income, race/ethnicity, body mass index, and school type, adolescents in schools that provided free water consumed significantly more water than adolescents who reported that water was not available, bivariate (standard error) = .67 (.28), p = .02. School water access did not significantly vary across the 2 years. CONCLUSIONS: Lunchtime school water availability was related to water consumption, but a quarter of adolescents reported that their school did not provide free water at lunch. Future research should explore what supports and inducements might facilitate provision of drinking water during school mealtimes.

Role models and social supports related to adolescent physical activity and overweight/obesity.

Positive role models, social and community activities, and school support are protective social factors that promote youth health and well-being. Latino, African-American, Asian, multi-racial, and low-income adolescents are less likely to experience these protective social factors compared to other groups, which may contribute to health disparities. Adolescents who identify a role model, volunteer, participate in organizations outside of school, or experience high levels of teacher or other adult support at school engage in greater physical activity and are more likely to have a healthy weight. Strategies to increase these protective social factors among adolescents could help promote healthy weight and healthy behaviors.

Neighborhood, family and individual characteristics related to adolescent park-based physical activity.

BACKGROUND: Local parks are an important community resource that may influence levels of physical activity among youth. However, few population-based studies have investigated park-based physical activity among youth. PURPOSE: This study examines sociodemographic, family, and neighborhood characteristics associated with park-based physical activity among adolescents. METHODS: Data were from the 2007 California Health Interview Survey (CHIS), a population-based survey of California households, and were analyzed in 2012-2013 and 2015. This study examined individual (age, gender, race/ethnicity, and nativity), family (household income, parental education, and nativity), and neighborhood characteristics (urbanicity, perceived park availability, perceived park safety, neighborhood income, and racial composition) associated with engaging in park-based physical activity among adolescents. RESULTS: In California, 71% of adolescents reported being physically active the last time they visited a park. In adjusted multinomial logistic regression analyses, older adolescents and females were less likely to be physically active in parks. Adolescents with a park within walking distance of home and those with a safe park nearby were more likely to be physically active during a park visit. CONCLUSIONS: Park availability and perceptions of park safety are important predictors of engaging in park-based physical activity among adolescents. These findings provide information that can help inform interventions intended to increase physical activity among youth. Strategies that increase availability and safety of parks and other recreation spaces may be particularly effective.

School-based program options to promote physical activity: a response.

This commentary is a response to PM-14-1065R1 and addresses issues raised regarding research presented in PM-14-443.

How can schools help youth increase physical activity? An economic analysis comparing school-based programs.

OBJECTIVE: For optimal health, physical activity should be an integral and routine part of daily life. Youth spend a significant amount of time at school yet rarely achieve the recommended 60 min of moderate and vigorous physical activity in physical education (PE) classes or recess. This study assessed the following types of school-based opportunities to improve physical activity for youth: after-school programs, before-school programs, PE classes, extended-day PE, and short physical activity breaks during the school day. METHOD: An economic analysis conducted in 2013 compared school-based approaches to increasing physical activity. Analysis factors included costs, reach, effects on physical activity gains, cost-effectiveness, and other potentially augmenting benefits. RESULTS: Two programs were significantly superior in terms of reach and cost per student: (1) extending the school day with mandatory PE participation and (2) offering short (10-minute) physical activity breaks during regular classroom hours. After-school program costs per student are high and the programs have a smaller reach, but they offer benefits (such as childcare) that may justify their higher costs. Before-school programs did not appear feasible. CONCLUSION: Incorporating short physical activity breaks into the existing school day would be a cost-effective way to increase school-based activity. This type of program is inexpensive and has broad reach. Inserting activity breaks throughout the day is appropriate, especially when youth are otherwise largely sedentary.

Diabetes tied to a third of California hospital stays, driving health care costs higher.

Increasing diabetes prevalence has been found to be a primary driver of increased health care costs in the United States. This policy brief examines the impact of diabetes on hospitalizations and related hospitalization costs in California. Using 2011 hospital patient discharge data and annual financial data from the Office of Statewide Health Planning and Development (OSHPD), this study found that patients with diabetes represented 31 percent of hospitalizations in California in 2011 among patients 35 years or older, including 39 percent of African-American and Asian-American patients and 43 percent of Latino patients. Moreover, these hospitalizations cost nearly $2,200 more per hospitalization than those for patients without diabetes, regardless of the primary reason for the hospitalization. Given that approximately 90-95 percent of diagnosed diabetes among adults is type 2 diabetes and is therefore preventable, public health measures can and should be taken to relieve the burden of type 2 diabetes. Such measures include promoting a healthy diet and regular physical activity and providing adequate access to primary and specialty care.

Physical activity, park access, and park use among California adolescents.

In California, 2.15 million adolescents (62.9%) do not engage in at least 60 minutes of physical activity five or more days per week. Adolescents who visited a park in the past month and those who live in a park service area are more likely to meet this goal. Lower-income California adolescents are less likely to visit local parks and more likely to believe local parks are unsafe. Actions by state and local policymakers to increase park access and attractiveness, especially to underserved populations, may be an effective way to promote physical activity among California's adolescents.

Adolescent sedentary behaviors: correlates differ for television viewing and computer use.

PURPOSE: Sedentary behavior is associated with obesity in youth. Understanding correlates of specific sedentary behaviors can inform the development of interventions to reduce sedentary time. The current research examines correlates of leisure computer use and television viewing among adolescents in California. METHODS: Using data from the 2005 California Health Interview Survey, we examined individual, family, and environmental correlates of two sedentary behaviors among 4,029 adolescents: leisure computer use and television watching. RESULTS: Linear regression analyses adjusted for a range of factors indicated several differences in the correlates of television watching and computer use. Correlates of additional time spent watching television included male sex, American Indian and African American race, lower household income, lower levels of physical activity, lower parent educational attainment, and additional hours worked by parents. Correlates of a greater amount of time spent using the computer for fun included older age, Asian race, higher household income, lower levels of physical activity, less parental knowledge of free-time activities, and living in neighborhoods with higher proportions of nonwhite residents and higher proportions of low-income residents. Only physical activity was associated similarly with both watching television and computer use. CONCLUSIONS: These results suggest that correlates of time spent on television watching and leisure computer use are different. Reducing screen time is a potentially successful strategy in combating childhood obesity, and understanding differences in the correlates of different screen time behaviors can inform the development of more effective interventions to reduce sedentary time.