Association between Childhood Maltreatment and Depressive and Anxiety Symptoms among Men Who Have Sex with Men in Los Angeles.

Adverse childhood experiences (ACEs) have been associated with poor mental health outcomes in adulthood. Childhood maltreatment is related to both depressive and anxiety symptoms. Our objective was to investigate these associations among low-income, mostly Black and Latino men who have sex with men (MSM), as these may be a particularly vulnerable population group. Data come from a longitudinal study of MSM with varied substance use behaviors (n = 321) collected between August 2014 and April 2022. Cumulative, childhood maltreatment ACEs, and the single ACE of childhood sexual abuse were investigated as potential predictors of self-reported depressive and anxiety symptoms in mixed-effects logistic and ordinal regression models. There was no evidence of a dose-response relationship between the number of ACEs and the predicted probability of depressive and anxiety symptoms. Compared to MSM reporting fewer than five ACEs, those with five or more ACEs had approximately double the odds ratio of reporting depressive (OR = 1.93; 95% CI: 1.04-3.60) and anxiety symptoms (OR = 2.21; 95% CI: 1.05-4.68). The dimension of childhood maltreatment had a more robust prediction of depressive symptoms than the dimension of household dysfunction across all models. The association between childhood sexual abuse history and depressive symptoms remained after adjustment for the other nine ACEs (OR = 2.27; 95% CI: 1.11-4.68). The ordinal logistic model suggested that cumulative ACEs more than triple the odds of being in a higher anxiety category (OR = 3.12; 95% CI: 1.58-6.14), with associations reported for childhood maltreatment ACEs (OR = 1.31; 95% CI: 1.06-1.66) and childhood sexual abuse (OR = 1.93; 95% CI: 0.89-4.21). Childhood maltreatment ACEs, particularly childhood sexual abuse, are salient predictors of depressive and anxiety symptoms among adult urban MSM. Mitigating the impact of childhood maltreatment requires understanding the additional burden of social distress often faced by MSM throughout the life course.

Perceived social support moderates the association between household dysfunction adverse childhood experiences (ACEs) and self-reported drug use among men who have sex with men in Los Angeles, California.

BACKGROUND: Adverse childhood experiences (ACEs) have been shown to be associated with drug use in adulthood. The single ACE of household substance use history (part of the household dysfunction category) has frequently been associated with drug use. Resilience factors such as perceived social support appear to buffer the association between ACEs and drug use and may be particularly relevant for urban men who have sex with men (MSM). The current study of low-income mostly Black and Latino MSM aims to investigate whether the cumulative ACE score predicts self-reported drug use in a dose-response manner and whether this potential association differs by perceived social support. METHODS: Data was utilized from a longitudinal study of MSM (mean age=34; SD=7.1) with varied substance use behaviors (n = 321) collected between August 2014 and April 2022. Cumulative, household dysfunction ACEs, and the single ACE of household substance use history were investigated as predictors of self-reported drug use (methamphetamine, ecstasy, cocaine/crack, heroin/fentanyl, party drugs [GHB, special K, mushrooms, LSD/acid], other drugs [bath salts, PCP]) during the past six months in mixed-effects logistic regression models, with moderation analyses by perceived social support (measured by the Multidimensional Scale of Perceived Social Support) across all models using stratified analysis and one model of multiplicative interaction. RESULTS: There was no suggestion of a dose-response relationship between the number of ACEs and the predicted probability of self-reported drug use. Cumulative ACEs did not predict the outcome overall (aOR=1.99; 95% CI: 0.86-4.59), however, a positive association was estimated for individuals reporting lower levels of perceived social support (aOR=2.80; 95% CI: 0.97-8.06). The dimension of household dysfunction had a positive association with drug use (aOR=1.32; 95% CI: 1.00-1.74) whereas the dimension of childhood maltreatment did not. The association between household dysfunction and drug use was moderated by the perception of social support, with those reporting lower levels having greater odds of reporting drug use (aOR=2.94; 95% CI: 1.04-8.31). The association between household substance use history and self-reported drug use was similarly moderated by perceived social support in a multiplicative interaction model (p = .02). CONCLUSION: Perceived social support emerged as a potential buffering factor for any reported drug use, particularly for the single ACE of household substance use history. Given that the association between ACEs and drug use was weak among those with higher levels of perceived social support, promotion of social ties in the community may help reduce the burden of substance use among MSM exposed to ACEs.

Real World Feedback: How Well Did the Virtual Training Academy Prepare California's COVID-19 Contact Tracing Workforce?

To effectively respond to the COVID-19 pandemic, California had to quickly mobilize a substantial number of case investigators (CIs) and contact tracers (CTs). This workforce was comprised primarily of redirected civil servants with diverse educational and professional backgrounds. The purpose of this evaluation was to understand whether the weeklong, remote course developed to train California's CI/CT workforce (i.e., Virtual Training Academy) adequately prepared trainees for deployment. From May 2020 to February 2021, 8,141 individuals completed the training. A survey administered ~3 weeks post-course assessed two measures of overall preparedness: self-perceived interviewing proficiency and self-perceived job preparedness. Bivariate analyses were used to examine differences in preparedness scores by education level, career background, and whether trainees volunteered to join the COVID-19 workforce or were assigned by their employers. There were no significant differences in preparedness by education level. Compared to trainees from non-public health backgrounds, those from public health fields had higher self-perceived interviewing proficiency (25.1 vs. 23.3, p < 0.001) and job preparedness (25.7 vs. 24.0, p < 0.01). Compared to those who were assigned, those who volunteered to join the workforce had lower self-perceived job preparedness (23.8 vs. 24.9, p = 0.02). While there were some statistically significant differences by trainee characteristics, the practical significance was small (<2-point differences on 30-point composite scores), and it was notable that there were no differences by education level. Overall, this evaluation suggests that individuals without bachelor's degrees or health backgrounds can be rapidly trained and deployed to provide critical disease investigation capacity during public health emergencies.

Measuring impact of storyline engagement on health knowledge, attitudes, and norms: A digital evaluation of an online health-focused serial drama in West Africa.

Background: "Cest la Vie!" (CLV) is a serial drama that entertains, educates, and promotes positive health behaviors and social change for West African audiences. The purpose of this study was to evaluate if watching the CLV Season 2 series online had an impact on people's health knowledge, attitudes, and norms, focusing on populations in francophone West Africa. Methods: Between July 2019 and October 2019, viewers of CLV and non-viewers were recruited from Facebook and YouTube. We conducted an online longitudinal cohort study that assessed changes in health knowledge, attitudes, and norms (KAN) between these groups. Participants completed a baseline survey prior to the online airing and up to three follow-up surveys corresponding to specific health stories in the series, including sexual violence, emergency contraception, and female circumcision. We used descriptive statistics to describe viewers and non-viewers, and an item response theory (IRT) analysis to identify the effect of viewing CLV on overall KAN. Results: A total of 1674 respondents participated in the study. One in four participants (23%, n = 388) had seen one of the three storylines from CLV Season 2 (ie, CLV viewers). At follow-up, viewers were more likely than non-viewers to know when to correctly use emergency contraception (P < 0.001) and to believe that the practice of female circumcision should end (P = 0.001). Compared to people who did not see CLV, viewers of the series had 26% greater odds of answering pro-health responses at follow-up about sexual assault, emergency contraception, and female circumcision. Further, the level of engagement with specific storylines was associated with a differential impact on overall outcome questions. Conclusions: As internet access continues to grow across the globe and health education materials are created and adapted for new media environments, our study provides a novel approach to examining the impact of online entertainment-education content on health knowledge, attitudes, and norms.

Cardiovascular disease behavioral risk factors among Latinos by citizenship and documentation status.

BACKGROUND: Studies have observed that recent Latino immigrants tend to have a physical health advantage compared to immigrants who have been in the US for many years or Latinos who are born in the United States. An explanation of this phenomenon is that recent immigrants have positive health behaviors that protect them from chronic disease risk. This study aims to determine if trends in positive cardiovascular disease (CVD) risk behaviors extend to Latino immigrants in California according to citizenship and documentation status. METHODS: We examined CVD behavioral risk factors by citizenship/documentation statuses among Latinos and non-Latino US-born whites in the 2011-2015 waves of the California Health Interview Survey. Adjusted multivariable logistic regressions estimated the odds for CVD behavioral risk factors, and analyses were stratified by sex. RESULTS: In adjusted analyses, using US-born Latinos as the reference group, undocumented Latino immigrants had the lowest odds of current smoking, binge drinking, and frequency of fast food consumption. There were no differences across the groups for fruit/vegetable intake and walking for leisure. Among those with high blood pressure, undocumented immigrants were least likely to be on medication. Undocumented immigrant women had better patterns of CVD behavioral risk factors on some measures compared with other Latino citizenship and documentation groups. CONCLUSIONS: This study observes that the healthy Latino immigrant advantage seems to apply to undocumented female immigrants, but it does not necessarily extend to undocumented male immigrants who had similar behavioral risk profiles to US-born Latinos.

Exploring the Relationship Between MyPlate Knowledge, Perceived Diet Quality, and Healthy Eating Behaviors Among Adolescents.

PURPOSE: MyPlate is the current dietary guidance icon meant to communicate healthy eating patterns. The purpose of this study is to evaluate knowledge of MyPlate nutrition education messages among middle school students and its association with dietary intake and perceived diet quality. DESIGN: Secondary analysis of cross-sectional data. SETTINGS: Survey of eighth-grade students from 16 middle schools in California. SUBJECTS: A total of 3521 eighth-grade students. MEASURES: MyPlate knowledge was assessed with 3 questions asking how much of the plate in a typical meal should be (1) fruits and vegetables, (2) grains, and (3) proteins. A brief food frequency questionnaire measured intake of fruits, vegetables, sweets, salty snacks, fast-food, and sugar-sweetened beverages (SSBs) over the past 7 days. Students self-rated their diet quality as poor, fair, good, or excellent. ANALYSIS: Hierarchical logistic regression models controlling for gender, ethnicity, and socioeconomic status. RESULTS: Only 11% of students answered all MyPlate questions correctly. MyPlate knowledge was associated with 65% higher odds of not consuming SSBs, but 46% lower odds of not consuming sweets. MyPlate knowledge was not associated with adolescents' perceived diet quality or intake of salty snacks, fruits, or vegetables. CONCLUSION: Knowledge of nutrition education messages communicated by the MyPlate dietary guidance icon is limited among adolescents. The association between MyPlate knowledge and lower consumption of SSBs is encouraging, given the strong association between SSBs and childhood obesity.

Strategies for Effective Collaboration with Middle School Physical Education Teachers: An Application of School-Engaged Research.

BACKGROUND: Increasing the capacity of teachers to deliver physical education (PE) lessons that are high in moderate to vigorous physical activity (PA) is one strategy to increase the amount of exercise students receive during school. However, traditional research approaches have not directly engaged the school community as equitable partners in the intervention design process. The purpose of this article is to describe the process, outputs, and lessons learned from a school-engaged research study, which incorporates the unique needs of schools-in terms of structure, accountability measures, and array of stakeholders into the research process and design. METHODS: This article describes lessons learned from Project SHAPE, a PA intervention that used principles of school-engaged research to guide program planning, recruitment, implementation, and data dissemination. RESULTS: The study team successfully partnered with 16 schools and enrolled 55 teachers and surveyed 4,773 students. CONCLUSIONS: Efforts to improve PE programs can benefit from a school-engaged research approach that directly involves teachers, fosters mutually beneficial relationships, and integrates the schools' perspective in the research process.

"You Only Teach PE and It Doesn't Really Matter": Middle School PE Teachers' Perspectives on Intervention Efforts to Increase Physical Activity.

Physical education (PE) is a frequent site of public health intervention to promote physical activity (PA); however, intervention research frequently overlooks the perspective of PE teachers. The purpose of this qualitative study was to explore teachers' experiences with and perceptions of a PA curriculum intervention. Six findings within three categories were identified and described in detail. In-depth one-on-one semistructured interviews were conducted with nine PE teachers from eight middle schools in Los Angeles. Feeling underappreciated and having a "muddled mission" within PE were driving factors in teacher morale and practice. Teachers had positive experiences with the curriculum, but significant barriers remained and limited the potential for PA during PE classes. PE teachers are pulled in multiple directions and perceive a lack of necessary support systems to achieve student health goals. Interventions aimed at leveraging PE as a site of PA promotion must incorporate the perspectives of PE teachers.

Evaluation of an Intervention to Increase Physical Activity in Low-Income, Urban Middle Schools.

BACKGROUND: Physical education (PE) can provide opportunities to engage in daily moderate-to-vigorous physical activity (MVPA), but MVPA levels in many classes are low. This study examines MVPA during middle school PE lessons before and after receiving the SPARK (Sports, Play, and Active Recreation for Kids) program. METHODS: Sixteen schools were enrolled in the study. PE teachers at eight schools received the intervention. PE lessons at all schools (N = 561) were observed over 2 years. Hierarchical linear regression models examined the effect of the intervention on the amount and consistency of MVPA and sedentary behavior. RESULTS: An average of 13.7% of observed class time was spent in MVPA (approximately 5 minutes of a 60-minute class), compared to 27.5% of time spent sedentary. There was no evidence that the curriculum resulted in increased MVPA or consistent MVPA, or that it decreased sedentary behavior. Findings also suggested that contextual factors may contribute to physical activity levels in PE. CONCLUSIONS: Mixed evaluation findings of the SPARK middle school curriculum demonstrate that an out-of-the-box curriculum does not have the same results in all contexts. Implications for school health are described based upon findings. Further research is needed to identify effective strategies to increase MVPA for adolescents both in and outside of PE.

The Effects of a 2-Year Middle School Physical Education Program on Physical Activity and Its Determinants.

Purpose: This study examines the effects of the middle school SPARK physical education (PE) curriculum on predisposing, enabling, and reinforcing factors for physical activity (PA) as well as self-reported PA in a predominantly low-income, Latinx student population in Los Angeles, CA. Methods: Data were collected from 3763 students of seventh and eighth grades at 2 time points at the 16 middle schools enrolled in the study. Hierarchical logistic regression models were used to assess intervention effects on PA attitudes, PE enjoyment, FitnessGram passing, daily PA, and muscle-strengthening PA, controlling for demographic variables. Results: Although there was no detectable intervention effect on increasing the number of students exercising 60 minutes per day, there was a negative intervention effect detected for muscle-strengthening exercises. A significant positive intervention effect was detected for both PE enjoyment and FitnessGram passing. Deeper analysis of these findings revealed that the positive effect on PE enjoyment occurred only among male students. Conclusion: The SPARK curriculum had mixed effects on students' PA behavior as well as predisposing, enabling, and reinforcing factors for PA. Incorporating student perspectives into the evaluation of intervention efforts to promote PA can facilitate a better understanding of the ways in which these efforts influence PA behaviors and its determinants.

Physical Activity Correlates in Middle School Adolescents: Perceived Benefits and Barriers and Their Determinants.

The purpose of this study was to examine the determinants of benefits and barriers and their relationship with physical activity (PA) among predominantly Latino middle school students. Data were collected in a cross-sectional survey of 4,773 seventh-grade students recruited from a large, urban school district in Los Angeles. Hierarchical logistic regression models were used to assess determinants of benefits and barriers as well as their association with self-reported PA. Differences in benefits and barriers were observed by gender, ethnicity, and body size. Barriers were negatively correlated with all three PA outcomes while benefits were positively associated with exercising at least 60 min daily. A deeper understanding of benefits and barriers can facilitate the development of interventions and collaborative efforts among physical education teachers, school nurses, and administrators to implement comprehensive approaches that encourage students' participation in PA inside and outside of the classroom.

A Multifaceted Approach to Public Health Career and Professional Development Training.

The purpose of this article is to describe how a multifaceted approach to career and professional development training, focused on core competencies, student-driven programming, inter and multidisciplinary collaboration, and cultivating a community of insight and support, is being implemented by a university Public Health Career Services office with limited staff and resources and to share these practices for other public health programs to scale this approach to their own students' needs. The design of the career and professional development training program comprised five main approaches: (1) one-on-one career counseling, (2) peer-to-peer learning workshops, (3) community partnerships and experiential opportunities, (4) student-driven programming, and (5) accessible training and digital resources. All programs were tracked to gauge participation and to assess effectiveness. Noteworthy findings from program evaluations include (1) a large increase in student confidence levels in professionalism topics, from all of the school's departments; (2) benefits of student-driven programming and peer-to-peer learning, and (3) importance of employer and alumni engagement. Rather than use an optional participation model, it is recommended that a cohort model or mandatory participation be implemented as the opportunity to build on curriculum is vital.

Rapid Assessment of Nutrition Services in Los Angeles Substance Use Disorder Treatment Centers.

The objective of this study was to determine the prevalence of nutrition services and utilization of registered dietitian nutritionists at substance use disorder treatment centers in Los Angeles. This cross-sectional descriptive study utilized phone interviews with facilities within a 25-mile radius of the Los Angeles metropolitan area using the Substance Abuse and Mental Health Services Administration Treatment Services Locator to identify facilities that included a listing of substance abuse as primary focus of care (n = 128). Facilities were asked if they offered any kind of nutrition services, the type of services that were offered, and the credential of the professional providing the services. We compared facilities that offered a residential level of care to those offering outpatient services only. The Fisher's exact test was used to determine statistical significance. The study showed that only 39 sites (30.5%) offered any type of nutrition services on site, and the odds of a residential level of care offering nutrition services was 2.7 times higher than outpatient only facilities (p = 0.02). Of the 39 facilities offering nutrition services, only 8 (20.5%) utilized a registered dietitian nutritionist. Overall fewer than 7% of the facilities utilized the services of a dietitian. Recovery programs for substance use disorder should consider using a registered dietitian nutritionist as a member of the treatment team, which may contribute to better clinical outcomes.

Severe housing-cost burden and obesity among preschool-aged low-income children in Los Angeles County.

Despite high rates of housing-cost burden in the United States, little is known regarding its impact on childhood obesity. In this article, we determine whether low-income 2-5-year-olds living in housing-cost burdened households are more likely to be obese and examine the potential moderators and behavioral and psychosocial mediators of this relationship. We used data from a triennial survey (2011, 2014) of a random sample of Los Angeles County participants of the Special Supplemental Nutrition Program for Women, Infants and Children (n = 2307). Logistic regression was used to examine the association between child's obesity status (Body Mass Index for age and sex ≥ 95th percentile) and severe housing-cost burden (finding it very difficult to pay for housing). Mother's depressive symptoms and child's diet and screen time were tested for mediation. We found that 16% of children lived in severe housing-cost burdened households. Severe housing-cost burden was associated with an increase in the odds of childhood obesity [aOR (95%CI) = 1.33 (1.00, 1.78)] and household size moderated this relationship. Child's diet and screen time and mother's depressive symptoms were not mediators. Given the high and vacillating rates of early childhood obesity and the increasing burden of housing costs in low-income populations, there is an urgency to better understand the role of housing-cost burden in epidemiologic investigations of early childhood obesity.

Trends in Socioeconomic Disparities in Obesity Prevalence among Low-Income Children Aged 2-4 Years in Los Angeles County, 2003-2014.

BACKGROUND: Obesity prevalence among low-income preschool-aged children in the United States decreased between 2010 and 2014. However, this decreasing trend may be varied across socioeconomic subgroups. This study examined trends in obesity prevalence among low-income children from 2003 to 2014 by child's age and household and neighborhood socioeconomic status (SES). METHODS: This study used administrative data for all children, aged 2-4 years, participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Los Angeles County (LAC) during the years 2003-2014. Obesity was defined as having a BMI ≥95th percentile of CDC's age- and sex-specific growth charts. Household income and household educational attainment were indicators of household SES. Neighborhood median household income was an indicator of neighborhood SES. RESULTS: Childhood obesity prevalence increased sharply from 15.7% in 2003 to 19.1% in 2005, and remained constant until 2010, when it started decreasing. During most years, the prevalence of obesity was higher among the lowest SES groups. Despite the recent decreasing trend, the 2014 estimates were still generally higher than the 2003 levels except among some low-income children living in less-poor and more-educated households. CONCLUSIONS: The decreasing trend between 2010 and 2014 among WIC-participating children in LAC is encouraging and mirrors national trends among WIC-participating children. However, continued efforts should be made to focus obesity prevention efforts on low-income children, especially those who are the most vulnerable as they have experienced significant gains in obesity since 2003.

Widening socio-economic disparities in early childhood obesity in Los Angeles County after the Great Recession.

OBJECTIVE: While economic crises can increase socio-economic disparities in health, little is known about the impact of the 2008-09 Great Recession on obesity prevalence among children, especially low-income children. The present study examined whether socio-economic disparities in obesity among children of pre-school age participating in a federal nutrition assistance programme have changed since the recession. DESIGN: A pre-post observational study using administrative data of pre-school-aged programme participants from 2003 to 2014. Logistic regression was used to examine whether the relationship between obesity prevalence (BMI≥95th percentile of the Centers for Disease Control and Prevention's growth charts) and three measures of socio-economic status (household income, household educational attainment, neighbourhood-level median household income) changed after the recession by examining the interaction between each socio-economic status measure and a 5-year time-period variable (2003-07 v. 2010-14), stratified by child's age and adjusted for child's sociodemographic characteristics. SETTING: Los Angeles County, California, USA. SUBJECTS: Children aged 2-4 years (n 1 637 788) participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. RESULTS: The magnitude of the association of household income and household education with obesity increased after 2008-09 among 3- and 4-year-olds and 2- and 3-year-olds, respectively. However, the magnitude of the association of neighbourhood-level median household income with obesity did not change after 2008-09. CONCLUSIONS: Disparities in obesity by household-level socio-economic status widened after the recession, while disparities by neighbourhood-level socio-economic status remained the same. The widening household-level socio-economic disparities suggest that obesity prevention efforts should target the most vulnerable low-income children.

Correlates of Social Support and its Association With Physical Activity Among Young Adolescents.

BACKGROUND: A substantial proportion of adolescents, particularly girls and minority youth, fail to meet daily physical activity (PA) recommendations. Social support contributes to adolescent PA, but studies examining this relationship have yielded inconsistent results and rarely focus on diverse, urban populations. AIMS: This study examines the correlates of support for PA from family and friends and its relationship with PA outcomes among young adolescents. METHODS: Data were collected in a cross-sectional survey of 4,773 middle school students. Social support from family and friends was separately measured using the Sallis Support for Exercise Scales. Hierarchical logistic regression models were used to assess correlates of high support and the relationship between support and self-reported PA. RESULTS: Approximately one quarter of students reported being active for at least an hour each day. 31.7% of students reported high family support for PA, while 17.8% reported high friend support. Differences in perceptions of support by gender, ethnicity, and language emerged. Support from family and friends were both consistently strong predictors of all three PA outcomes measured. DISCUSSION: Findings highlight the need for multilevel interventions targeting both psychosocial influences on behavior in addition to addressing the physical environment. Given low rates of friend support for PA, there appears to be an opportunity to increase PA levels through promotion of supportive behaviors among peers. CONCLUSION: Support for PA from family and friends is a key contributor to increased PA among adolescents. Further research is needed to further understand the mechanisms by which these factors influence PA.

Nutrition Campaign Knowledge and Dietary Behavior in Middle School Students.

BACKGROUND: Federal nutrition campaigns are designed to make dietary recommendations accessible but have not been extensively evaluated. This paper explores whether knowledge of nutrition campaigns is associated with dietary behavior among young adolescents. METHODS: Cross-sectional survey data were collected from 4,773 middle school students in Southern California. Hierarchical logistic regression models were used to assess the association between dietary behaviors and nutrition campaign knowledge, controlling for gender and ethnicity. RESULTS: Knowledge of the Fruit & Veggies-More Matters campaign was associated with increased odds of high fruit and vegetable consumption, knowledge of the MyPlate campaign was associated with neither, and both were associated with increased odds of not consuming soda. CONCLUSION: Overall, low percentages of students demonstrated knowledge of nutrition campaigns, and knowledge was associated with some dietary behaviors. More research is needed to examine the impact of nutrition campaigns while also accounting for other psychosocial and environmental factors that may affect soda, fruit, and vegetable consumption.

Assessing quality of care through client satisfaction at an interprofessional student-run free clinic.

Student-run free clinics (SRFCs) have become important contributors not only to improve access to primary-care services for homeless and uninsured populations but also to enhance health sciences student education. In order for SRFCs to reliably provide high quality healthcare services and educationally benefit students, it is imperative to assess client perceptions of the quality of care provided. The objective of this study was to evaluate the delivery of healthcare services through a client satisfaction questionnaire at the University of California, Los Angeles Mobile Clinic Project (UCLA MCP). From 2012 to 2015, 194 questionnaires that addressed demographic information, satisfaction with services and client outcomes were analysed. Satisfaction scores were evaluated on a four-point scale and differences in the composite satisfaction scores were assessed using Mann-Whitney U-tests. Half (50%) of the client respondents report that UCLA MCP is their primary source of health care (MCP primary care clients), while 81.3% reported that the clinic improved access to other healthcare resources. Overall, clients are highly satisfied with their experiences (Range: 3.5-3.9) and 62% have recommended our services to others. While MCP primary-care clients report significantly higher satisfaction scores than non-primary-care clients on average (p < 0.01), the mean composite scores for all subgroups are consistently high. The UCLA MCP clients perceive the clinic to provide high-quality healthcare services. This article presents a framework that may help other SRFCs evaluate clients' perception of the quality of their care, an essential building block for effective physician-client relationships.