Does distance decay modelling of supermarket accessibility predict fruit and vegetable intake by individuals in a large metropolitan area?

UNLABELLED: Obesity, a risk factor for hypertension, diabetes, and other chronic diseases is influenced by geographic accessibility to supermarkets, which has been shown to affect nutritional behaviors. PURPOSE: To determine how individual fruit and vegetable (FV) consumption was independently influenced by accessibility to supermarkets, and to quantify that relationship. METHODS: A distance decay based model was specified for a random sample (n=7,514) of urban residents. Associations between FV consumption and accessibility to supermarkets were explored, controlling for factors known to influence eating behaviors. RESULTS: There was as independent effect of accessibility to supermarkets, even after the inclusion of the significant controlling factors of age, gender, race/ethnicity, education, marital status, and knowledge of nutritional guidelines. CONCLUSION: Our model of accessibility was an effective predictor of FV consumption in an urban population, setting the stage for inclusion of supply and demand parameters, and estimation of local factors that contribute to differential obesity rates.

The effect of urban street gang densities on small area homicide incidence in a large metropolitan county, 1994-2002.

The presence of street gangs has been hypothesized as influencing overall levels of violence in urban communities through a process of gun-drug diffusion and cross-type homicide. This effect is said to act independently of other known correlates of violence, i.e., neighborhood poverty. To test this hypothesis, we independently assessed the impact of population exposure to local street gang densities on 8-year homicide rates in small areas of Los Angeles County, California. Homicide data from the Los Angeles County Coroners Office were analyzed with original field survey data on street gang locations, while controlling for the established covariates of community homicide rates. Bivariate and multivariate regression analyses explicated strong relationships between homicide rates, gang density, race/ethnicity, and socioeconomic structure. Street gang densities alone had cumulative effects on small area homicide rates. Local gang densities, along with high school dropout rates, high unemployment rates, racial and ethnic concentration, and higher population densities, together explained 90% of the variation in local 8-year homicide rates. Several other commonly considered covariates were insignificant in the model. Urban environments with higher densities of street gangs exhibited higher overall homicide rates, independent of other community covariates of homicide. The unique nature of street gang killings and their greater potential to influence future local rates of violence suggests that more direct public health interventions are needed alongside traditional criminal justice mechanisms to combat urban violence and homicides.

Alcohol availability and neighborhood characteristics in Los Angeles, California and southern Louisiana.

The objective of this study was to examine the associations between alcohol availability types and community characteristics in randomly selected census tracts in Southern California and Southeastern Louisiana. Outlet shelf space and price by beverage type was collected from all off-sale alcohol outlets in 189 census tracts by trained research personnel. Three aspects of alcohol availability at the census tract level were considered--outlets per roadway mile, shelf space, and least price by beverage type. Using multivariate analyses, we examined the associations between census tract socioeconomic and demographic characteristics and alcohol availability types. Fifteen measures of alcohol availability were calculated-total shelf space and shelf space by beverage types (beer, malt liquor, and distilled spirits); outlets per roadway mile, per tract, and per capita; and least price by beverage type (including wine). In multivariate analyses controlling for state, male unemployment rate was inversely associated with total shelf space (p = 0.03) and distilled spirit shelf space (p = 0.05). Malt liquor shelf space was inversely associated with percent White (p = 0.02). Outlets per roadway mile was positively associated with household poverty (p < 0.0001), whereas percent African American was inversely associated with outlets per roadway mile (p = 0.03). Beverage-specific least prices were not associated with any socioeconomic or demographic community characteristics. Alcohol availability types, but not least price, were associated with some community characteristics. More research exploring how alcohol availability types vary by community and their relationship to alcohol-related harms should be conducted.

Are racial disparities in alcohol treatment completion associated with racial differences in treatment modality entry? Comparison of outpatient treatment and residential treatment in Los Angeles County, 1998 to 2000.

OBJECTIVE: To determine whether racial and ethnic disparities in publicly funded alcohol treatment completion are due to racial differences in attending outpatient and residential treatment. METHODS: Statistical analysis of alcohol treatment completion rates using alcohol treatment patients' discharge records from all publicly funded treatment facilities in Los Angeles County from 1998 to 2000 (n = 10,591). RESULTS: Among these patients, African American (OR = 0.52; 95% CI 0.47, 0.57) and Hispanic (OR = 0.89; 95% CI 0.81, 0.99) patients were significantly less likely to complete treatment as compared with White patients. We found that the odds of being in outpatient versus residential care were 1.42 (95% CI 1.29, 1.55) and 2.05 (95% CI 1.85, 2.26) for African American and Hispanic alcohol treatment patients, respectively, compared with White patients. Adjusting for addiction characteristics, employment, other patient-level factors that might influence treatment enrollment, and unobserved facility-level differences through a random effects regression model, these odds increased to 1.89 (95% CI 1.22, 2.94) for African American and to 2.12 (95% CI 1.40, 3.21) for Hispanics. We developed a conditional probability model to assess the contribution of racial differences in treatment modality to racial disparities in treatment completion. Estimates from this model indicate that were African American and Hispanic patients observed in outpatient care in this population to have the same probability of receiving residential care as White patients with otherwise similar characteristics, the White-African American difference in completion rates would be reduced from 13.64% (95% CI 11.58%, 15.71%) to 11.09% (95% CI 8.77%, 13.23%) and the White-Hispanic difference would disappear, changing from 2.63% (95% CI 0.29%, 4.95%) to -0.45% (-3.52%, 2.43%). CONCLUSION: It appears that reductions in racial disparities in treatment completion could be gained by increasing enrollment in residential alcohol treatment for African American and Hispanic alcohol abusers in Los Angeles County. Further research addressing why minority alcohol abusers are less likely to receive residential alcohol treatment should be conducted, as well as research that examines why African American alcohol treatment patients have lower completion rates as compared with White patients regardless of treatment modality.

Racial disparities in completion rates from publicly funded alcohol treatment: economic resources explain more than demographics and addiction severity.

OBJECTIVES: To assess racial and ethnic differences in rates of completion from publicly funded alcohol treatment programs, and to estimate the extent to which any identified racial differences in completion rates are related to differences in patient characteristics. DATA SOURCES: Administrative intake and discharge records from all publicly funded outpatient and residential alcohol treatment recovery programs in Los Angeles County (LAC) during 1998-2000. Study participants (N=10,591) are African American, Hispanic, and white patients discharged from these programs, ages 18 or older, who reported alcohol as their primary substance abuse problem. STUDY DESIGN: Bivariate tests identified racial and ethnic differences in rates of treatment completion and patient characteristics. Logistic regression models assessed the contribution of differences in patient characteristics to differences in completion. PRINCIPAL FINDINGS: Significantly lower completion rates by African Americans (17.5 percent) relative to whites (26.7 percent) (odds ratio [OR]=0.58, 95 percent confidence interval [CI]: 0.50-0.68) are partially explained (40 percent) by differences in patient characteristics in outpatient care (adjusted OR=0.75, 95 percent CI: 0.63-0.90), mostly by indicators of economic resources (i.e., employment, homelessness, and Medi-Cal beneficiary). In residential care, only 7 percent of differences in completion (30.7 versus 46.1 percent) could be explained by the patient-level measures available (OR=0.52, 95 percent CI: 0.45-0.59; AOR=0.55, 95 percent CI: 0.47-0.65). Differences in completion rates between Hispanic and white patients were not detected. CONCLUSIONS: Large differences in rates of outpatient and residential alcohol treatment completion between African American and white patients at publicly funded programs in LAC, the nation's second largest, publicly funded alcohol and drug treatment system, are partially because of economic differences among patients, but remain largely unexplained. These racial disparities merit additional investigation and the attention of health professionals.

Multi-cultural surveillance for ectopic pregnancy: California 1991-2000.

BACKGROUND: National surveillance for ectopic pregnancy (EP), the primary cause of maternal death in the first trimester, began in 1970. EP rates peeked during the late 1980s and have been highest for African Americans. However, limited reports on EP rates exist for other racial/ethnic groups. OBJECTIVES: To report state-level, multicultural trends in EP rates from 1991 to 2000. METHODS: Secondary data analysis of the California hospital discharge database collected by the Office of Statewide Health Planning and Development by using codes 633.0-633.9, from the International Classification of Diseases, Ninth Revision. EP rates are reported per 1000 pregnancies. RESULTS: From 1991 to 2000, 62,839 EP were reported in California. Mean EP rate was 11.2/1000, decreased from 15/1000 to 9.3/1000, and varied significantly by race/ethnicity and age. EP rates were highest among African Americans (25/1000) and lowest among Hispanics (7.7/1000); African Americans had higher odds of having EP relative to non-Hispanic Whites (odds ratio [OR] 2.14, 95% confidence interval [CI] 2.09-2.19). Women 35-44 years of age had the highest EP rates (17.6/1000) and higher odds of having EP compared to other age groups (OR 2.45, 95% CI 2.39-2.50). The highest rate of EP was found among African Americans 35-44 years of age (43.1/1000). CONCLUSIONS: The study showed declining EP rates in California for all groups but highlights disparities in EP rates and the attenuated rate of decline for African Americans, which places them at highest risk of death in the first trimester. This study demonstrates the usefulness of analyzing state-level data that may differ from aggregated national data when studying culturally diverse populations.

Characteristics of malt liquor beer drinkers in a low-income, racial minority community sample.

BACKGROUND: The authors describe and compare drinking patterns among malt liquor beer (MLB), regular beer (RB), and hard liquor (HL) drinkers in a low-income, racial/ethnic minority community. METHODS: Drinkers were recruited from randomly selected alcohol outlets in South Los Angeles. Respondents were assessed on sociodemographic characteristics, alcohol use history, drinking patterns, and drinking context among other items in a face-to-face interview with research staff. RESULTS: Three hundred twenty-nine drinkers were interviewed, of whom 297 reported drinking MLB, RB, or HL brands of alcohol most often in the past 90 days. This subsample was 88% African-American, 72% male, and 35% unemployed. As compared with RB and HL drinkers, MLB drinkers were more likely to be homeless, to receive public assistance for housing, and to be unemployed. MLB drinkers also reported significantly higher rates of daily or near-daily drinking (74%, as compared with 48% for RB and 29% for HL) of drinks per day on drinking days (5.2, as compared with 4.2 for RB and 3.1 for HL), and daily average ethanol consumption (6.97 oz, as compared with 2.13 oz for RB drinkers and 6.13 oz for HL drinkers). In multinomial regression analysis that controlled for potential confounders, the odds of preferring RB as compared with MLB were significantly increased among persons with blue-collar occupations and those who reported drinking in public settings and were reduced among persons who drank outdoors, those who combined drinking with tobacco smoking, and those who drank alcohol with members of the same sex. Average daily ethanol consumption odds were reduced for RB drinkers as compared with MLB drinkers. The odds of preferring HL as compared with MLB were significantly increased for persons with white-collar occupations and those who drank in public settings and were reduced for persons who drank outdoors and those who combined drinking and smoking. CONCLUSION: The authors observed substantial differences in sociodemographic characteristics, drinking patterns, and ethanol consumption by beverage type in this community sample. MLB drinkers seem to have distinctive drinking patterns that require additional study to determine whether this pattern is associated with increased individual or community risk.

100% access, zero health disparities, and GIS: an improved methodology for designating health professions shortage areas.

The (Health Professions Shortage Areas) HPSA designation process was developed as a mechanism to identify primary care shortage areas eligible for participation in specific federally funded programs including a 10% Medicare supplement, the National Health Service Corps, and health professions training programs. The purpose of this paper was to explore the utility of Geographic Information Systems (GIS) technology as an improved methodology for obtaining HPSA designation status for geographic areas. Results showed that GIS identified 24 Medical Services Study Areas (rational planning areas) in Los Angeles County that met the minimum 3500:1 population-to-primary-care physician ratio for geographic area HPSA designation compared to only three that currently are identified. Authors concluded that restructuring of the state/county responsibilities for HPSA designation is long overdue and that use of GIS as a required methodology would help ensure that all areas in any state that meet the intent of federal legislation are included.