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1.  Multiple Streams Approach to Tobacco Control Policymaking in a Tobacco-Growing State 
Journal of community health  2014;39(4):633-645.
Smokefree policies (SFPs) have diffused throughout the US and worldwide. However, the development of SFPs in the difficult policy environment of tobacco-producing states and economies worldwide has not been well-explored. In 2007, Tennessee, the third largest tobacco producer in the US, enacted the Non-Smoker Protection Act (NSPA). This study utilizes the multiple streams model to provide understanding of why and how this policy was developed by triangulating interviews with key stakeholders and legislative debates with archival documents. In June 2006, the Governor unexpectedly announced support for SFP, which created a window of opportunity for policy change. The Campaign for Healthy and Responsible Tennessee, a health coalition, seized this opportunity and worked with the administration and the Tennessee Restaurant Association to negotiate a comprehensive SFP, however, a weaker bill was used by the legislative leadership to develop the NSPA. Although the Governor and the Tennessee Restaurant Association’s support generated an environment for 100 % SFP, health groups did not fully capitalize on this environmental change and settled for a weak policy with several exemptions. This study suggests the importance for proponents of policy change to understand changes in their environment and be willing and able to capitalize on these changes.
PMCID: PMC4074267  PMID: 24370600
Tennessee; Smokefree policy; Tobacco-producing state; Multiple streams model; Smokefree coalition
2.  Racial Disparities at the Point of Care for Urban Children with Persistent Asthma 
Journal of community health  2014;39(4):706-711.
Little is known about disparities in preventive asthma care delivery at the time of an office visit. Our objective was to better understand what treatments are delivered at the point of care for urban children with asthma, and whether there are racial disparities. We enrolled 100 Black and 77 White children (2–12 years) with persistent asthma from 6 primary care practices. We evaluated how frequently providers delivered guideline-based asthma actions at the index visit. We also assessed asthma morbidity prior to the index visit and again at two month follow-up. Black children had greater symptom severity and were less likely to report having a preventive medication at baseline, but were no more likely to report a preventive medication action at the time of an office visit. Symptoms persisted for Black children at follow-up, suggesting additional preventive actions were needed. Further efforts to promote consistent guideline-based preventive asthma care are critical.
PMCID: PMC4074435  PMID: 24435717
childhood asthma; disparities; urban health
3.  Characterizing customers at medical center farmers’ markets1 
Journal of community health  2014;39(4):727-731.
Approximately 100 farmers’ markets operate on medical center campuses. Although these venues can uniquely serve community health needs, little is known about customer characteristics and outreach efforts. Intercept survey of markets and market customers between August 2010-October 2011 at three medical centers in different geographic regions of the US: Duke University Medical Center, Cleveland Clinic, and Penn State Hershey Medical Center were conducted. Markets reported serving 180–2000 customers per week and conducting preventive medicine education sessions and community health programs. Customers (n=585) across markets were similar in sociodemographic characteristics – most were middle-aged, white, and female, who were employees of their respective medical center. Health behaviors of customers were similar to national data. The surveyed medical center farmers’ markets currently serve mostly employees; however, markets have significant potential for community outreach efforts in preventive medicine. If farmers’ markets can broaden their reach to more diverse populations, they may play an important role in contributing to community health.
PMCID: PMC4074446  PMID: 24421001
Farmers’ Markets; Medical Center Campuses; Market customers; Community Outreach
4.  Factors impacting influenza vaccination of urban low-income Latino children under nine years requiring two doses in the 2010–2011 season 
Journal of community health  2015;40(2):227-234.
The Advisory Committee on Immunization Practices (ACIP) recommends that certain children under nine years of age receive two influenza vaccine doses in a season for optimal protection. Recent data indicate that many of these children fail to receive one or both of these needed doses. Contributing factors to under-vaccination of this population remain unclear.
Caregivers of children aged 6 months-8 years requiring two influenza vaccine doses in the 2010–2011 season were identified from households enrolled in four urban Head Start programs. Recruitment and survey administration were conducted between March and June 2011. The impact of caregiver, provider, and practice-based factors on influenza vaccine receipt (0, 1, or 2 doses) was assessed using bivariate and multivariable logistic regression analyses.
Caregivers (n=128) were predominantly mothers, Latina, Spanish-speaking, and non-U.S. born. Few children received one (31%) or both (7%) influenza vaccine doses. Caregivers who discussed influenza vaccination with providers were more likely to know their child needed two doses (55% vs. 36%, p<0.05) and have a fully vaccinated child (11% vs. 0%, p<0.05). Among caregivers whose child received the first dose, those who reported being told when to return for the second dose were also more likely to have a fully vaccinated child (35% vs. 0%, p=0.05). Belief in influenza vaccine effectiveness was positively associated with vaccination (p<0.001), while safety concerns were negatively associated (p<0.05).
This study highlights the importance of provider-family communication about the two-dose regimen as well as influenza vaccine effectiveness and safety.
PMCID: PMC4314518  PMID: 25082482
influenza; vaccination; underserved; children
5.  Predictors of Never Being Screened for Cervical Cancer by Metropolitan Area 
Journal of community health  2014;39(2):400-408.
Previous studies have shown an association between cervical cancer screening and racial/ethnic minority status, no usual source of care, and lower socioeconomic status. This study describes the demographics and health beliefs of women who report never being screened for cervical cancer by area of residence. Data from the 2010 Behavioral Risk Factor Surveillance System were used to study women aged 21–65 years who reported never being screened for cervical cancer. Multivariate logistic regression modeling was used to calculate predicted marginals to examine associations between never being screened and demographic characteristics and health belief model (HBM) constructs by metropolitan statistical area (MSA). After adjusting for all demographics and HBM constructs, prevalence of never being screened was higher for the following women: non-Hispanic Asians/Native Hawaiians/Pacific Islanders (16.5 %, 95 % CI = 13.7 %, 19.8 %) who live in MSAs; those with only a high school diploma who live in MSAs (5.5 %, 95 % CI = 4.7 %, 6.5 %); those living in non-MSAs who reported “fair or poor” general health (4.1 %, 95 % CI = 3.1 %, 5.4 %); and those living in either MSAs and non-MSAs unable to see a doctor within the past 12 months because of cost (MSA: 4.4 %, 95 % CI = 4.0 %, 4.8 %; non-MSA: 3.4 %, 95 % CI = 2.9 %, 3.9 %). The Affordable Care Act will expand access to insurance coverage for cervical cancer screening, without cost sharing for millions of women, essentially eliminating insurance costs as a barrier. Future interventions for women who have never been screened should focus on promoting the importance of screening and reaching non-Hispanic Asians/Native Hawaiians/Pacific Islanders who live in MSAs.
PMCID: PMC4451596  PMID: 24162857
Cervical cancer screening; Never screened; Health disparities; Metropolitan area; Health belief model
6.  Utility of Anthropometric Measures in a Multiethnic Population: Their Association with Prevalent Diabetes, Hypertension and Other Chronic Disease Comorbidities 
Journal of community health  2014;39(3):471-479.
Body mass index (BMI) and waist circumference (WC) are two common anthropometric measures of obesity in clinical and public health practice. Consensus, however, remains elusive regarding their utility for predicting cardiovascular disease risk in multiethnic populations. We address this gap in the literature by analyzing cross-sectional data from the first round of the Los Angeles County Health and Nutrition Examination Survey, 2011. We characterized the relationships between BMI, WC, waist-to-hip ratios, waist-to-height ratios, and chronic disease extent, as confirmed by the presence of hypertension, diabetes, and/or two or more other chronic conditions as defined by a composite indicator ‘comorbidity’. To account for race/ethnicity, age, gender, and cigarette smoking frequency, adjusted odds ratios (aOR) were generated and reported for each of the regression analyses. Whereas being overweight was associated with hypertension alone (aOR 2.10; 95% CI 1.12–3.94), obesity was associated with hypertension (aOR 5.04; 95% CI 2.80–9.06) as well as diabetes (aOR 5.28; 95% CI 2.25–12.3) and comorbidity (aOR 3.69; 95% CI 2.02–6.77). In whites and African-Americans, BMI and WC were positively related to diabetes, hypertension and comorbidity. In Hispanics, BMI and WC were also positively related to diabetes and comorbidity, but only the former measure was associated with hypertension (p<0.050). In Asians, BMI was not a significant predictor of diabetes, hypertension and/or comorbidity. Collectively, the findings suggest that BMI is not universally informative and waist circumference and its derivatives may represent a viable, more racially/ethnically appropriate alternative for use with selected minority groups.
PMCID: PMC3990653  PMID: 24132872
anthropometry; race/ethnicity; obesity; diabetes; hypertension; health disparities
7.  Smoke-free Coalition Cohesiveness in Rural Tobacco-growing Communities 
Journal of community health  2014;39(3):592-598.
Promoting tobacco control policies in rural tobacco-growing communities presents unique challenges. The purpose of this study was to assess smoke-free coalition cohesiveness in rural communities and identify coalition members’ perceived barriers or divisive issues that impede the development of smoke-free policies. A secondary aim was to evaluate differences in coalition cohesiveness between advocates in communities receiving stage-based, tailored policy advocacy assistance vs. those without assistance.
Tobacco control advocates from 40 rural Kentucky communities were interviewed by telephone during the final wave of a 5-year longitudinal study of community readiness for smoke-free policy. On average, five health advocates per county participated in the 45-minute interview. Participants rated coalition cohesiveness as not at all cohesive, somewhat cohesive, or very cohesive, and answered one open-ended question about potentially divisive issues within their coalitions.
The mean age of the 186 participants was 48.1 years (SD=13.3). The sample was predominantly female (83.6%) and Caucasian (99.5%). Divisive concerns ranged from rights issues, member characteristics, type of law, and whether or not to allow certain exemptions. Three of the divisive concerns were significantly associated with their rankings of coalition cohesiveness: raising tobacco in the community, the belief that smoke-free would adversely affect the economy, and government control.
Educating coalition members on the economics of smoke-free laws and the actual economic impact on tobacco-growing may promote smoke-free coalition cohesiveness. More resources are needed to support policy advocacy in rural tobacco-growing communities as well as efforts to reduce the divisive concerns reported in this study.
PMCID: PMC4004689  PMID: 24338076
Tobacco control; community readiness; coalitions; smoke-free laws
8.  Assessment of active play, inactivity and perceived barriers in an inner city neighborhood 
Journal of community health  2014;39(3):538-544.
Avondale, a disadvantaged neighborhood in Cincinnati, lags behind on a number of indicators of child well-being. Childhood obesity has become increasingly prevalent, as one third of Avondale’s kindergarteners are obese or overweight. The study objective was to determine perceptions of the quantity of and obstacles to childhood physical activity in the Avondale community. Caregivers of children from two elementary schools were surveyed to assess their child’s physical activity and barriers to being active. Three hundred forty surveys were returned out of 1,047 for a response rate of 32%. On school days, 41% of caregivers reported that their children spent more than 2 hours watching television, playing video games, or spending time on the computer. While over half of respondents reported that their children get more than 2 hours of physical activity on school days, 14% of children were reported to be physically active less than 1 hour per day. Caregivers identified violence, cost of extracurricular activities, and lack of organized activities as barriers to their child’s physical activity. The overwhelming majority of caregivers expressed interest in a program to make local playgrounds safer. In conclusion, children in Avondale are not participating in enough physical activity and are exposed to more screen time than is recommended by the AAP. Safety concerns were identified as a critical barrier to address in future advocacy efforts in this community. This project represents an important step toward increasing the physical activity of children in Avondale and engaging the local community.
PMCID: PMC4004696  PMID: 24306236
Physical activity; community engagement; 5-2-1-0; advocacy
9.  HIV Testing of Tuberculosis Patients by Public and Private Providers in New York City 
Journal of community health  2014;39(3):494-502.
Thirty percent of tuberculosis (TB) patients in New York City in 2007 were not tested for HIV, which may be attributable to differential testing behaviors between private and public TB providers. Adult TB cases in New York City from 2001–2007 (n=5172) were evaluated for an association between TB provider type (private or public) and HIV testing. Outcomes examined were offers of HIV tests and patient refusal of HIV testing, using multivariate logistic and binomial regression, respectively. HIV test offers were less frequent among patients who visited only private providers than patients who visited only public providers (males: adjusted odds ratio [aOR]=0.33, 95% confidence interval (CI): 0.15–0.74; females: aOR=0.26, 95% CI: 0.12–0.57). Changing from private to public providers was associated with an increase in HIV tests offered among male patients (aOR=1.96, 95% CI: 1.04–3.70). Among patients who did not use substances, those who visited only private providers were more likely to refuse HIV testing than those who visited only public providers (males: adjusted prevalence ratio [aPR]=1.26, 95% CI: 0.99–1.60; females: aPR=1.78, 95% CI: 1.43–2.22). Patients of private providers were less likely to have an HIV test performed during their TB treatment. Education of TB providers should emphasize HIV testing of all TB patients, especially among patients who are traditionally considered low-risk.
PMCID: PMC4004671  PMID: 24173530
HIV testing; tuberculosis; medical providers
10.  Awareness of Biologically Confirmed HCV Among a Community Residing Sample of Drug Users in Baltimore City 
Journal of community health  2014;39(3):487-493.
The present study sought to examine: (1) the prevalence and correlates of biologically confirmed Hepatitis C (HCV) and (2) the prevalence and correlates of prior HCV diagnosis and an unmet need for HCV treatment, among a community residing sample of drug users. The current study used a subset of HCV tested participants from the larger NEURO-HIV Epidemiologic Study from Baltimore, Maryland (Mage = 34.81, SD = 9.25; 46 % female). All participants were tested for HCV at baseline. Self-report was used to assess awareness of an HCV diagnosis and participation in treatment. Of the 782 participants tested for HCV, 19 % reported having received an HCV diagnosis in the past while 48 % tested positive for HCV. Only 6 % reported having received treatment for any form of hepatitis. Of those who tested HCV positive, 63 % reported never being diagnosed, and only 13 % received any treatment for HCV. We found that only 35 % of those who reported a prior HCV diagnosis received any treatment. The findings regarding lack of HCV awareness and diagnosis were considerable as expected. These deficits suggest that there are numerous gaps in patients' knowledge and beliefs regarding HCV that may interfere at multiple steps along the path from diagnosis to treatment. This study clearly demonstrates that a critical need exists to improve public knowledge of HCV risk factors, the need for testing, and the availability of effective treatment.
PMCID: PMC4141524  PMID: 24173529
Hepatitis C awareness; Hepatitis C treatment; Drug use
11.  Evaluation of Bedtime Basics for Babies: A National Crib Distribution Program to Reduce the Risk of Sleep-Related Sudden Infant Deaths 
Journal of community health  2015;40(3):457-463.
Rates of sleep-related infant deaths have remained stagnant in recent years. Although most parents are aware of safe sleep recommendations, barriers to adherence, including lack of access to a safe crib, remain. The objective of this study was to describe parental knowledge and practices regarding infant sleep position, bedsharing, pacifier use, and feeding practices before and after receipt of a free crib and safe sleep education. Bedtime Basics for Babies (BBB) enrolled high-risk families in Washington, Indiana, and Washington, DC and provided them with cribs and safe sleep education. Parents completed surveys before (“prenatal” and “postnatal”) and 1–3 months after crib receipt (“follow-up”). Descriptive and bivariate analyses were completed. 3,303 prenatal, 1,483 postnatal, and 1,729 follow-up surveys were collected. Parental knowledge of recommended infant sleep position improved from 76 % (prenatal) and 77 % (postnatal) to 94 % after crib receipt (p < 0.001). Intended use of supine positioning increased from 84 % (prenatal) and 80 % (postnatal) to 87 % after the intervention (p < 0.001). Although only 8 % of parents intended to bedshare when asked prenatally, 38 % of parents receiving the crib after the infant’s birth reported that they had bedshared the night before. This decreased to 16 % after the intervention. Ninety percent reported that the baby slept in a crib after the intervention, compared with 51 % postnatally (p < 0.01). BBB was successful in changing knowledge and practices in the majority of high-risk participants with regards to placing the infant supine in a crib for sleep. Crib distribution and safe sleep education positively influence knowledge and practices about safe sleep.
PMCID: PMC4405482  PMID: 25331608
Safe sleep; Bedsharing; Breastfeeding; Sleep position
12.  Level of nutrition knowledge and its association with weight loss behaviors among low-income reproductive-age women 
Journal of community health  2015;40(3):542-548.
To examine influence of nutrition knowledge on weight loss behaviors among low-income reproductive-age women.
we conducted a self-administered cross-sectional survey of health behaviors including socio-demographic characteristics, nutrition knowledge, and weight loss behaviors of 16–40 year old women (n=1057) attending reproductive health clinics located in Southeast Texas between July 2010 and February 2011. Multiple linear regression and multivariable logistic regression analyses were performed to identify correlates of nutrition knowledge and examine its association with various weight loss behaviors after adjusting for confounders.
The mean nutrition knowledge score was low (5.7 ± 2.8) (possible score 0–15). It was significantly lower among African American women than whites (P<.001). Obese women (P=.002), women with high school enrollment/diploma (P=.030), and some college hours/degree (P<.001) had higher nutrition knowledge scores than their counterparts. The higher score of nutrition knowledge was significantly associated with higher odds of engaging in healthy weight loss behaviors: eating less food (odds ratio (OR) 1.12, 95% confidence interval (CI) 1.06–1.18), switching to foods with fewer calories (OR 1.10, 95% CI 1.04–1.16), exercising (OR 1.10, 95% CI 1.04–1.16), eating more fruits/vegetables/salads (OR 1.11, 95% CI 1.06–1.17) and less sugar/candy/sweets (OR 1.09, 95% CI 1.04–1.15). However, it was not associated with unhealthy weight loss behaviors, such as using laxatives/diuretics or inducing vomiting.
Nutrition knowledge is low among reproductive-age women. An increase in nutrition knowledge may promote healthy weight loss behaviors.
PMCID: PMC4427532  PMID: 25394404
Reproductive-age women; nutrition knowledge; weight loss behavior; healthy weight loss behavior; unhealthy weight loss behavior
13.  The Effect of Neighborhood and Individual Characteristics on Pediatric Critical Illness 
Journal of community health  2014;39(4):753-759.
The relationship between neighborhood/individual characteristics and pediatric intensive care unit (PICU) outcomes is largely unexplored. We hypothesized that individual- level racial/ethnic minority status and neighborhood-level low socioeconomic status and minority concentration would adversely affect children’s severity of illness on admission to the PICU. Retrospective analyses (1/1/2007–5/ 23/2011) of clinical, geographic, and demographic data were conducted at an academic, tertiary children’s hospital PICU. Clinical data included age, diagnosis, insurance, race/ethnicity, Pediatric Index of Mortality 2 score on presentation to the PICU (PIM2), and mortality. Residential addresses were geocoded and linked with 2010 US Census tract data using geographic information systems geocoding techniques. Repeated measures models to predict PIM2 and mortality were constructed using three successive models with theorized covariates including the patient’s race/ethnicity, the predominant neighborhood racial/ethnic group, interactions between patient race/ethnicity and neighborhood race/ethnicity, neighborhood socioeconomic status, and insurance type. Of the 5,390 children, 57.8 %were Latino and 70.1 %possessed government insurance. Latino children (β = 0.31; p < 0.01), especially Latino children living in a Latino ethnic enclave (β = 1.13; p < 0.05), had higher PIM2 scores compared with non-Latinos. Children with government insurance (β = 0.29; p < 0.01) had higher PIM2 scores compared to children with other payment types and median neighborhood income was inversely associated with PIM2 scores (β = −0.04 per $10,000/year of income; p < 0.05). Lower median neighborhood income, Latino ethnicity, Latino children living in a predominantly Latino neighborhood, and children possessing government insurance were associated with a higher severity of illness on PICU admission. The reasons why these factors affect critical illness severity require further exploration.
PMCID: PMC4443908  PMID: 24488647
Neighborhood; Geocoding; Pediatric; Intensive care; Health care disparities
14.  Reported Benefits of Participation in a Research Study 
Journal of community health  2012;37(1):59-64.
Racial and ethnic minorities are significantly underrepresented in clinical research trials. Several socio-cultural and systemic barriers, ranging from discrimination by the health care system, medical mistrust, to low physician referral rates and lack of knowledge of research studies have been identified as impacting participation. One hundred and fifteen participants were culturally matched and were interviewed followed by up to an additional four interviews over a 12 month period. Responses were analyzed to understand the perceived benefits to participating in a prospective, randomized, longitudinal clinical research trial about screening colonoscopy. Over two-thirds (64.4%) of participants reported “knowledge, awareness, and/or information about colonoscopy and general health” as being the greatest benefit they received. Desire to undergo the screening and the pride of completing the study was ranked second and third, respectively. Understanding the reasons that participants choose to participate in research studies will ultimately assist researchers close the gap in minority representation, allowing for greater generaliz-ability of research findings.
PMCID: PMC4399714  PMID: 21644025
Minority groups; Clinical trials; randomized; Participation; Colonoscopy
15.  Knowledge and Beliefs of African-American and American Indian Parents and Supporters About Infant Safe Sleep 
Journal of community health  2015;40(1):12-19.
To investigate, by using qualitative methods, beliefs among African-American and American Indian families about infant safe sleep practices, barriers to acceptance of prevention recommendations, and more effective messaging strategies. Seventy-three mothers and supporters participated in focus groups. Participants discussed infant sleep practices and effectiveness of safe sleep messages. Data were coded, and themes were developed and revised in an iterative manner as patterns became more apparent. Themes included reasons for and influences on sleep decisions, and concerns about safe sleep recommendations. Parental sleep decisions seemed to be driven by perceptions of what would make their infant most comfortable and safe, and what would be most convenient. Parents were aware of safe sleep recommendations but unaware of the rationale. Because they generally did not believe that their infants were at risk for a sleep-related death, day-to-day decisions seemed to focus on what was most effective in getting their infant to sleep. There appeared to be no distinctions in opinions among African-American and American Indian families. African-American and American Indian families seemed to have similar concerns about infant comfort and safety, and their perceptions about what would be most effective in achieving these goals appeared to be important influences on their sleep practices. Adherence with safe sleep recommendations may be enhanced if health care providers and educational materials discussed rationale underlying recommendations and addressed common parental concerns. It may be beneficial to target educational interventions towards fathers, as they may be untapped sources in implementing safe sleep practices.
PMCID: PMC4382631  PMID: 24859736
Racial disparity; Safe sleep; Infant mortality; Sudden infant death syndrome
16.  Differences in Knowledge, Attitudes, Beliefs, and Perceived Risks Regarding Colorectal Cancer Screening Among Chinese, Korean, and Vietnamese Sub-Groups 
Journal of community health  2014;39(2):248-265.
Asian ethnic subgroups are often treated as a single demographic group in studies looking at cancer screening and health disparities.
To evaluate knowledge and health beliefs associated with colorectal cancer (CRC) and CRC screening among Chinese, Korean, and Vietnamese subgroups.
A survey assessed participants’ demographic characteristics, healthcare utilization, knowledge, beliefs, attitudes associated with CRC and CRC screening. Exploratory factor analysis identified six factors accounting >60% of the total variance in beliefs and attitudes. Cronbach’s alpha coefficients assessed internal consistency. Differences among Asian subgroups were assessed using a chi-square, Fisher’s exact, or Kruskal-Wallis test. Pearson’s correlation coefficient assessed an association among factors.
654 participants enrolled: 238 Chinese, 217 Korean, and 199 Vietnamese. Statistically significant differences existed in demographic and health care provider characteristics, knowledge, and attitude/belief variables regarding CRC. These included knowledge of CRC screening modalities, reluctance to discuss cancer, belief that cancer is preventable by diet and lifestyle, and intention to undergo CRC screening. Chinese subjects were more likely to use Eastern medicine (52% Chinese, 25% Korean, 27% Vietnamese; p < 0.001); Korean subjects were less likely to see herbs as a form of cancer prevention (34% Chinese, 20% Korean, 35% Vietnamese; p < 0.001). Vietnamese subjects were less likely to consider CRC screening (95% Chinese, 95% Korean, 80% Vietnamese; p < 0.0001).
Important differences exist in knowledge, attitudes, and health beliefs among Asian subgroups. Understanding these differences will enable clinicians to deliver tailored, effective health messages to improve CRC screening and other health behaviors.
PMCID: PMC3943615  PMID: 24142376
17.  State and local law enforcement agency efforts to prevent sales to obviously intoxicated patrons 
Journal of community health  2014;39(2):339-348.
Alcohol sales to intoxicated patrons are illegal and may lead to public health issues such as traffic crashes and violence. Over the past several decades, considerable effort has been made to reduce alcohol sales to underage persons but less attention has been given to the issue of sales to obviously intoxicated patrons. Studies have found a high likelihood of sales to obviously intoxicated patrons (i.e., overservice), but little is known about efforts by enforcement agencies to reduce these sales. We conducted a survey of statewide alcohol enforcement agencies and local law enforcement agencies across the U.S. to assess their strategies for enforcing laws prohibiting alcohol sales to intoxicated patrons at licensed alcohol establishments. We randomly sampled 1,631 local agencies (1082 participated), and surveyed all 49 statewide agencies that conduct alcohol enforcement. Sales to obviously intoxicated patrons were reported to be somewhat or very common in their jurisdiction by 55% of local agencies and 90% of state agencies. Twenty percent of local and 60% of state agencies reported conducting enforcement efforts to reduce sales to obviously intoxicated patrons in the past year. Among these agencies, fewer than half used specific enforcement strategies on at least a monthly basis to prevent overservice of alcohol. Among local agencies, enforcement efforts were more common among agencies that had a full-time officer specifically assigned to carry out alcohol enforcement efforts. Enforcement of laws prohibiting alcohol sales to obviously intoxicated patrons is an underutilized strategy to reduce alcohol-related problems, especially among local law enforcement agencies.
PMCID: PMC3943669  PMID: 24068596
alcohol; enforcement; overservice; sales to intoxicated patrons
18.  Acculturation and Cancer Screening among Asian Americans: Role of Health Insurance and Having a Regular Physician 
Journal of community health  2014;39(2):201-212.
Cancer is the leading cause of death among Asian Americans, but screening rates are significantly lower in Asians than in non-Hispanic Whites. This study examined associations between acculturation and three types of cancer screening (colorectal, cervical, and breast), focusing on the role of health insurance and having a regular physician. A cross-sectional study of 851 Chinese, Korean, and Vietnamese Americans was conducted in Maryland. Acculturation was measured using an abridged version of the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA), acculturation clusters, language preference, length of residency in the U.S., and age at arrival. Age, health insurance, regular physician, gender, ethnicity, income, marital status, and health status were adjusted in the multivariate analysis. Logistic regression analysis showed that various measures of acculturation were positively associated with the odds of having all cancer screenings. Those lived for more than 20 years in the U.S. were about 2-4 times [odds ratio (OR) and 95% confidence interval (CI): colorectal: 2.41 (1.52-3.82); cervical: 1.79 (1.07-3.01); and breast: 2.11 (1.25-3.57)] more likely than those who lived for less than 10 years to have had cancer screening. When health insurance and having a regular physician were adjusted, the associations between length of residency and colorectal cancer (OR: 1.72 (1.05-2.81)) was reduced and the association between length of residency and cervical and breast cancer became no longer significant. Findings from this study provide a robust and comprehensive picture of AA cancer screening behavior. They will provide helpful information on future target groups for promoting cancer screening.
PMCID: PMC4143174  PMID: 24002493
Asian Americans; Acculturation; Early Detection of Cancer; Breast Neoplasms/prevention & control; Uterine Cervical Neoplasms/prevention & control; Colorectal Neoplasms/prevention & control
19.  Proyecto MercadoFRESCO: A Multi-level, Community-Engaged Corner Store Intervention in East Los Angeles and Boyle Heights 
Journal of community health  2015;40(2):347-356.
Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents’ access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp.
PMCID: PMC4348161  PMID: 25209600
Food deserts; Hispanic health; Mexican; Environmental intervention; Convenience stores; Bodegas
20.  Cardiovascular Health Status Among Caribbean Hispanics Living in Northern Manhattan and Ecuadorian Natives/Mestizos in Rural Coastal Ecuador: A Comparative Study 
Journal of community health  2013;38(4):634-641.
Knowledge of cardiovascular health (CVH) status of a given population is mandatory to reduce the burden of vascular diseases in the region. We compared CVH of two distinct populations having similar ethnic backgrounds to understand the role of lifestyle and environment on their CVH, and to provide insights in the planning of cost-effective health strategies. CVH status was compared in two Hispanic populations living in Northern Manhattan and Atahualpa (rural coastal Ecuador) using the health metrics proposed by the American Heart Association. Both studies used similar definitions of CVH and similar inclusion criteria for participating subjects (age ≥40 years, cardiovascular disease-free status, and living at their respective localities for ≥3 months). The studied populations consisted of 1,617 Caribbean Hispanics living in Northern Manhattan (mean age 66 ± 9 years), and 616 Atahualpa residents (mean age 59 ± 13 years). Atahualpa residents had significantly better metrics than Caribbean Hispanics, with the exception of fasting glucose levels. Likewise, the odds for having 5–7 ideal metrics were also better in Atahualpa residents, irrespective of age. CVH is better in Atahualpa residents than in Caribbean Hispanics living in Northern Manhattan. These differences are likely related to a healthier lifestyle in a rural setting and provide insights for setting cardiovascular prevention priorities.
PMCID: PMC4380261  PMID: 23456686
Cardiovascular health; Arterial hypertension; Diabetes mellitus; Atahualpa; Northern Manhattan
21.  [No title available] 
PMCID: PMC3880645  PMID: 23963855
22.  [No title available] 
PMCID: PMC3889655  PMID: 24026303
23.  [No title available] 
PMCID: PMC3947220  PMID: 24026301
24.  [No title available] 
PMCID: PMC3947222  PMID: 23913106
25.  [No title available] 
PMCID: PMC3947232  PMID: 23918645

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