Hepatitis and human immunodeficiency virus co-infection among injection drug users in Los Angeles County, California

This study examined the prevalence of hepatitis A (HAV), B (HBV), C (HCV), and Human Immunodeficiency Virus (HIV) co-infection among Injection Drug Users (IDUs) in Los Angeles County, California, and predictors of multiple infections in this population. Six hundred seventy-nine IDUs were recruited from October 2002 through June 2004. Participants completed questionnaires to elicit demographic, drug and sex risk information, and were tested for hepatitis A, B, C and HIV.A linear regression model predicting the total number of infections (0 to 4 possible) was constructed. Significant associations were found between HAV and HBV infection, HAV and HCV infection, and HBV and HCV infection. Predictors of total co-infections included age of first injection, lifetime years in jail, and Hispanic ethnicity. Latinos had the highest proportion of HAV and HBV co-infection with HCV. The total number of co-infections, especially those co-infected with all three of the hepatitis infections, was unexpectedly high.     

Improving client engagement and retention in treatment: The Los Angeles County experience

This article discusses a two-phase demonstration project focused on the implementation of the Network for the Improvement of Addiction Treatment model of process improvement among substance abuse treatment providers in Los Angeles County, California. A total of 30 Change Teams from 12 county-contracted treatment agencies planned and executed one or more rapid-cycle change projects to reduce wait time to treatment, reduce no-shows to scheduled appointments, increase admissions, or improve continuation in treatment. The findings and lessons learned illustrate the importance of a concrete and straightforward methodology and consistent peer-to-peer interaction provided in a learning collaborative environment. In addition, both ongoing technical assistance and coaching are essential for successful implementation of this innovative, low-cost, evidence-based process improvement strategy.     

Improving service delivery to the dually diagnosed in Los Angeles County

Service delivery to dually diagnosed individuals remains problematic in many communities because of entrenched administrative structures that maintain the separation of mental health and substance abuse treatment systems. This article describes efforts to improve service delivery to dually diagnosed individuals in Los Angeles County by increasing communication, coordination, and collaboration across the two treatment systems. Findings are presented on the relationships among program models of service delivery, treatment orientations of programs, and interactions with other service providers to the dually diagnosed. Results showed that drug treatment programs that adhered more closely to an integrated model of service delivery received more patient referrals from case management outreach teams and that programs with a stronger counseling approach to treatment had more linkages with other service providers. Knowledge gained from research on these differing models of service delivery can be combined with new clinical advances to improve service delivery to the dually diagnosed.     

Drugs of abuse found in fatally injured drivers in Los Angeles County

Blood or urine specimens from nearly 600 fatally injured drivers in two Los Angeles County studies were analyzed for the presence of alcohol and other drugs of abuse, including PCP, cocaine, opiates and marijuana. The results of the preliminary study indicate that 65 out of 102 fatally injured drivers had used alcohol and/or another drug of abuse - 34 had used alcohol only, 12 had used one or more other drug(s) of abuse, and 19 had used alcohol in combination with another drug of abuse. The results of the larger follow-up study, begun a year later, indicate a continued high level of both alcohol use (41.5%) and marijuana use (19%) with moderate cocaine usage (8%) and low levels (less than 2%) of barbiturate and PCP usage.     

Documenting need for naloxone distribution in the Los Angeles County jail system

BackgroundThe Los Angeles County Jail system is the largest jail system in the United States, with an average daily inmate population of 17,024 in 2017. Existing literature shows the weeks following release from incarceration are associated with increased risk of overdose death among individuals who previously used opioids. One response is to train inmates in overdose prevention and response (OPR) and to provide the opioid antagonist naloxone on release. However, in large jail systems training all inmates can be logistically and financially difficult, leading to interest identifying individuals most likely to benefit from such programs.MethodIn 2017, the Los Angeles County Office of Diversion and Reentry collaborated with the Los Angeles County Sheriff Department to conduct an OPR needs assessment evaluation with all inmates entering the jail over a two week period.Results3781 inmates provided complete data for this analysis (3315 men, 466 women). 17% reported using opioids within the last 12 months, 7% reported witnessing an overdose within the last 12 months, and 5% report ever having received medication assisted treatment (MAT). 39% reported interest in being trained in overdose prevention and response. The single largest predictor of interest in OPR was being present at an overdose in the past year.ConclusionOur results suggest OPR should be provided to all inmates who opt-in to receiving training regardless of other risk factors. Our results also suggest this population has had little prior exposure to MAT and incarceration could represent a significant opportunity to provide such evidence-based treatments.     

Male Chinese drinking behavior in Los Angeles

The purpose of this research was to identify the characteristics that distinguish male Chinese drinkers from abstainers and to clarify differences between Chinese men who drink limited amounts of alcohol and those who drink more heavily. A random sample of 218 adult Chinese men was interviewed using a schedule based on a national study of drinking behavior. The stereotype of Chinese as limited drinkers was partially supported by the data. Approximately 22% of the sample were abstainers whereas only 14% were heavy drinkers. Light drinkers were the modal category. A logistic regression model was used to evaluate the relative importance of the significant characteristics of drinkers and abstainers. Parents' drinking behavior influenced respondent's drinking behavior, and drinkers tended to like to go to parties. Chinese men with higher education were more apt to be drinkers. A second logistic regression model was used to identify the predictive variables related to the level of drinking. Chinese men who go to bars and who have friends who drink were the most likely to be heavy drinkers.     

Disparities in completion of substance abuse treatment among Latino subgroups in Los Angeles County, CA

Rationale

A growing body of research has revealed disparities with respect to drug use patterns within Latino subgroups. However, the extent to which these potential disparities enable different Latino subgroups to respond favorably to treatment is unclear.

Methods

This study analyzed a subset of multicross-sectional data (2006–2009) on Latinos collected from publicly funded facilities in Los Angeles County, CA (N = 12,871). We used multilevel logistic regressions to examine individual and service-level factors associated with treatment completion among subgroups of first-time Latino treatment clients.

Results

Univariate analysis showed that Cubans and Puerto Ricans were less likely to complete treatment than Mexicans and other Latinos. Cubans and Puerto Ricans entered treatment at an older age and with higher formal education than Mexicans, yet they were more likely to report mental health issues and use of cocaine and heroin as primary drugs of choice respectively. Multivariate analysis showed that age, having mental health issues, reporting high use of drugs at intake, and use of methamphetamines and marijuana were associated with decreased odds of completing treatment among all Latino subgroups. In contrast, age at first drug use, treatment duration, and referral monitoring by the criminal system increased the odds of completing treatment for all members.

Conclusion

These findings have implications for targeting interventions for members of different Latinos groups during their first treatment episode. Promising individual and service factors associated with treatment completion can inform the design of culturally specific recovery models that can be evaluated in small-scale randomized pilot studies.     

The Spatial Distribution of Underage Tobacco Sales in Los Angeles

Objective: Underage tobacco sales is considered a serious public health problem in Los Angeles. Anecdotally, rates have been thought to be quite high. In this paper, using spatial statistical techniques, we describe underage tobacco sales, identifying areas with high levels of sales and hot spots controlling for sociodemographic measures. Methods: Six hundred eighty-nine tobacco outlets were investigated throughout the city of Los Angeles in 2001. We consider the factors that explain vendor location of illegal sales of tobacco to underage youth and focus on those areas with especially high rates of illegal sales when controlling for other independent measures. Using data from the census, the LA City Attorney's Office, and public records on school locations in Los Angeles, we employ general least-squares (GLS) estimators in order to avoid biased estimates. Main outcome measure: vendor location of underage tobacco compliance checks, violators, and nonviolators. Results: Underage tobacco sales in Los Angeles were very high (33.5%) for the entire city in 2001. In many zip codes this rate is considerably higher (60%–100%). When conducting spatial modeling, lower income and ethnicity were strongly associated with increases in underage tobacco sales. Hotspot areas of underage tobacco sales also had much lower mean family income and a much higher percentage of foreign born and greater population density. Conclusions: Spatial techniques were used to better identify areas where vendors sell tobacco to underage youth. Lower income areas were much more likely to both have higher rates of underage tobacco sales and to be a hot spot for such sales. Population density is also significantly associated with underage tobacco sales. The study's limitations are noted.     

Use ecology and drug use motivations of methamphetamine users admitted to substance abuse treatment facilities in Los Angeles: an emerging profile

Who are methamphetamine (MA) users and what are the circumstances that surround their drug use? This article provides a foundation for future ethnographic studies and collaborative clinician-researcher assessments of MA use by describing use ecology and drug use motivation for 260 MA users admitted to treatment at public Los Angeles County facilities in 1996. Use ecology data include MA varieties and street names, first introductions to use, drug use histories, access, selling and manufacturing, routes of administration, unwanted results of use, and participants' use behavior in the year before the 1996 treatment. Use motivation data describe clients using MA as a substitute for other stimulants; to cope with mental distress; to stay awake; to enhance sexual experience; and to lose weight. Qualitative case studies illustrate the findings and demonstrate the complex inter-relations of society, culture, psyche and soma shaping MA use over time.     

Surveying the persistence of age- and gender-based restrictions on over-the-counter emergency contraception across pharmacies in Los Angeles County,CA

BackgroundOver-the-counter levonorgestrel emergency contraception (OTC EC) is safe and effective but underutilized for postcoital pregnancy prevention. Unnecessary restrictions imposed by pharmacies and pharmacy workers may impede EC uptake.ObjectiveTo assess the persistence of age- and gender-based barriers to OTC EC access among pharmacists and pharmacy staff across Los Angeles, CA.MethodsWe conducted a cross-sectional survey of registered community pharmacies randomly chosen from regions with the highest unintended pregnancy rates in Los Angeles County. Using an adaptation of the 2017 American Society for Emergency Contraception EC Access and Price Survey, we interviewed pharmacy staff about their attitudes and practices related to OTC EC, with attention to age- and gender-based barriers.ResultsWe surveyed 139 staff members (45% pharmacists, 20% technicians, 26% retail) from 93 publicly accessible pharmacies. Thirteen pharmacies did not stock EC. Half of respondents cited age-based restrictions; only 4% noted gender-based restrictions. More than 75% reported being asked for EC by a man; 7% reported refusing to sell to a man. Nearly 40% reported that men never or rarely purchased EC. Pharmacists were more likely than technicians or retail staff to believe men rarely purchased EC (P = 0.01). The most frequently cited concern about selling to men was inability to confirm the female partner’s age.ConclusionAlthough gender-based restrictions to EC are rare, more than half of pharmacy staff continue to report age-based restrictions. Inability to verify the female partner’s age may underlie cases where men are unable to purchase OTC EC.     

Profile of lifetime methamphetamine use among homeless adults in Los Angeles

Although the dramatic rise of methamphetamine use in the general population has been well-documented, little is known about methamphetamine use in the homeless population. This study examines self-reported methamphetamine use and its correlates among a sample of 664 urban homeless adults in Los Angeles. Over one-quarter of the overall sample, and 60% of whites, disclosed lifetime methamphetamine use. Less than 10% of African-Americans reported ever using methamphetamine. Approximately one-tenth of respondents reported current methamphetamine use; almost 90% of current users shared straws to snort methamphetamine and half used it daily. Logistic regression analysis in younger (18-39) and older (40+) respondents revealed that white ethnicity, polydrug use and binge drinking were independently associated with lifetime methamphetamine use, regardless of age. Injection drug use (IDU) was also an important correlate of methamphetamine use for older African-Americans. IDU was not important for the younger group. Findings suggest that there is need for greater surveillance of methamphetamine use among homeless whites and Hispanics, and methamphetamine-use prevention and reduction targeted to younger, polydrug-using, alcohol-binging homeless adults.     

Air Pollution and Asthma Exacerbations Among African-American Children in Los Angeles

Abstract

Clinical and epidemiologic evidence suggests that particulate matter and ozone are associated with exacerbations of asthma. African-American children, who experienced a marked increase in asthma morbidity and mortality during the 1980s, may represent a particularly sensitive subgroup. In order to examine potential effects of air pollution on exacerbations of asthma, a panel of 83 African-American children, aged 7–12 yr, were recruited from 4 allergy and pediatrics clinics in central Los Angeles and two asthma camps in the summer of 1992. Daily data on asthma symptoms, medication use, and peak flows were recorded for 3 mo and examined in conJunction with data on PM-IO, ozone, nitrogen dioxide, sulfur dioxide, pollens, molds, and meteorologic factors. Using multiple logistic regression analysis corrected for autocorrelation, the daily probability of shortness of breath was shown to be associated with both ozone and PM-IO concentrations. The effect of particles on shortness of breath was greater among children with moderate or severe asthma. These findings were confirmed by an individual-level analysis that took full advantage of the panel study design.