Colorectal Cancer Screening among Underserved Korean Americans in Los Angeles County

Objectives Use of colorectal cancer screening is extremely low among Korean Americans. The objective of this study was to gather information on predictors, facilitators, barriers, and intervention preferences with respect to colorectal cancer screening that may inform the development of future interventions for underserved Korean Americans. Design We developed a questionnaire guided by the Health Behavior Framework and administered it to a convenience sample of 151 Korean Americans aged 40–70 recruited through a community based organization in Los Angeles. Results In our sample in which 60% of the subjects did not have health insurance, only 17% reported having received a stool blood test within the past year or sigmoidoscopy or colonoscopy within the past 5 years. Having received a physician recommendation was significantly associated and having symptoms of the disease was marginally associated with the outcome variable. Although 64% of respondents reported having a primary care physician, only 29% received a screening recommendation from a physician. Barriers to colorectal cancer screening were lack of health insurance and inability to afford testing, not knowing where to go for testing, language barrier, and fear of being a burden to the family. Intervention preferences included educational seminars, media campaigns, and print materials. Conclusion Our findings point to the need for a multi-faceted approach that includes educational seminars at community venues, a media campaign, and physician education to increase colorectal cancer screening in this underinsured Korean American population.     

Monitoring health in Los Angeles County

The University of California at Los Angeles School of Public Health, in collaboration with the Los Angeles County Department of Health Services, compiled data and developed a standardized format that displayed a comparison of mortality and morbidity data between Los Angeles County, the State of California, and the United States in 1960, 1970, and 1980 for 16 health topic areas. Findings noted both favorable and unfavorable health trends, as well as substantial data collection problems. In 1980, compared with the United States, the Los Angeles County rates for tuberculosis, gonorrhea, syphilis, and hepatitis B were as much as 45 to 128 percent higher, the homicide rate was more than double, and, for the population aged 65 years and over, the cirrhosis of the liver rate was more than 56 percent higher. The myocardial infarction rate was 58 percent lower in the population aged 18 to 64. Problems of inadequate data for many health indicators, lack of comparability in data, and conflicting information from different data sources were noted. These limitations with the data underscore the need to standardize data collection procedures and to extend the parameters on which information is collected. The approach represents a tool that could be used by many health departments to monitor their activities and set future goals.     

A trial to increase mammography utilization among Los Angeles Hispanic women

The objective of this program was to increase mammography screening rates among Hispanic women through a series of targeted community-wide interventions. A diverse array of outreach efforts was offered by the program to increase awareness and use of screening mammography. Before the program, 12 percent of the Hispanic women surveyed in the intervention community had been screened, compared with 27 percent after the program. There was no change in screening among Hispanic women in the control community (23 percent before and 24 percent after the program). The program demonstrated that the awareness and behavior of "hard-to-reach" underscreened Hispanic women can be changed through intensive targeted outreach and that a church-based cancer control program can play an effective role in the process. This finding has national health policy implications.     

Measles vaccination coverage among Latino children aged 12 to 59 months in Los Angeles County: a household survey.

A high rate of measles transmission has occurred in Los Angeles County since 1987. To determine measles vaccination coverage among Latino preschoolers, the group at highest risk of measles during this period, a cluster survey was conducted among Latino households with children aged 12 to 59 months. Of 279 children enrolled, 240 (86%, 95% confidence interval = 81% to 91%) reportedly had received the measles vaccine. Measles vaccination coverage among Latino preschoolers in Los Angeles County is insufficient to halt measles transmission within this subpopulation.     

Tailoring outdoor tobacco advertising to minorities in Los Angeles County

This study provides the first longitudinal comparison of the frequency and content characteristics of tobacco ads that appeared along thoroughfares running through four types of Los Angeles ethnic neighborhoods. Tobacco ad density (tobacco billboards per mile), concentration (proportion of billboards with tobacco content), and content were compared from 1990 to 1994 across four neighborhoods at multiple time points. Compared with White neighborhood thoroughfares, African American and Hispanic neighborhoods contained greater tobacco ad density, and all minority neighborhoods contained greater tobacco ad concentration along the roadsides. Initial differences in tobacco ad frequency decreased significantly over time. However, the age, race, and gender of billboard characters remained different among the different ethnic neighborhood thoroughfares, with greater ethnicity-specific content in African American neighborhood thoroughfares than in other neighborhood thoroughfares. These data are consistent with the assertion that tobacco companies target ethnic minorities with higher rates of advertising and ethnically tailored campaigns. This may be used in order to expand the total market of minority consumers.     

Physical inactivity and overweight among Los Angeles County adults

OBJECTIVES: The present study examines sociodemographic, health status, health behavioral, and health-related self-perception correlates of physical inactivity in a large, multiethnic urban population. METHODS: A random-digit-dialed telephone survey of a representative sample of 8353 Los Angeles County adults aged >/= 18 years was conducted between September 17, 1999 and December 31, 2000. Data were analyzed to assess the prevalence and identify independent correlates of physical inactivity, defined as <10 minutes of continuous physical activity weekly ("sedentary"). RESULTS: Overall, the prevalence of sedentary adults was 41%. Lower educational attainment, female gender, advancing age, non-U.S. birthplace, poorer self-perceived health status, self-perceived depression, smoking, leisure-time television watching/computer use, and receiving a diabetes diagnosis were significantly related to sedentariness in both bivariate and multivariate analyses. CONCLUSIONS: Mental and physical health status were prominent correlates of sedentariness. Lower socioeconomic class was also associated with sedentary behavior. Further research is needed to understand the relationship between self-perceived overweight and sedentary behavior.     

Trends in Air Pollution Outside Los Angeles County

Polyvinyl chloride polymers and formulations were pyrolyzed in a stream of air by gradually raising the temperature from ambient to approximately 600 C. The pyrolysis air stream was diluted with twice its volume of room air, and rats were exposed to it. Exposure to an air stream containing the pyrolyzed products of 1 to 2 gm of polyvinyl chloride polymer resulted in the death of 50% of the animals. Most deaths were due to carbon monoxide (CO), and carboxyhemoglobin (COHb) levels correlated well with the amount of plastic pyrolyzed. Little histological evidence of lung damage was evident. When oxygen (O₂) was added to the air stream to prevent deaths from CO, pulmonary edema and interstitial hemorrhage developed. The lungs of some animals exposed to high levels of pyrolysis products of vinyl chloride-vinyl acetate copolymer also showed focal edema and intra-alveolar hemorrhage. Polyvinyl chloride formulations, containing additives and inert materials, were in general less toxic per gram of sample pyrolyzed.     

Providers of primary care to homeless women in Los Angeles County

Little is known about the access barriers homeless women face at the sites where they are most likely to receive primary health care. To investigate this issue, we administered a mail survey to administrators and clinicians at clinic sites that were actual or potential providers of primary health care to homeless women in Los Angeles County in 1997. The response rate was 65%. Ninety percent of the homeless women seen by responding sites were seen at only 34% of those sites (designated as "major providers"). Deficiencies were identified in several structural and process characteristics that enhance access to and quality of care for homeless women, including clinician training in care for homeless persons; formal screening for homeless status and associated risk factors; and on-site provision of comprehensive health services, including mental health, substance abuse, reproductive health, and ancillary services. Some, but not all, deficiencies were less severe at major providers. Our results suggest that, although providers of care to homeless women share challenges faced by many safety net providers, there are several policy interventions that could improve access to and quality of care for homeless women.     

Acute illnesses among Los Angeles County lifeguards according to worksite exposures

Due to public concern regarding the potential adverse health effects of exposure to Santa Monica Bay waters, a case-control study of acute illnesses among Los Angeles County lifeguards was conducted. Workers' compensation claimants (N = 112) were matched to healthy lifeguards working in the same year and having the same job classification. Conditional logistic regression showed that the southernmost worksites of the bay were associated with all acute illnesses (OR = 14.4, 95% CI = 4.7, 44.8) and with ear infections (OR = 12.5, 95% CI = 2.9, 53.4).     

Developing a public health Web site: the Los Angeles County experience.

The use of the Internet in public health practice is becoming increasingly widespread. The Internet is an important tool for supporting the mission and core functions of local health departments. However, most local health departments have limited resources and technical capacity to develop, deploy, and encourage use of large and complex Web sites. In Los Angeles County, the local health department was able to build and expand public health information systems on the Internet with a limited investment of financial and technical resources. The development process, key functions, and key factors in the success of this effort are described.