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Open Access Publications from the University of California

Scholarly Works (8 results)

  • Article
CLPR Working Papers (1996)

This study examines key characteristics and external factors that influence health promotion and disease (HPD) programs serving Latina and Latino (L/L) youth. It also explores challenges associated with program development, sustainability, and the relative capacity to respond to historical and emergent problems experienced by this population.

California is experiencing an increase in risk behaviors among L/L youth at a time when there are significant pressures to limit public sector funding for health and social programs. L/L youth are increasing more rapidly than any other ethnic youth cohort; by the year 2000 they will comprise 39% of all California youth. This rapid population growth is accompanied by an increase in poverty and deterioration in L/L quality of life. By 1991, Latinas under 20 were twice as likely as non-Latina Whites to commence childbearing, and Latinas comprised 56.6% of all unmarried mothers under 20 in California; a 10% increase since 1998. A California studying 1994 indicated that L/L youth have the highest overall licit and illicit drug use rates, and these rates had increased from a previous survey conducted in 1991. Recent California juvenile arrest statistics also showed Latinos constitute the highest proposition of felony, misdemeanor, and status offenses. Second generation L/L adolescents are especially at high risk for early pregnancies, drug use, and committing juvenile offenses.

This study was motivated by the apparent urgency represented by these trends, and the need to enhance the capacity of our urban and rural communities to foster healthy lifestyles among L/L youth; thereby increasing the likelihood that they will become substantive contributors to the commonweal. It was also motivated by an awareness of chronic problems faced by public institutions and community-based programs that serve these youth. These problems range from a lack of continuity in funding patterns and program objectives to an inability to involve community residents, develop substantive inter-sectoral linkages, and carry out necessary institutional reforms.

Recommendations include the allocation of targeted funds and provisions of technical assistance to enhance the cultural content, expand leadership development components, and strengthen the collaborative capacity of existing programs; enhancement of linkages to private sector resources; and the enhancement of statewide capacity to develop and monitor youth HPD programs and conduct relevant policy research.

    Cover page: Community-Based Health Promotion / Disease Prevention Programs for Latina/Latino Youth in California: Comparative Analysis and Policy Recommendations
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2009)
      Cover page: Confronting Inequities in Latino Health Care
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2009)
      There is suggestive evidence that lower rates of health insurance coverage increases the gaps in quality and access to care among Latinos as compared with non-Latino whites. In order to examine these potential disparities, we assessed the effects of insurance coverage and multiple covariates on perceived quality of care. To assess the distribution of perceived quality of care received in a national Latino population sample, and the role of insurance in different patient subgroups. Telephone interviews conducted between 2007 and 2008 using the Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health Surveys (Waves 1 and 2). Randomly selected Latino adults aged ≥18 years living in the United States. Pearson χ2 tests identified associations among various demographic variables by quality of care ratings (poor, fair, good, excellent) for the insured and uninsured (Wave 1: N = 3545). Subgroup analyses were conducted among Wave 2 participants reporting chronic conditions (N = 1067). Bivariate and multivariate analyses were conducted to estimate the effects of insurance, demographic variables and consumer characteristics on quality of care. Insurance availability had an odds ratio of 1.47 (95% CI, 1.22–1.76) net of confounders in predicting perceived quality of care among Latinos. The largest gap in rates of excellent/good ratings occurred among the insured with eight or more doctor visits compared to the uninsured (76.2% vs. 54.6%, P < .05). Future research can gain additional insights by examining the impact of health insurance on processes of care with a refined focus on specific transactions between consumers and providers’ support staff and physicians guided by the principles of patient-centered care.
        Cover page: Effects of Health Insurance on Perceived Quality of Care Among Latinos in the United States
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2016)
        We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed.
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2009)
          To provide national prevalence estimates of usual source of healthcare (USHC), and examine the relationship between USHC and diabetes awareness and knowledge among Latinos using a modified Andersen model of healthcare access. Three thousand eight hundred and ninety-nine Latino (18-years or older) participants of the Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic/Latino Health survey from the 48 contiguous United States. Cross-sectional, stratified, random sample telephone interviews. Self-reported healthcare service use was examined in regression models that included a past-year USHC as the main predictor of diabetes awareness and knowledge. Anderson model predisposing and enabling factors were included in additional statistical models. Significant differences in USHC between Latino groups were found with Mexican Americans having the lowest rates (59.7%). USHC was associated with significantly higher diabetes awareness and knowledge (OR=1.24; 95%CI=1.05-1.46) after accounting for important healthcare access factors. Men were significantly (OR=0.64; 95%CI=0.52-0.75) less informed about diabetes than women. We found important and previously unreported differences between Latinos with a current USHC provider, where the predominant group, Mexican Americans, are the least likely to have access to a USHC. USHC was associated with Latinos being better informed about diabetes; however, socioeconomic barriers limit the availability of this potentially valuable tool for reducing the risks and burden of diabetes, which is a major public health problem facing Latinos.
            Cover page: Diabetes Awareness and Knowledge Among Latinos: Does a Usual Source of Healthcare Matter?
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2017)
            BACKGROUND: Medicaid has become the largest payer of substance use disorder treatment and may enhance access to quality care and reduce disparities. We tested whether treatment programs acceptance of Medicaid payments was associated with reduced disparities between Mexican Americans and non-Latino Whites. METHODS: We analyzed client and program data from 122 publicly funded treatment programs in 2010 and 112 programs in 2013. These data were merged with information regarding 15,412 adult clients from both periods, of whom we selected only Mexican Americans (n = 7130, 46.3%) and non-Latino Whites (n = 8282, 53.7%). We used multilevel logistic regression and variance decomposition to examine associations and underlying factors associated with Mexican American and White differences in treatment completion. Variables of interest included client demographics; drug use severity and mental health issues; and program license, accreditation, and acceptance of Medicaid payments. RESULTS: Mexican Americans had lower odds of treatment completion (OR = 0.677; 95% CI = 0.534, 0.859) compared to non-Latino Whites. This disparity was explained in part by primary drug used, greater drug use severity, history of mental health disorders, and program acceptance of Medicaid payments. The interaction between Mexican Americans and acceptance of Medicaid was statistically significant (OR = 1.284; 95% CI = 1.008, 1.637). CONCLUSIONS: Findings highlighted key program and client drivers of this disparity and the promising role of program acceptance of Medicaid payment to eliminate disparities in treatment completion among Mexican Americans. Implications for health policy during the Trump Administration are discussed.
              Cover page: Identifying and reducing disparities in successful addiction treatment completion: testing the role of Medicaid payment acceptance.
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2014)

              Background

              We examined Mexican migrants' perceived barriers to entering substance abuse treatment and potential differences by gender.

              Methods

              This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment.

              Results

              Significant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City.

              Conclusions

              Drug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico.
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2016)
                Older adults consistently prefer aging in place, which requires a high level of community support and services that are currently lacking. With a rapidly aging population, the present infrastructure for healthcare will prove even more inadequate to meet seniors' physical and mental health needs. A paradigm shift away from the sole focus on delivery of interventions at an individual level to more prevention-focused, community-based approaches will become essential. Recent initiatives have been proposed to promote healthy lifestyles and preventive care to enable older adults to age in place. Prominent among these are the World Health Organization's Global Age-Friendly Communities (AFC) Network, with 287 communities in 33 countries, and AARP's Network of AFCs with 77 communities in the United States. In an AFC, older adults are actively involved, valued, and supported with necessary infrastructure and services. Specific criteria include affordable housing, safe outdoor spaces and built environments conducive to active living, inexpensive and convenient transportation options, opportunities for social participation and community leadership, and accessible health and wellness services. Active, culture-based approaches, supported and developed by local communities, and including an intergenerational component are important. This article provides a brief historical background, discusses the conceptualization of the AFC, offers a list of criteria, narrates case studies of AFCs in various stages of development, and suggests solutions to common challenges to becoming age-friendly. Academic geriatric psychiatry needs to play a major role in the evolving AFC movement to ensure that mental healthcare is considered and delivered on par with physical care.
                  Cover page: Age-Friendly Communities Initiative: Public Health Approach to Promoting Successful Aging
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