San Francisco Research Articles

The Bay Area Muslim mental health community advisory board: evaluation of a community based participatory approach.

The aim of this paper is to present a novel case for the formation, operation and evaluation of a community advisory aboard comprised of Muslims residing in the San Francisco Bay Area, California that utilised a community based participatory approach to address local Muslim mental health needs. The CAB was recruited in partnership with the Muslim Community Association (MCA), one of the largest Islamic centres in the San Franscisco Bay Area. In addition to describing the development of the CAB, the authors present the findings of the evaluation and synthesis of best processes based on CAB members' feedback. To evaluate the perceived community advisory board members' perceptions of their roles and elicit feedback on how to enhance the relationship between the university team and the CAB, an evaluation was conducted by an independent team who was not part of the research process. Data was collected using anonymous individual surveys and small group open discussions that were conducted over three evaluation meetings. The evaluation utilised mixed method data collection strategies using questions from Schulz et al. (, Evaluation and Program Planning 26, 249-262), an instrument for evaluating dimensions of group dynamics within CBPR partnerships. Results of the evaluation within the sphere of CAB operation indicated that CAB members found the greatest satisfaction from their contributions through direct participation in the research activities that were conducted by the university-CAB team. The collective responses indicated that most CAB members were satisfied with trust built between the university-CAB team and the diversity represented in the members of the board. However, given that the Bay Area is home to a very diverse Muslim community, challenges in recruiting representatives that account for all possible self-identifying groups was reported by the CAB with recommendations to recruit religious leaders. Recommendations also included eliciting funds for potential financial compensation for CAB members. The Stanford-San Francisco Bay Area CAB demonstrated that empowering community members through direct participation, creating channels and safe spaces for feedback help create community rooted research that carry the true voices of marginalised communities and reflects their evolving needs.

S.F. seeks improved recovery programs amid a philosophical tug‐of‐war

An array of initiatives targeting San Franciscans experiencing some combination of a substance use disorder, homelessness and serious mental illness are being introduced during a tumultuous time in policy making for the city–county government. Some view the often‐contentious debate that has unfolded in recent months as a struggle between advocates of harm reduction and tougher drug enforcement, while others point to an equally compelling discussion of the merits of a “Housing First” approach vs. a greater emphasis on treatment and support services to break the cycle of homelessness.

Evaluating the Effect of San Francisco's Paid Parental Leave Ordinance on Birth Outcomes.

Since 2017, San Francisco’s Paid Parental Leave Ordinance (PPLO) has allowed parents who work for private-sector employers to take 6 weeks of fully paid postnatal parental leave. Previous studies have linked paid parental leave with health improvements for birthing people and babies, although evidence for birth outcomes is limited. We hypothesized that the PPLO may have improved birth outcomes via reduced stress during pregnancy due to anticipation of increased financial security and postnatal leave. We used linked California birth certificate and hospital discharge records from January 2013 to December 2018 (n = 1,420,781). We used quasi-experimental difference-in-difference (DD) models to compare outcomes among SF births before and after PPLO to outcomes among births in control counties. Births from January 2017 through December 2018 among working San Francisco (SF) people were considered “exposed” to PPLO; births during this time among working people outside of SF, as well as all births before 2017, served as controls. We conducted subgroup analyses by race/ethnicity, education and Medicaid coverage at delivery. Overall analyses adjusting for covariates and indicators for time and seasonality indicated no association between PPLO and birth outcomes. Our results indicate that PPLO may not have affected the birth outcomes we examined among marginalized groups who, due to structural racism, are at heightened risk of poor outcomes. We speculate that this result is due to the PPLO’s design and focus on postnatal leave. Future work should examine the policy’s effects on other outcomes.

Policies restricting flavors and non-cigarette tobacco product availability: A study of vape shops in San Francisco and Alameda Counties, California, USA

We examined flavored non-cigarette tobacco availability in brick-and-mortar vape shops in San Francisco (SF) and Alameda Counties, California (USA), comparing cities organized by flavored tobacco sales restriction policy. A total of 22 brick-and-mortar vape shops were identified and audited in October-November 2019; shops were located in SF City-County and nine cities in Alameda County. Fisher Exact Tests were used to assess differences in the availability of products between vape shops in cities with versus without comprehensive or partial flavored tobacco sales restrictions enacted before November 21, 2019 (n = 15 shops in six cities with policies vs n = 7 shops in four cities without policies). In the six cities with any flavored sales restrictions, fewer vape shops sold menthol/mint flavored JUUL pods (27% vs 71%, p = 0.074), candy/fruit (53% vs 100%, p = 0.051) and menthol/mint (53% vs 100%, p = 0.051) nicotine e-cigarette liquids compared to cities without flavored tobacco sales restrictions, but results were borderline significant. Tobacco-flavored JUUL pods (47% vs 71%, p = 0.381), tobacco-flavored nicotine e-cigarette liquids (67% vs 100%, p = 0.135), and flavored e-cigarette liquids without nicotine (candy/fruit: 87% vs 71%, p = 0.565 and menthol/mint: 87% vs 57%, p = 0.274) were not included in the policies, and availability was not significantly different between cities with or without policies. Enactment of local policies was associated with lower flavored e-cigarette tobacco product availability but not tobacco-flavored or non-nicotine product availability; federal policies restricting sales of flavored tobacco products may reduce access to flavored e-cigarette products in vape shops.

Impact of fruit and vegetable benefits on pregnancy outcomes among WIC participants: a natural experiment.

Proper nutrition is critical for maternal and neonatal health. In January 2017, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in San Francisco, California, began providing an additional $40 per month in fruit and vegetable (F&V) benefits to pregnant clients with the goal of improving food security and nutrition-related outcomes. We evaluated whether pregnant women on WIC who received this additional F&V benefit exhibited better perinatal and birth outcomes compared with those who received standard WIC benefits. We used 2010-2019 birth certificate data from the National Center for Health Statistics. The intervention group consisted of WIC participants living in San Francisco (SF) County (intervention county) and whose first trimester started after January 2017. We used a quasi-experimental synthetic control method to compare trends between the intervention and control groups (a weighted sample of other California counties that did not distribute additional F&V benefits). Outcomes included low birth weight, preterm birth, small-for-gestational-age, gestational diabetes, and gestational weight gain. No significant differences in maternal and neonatal outcomes among WIC recipients in SF and synthetic control group were observed after the F&V benefits were distributed. Prior studies have shown that additional F&V benefits have positive effects on maternal and infant outcomes, indicating that F&V vouchers are a promising strategy for supporting equitable health outcomes. Our null results suggest that more rigorous research is needed to determine their optimal dose and duration, especially in high-cost-of-living areas, and to examine more upstream and structural interventions.

Mimicking the Mode: The Fashionable Dress of Working-Class San Franciscans, 1880–95

In the late nineteenth century, the fashionable garments of women in the United States drew inspiration from the abundance of contemporary sources available to them, ranging from fashion plates in women’s periodicals to sewing patterns and ready-to-wear clothing. As Joan Severa details in her seminal book Dressed for the Photographer: Ordinary Americans and Fashion, 1840–1900 (1995), studio photographs from the time demonstrate precisely how high fashion was reinterpreted by working-class Americans in terms of materials, fit, and wear to suit their particular needs and lifestyles. One portrait album recently discovered at an estate sale illustrates Severa’s thesis, and this article offers a close examination of the album in tandem with contemporary fashion coverage in newspapers and elsewhere, social history, and demographics specific to working-class San Francisco. A focused regional case study, it offers insight into dress codes at a particular place and time that have to date been little studied by fashion scholars.

"I Have to Ask": A Mixed-Methods Study on the Collection of Sexual Orientation and Gender Identity Data Within the San Francisco County COVID-19 Case Investigation and Contact Tracing Program.

To understand how the San Francisco (SF) COVID-19 case investigation and contact tracing (CICT) workforce documented sexual orientation and gender identity (SOGI) data, as well as a qualitative assessment of the workforce's capacity to successfully collect that data. This mixed-methods project analyzed data from 2 sources: SOGI item completeness among adult completed/partially completed interviews in the SF digital CICT COVID-19 database, and a secondary data analysis of qualitative data from 16 semistructured 90-minute virtual interviews with the SF CICT workforce, between November 14, 2020, and April 14, 2021. Among 15 416 COVID-19 cases and 7836 close contacts, sexual orientation data are missing from 20% of cases and 17% of contacts. The proportion of transgender/nonbinary individuals was 0.32% and 0.5%, respectively. The SF CICTs participants discussed challenges in collecting SOGI data, not understanding SOGI measure rationale, and feeling uncomfortable asking the questions. Qualitative interviews with the COVID-19 CICT workforce and quantitative data on SOGI parameters in COVID-19 surveillance suggest that these data may have been underreported. Our results strongly suggest that comprehensive training is crucial in the collection of SOGI data among COVID-19 cases and their close contacts. If SOGI data are not collected accurately, the true impact of COVID-19 among lesbian, gay, bisexual, transgender, and queer populations remains unknown, preventing data-driven allocation of COVID-19 funds to lesbian, gay, bisexual, transgender, and queer communities.

Impact of COVID-19 on the Ophthalmology Residency Home-Institution Match Rate

Abstract Purpose The aim of this study was to evaluate the ophthalmology residency match results to determine changes in the rate of home-institution matches during the coronavirus disease 2019 (COVID-19) pandemic. Methods Aggregate deidentified summary match result data from 2017 to 2022 was obtained from the Association of University Professors of Ophthalmology and the San Francisco (SF) Match. A chi-squared test was performed to determine if the rate of candidate matching to the home residency program in ophthalmology was higher in the post-COVID-19 compared with pre-COVID-19 match years. A literature review using PubMed was performed of other medical subspecialty match rates to home institution during the same study period. Results A chi-squared test for difference in proportions confirmed a significantly higher chance of matching to the home program for ophthalmology in the post-COVID-19, SF Match year of 2021 to 2022 compared with 2017 to 2020 (p = 0.001). Other medical specialties including otolaryngology, plastic surgery, and dermatology also showed similar increased home institution residency match rates during the same time period. Although neurosurgery and urology also had increased trend rates for home institution match rates, these results did not reach statistical significance. Conclusions The ophthalmology home-institution residency SF Match rate was significantly increased during the COVID-19 pandemic year 2021 to 22. This mirrors a trend reported in other specialties including the otolaryngology, dermatology, and plastic surgery in the 2021 match. Additional study will be required to identify factors leading to this observation.

Trends in Cornea Fellowship Applications and Applicant Characteristics: A San Francisco Match Analysis

Abstract Purpose We investigate trends in cornea fellowship positions filled over time and applicant characteristics associated with matching into cornea fellowship. Methods Characteristics of cornea fellowship applicants were assessed using deidentified 2010 to 2017 San Francisco (SF) Match data. Publicly available SF Match cornea fellowship data including the number of participating programs, number of positions offered, number of positions filled, percentage of positions filled, and number of vacancies from 2014 to 2019 were also analyzed as data from 2010 to 2013 were unavailable. Results From 2014 to 2019, the number of cornea fellowship programs increased by 11.3% (mean 2.3% per year, p = 0.006) and the number of positions offered increased by 7.7% (mean 1.4% per year, p = 0.065). Of 1,390 applicants from 2010 to 2017, 589 (42.4%) matched into cornea. After controlling for potential covariates, graduation from a U.S residency program (odds ratio [OR]: 6.15, 95% confidence interval [CI]: 4.05–9.35, p < 0.001) and a greater number of interviews completed (OR: 1.35, 95% CI: 1.29–1.42, p < 0.001) were associated with increased odds of cornea fellowship match. A greater number of applied programs (OR: 0.97, 95% CI: 0.95–0.98, p < 0.001) was associated with decreased odds of matching into cornea fellowship. The proportion of applicants matching into cornea fellowship increased until 30 applications. Conclusions The number of cornea fellowship programs and positions increased from 2014 to 2019. Graduation from a U.S residency program and a greater number of interviews completed were associated with an increased likelihood of cornea fellowship match. Unlike applying to any ophthalmology subspecialty fellowship, applying to greater than 30 cornea fellowship programs was associated with decreased odds of matching.

The Gateway to the Pacific: Japanese Americans and the Remaking of San Francisco

The Gateway to the Pacific: Japanese Americans and the Remaking of San Francisco

Applicant Characteristics Associated with Retina Fellowship Match from 2010–2019

To describe trends in the surgical and medical retina fellowship match and applicant characteristics associated with matching in retina fellowship. Retrospective study. Ophthalmology fellowship applicants who applied through the San Francisco (SF) Match. Publicly available SF Match data were used to describe trends in the number of programs participating and positions offered, filled, and left vacant in the retina fellowship match from 2014 to 2019. Deidentified applicant data for match cycles from 2010 to 2017 were stratified by match status, and characteristics were compared across groups. Trends in matched applicant characteristics were evaluated using linear regression on log-transformed variables. Multivariable logistic regression was used to determine applicant characteristics that were associated with a successful match. Match status. From 2014 to 2019, the number of programs participating, positions filled, and positions left vacant in the retina fellowship match increased from 101 to 119 (P= 0.010), 118 to 123 (P= 0.078), and 18 to 37 (P= 0.045), respectively. Compared with unmatched applicants, matched applicants were more likely to have graduated from a top 10 residency program, US residency, or medical school; hold a United States (US) visa (J-1, H-1B, or O1); distribute more applications; complete more interviews; rank more programs; and score higher on the United States Medical Licensing Examination (USMLE) Step examinations 1-3. Matched applicants completed a median of 10 interviews. After controlling for potential covariates, graduating from a US residency (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.48-2.92), a top 10 residency (OR, 1.74; 95% CI, 1.07-2.84), having an allopathic medical degree (MD; OR, 2.39; 95% CI, 1.08-5.33), completing more interviews (OR, 1.28; 95% CI, 1.23-1.33), and scoring higher on USMLE Step 3 (OR, 1.01; 95% CI, 1.01-1.03) were associated with matching into a retina fellowship. Although the number of programs participating and positions offered in the retina fellowship match are increasing, the number of positions filled remained relatively stagnant. Factors associated with matching in both medical and surgical retina included graduating from a US and top 10-ranked residency program, having an MD, completing more interviews, and scoring higher on USMLE Step3.

Coordination issues for concrete floating floors; san francisco conservatory of music bowes center, case study

The San Francisco Conservatory of Music (SFCM) Bowes Center is a complex, vertical building housing SFCM's performance, rehearsal, instruction, and dormitory spaces. Coordination issues during design and construction that are not strictly acoustical but that are critical to achieving the floating floor's optimum sound and impact isolation performance are discussed. This paper examines issues from early design to construction phases applicable to many types of floating floor systems, such as: setting structural point loading criteria, developing a sound isolation envelope, coordination with audiovisual (AV) and theater consultants with respect to routing of conduits and locating recessed AV boxes in floating floor, coordination with the architect and structural engineer to identify high point loads on floating floor, consideration of seismic restraint elements, structural coordination to evaluate anchorage needs for elements supported on floating floor, construction sequencing coordination with pre-construction contractor with respect to anticipated needs for lifts on raised floating floors, and coordination of floating floor shop drawings with framing shop drawings for elements supported from the floating floor. This project case study outlines a useful list to help architects, consultants, and engineers navigate the complex and varied coordination issues that may arise on projects with concrete floating floors.

Hepatitis C prevalence and key population size estimate updates in San Francisco: 2015 to 2019.

BackgroundIn 2017, San Francisco’s initiative to locally eliminate hepatitis C virus (HCV) as a public health threat, End Hep C SF, generated an estimate of city-wide HCV prevalence in 2015, but only incorporated limited information about population HCV treatment. Using additional data and updated methods, we aimed to update the 2015 estimate to 2019 and provide a more accurate estimate of the number of people with untreated, active HCV infection overall and in key subgroups–people who inject drugs (PWID), men who have sex with men (MSM), and low socioeconomic status transgender women (low SES TW).MethodsOur estimates are based on triangulation of data from blood bank testing records, cross-sectional and longitudinal observational studies, and published literature. We calculated subpopulation estimates based on biological sex, age and/or HCV risk group. When multiple sources of data were available for subpopulation estimates, we calculated an average using inverse variance weighting. Plausible ranges (PRs) were conservatively estimated to convey uncertainty.ResultsThe total number of people estimated to have anti-HCV antibodies in San Francisco in 2019 was 22,585 (PR:12,014–44,152), with a citywide seroprevalence of 2.6% (PR:1.4%–5.0%)–similar to the 2015 estimate of 21,758 (PR:10,274–42,067). Of all people with evidence of past or present infection, an estimated 11,582 (PR:4,864–35,094) still had untreated, active HCV infection, representing 51.3% (PR:40.5%–79.5%) of all people with anti-HCV antibodies, and 1.3% (PR:0.6%–4.0%) of all San Franciscans. PWID comprised an estimated 2.8% of the total population of San Francisco, yet 73.1% of people with anti-HCV antibodies and 90.4% (n = 10,468, PR:4,690–17,628) of untreated, active HCV infections were among PWID. MSM comprised 7.8% of the total population, yet 11.7% of people with anti-HCV antibodies and 1.0% (n = 119, PR:0–423) of those with untreated active infections. Low SES TW comprised an estimated 0.1% of the total population, yet 1.4% of people with HCV antibodies and 1.6% (n = 183, PR:130–252) of people with untreated active infections.ConclusionsDespite the above-average number (2.6%) of people with anti-HCV antibodies, we estimate that only 1.3% (PR:0.6%–4.0%) of all San Francisco residents have untreated, active HCV infection–likely a reflection of San Francisco’s robust efforts to diagnose infection among high-risk groups and initiate curative treatment with as many people as possible. While plausible ranges of infections are wide, these findings indicate that while the overall number of people with anti-HCV antibodies may have increased slightly, the number of people with active HCV infection may have decreased slightly since 2015. This estimate improves upon the 2015 calculations by directly estimating the impact of curative treatment citywide and in subgroups. However, more research is needed to better understand the burden of HCV disease among other subgroups at high risk, such as Blacks/African Americans, people with a history of injection drug use (but not injecting drugs in the last 12 months), people who are currently or formerly incarcerated, and people who are currently or formerly unhoused.

“When I tell them my caste, silence descends”: Caste-based Discrimination among the Nepali Diaspora in the San Francisco Bay Area, USA

Recent cases of caste-based workplace discrimination in Silicon Valley in the United States (US) have highlighted the practice of caste-based discrimination in the San Francisco (SF) Bay Area. Most documentation of caste-based discrimination in diaspora populations in the US has focused on the Indian diaspora, omitting the perspectives of Dalits from other South Asian countries. This study investigated caste-based discrimination among the Nepali diaspora living in the SF Bay Area. Twenty-seven Nepali-American Dalits in the SF Bay Area participated in qualitative research on their experiences of caste-based discrimination. Aligned with findings from studies of Dalit diaspora members in other settings, the research found that Dalits faced social exclusion, workplace prejudice, microaggressions, and housing bias in the Nepali diaspora in the SF Bay Area. To preempt or avoid discrimination, some Dalits hid their caste, and many did not feel comfortable taking action regarding caste-based discrimination because of the absence of caste as a protected category in their workplaces and in local government policies. Caste-based discrimination affected the Dalits’ mental health as well. The findings highlight the need for policy interventions for Dalits living in the SF Bay Area and facing caste-based discrimination within their diaspora communities.

A Community Divided: The Ho Lawsuit and Chinese San Franciscans’ Search for Education Equality and Racial Inclusion

Abstract The Brian Ho lawsuit in the 1990s, brought about by several school children of Chinese descent in the San Francisco United School District against the school district, state defendants, and the San Francisco NAACP, signified a shift in the understanding of education equality that spotlighted divergent views, motivations, and actions concerning race-conscious education policies among Chinese San Franciscans. This article examines the intra-community dynamics and conflicts in Chinese San Franciscans’ pursuit of education rights and racial equality in the 1980s and 1990s by reconstructing their various claims to education equality. These divergent yet analogous struggles for equal educational opportunities reflected varied racial attitudes and conceptions of Chinese American racial identity. What these disparate racial perceptions and identity conceptions embodied fundamentally was a range of arguments for racial inclusion and equality. The contrast and contradictions between these distinct views persisted, reemerging in Chinese Americans’ continued apprehension of their racial identity in the wake of the renewed debate about race-based education policies that was juxtaposed with the rising racial hatred toward Asian Americans during the COVID-19 pandemic.

Factors Considered in Ranking Pediatric Orthopaedic Surgery Fellowship Applicants

Background: Pediatric orthopaedic surgery is a competitive orthopaedic subspecialty that has seen a rise in the number of applications submitted per applicant over the past decade. Surveys of fellowship program directors in other orthopaedic subspecialties including orthopaedic trauma, spine, sports medicine, and hip and knee arthroplasty have demonstrated differing opinions regarding the factors considered most important when ranking applicants. The selection criteria considered most important by pediatric orthopaedic surgery fellowship program directors have not yet been evaluated. Methods: A web-based questionnaire was sent to the program directors of all pediatric orthopaedic surgery fellowship programs that participate in the San Francisco (SF) Match program. In addition to providing information about program size, number of applicants interviewed, and number of applicants ranked, program directors were presented with 12 selection criteria based on previous surveys of orthopaedic fellowship directors and were asked to rank them in order of importance. A weighted score for each selection criteria was calculated using the following scale: 5 points for each criterion ranked 1st, 4 points for 2nd, 3 points for 3rd, 2 points for 4th, and 1 point for 5th. The total weighted score of each criterion was calculated. Results: Of the 45 program directors that we contacted, 36 responded (80% response rate). A plurality of programs both interviewed and ranked between 16 and 20 applicants. The interview and letters of recommendation were the most important selection criteria according to program directors. Other selection criteria deemed important included the applicant’s residency program, personal connections, and life experience. Conclusions: Pediatric orthopaedic surgery fellowship program directors consider the interview, letters of recommendation, and the applicant’s residency program to be the most important factors when ranking fellowship candidates. These findings may be useful to orthopaedic residents interested in pursuing fellowship training in pediatric orthopaedic surgery by providing applicants with a better understanding of which areas to focus on when preparing for the fellowship interview and subsequent match process.

Investigating city bike rental usage and wet-bulb globe temperature.

Extreme heat exacerbates human illness and constrains the intensity and/or duration of outdoor activities. Temperature is an incomplete metric of outdoor heat exposures. By contrast, Wet Bulb Globe Temperature (WBGT) is a heat exposure metric that considers air temperature, moisture, solar radiation, and wind speed. In the USA, bicycle activity increased by 60% from 2000 to 2010. Several studies examined weather conditions and bicycling activities. However, few studies examined how the public should conduct their daily physical activities per weather conditions.This study investigated the relationship between WBGT and shared city bicycle activity in New York City(NYC) and San Francisco (SF), USA. Generalized Additive Models examined nonlinear relationships between WBGT and bicycle activity while controlling for rider demographics and temporal trends. Next, bootstrapping estimated the "peak point", when the relationship between the bike rentals and WBGT notably changed.The analysis also examined whether the heat warning messages affected cycling activities. We found that the number of rented bikes declined at different peak points in each city. The peak point was in NYC at 34.3°C (95% CI 33°C-35°C) and 10.8°C (95% CI 10-12°C) in SF. Somewhat paradoxically, bike rentals increased when heat warnings were issued in both cities.

Geospatial Distributions of Lead Levels Found in Human Hair and Preterm Birth in San Francisco Neighborhoods.

In San Francisco (SF), many environmental factors drive the unequal burden of preterm birth outcomes for communities of color. Here, we examine the association between human exposure to lead (Pb) and preterm birth (PTB) in 19 racially diverse SF zip codes. Pb concentrations were measured in 109 hair samples donated by 72 salons and barbershops in 2018–2019. Multi-method data collection included randomly selecting hair salons stratified by zip code, administering demographic surveys, and measuring Pb in hair samples as a biomarker of environmental exposure to heavy metals. Concentrations of Pb were measured by atomic emission spectrometry. Aggregate neighborhood Pb levels were linked to PTB and demographic data using STATA 16 SE (StataCorp LLC, College Station, TX, USA). Pb varied by zip code (p < 0.001) and correlated with PTB (p < 0.01). Increases in unadjusted Pb concentration predicted an increase in PTB (β = 0.003; p < 0.001) and after adjusting for poverty (β = 0.002; p < 0.001). Confidence intervals contained the null after further adjustment for African American/Black population density (p = 0.16), suggesting that race is more indicative of high rates of PTB than poverty. In conclusion, Pb was found in every hair sample collected from SF neighborhoods. The highest concentrations were found in predominately African American/Black and high poverty neighborhoods, necessitating public health guidelines to eliminate this environmental injustice.

Harm Reduction Policing: An Evaluation of Law Enforcement Assisted Diversion (LEAD) in San Francisco

In 2017, San Francisco (SF) implemented Law Enforcement Assisted Diversion (LEAD), a program Beckett described as harm reduction policing. Through a process and outcome evaluation of LEAD SF, this paper demonstrates the positive impacts of harm reduction policing, on those who use drugs and/or engage in sex work. When law enforcement officers used their discretion to divert individuals into LEAD rather than arrest, those individuals had significantly fewer felony and misdemeanor arrests and felony cases, in comparison to a propensity score matched group. The focus group and interview data describe that the collaboration, the warm handoff, and LEAD’s harm reduction principles were mechanisms of success. However, obtaining officer buy-in was a key challenge. Despite that obstacle, LEAD SF’s harm reduction policing reduces offending, improves the wellbeing of people who use drugs and engage in sex work, and allows the police to carry out their mandate to protect and serve.

Abstract 11280: Effect of Homelessness on Incidence of Autopsy-Defined Causes of Presumed Sudden Cardiac Death: Insights from the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death (POST SCD) Study

Introduction: Prior studies report higher cardiovascular mortality in persons experiencing homelessness (PEH), but presume cardiac cause of death (COD) from EMS records or death certificates. The effect of homelessness on autopsy-defined SCD is unknown. In this prospective postmortem study of all SCDs in San Francisco (SF) County, we hypothesized a greater incidence of presumed SCD in PEH, but more non-cardiac COD on autopsy. Methods: Between 2/2011 - 3/2014, all incident World Health Organization-defined (presumed) SCDs ages 18-90 were autopsied via active surveillance of out of hospital deaths in the POST SCD Study. A multidisciplinary committee adjudicated COD. Autopsy-defined SCDs had no extra-cardiac COD (e.g., overdose, pulmonary embolism, stroke). Homeless status was determined from medical records; rates of presumed and autopsy-defined SCD were compared to those for housed individuals. The countywide homeless population was determined from the 2013 SF Homeless Count and Survey. Results: We identified 525 presumed SCDs over 37 months: 36 (7%) were PEH and 489 (93%) were housed. Presumed SCDs in PEH were younger than housed subjects (56.5 ± 9.9 v. 63.2 ± 14.6 years), more often male (97% v. 67%), less likely to be Asian (0% v. 22%) or have dyslipidemia (3% v. 32%), but more likely to have alcohol (58% v. 21%) and substance use disorder (44% v. 13%, p&lt;0.01 for all). The presence of psychiatric disorders was similar between groups. Among presumed SCDs, PEH had a lower proportion of autopsy-defined SCDs than housed individuals (9/36 [25%] v. 306/489 [63%]), with more non-cardiac COD including aspiration, aortic dissection, occult overdose, and infection (p&lt;0.05 for all). Observed incidence rates for presumed SCD were 181.4 v. 22.7 per 100,000 person-years (IRR 8.01, p&lt;0.01) in PEH v. housed individuals, and 45.4 v. 14.2 per 100,000 person-years (IRR 3.20, p&lt;0.01) for autopsy-defined SCD. Conclusion: In this 3-year comprehensive postmortem study of all incident SCDs in a diverse urban setting, homelessness was associated with &gt;3-fold higher risk of autopsy-confirmed SCD and 8-fold higher risk of sudden mortality overall. Only one-fourth of presumed SCDs in PEH were autopsy-confirmed SCDs, while one-third of non-cardiac causes were due to occult drug overdose.