Service Planning Areas Research Articles

Five years later: Can women in Los Angeles County, California, get adequate pill supplies?

ObjectivesThis study sought to determine if pharmacies in Los Angeles County had implemented 2017 legislation requiring insurance companies based in California to fully reimburse for 13 cycles of oral contraceptives dispensed at once. Study designWe conducted a secret shopper telephone survey of Los Angeles County pharmacies nearly 5 years after the legislation went into effect. We chose the categorical state family program (Family PACT) to represent all programs covered by the legislation. Representative numbers of pharmacies were randomly selected in each of Los Angeles County’s eight service planning areas in proportion to the number of women living in each area. We asked pharmacies if they would fill a prescription for a year’s supply of contraception all at once for a patient enrolled in Family PACT. ResultsWe contacted a total of 582 pharmacies and excluded the 150 unresponsive pharmacies. Of the 432 pharmacies contacted, only 3.2% said they would dispense a 1-year supply of pills at once to a patient enrolled in this representative program. Nearly 50% explicitly said they would not dispense 13 cycles at one time regardless of the prescription. ConclusionsOnly 3.2% of surveyed pharmacies in Los Angeles County said they would comply with current legislation, which requires dispensing 1-year supply of pills at once. ImplicationsCollaboration among physicians, pharmacies, and patients along with enhanced insurance company oversight will be needed to improve dispensing practices to achieve the lower unintended pregnancy rates associated with providing adequate contraceptive supplies.

Geospatial analysis of access to dermatology care in Los Angeles County: a cross sectional study.

Geographic maldistribution of dermatologists contributes to disparities in access to dermatologic care. We aimed to investigate the geographic distribution of, and differences in wait times for medical dermatology services in Los Angeles County (LAC). We placed phone calls to 251 dermatology practices in LAC to ask for a new patient appointment for a changing mole. We found West LAC (Service Planning Area [SPA] 5) had the highest number of dermatologists and South LAC (SPA 6) had the lowest (26.1 versus 0 per 100,000 residents, P=0.01). Service Planning Area 6 has a higher non-White, uninsured, and impoverished population than SPA 5. Dermatology appointment wait times and Medicaid acceptance varied between SPAs but was not statistically significant (P=0.37 and P=0.20, respectively). Medicaid-accepting practices had a significantly longer mean wait time for an appointment than practices that did not accept Medicaid (26.1 versus 15.1 days, P=0.003). Regions with predominantly non-White, Spanish-speaking, and medically underinsured residents were found to be disproportionately lacking in dermatologists across LAC, which may contribute to impaired access to dermatology services in LAC.

Racial disparities in diabetes prevalence among cancer patients.

Cancer inequity is one of the most critical public health issues faced by ethnic minorities and people of lower socioeconomic status. The disparate burden of cancer is caused by poor access to care and inadequate delivery of cancer treatment, as well as comorbid and co-occurring conditions. Diabetes is a common and serious comorbid condition of cancer. To better understand diabetes prevalence among diverse cancer patients, this study analyzed and described characteristics of cancer patients with diabetes from local-level Service Planning Area (SPA) data using City of Hope Comprehensive Cancer Center data, and United States national-level data from The National Health Interview Survey. Findings from national level data showed that patients in racial/ethnic minority groups had a higher occurrence of being diagnosed with diabetes, especially for non-Hispanic Blacks (OR=1.76, 95% CI=1.51, 2.03) and Hispanic/Latino individuals (OR=1.34, 95% CI=1.18, 1.52). Cancer patients who are older, ethnic minority, overweight/obese and with lower educational levels were more likely to have co-occurring diabetes. SPA-level patient data found similar results. In response to our findings and other reports, clinicians and health system including health coverage organizations should routinely assess cancer patients for cooccurring chronic illnesses, in particular diabetes. Interventions improving coordinated care that integrates oncology, endocrinology and primary care, targeting cancer patients --especially racial/ethnic minorities, overweight/obese, and older patients who are at increased risk for diabetes -- ought to be considered as best practice Whole Person care. With coordinated care management, ethnic disparities in cancer may be better addressed and reduced. Additionally, policymakers can contribute by enacting policies improving access to and coverage of integrated oncology, chronic disease prevention, and associated specialty care i.e., endocrinology to equalize quality care for ethnic minority, lower educated, overweight/obese and older cancer patients who are more likely to suffer greater comorbidity, and inadequate oncology and coordinated care to reduce disparities.

S294 Decline in Colorectal Cancer Screening Rates in Federally Qualified Health Centers in Los Angeles County From 2019 to 2020

Introduction: Federally Qualified Health Centers (FQHCs) are funded by the Health Resources and Services Administration (HRSA) to provide primary care services to low-income and underinsured individuals. Los Angeles County (LAC) is a large, diverse county with greater than 10.2 million residents and 8 distinct Service Planning Areas (SPAs) that represent specific geographic regions with variable resources. We aimed to describe colorectal cancer (CRC) screening rates (CRCSR) and the screening rate change (SRCs) in LAC overall and for each SPA between 2019 and 2020 to determine where resources are most needed for CRCSR recovery following the COVID-19 pandemic. Methods: Our data source was the Uniform Data System (UDS), which includes quality data for the FQHCs funded by HRSA. We determined 2019 and 2020 CRCSR for LAC FQHCs overall and for each FQHC, including average-risk patients age 50-74. We then separated FQHCs into quartiles based on SRC and performed mixed-effects logistic regression to determine FQHC-level characteristics associated with the largest decline in CRCSR from 2019 to 2020 (i.e., predictors of category SRC Q1). Lastly, we determined SRC for each SPA in LAC. Results: In 2019, there were 58 FQHCs in LAC with 326,473 patients eligible for CRC screening. In 2020, there were 59 FQHCs with 350,405 eligible patients. The median 2020 CRCSR in LAC FQHCs was 37.3%, down from 48.0% in 2019 (2020 median SRC= -9.6%) (Table). In the regression model among all LAC FQHCs, those with higher proportions of patients preferring a non-English language had significantly higher odds of having the largest decline in CRCSR from 2019 to 2020 (SRC Q1) (aOR=3.25, 95% CI=1.22-8.65; data not shown). CRCSR decreased from 2019 to 2020 in all SPAs with SRC ranging from -17.0% (South Bay) to -1.4% (West LA) (Figure). Conclusion: In Los Angeles County FQHCs, CRC screening rates were higher than the national FQHC average in 2019 however declined considerably between 2019 and 2020. The decline in CRC screening rates was highest in FQHCs serving a higher proportion of patients with a preference for a non-English language and varied by county region. Our findings highlight the need for targeted measures, including language-appropriate resources, to improve CRC screening uptake in FQHCs that provide care to some of the most historically marginalized individuals.Figure 1.: A) Median CRC screening rate among adults age 50 to 74 at FQHCs in Los Angeles County in 2019, by Service Planning Area (SPA). B) Percent change in CRC screening rate (screening rate change, SRC) for adults age 50 to 74 at FQHCs in LA County between 2019 and 2020, by SPA; n=58 FQHCs Table 1. - FQHC characteristics (2020 data) and CRC screening rates (2019 and 2020) for HRSA-funded FQHCs in LA County overall and by 2020 CRC screening rate change quartiles Frequency or percent Overall (n=59) SRC Q1 (n=15) SRC Q2+Q3+Q4 (n=44) p-value Total patients eligible for CRC screening (age 50-74) 350,405 79,218 271,187 n/a CRC screening rate in 2019 (median %) 48.0 61.4 44.7 0.0001 CRC screening rate in 2020 (median %) 37.3 37.3 37.3 0.97 Change in CRC Screening Uptake between 2020 and 2019 Median -9.58 -24.49 -5.52 < 0.0001 Interquartile Range -15.2, -2.2 -31.4, -17.2 -10.0, -1.3 Sex Male (median %) 41.5 42.2 41.4 0.83 Race & Ethnicity (median %) White Non-Hispanic 8.7 6.2 10.2 0.12 Black Non-Hispanic 6.4 4.6 6.7 0.40 Hispanic/Latine 63.5 54.9 63.7 0.94 Other Non-Hispanic 2.6 1.8 2.6 0.16 Preference for non-English Language (median %) 34.1 43.4 33.3 0.01 Urban FQHCs, n (%) 59 (100%) 15 (100%) 44 (100%) n/a Experiencing homelessness (median %) 2.3 2.4 2.2 0.57 Income Level >200% FPL (median %) 2.1 1.8 2.2 0.60 Uninsured (median %) 22.6 22.7 22.6 0.72 Medicaid (median %) 41.8 40.0 42.0 0.52 Medicare/Medicaid Dually Eligible (median %) 3.0 2.8 3.0 0.64 Private Ins (median %) 7.1 10.2 6.5 0.19 Agricultural Workers (median %) 0.26 0.30 0.26 0.74

Geospatial analysis of associations among mental health need, housing need, and involuntary psychiatric hospitalizations of people experiencing homelessness in Los Angeles County

The purpose of this study was to use geospatial indicators of mental health need and homelessness in Los Angeles County Service Planning Areas (SPAs) and a psychiatric sample of adults who were homeless to investigate 1) overlap between SPA level of mental health need and corresponding volume of involuntary psychiatric hospitalizations over time; 2) overlap between SPA level of unsheltered homelessness and corresponding volume of involuntary psychiatric hospitalizations over time; and 3) associations between SPA level of mental health need, SPA level of unsheltered homelessness, and initiation of a mental health conservatorship for grave disability. A sample of 373 adults who were homeless and hospitalized on an involuntary psychiatric hold from 2016 to 2018 were linked to data from the Greater Los Angeles Homeless Count on unsheltered homelessness and from the California Health Interview Survey on need for mental health services and suicidality, using admission zip codes to link variables at the SPA level. Geospatial mapping and bivariate tests were used to examine geographic overlap of SPA mental health need and unsheltered homelessness with volume of involuntary psychiatric admissions over the study period. Multiple logistic regression modeling was used to examine associations of SPA mental health need and unsheltered homelessness with conservatorship initiation. The volume of patients admitted from SPAs with higher levels of mental illness need grew from 2016 to 2018 (Tau = 0.27, P < 0.001; Tau = 0.40, P < 0.001), but there were fewer patients admitted from SPAs with higher levels of unsheltered homelessness over the same years (Tau of −0.33, P < 0.001). Being admitted from SPAs with the highest levels of unsheltered homelessness was associated with higher odds of conservatorship initiation (OR = 1.73, 95% CI = 1.82–16.74). Results suggest a need for targeted mental health and housing services to reach areas of highest need in Los Angeles County.

Abstract CT087: A geospatial approach to explore the socioecological context of tobacco and vape shop locations

Abstract Introduction: Despite growing public health efforts to discourage teens from using hazardous tobacco products, their use of ENDS (electronic nicotine delivery system) remain piqued due to direct youth targeting by tobacco and vaping companies. ENDs especially e-cigs most often have a fruit or candy flavor that are particularly attractive to young people and may have high nicotine - which is highly addicting. Methods: 1) analyzed national/local nicotine product use in youth by gender, age, and racial/ethnic groups, 2) explored socio-ecological context of tobacco/vape shops via geo-spatial mapping within Los Angeles Service Planning Area 3 (SPA 3), 3) conducted environmental scan of social media platforms combined with Google and Yellow Pages searches. Results: Population level results were drawn from US Census, 2013-2017 American Community Survey (ACS) and California Tobacco Facts and Figures, 2019. 13.5% middle schoolers and 37.7% high schoolers reported ever using e-cigarettes. Use of basic or disposable devices was associated with younger age especially among Latinos (5% reported use in the past month compared to &amp;lt; 3% among other ethnicities). To explore socioecological contexts of tobacco and vape shops in SPA 3. Regardless of income, a higher number of tobacco and vape shops appear to correspond with higher percentage ethnic minorities. Lower income cities tended to have more tobacco and vape shops compared to very high-income cities. Tobacco products cost less in neighborhoods with a lower median household income and in neighborhoods with a higher proportion of Hispanic residents, even after adjusting for store type.Additionally, prior to the presentation, we will conduct geospatial mapping analysis: We will utilize open GIS software (QGIS) and open web map tools (Leaflet) to geocode locations of smoke/vape shops and overlay them with city demography to illustrate their spatial relationships and proximity to various neighborhoods. Discussion: Sustained implementation of population-based tobacco, including vaping, prevention and control strategies, in coordination with the Food and Drug Administration, are critical to reducing tobacco use including vaping and initiation among all U.S. population especially ethnic minorities and youths. There are associations of Tobacco Products marketing (price, placement, promotion, or product availability) with a neighborhood demographic (socioeconomic challenged, minority race/ethnicity and high traffic volume). Vape shops are more likely to be concentrated in low resourced communities with less political clout - these areas tend to be minority dense with fewer restrictions. Findings could inform initiatives aimed at a stronger licensing requirement for vape shops and federal and state-level regulations of this industry to prevent tobacco/vape shop from targeting minority and other socially challenged groups. Citation Format: Kimlin T. Ashing, Brian Tiep, Jonjon Macalintal, Sophia Yeung, Timothy O'Connor, Bin Xie, Udochukwu Obodo, Ming-Hsiang Tsou, Gaole Song, Faith Abuan, Christyl Dawson. A geospatial approach to explore the socioecological context of tobacco and vape shop locations [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT087.

Assessing Front Office StaffAwareness on Mental Health Resources at Youth Friendly Clinics in Los Angeles County.

Mental illness is a global health challenge and continues to rise among minors. Community clinics are well positioned to provide mental health services to young people. To assess community clinic front staff awareness of recent legislation mandating access by minors to mental health services and the actual services delivered by these clinics. We conducted a face-to-face survey with front office staff at community clinics in service planning areas (SPA) 6, 7, and 8 in Los Angeles County (LAC) to understand the staff awareness of the services provided to the minor by the clinic. These SPAs have been previously identified as serving a low socioeconomic population. Fisher's exact test and the chi-square test were conducted to understand the factors influencing the front desk personnel awareness. Data were collected from 17 clinics in SPA6, 15 clinics in SPA7, and 4 clinics in SPA8. All of the clinics provided Family-PACT insurance, resources for domestic abuse, intimate partner violence, mental health (such as anxiety and depression) and alcohol/drug abuse; however responding front desk staff in twenty-five out of 36 (69.4%) clinics was aware of the availability of Family-PACT insurance to minor patients; 21 (58.3%) was aware that the clinic provided resources for domestic abuse or intimate partner violence, and 20 (55.5%) was aware that the clinic offered resources for mental health (such as anxiety or depression) or alcohol/drug abuse to minor patients. In this pilot study, about half of the front desk staff at the surveyed clinics in LA County did not know that the clinic is fully authorized and equipped to provide mental health services to the minors (patients under 18years of age). These are missed opportunities. There is a need for better education of the front-desk personnel.

A Geospatial Analysis of Health, Mental Health, and Stressful Community Contexts in Los Angeles County.

IntroductionDespite numerous federal investments, chronic disease continues to disproportionately affect certain communities across the United States. Understanding the regional distribution (including any overlaps) of factors that extend beyond built and food environments, especially factors that may adversely affect chronic disease–related behaviors, is important. This case study of Los Angeles County’s geospatial landscape sought to address these gaps in research and practice.MethodsWe examined the distributions and geographic overlaps between economic hardship, psychological distress, soda consumption, and availability of publicly funded mental health facilities in 8 Service Planning Areas in Los Angeles County. We categorized the geospatial presence of each variable as low, intermediate, or high. We imported all data, collected during 2014–2018, into ArcGIS Pro version 2.3.3 to create 5 bivariate choropleth maps.ResultsLevels of economic hardship were not equally distributed across communities; the county was characterized by intermediate levels of soda consumption and psychological distress. Most areas had low or intermediate availability of publicly funded mental health facilities. We also found some discordance between psychological distress and availability of publicly funded mental health facilities, and between economic hardship and availability of these facilities.ConclusionThe need exists to address disparities in economic hardship and to increase access to publicly funded mental health supports and providers in Los Angeles County. The information collected in this case study has policy implications for health, public health, and mental health services planning at the local level.

Chronic Respiratory Disease and Health-Related Quality of Life of African American Older Adults in an Economically Disadvantaged Area of Los Angeles.

Background. Most of the attention of policy makers, program planners, clinicians, and researchers in the area of physical health disparities among African American older adults has been traditionally focused on cardiometabolic disease and cancer. Among a long list of chronic medical conditions, chronic respiratory conditions (CRCs), such as asthma, chronic bronchitis, and emphysema, have received less attention. Purpose. This study investigated whether CRCs contribute to physical and mental health-related quality of life (HRQoL) of African American older adults who live in economically disadvantaged urban areas, and whether these effects are due to demographic factors, socioeconomic status (SES), health behaviors, and comorbid medical and mental conditions. Methods. This community-based study recruited 617 African American older adults (age ≥ 65 years) from Service Planning Areas (SPA) 6, an economically disadvantaged area in South Los Angeles. Structured face-to-face interviews were used to collect data on demographic factors (age and gender), SES (educational attainment and financial difficulty), living arrangements, marital status, health behaviors (cigarette smoking and alcohol drinking), health (CRC, number of comorbid medical conditions, depressive symptoms, and pain intensity), and physical and mental HRQoL (Physical and Mental Component Summary Scores; PCS and MCS; SF-12). Linear regressions were used to analyze the data. Results. The presence of CRCs was associated with lower PCS and MCS in bivariate analysis. The association between CRCs and PCS remained significant above and beyond all confounders. However, the association between CRCs and MCS disappeared after controlling for confounders. Conclusion. For African American older adults living in economically disadvantaged urban areas, CRCs contribute to poor physical HRQoL. Evaluation and treatment of CRCs in African American older adults may be a strategy for reduction of disparities in HRQoL in this population. As smoking is the major modifiable risk factor for CRCs, there is a need to increase accessibility of smoking cessation programs in economically disadvantaged urban areas. More research is needed on the types, management, and prognosis of CRCs such as asthma, chronic bronchitis, and emphysema in African American older adults who reside in low-income and resource limited urban areas.

Cigarette Smoking among Economically Disadvantaged African-American Older Adults in South Los Angeles: Gender Differences.

The current study aims to explore gender differences in the risk of cigarette smoking among African-American (AA) older adults who live in economically disadvantaged urban areas of southern Los Angeles. This cross-sectional study enrolled 576 older AA adults (age range between 65 and 96 years) who were residing in Service Planning Area 6 (SPA 6), one of the most economically challenged areas in southern Los Angeles. All participants had cardiometabolic disease (CMD). Data were collected using structured face-to-face interviews. Demographic factors (age and gender), socioeconomic status (educational attainment and financial difficulty), health (number of comorbid medical conditions and depressive symptoms), and health behaviors (current alcohol drinking and current smoking) were measured. Logistic regressions were used to analyze the data without and with interaction terms between gender and current drinking, depressive symptoms, and financial difficulty. AA men reported more smoking than AA women (25.3% versus 9.3%; p < 0.05). Drinking showed a stronger association with smoking for AA men than AA women. Depressive symptoms, however, showed stronger effects on smoking for AA women than AA men. Gender did not interact with financial difficulty with regard to current smoking. As AA older men and women differ in psychological and behavioral determinants of cigarette smoking, gender-specific smoking cessation interventions for AA older adults who live in economically deprived urban areas may be more successful than interventions and programs that do not consider gender differences in determinants of smoking. Gender-tailored smoking cessation programs that address drinking for AA men and depression for AA women may help reduce the burden of smoking in AA older adults in economically disadvantaged urban areas. Given the non-random sampling, there is a need for replication of these findings in future studies.

Stakeholder Perspectives on the Social Determinants of Mental Health in Community Coalitions.

Although evidence supports the potential for community coalitions to positively address social determinants of mental health, little is known about the views of stakeholders involved in such efforts. This study sought to understand county leaders' perspectives about social determinants related to the Health Neighborhood Initiative (HNI), a new county effort to support community coalitions. Descriptive, qualitative study, 2014. Community coalitions, located in a large urban city, across eight service planning areas, that serve under-resourced, ethnic minority populations. We conducted key informant interviews with 49 health care and community leaders to understand their perspectives about the HNI. As part of a larger project, this study focused on leaders' views about social determinants of health related to the HNI. All interviews were audio-recorded and transcribed. An inductive approach to coding was used, with text segments grouped by social determinant categories. County leaders described multiple social determinants of mental health that were relevant to the HNI community coalitions: housing and safety, community violence, and employment and education. Leaders discussed how social determinants were interconnected with each other and the need for efforts to address multiple social determinants simultaneously to effectively improve mental health. Community coalitions have an opportunity to address multiple social determinants of health to meet social and mental health needs of low-resourced communities. Future research should examine how community coalitions, like those in the HNI, can actively engage with community members to identify needs and then deliver evidence-based care.

Community Partners in Care: 6- and 12-month Outcomes of Community Engagement versus Technical Assistance to Implement Depression Collaborative Care among Depressed Older Adults.

Community Partners in Care, a community-partnered, cluster-randomized trial with depressed clients from 95 Los Angeles health and community programs, examined the added value of a community coalition approach (Community Engagement and Planning [CEP]) versus individual program technical assistance (Resources for Services [RS]) to implement depression collaborative care in underserved communities. This exploratory subanalysis examines 6- and 12-month outcomes among CPIC participants aged >50 years. Community-partnered, cluster-randomized trial conducted between April 2010 and March 2012. Hollywood-Metropolitan (HM) and South Los Angeles (SLA) Service Planning Areas (SPAs), Los Angeles, California. 394 participants aged >50 years with depressive symptoms (8-item Patient Health Questionnaire score ≥ 10). A community-partnered multi-sector coalition approach (Community Engagement and Planning [CEP]) vs individual program technical assistance (Resources for Services [RS]) to implement depression collaborative care. Depressive symptoms (PHQ-8 score), mental health-related quality of life (MHRQL), community-prioritized outcomes including mental wellness, homelessness risk and physical activity, and services utilization. At 6 months, CEP was more effective than RS at improving MHRQL and mental wellness among participants aged >50 years; no differences were found in the effects of CEP vs RS on other outcomes. No significant outcome differences between CEP and RS were found at 12 months. A multisector community coalition approach may offer additional benefits over individual program technical assistance to improve outcomes among depressed adults aged >50 years living in underserved communities.

Health Disparities in Patients with Congestive Heart Failure Exacerbations in Los Angeles County.

1.1.Congestive Heart Failure (CHF) is a leading cause of death in the USA, with over 500,000 new cases diagnosed each year. While rates of CHF exacerbation across all races and ethnicities decreased from 2005 to 2009, the number of Black patients with CHF exacerbation who present in Los Angeles (L. A.) County Emergency Departments (ED) remained the highest. We examine disparities in CHF exacerbation rates in L. A. County, and in Los Angeles Service Planning Area (SPA) 6, and compare CHF-related outcomes, and the disposition of these patients post-ED visit. 1.2.This is a retrospective analysis using the Office of Statewide Health Planning and Development (OSHPD) Emergency Department, and Ambulatory Surgery Center database from 2005 to 2009. We used the following variables: congestive heart failure, ICD-9 code 428.0, age, gender, race/ethnicity, insurance status, and disposition. Univariate and descriptive statistics identified distributions of the study variables. There were a total of 13,766 in the study population. 1.3.SPA 6 had higher hospitalization rates across all races and ethnicities, compared to L.A. County as a whole. Blacks constitute 9.1% of the County population, but represented 32% of patients diagnosed with CHF in the ED. Only about 10% of L. A. County's population resides in SPA 6, yet over 22% of the entire County's CHF patients reside there. 1.4.CHF continues to disproportionately affect Black individuals in L.A. County, and younger adults in SPA 6. Our results indicate that residing in this service planning area, in addition to race, can predict greater likelihood of presenting with CHF exacerbation in the ED, and greater likelihood of hospitalization. Future research on the association of CHF exacerbation with different sociodemographic measures among minority, underserved and disadvantaged patients is needed. These can identify and help mitigate inequities and weaknesses in our health care system, which are manifest through stark health disparities among different racial, ethnic and socioeconomic groups.

Community-Based Health and Exposure Study around Urban Oil Developments in South Los Angeles.

Oilfield-adjacent communities often report symptoms such as headaches and/or asthma. Yet, little data exists on health experiences and exposures in urban environments with oil and gas development. In partnership with Promotoras de Salud (community health workers), we gathered household surveys nearby two oil production sites in Los Angeles. We tested the capacity of low-cost sensors for localized exposure estimates. Bilingual surveys of 205 randomly sampled residences were collected within two 1500 ft. buffer areas (West Adams and University Park) surrounding oil development sites. We used a one-sample proportion test, comparing overall rates from the California Health Interview Survey (CHIS) of Service Planning Area 6 (SPA6) and Los Angeles County for variables of interest such as asthma. Field calibrated low-cost sensors recorded methane emissions. Physician diagnosed asthma rates were reported to be higher within both buffers than in SPA6 or LA County. Asthma prevalence in West Adams but not University Park was significantly higher than in Los Angeles County. Respondents with diagnosed asthma reported rates of emergency room visits in the previous 12 months similar to SPA6. 45% of respondents were unaware of oil development; 63% of residents would not know how to contact local regulatory authorities. Residents often seek information about their health and site-related activities. Low-cost sensors may be useful in highlighting differences between sites or recording larger emission events and can provide localized data alongside resident-reported symptoms. Regulatory officials should help clarify information to the community on methods for reporting health symptoms. Our community-based participatory research (CBPR) partnership supports efforts to answer community questions as residents seek a safety buffer between sensitive land uses and active oil development.

Prediabetes, diabetes, and other CVD-related conditions among Asian populations in Los Angeles County, 2014

ABSTRACTObjective: To assess the prevalence of four common health conditions related to cardiovascular disease risk among Asians in Los Angeles County.Methods: A survey of Asians in Los Angeles County was conducted utilizing purposive sampling to recruit from the region’s Service Planning Areas 3 and 4; these underserved areas contain high density of Asian populations. Descriptive and multivariable regression analyses were performed to explore and describe potential associations between self-reported diagnoses of prediabetes, diabetes, hypertension, and high cholesterol and body mass index (measured with non-Asian versus Asian cut points) by race/ethnicity (Chinese/Filipino/Korean/Taiwanese/Thai/Vietnamese).Results: The survey response rate was nearly 60%. The analysis included 1,377 Asians, self-identified as either Chinese (n = 700), Filipino (n = 69), Korean (n = 339), Taiwanese (n = 48), Thai (n = 115), or Vietnamese (n = 106). Results showed that, in comparison to other Asians, Filipinos had the highest risks for two of the four conditions described. Other results by subgroup affirmed a similar heterogeneous pattern of Asian health locally.Conclusions: These and other results from the survey point to potential gaps in healthcare needs of Asians, and to opportunities where local public health efforts could help increase these populations’ access to cardiovascular disease-related health and social services.

(879) - Socioeconomic Status and Heart Transplantation

Socioeconomic status (SES) has been well-documented in regards to associated health outcomes. However, such effects have not been well-described in patients receiving heart transplants. We sought to analyze health outcomes of patients in two service planning areas (SPA) in Los Angeles with differing SES to assess the role of SES on cardiac transplantation outcomes.

A demonstration project implementing extended-release naltrexone in Los Angeles County

ABSTRACTBackground: Extended-released naltrexone (XR-NTX) is a Food and Drug Administration (FDA)-approved medication associated with higher rates of abstinence, reduced cravings, and delayed relapse to use. However, there is a dearth of literature on real-world implementation of XR-NTX. The Los Angeles County Department of Public Health, in collaboration with UCLA Integrated Substance Abuse Programs, developed a demonstration project to inc`rease access to XR-NTX. This article describes that project, along with data on the expansion of XR-NTX service delivery and patient uptake. Methods: A secondary descriptive data analysis of demographics, substance use history, current substance use behaviors, health-related variables, and dosing records was conducted on 609 patients who received XR-NTX from Los Angeles County substance use disorder (SUD) treatment facilities from April 2010 through July 2013. A geographic information system approach mapped the distribution of XR-NTX–referring agencies across Los Angeles County. Results: Of the 609 records analyzed, a majority of patients (64%) obtained more than 1 dose of XR-NTX. Most XR-NTX patients reported alcohol use disorder (71.9%; n = 438). Compared with the general Los Angeles County substance use disorder patients, XR-NTX recipients reported more severe substance use histories. Finally, XR-NTX was accessed by providers in 6 of the 8 Service Planning Areas of Los Angeles County. Conclusions: These findings reflect a higher XR-NTX cessation rate and a lower average number of doses, in contrast to similar demonstration projects in community settings with patients on parole or probation. However, this study shows that it is feasible to engage treatment providers in the use XR-NTX among their patients with alcohol or opioid use disorders. Several implications for future research and implementation are discussed.

Disaster preparedness education in South Los Angeles faith-based organizations: a pilot study in promoting personal and community preparedness and resiliency.

Faith-based organizations (FBOs) often provide crucial services to their communities during and after disasters, but they largely operate outside of the formal structures that manage disaster preparedness and response. Their status within communities and ability to reach broad populations make them potentially powerful groups to lead and promote health and safety initiatives. Thus, there is opportunity to reduce health and knowledge disparities and increase disaster resiliency by providing disaster preparedness education through FBOs. This pilot study aims to assess and enhance the current level of disaster knowledge and preparedness of congregation members from six FBOs in the Los Angeles County South Service Planning Area (SPA 6) to promote their community's disaster resiliency. A structured basic disaster education curriculum was implemented at six FBOs, and participants completed a questionnaire, pre-test and post-test, and satisfaction survey. Frequency distributions of survey questions and mean differences of pre- and post-test scores were obtained. Results of the questionnaire indicated that more than half of the participants had previous experience with disaster preparedness and had taken some steps toward stockpiling supplies but showed gaps in making concrete evacuation plans and meeting places. The mean disaster knowledge test score increased from 5.15 for the pre-test to 8.04 for the post-test (p < 0.0001). The participants reported high satisfaction with the seminar. This pilot study demonstrated that there is interest, as well as need, within the faith-based community to increase personal and community disaster preparedness. The implementation of a structured disaster education seminar for congregation members showed significant immediate improvement in disaster knowledge of the participants.

Impact of population density on collision rates in a rapidly developing rural, exurban area of Los Angeles County

ObjectivesTo determine if the commonly acknowledged relationships between population density and traffic collisions are found at the subcounty level and to describe how collision characteristics may vary substantially at a...

Health Care Disparities in Sickle Cell Disease : A Population-Based Study of Los Angeles County.

Abstract 2480Poster Board II-457 Introduction:As young adults with Sickle Cell Disease (SCD) age out of comprehensive pediatric coverage, they are left with suboptimal coverage for disease-appropriate comprehensive care, and rely on Emergency Departments (ED). This situation is implied to affect SCD outcome, as review of death certificates suggests that patients cared for outside comprehensive sickle cell centers (CSCC) die earlier on average than patients cared for within CSCCs. Los Angeles County (LAC) poses particular challenges, as even within the CSCC network patients die younger than the national average. There are no data describing LAC SCD patients outside of the tertiary care referral centers, nor are there population-based data describing the effect of access to health care on ED utilization in SCD. In order to eliminate these disparities in health care and health outcomes, the first step is to identify the population and where they receive care. This population-based study assesses the effect of where a patient lives, age, and insurance status on utilization of emergency departments (ED) and rates of inpatient admission. Methods:We conducted a retrospective cohort study using the 2007 LAC data from the California Office of Statewide Healthcare Planning and Development, with all hospital discharges from non-federal emergency departments (ED) and inpatient units. We selected patients based on ICD9 codes indicating SCD (282.60-282.69) or SB-thalassemia (282.41-282.42) as a primary or secondary diagnosis. Unique identifiers longitudinally link multiple visits. One of the 8 service planning areas (SPA) defined by LAC Department of Public Health has very poor health outcomes and access to care as compared to the others. Using Poisson regression, we evaluated the effect of living in this resource-poor SPA on the number of SCD-related ED visits per year. We controlled for age (adult ≥21 years old vs. child), gender (male vs. female), race (African American vs. not), ethnicity (Hispanic vs. not), and socioeconomic status (using insurance as a proxy). Finally, we evaluated the effect of living in the resource-poor SPA on disposition from the ED (admit vs. discharge) using binary logistic regression. Results:In LAC in 2007, 1088 identified individual patients with SCD visited the ED, leading to 4420 total ED visits. There were 298 children and 790 adults (>21yo). The mean number of visits per patient was 4.06 (SD = 10.84; range 1 to 180). The mean number of annual SCD-related ED visits per hospital was 35.93 (SD = 75.30; range 1 to 414). Children accounted for 18% of the visits and adults 82%. SCD adults had 2 times the rate of ED visits as compared to children. Patients living in the poor-resource SPA had 7% more ED visits than those living in the SPAs with better healthcare resources. Publicly insured SCD patients had a 33% higher rate of ED visits than privately insured patients and a 77% higher rate of visits than self-pay patients. Being male and African American were also significantly associated with an increased rate of ED visits. ED visits by patients from the resource-poor SPA were 13% less likely to result in an inpatient admission than were the ED visits by patients living in the other SPAs. Being female, African American, Hispanic, and having public insurance were also significantly associated with increased likelihood of the ED visit resulting in inpatient admission. Conclusions:Our data suggest that among SCD patients in LAC, adults ≥ 21 years of age, those living in a resource-poor area of LAC, and the publicly insured all have higher ED utilization rates. ED visits by patients from the resource-poor area of LAC are less likely to result in inpatient admissions whereas visits from publicly insured patients were more likely to result in an inpatient admission. The dramatically higher rate of ED visits by those 21 and over is consistent with the notion that adults with SCD have poor access to appropriate comprehensive care leading them to seek care in the ED. The results also support the premise that poor access to health care and public insurance are associated with suboptimal comprehensive care in SCD, leading to a higher rate of ED use. Considering LAC's population size and diversity, this population-based study substantiates findings from the tertiary care center cohorts. These findings beg further investigation into the outpatient utilization practices of patients with SCD as a means of developing measures of access to care in SCD. Disclosures:No relevant conflicts of interest to declare.