1
|
Sheridan S, de Guzman EB, Eisenman DP, Sailor DJ, Parfrey J, Kalkstein LS. Increasing tree cover and high-albedo surfaces reduces heat-related ER visits in Los Angeles, CA. Int J Biometeorol 2024:10.1007/s00484-024-02688-4. [PMID: 38684525 DOI: 10.1007/s00484-024-02688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/16/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
There is an urgent need for strategies to reduce the negative impacts of a warming climate on human health. Cooling urban neighborhoods by planting trees and vegetation and increasing albedo of roofs, pavements, and walls can mitigate urban heat. We used synoptic climatology to examine how different tree cover and albedo scenarios would affect heat-related morbidity in Los Angeles, CA, USA, as measured by emergency room (ER) visits. We classified daily meteorological data for historical summer heat events into discrete air mass types. We analyzed those classifications against historical ER visit data to determine both heat-related and excess morbidity. We used the Weather Research and Forecasting model to examine the impacts of varied tree cover and albedo scenarios on meteorological outcomes and used these results with standardized morbidity data algorithms to estimate potential reductions in ER visits. We tested three urban modification scenarios of low, medium, and high increases of tree cover and albedo and compared these against baseline conditions. We found that avoiding 25% to 50% of ER visits during heat events would be a common outcome if the urban environment had more tree cover and higher albedo, with the greatest benefits occurring under heat events that are moderate and those that are particularly hot and dry. We conducted these analyses at the county level and compared results to a heat-vulnerable, working-class Los Angeles community with a high concentration of people of color, and found that reductions in the rate of ER visits would be even greater at the community level compared to the county.
Collapse
Affiliation(s)
| | - Edith B de Guzman
- Division of Agriculture & Natural Resources and UCLA Luskin Center for Innovation, University of California, Los Angeles, CA, USA.
| | - David P Eisenman
- David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - David J Sailor
- School of Geographical Science and Urban Planning, Arizona State University, Tempe, AZ, USA
| | | | | |
Collapse
|
2
|
Eisenman DP. It's the Smoke, Not the Fire. Am J Public Health 2023; 113:724-725. [PMID: 37285569 DOI: 10.2105/ajph.2023.307327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- David P Eisenman
- David P. Eisenman is professor of medicine at the David Geffen School of Medicine, director of the Center for Public Health and Disasters, and codirector of the Center for Healthy Climate Solutions, School of Public Health, University of California, Los Angeles
| |
Collapse
|
3
|
Cole BL, Rosario ID, Hendricks A, Eisenman DP. Advancing Health Equity in Community-Based Climate Action: From Concept to Practice. Am J Public Health 2023; 113:185-193. [PMID: 36652648 PMCID: PMC9850624 DOI: 10.2105/ajph.2022.307143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 01/19/2023]
Abstract
Despite broad agreement that prioritizing health equity is critical to minimizing the health impacts of climate change, there is a lack of clarity about what advancing health equity means in practice. More than reducing health disparities; it also implies engaging and empowering marginalized communities. We propose a typology of health equity processes, focused on building community agency and power, and then apply it to a nonrepresentative, purposive sample of 48 community-based climate actions (CBCAs) selected from lists of projects funded by foundations and state climate programs and from other sources. All CBCAs were in the United States, community-based, active since 2015 or more recently, engaged in climate mitigation or adaptation, and stated health equity aims. Two team members reviewed project reports to assess the engagement of vulnerable and marginalized populations, agency-building, and transformation of community power relationships. Although 33 CBCAs reported efforts to build community agency, only 19 reported efforts to increase community power. City-led CBCAs showed less emphasis on agency-building and power transformation. This typology can support efforts to advance health equity by providing concrete indicators to diagnose gaps and track progress. (Am J Public Health. 2023;113(2):185-193. https://doi.org/10.2105/AJPH.2022.307143).
Collapse
Affiliation(s)
- Brian L Cole
- Brian L. Cole is with the Health Science Department, California State University, Long Beach, and the Center for Healthy Climate Solutions, University of California, Los Angeles. Irish Del Rosario is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Astrid Hendricks is with BCT Partners, Pasadena, CA. David P. Eisenman is with the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and the Centers for Public Health and Disasters and Healthy Climate Solutions, Fielding School of Public Health, University of California, Los Angeles
| | - Irish Del Rosario
- Brian L. Cole is with the Health Science Department, California State University, Long Beach, and the Center for Healthy Climate Solutions, University of California, Los Angeles. Irish Del Rosario is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Astrid Hendricks is with BCT Partners, Pasadena, CA. David P. Eisenman is with the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and the Centers for Public Health and Disasters and Healthy Climate Solutions, Fielding School of Public Health, University of California, Los Angeles
| | - Astrid Hendricks
- Brian L. Cole is with the Health Science Department, California State University, Long Beach, and the Center for Healthy Climate Solutions, University of California, Los Angeles. Irish Del Rosario is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Astrid Hendricks is with BCT Partners, Pasadena, CA. David P. Eisenman is with the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and the Centers for Public Health and Disasters and Healthy Climate Solutions, Fielding School of Public Health, University of California, Los Angeles
| | - David P Eisenman
- Brian L. Cole is with the Health Science Department, California State University, Long Beach, and the Center for Healthy Climate Solutions, University of California, Los Angeles. Irish Del Rosario is with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Astrid Hendricks is with BCT Partners, Pasadena, CA. David P. Eisenman is with the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and the Centers for Public Health and Disasters and Healthy Climate Solutions, Fielding School of Public Health, University of California, Los Angeles
| |
Collapse
|
4
|
Eisenman DP, Galway LP. The mental health and well-being effects of wildfire smoke: a scoping review. BMC Public Health 2022; 22:2274. [PMID: 36471306 PMCID: PMC9724257 DOI: 10.1186/s12889-022-14662-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Smoke from wildfires is a growing public health risk due to the enormous amount of smoke-related pollution that is produced and can travel thousands of kilometers from its source. While many studies have documented the physical health harms of wildfire smoke, less is known about the effects on mental health and well-being. Understanding the effects of wildfire smoke on mental health and well-being is crucial as the world enters a time in which wildfire smoke events become more frequent and severe. We conducted a scoping review of the existing information on wildfire smoke's impact on mental health and well-being and developed a model for understanding the pathways in which wildfire smoke may contribute to mental health distress. METHODS We conducted searches using PubMed, Medline, Embase, Google, Scopus, and ProQuest for 1990-2022. These searches yielded 200 articles. Sixteen publications met inclusion criteria following screening and eligibility assessment. Three more publications from the bibliographies of these articles were included for a total of 19 publications. RESULTS Our review suggests that exposure to wildfire smoke may have mental health impacts, particularly in episodes of chronic and persistent smoke events, but the evidence is inconsistent and limited. Qualitative studies disclose a wider range of impacts across multiple mental health and well-being domains. The potential pathways connecting wildfire smoke with mental health and well-being operate at multiple interacting levels including individual, social and community networks, living and working conditions, and ecological levels. CONCLUSIONS Priorities for future research include: 1) applying more rigorous methods; 2) differentiating between mental illness and emotional well-being; 3) studying chronic, persistent or repeated smoke events; 4) identifying the contextual factors that set the stage for mental health and well-being effects, and 5) identifying the causal processes that link wildfire smoke to mental health and well-being effects. The pathways model can serve as a basis for further research and knowledge synthesis on this topic. Also, it helps public health, community mental health, and emergency management practitioners mitigate the mental health and well-being harms of wildfire smoke.
Collapse
Affiliation(s)
- David P. Eisenman
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, UCLA Fielding School of Public Health, Center for Healthy Climate Solutions and Center for Public Health and Disasters, 1100 Glendon Avenue, Suite 850-878, Los Angeles, CA 90024 USA
| | - Lindsay P. Galway
- grid.258900.60000 0001 0687 7127Lakehead University Department of Health Sciences, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| |
Collapse
|
5
|
Kalkstein LS, Eisenman DP, de Guzman EB, Sailor DJ. Increasing trees and high-albedo surfaces decreases heat impacts and mortality in Los Angeles, CA. Int J Biometeorol 2022; 66:911-925. [PMID: 35325269 PMCID: PMC9042982 DOI: 10.1007/s00484-022-02248-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
There is a pressing need for strategies to prevent the heat-health impacts of climate change. Cooling urban areas through adding trees and vegetation and increasing solar reflectance of roofs and pavements with higher albedo surface materials are recommended strategies for mitigating the urban heat island. We quantified how various tree cover and albedo scenarios would impact heat-related mortality, temperature, humidity, and oppressive air masses in Los Angeles, California, and quantified the number of years that climate change-induced warming could be delayed in Los Angeles if interventions were implemented. Using synoptic climatology, we used meteorological data for historical summer heat waves, classifying days into discrete air mass types. We analyzed those data against historical mortality data to determine excess heat-related mortality. We then used the Weather Research and Forecasting model to explore the effects that tree cover and albedo scenarios would have, correlating the resultant meteorological data with standardized mortality data algorithms to quantify potential reductions in mortality. We found that roughly one in four lives currently lost during heat waves could be saved. We also found that climate change-induced warming could be delayed approximately 40-70 years under business-as-usual and moderate mitigation scenarios, respectively.
Collapse
Affiliation(s)
| | - David P Eisenman
- David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Edith B de Guzman
- UCLA Institute of the Environment & Sustainability, Los Angeles, CA, USA
| | - David J Sailor
- School of Geographical Science and Urban Planning, Arizona State University, Tempe, AZ, USA
| |
Collapse
|
6
|
Rosenberg H, Errett NA, Eisenman DP. Working with Disaster-Affected Communities to Envision Healthier Futures: A Trauma-Informed Approach to Post-Disaster Recovery Planning. Int J Environ Res Public Health 2022; 19:1723. [PMID: 35162746 PMCID: PMC8835046 DOI: 10.3390/ijerph19031723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022]
Abstract
Disasters are becoming increasingly common and devastating, requiring extensive reconstruction and recovery efforts. At the same time, the level of available resources and the need to rebuild can present opportunities for more resilient land use and infrastructure, and to build healthier, more equitable and sustainable communities. However, disaster-affected individuals may experience trauma and mental health impacts that impede their ability to engage in long-range recovery planning. It is essential to consider and address community trauma when engaging with disaster-affected communities and in developing plans for recovery. Planners and engineers from outside the community (including public, private and non-profit practitioners) are often brought in to support long-term recovery. Most of these practitioners (particularly those focused on longer-range recovery) have no training in how disasters can affect mental health or what this could mean for their interactions with individuals or communities. In order to acknowledge and address disaster trauma in community recovery and redevelopment, we propose a trauma-informed approach which aims to provide practitioners supporting post-disaster community recovery planning guidance, in order to: avoid the causation of harm by re-traumatizing communities; better understand community needs; make sense of observed behaviors and avoid potential roadblocks; avoid becoming traumatized themselves; and facilitate community healing.
Collapse
Affiliation(s)
| | - Nicole A. Errett
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA 98105, USA;
| | - David P. Eisenman
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
- Center for Public Health and Disasters, Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
| |
Collapse
|
7
|
Pollock BH, Kilpatrick AM, Eisenman DP, Elton KL, Rutherford GW, Boden-Albala BM, Souleles DM, Polito LE, Martin NK, Byington CL. Safe reopening of college campuses during COVID-19: The University of California experience in Fall 2020. PLoS One 2021; 16:e0258738. [PMID: 34735480 PMCID: PMC8568179 DOI: 10.1371/journal.pone.0258738] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/05/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Epidemics of COVID-19 in student populations at universities were a key concern for the 2020-2021 school year. The University of California (UC) System developed a set of recommendations to reduce campus infection rates. SARS-CoV-2 test results are summarized for the ten UC campuses during the Fall 2020 term. METHODS UC mitigation efforts included protocols for the arrival of students living on-campus students, non-pharmaceutical interventions, daily symptom monitoring, symptomatic testing, asymptomatic surveillance testing, isolation and quarantine protocols, student ambassador programs for health education, campus health and safety pledges, and lowered density of on-campus student housing. We used data from UC campuses, the UC Health-California Department of Public Health Data Modeling Consortium, and the U.S. Census to estimate the proportion of each campus' student populations that tested positive for SARS-CoV-2 and compared it to the fraction individuals aged 20-29 years who tested positive in their respective counties. RESULTS SARS-CoV-2 cases in campus populations were generally low in September and October 2020, but increased in November and especially December, and were highest in early to mid-January 2021, mirroring case trajectories in their respective counties. Many students were infected during the Thanksgiving and winter holiday recesses and were detected as cases upon returning to campus. The proportion of students who tested positive for SARS-CoV-2 during Fall 2020 ranged from 1.2% to 5.2% for students living on campus and was similar to students living off campus. For most UC campuses the proportion of students testing positive was lower than that for the 20-29-year-old population in which campuses were located. CONCLUSIONS The layered mitigation approach used on UC campuses, informed by public health science and augmented perhaps by a more compliant population, likely minimized campus transmission and outbreaks and limited transmission to surrounding communities. University policies that include these mitigation efforts in Fall 2020 along with SARS-CoV-2 vaccination, may alleviate some local concerns about college students returning to communities and facilitate resumption of normal campus operations and in-person instruction.
Collapse
Affiliation(s)
- Brad H. Pollock
- Department of Public Health Sciences, University of California Davis, Davis, California, United States of America
| | - A. Marm Kilpatrick
- Department of Ecology and Evolutionary Biology, University of California Santa Cruz, Santa Cruz, California, United States of America
| | - David P. Eisenman
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- Center for Public Health and Disasters, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Kristie L. Elton
- University of California Office of the President, Oakland, California, United States of America
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Bernadette M. Boden-Albala
- Department of Health Society and Behavior, Program in Public Health, Department of Neurology, School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, California, United States of America
| | - David M. Souleles
- Department of Health Society and Behavior, Program in Public Health, Department of Neurology, School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, California, United States of America
| | - Laura E. Polito
- Student Health, University of California Santa Barbara, Santa Barbara, California, United States of America
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Carrie L. Byington
- University of California Office of the President, Oakland, California, United States of America
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
| |
Collapse
|
8
|
Eisenman DP, Wiley DJ, Pollock BH, Rutherford GW, Rimoin AW, Bibbins-Domingo K, Checkoway H, Hurd T, Waters CM, Dawson-Rose C. Recommendations for Demonstrators, Law Enforcement Agencies, and Public Health Agencies for Reducing SARS-CoV-2 Transmission During Civil Protests. Public Health Rep 2021; 136:264-268. [PMID: 33593123 PMCID: PMC8580400 DOI: 10.1177/0033354921991939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- David P. Eisenman
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Center for Public Health and Disasters, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Dorothy J. Wiley
- School of Nursing, UCLA Clinical Translational Science Institute, University of California, Los Angeles, CA, USA
| | - Brad H. Pollock
- Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - Anne W. Rimoin
- Department of Epidemiology, Center for Global and Immigrant Health, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - Harvey Checkoway
- Department of Family Medicine & Public Health, and Department of Neurosciences, University of California, San Diego, CA, USA
| | - Thelma Hurd
- Department of Public Health, University of California, Merced, Merced, CA, USA
| | - Catherine M. Waters
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| |
Collapse
|
9
|
Eisenman DP, Adams RM, Lang CM, Prelip M, Dorian A, Acosta J, Glik D, Chinman M. A Program for Local Health Departments to Adapt and Implement Evidence-Based Emergency Preparedness Programs. Am J Public Health 2018; 108:S396-S398. [PMID: 30260692 DOI: 10.2105/ajph.2018.304535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The goal of this project was to enhance the capacity of local health departments to translate and implement evidence-based programs in emergency preparedness by using the Getting To Outcomes approach. Our evaluation determined that local health department staff reported improved capacities. A "Getting To Outcomes Guide for Community Emergency Preparedness" guidebook was produced and is available online.
Collapse
Affiliation(s)
- David P Eisenman
- David P. Eisenman, Rachel M. Adams, Cathy M. Lang, Michael Prelip, Alina Dorian, and Deborah Glik are with the Community Health Sciences Department, University of California, Los Angeles Fielding School of Public Health, Los Angeles. Joie Acosta is with the RAND Corporation, Arlington, VA. Matthew Chinman is with the RAND Corporation, Pittsburgh, PA
| | - Rachel M Adams
- David P. Eisenman, Rachel M. Adams, Cathy M. Lang, Michael Prelip, Alina Dorian, and Deborah Glik are with the Community Health Sciences Department, University of California, Los Angeles Fielding School of Public Health, Los Angeles. Joie Acosta is with the RAND Corporation, Arlington, VA. Matthew Chinman is with the RAND Corporation, Pittsburgh, PA
| | - Cathy M Lang
- David P. Eisenman, Rachel M. Adams, Cathy M. Lang, Michael Prelip, Alina Dorian, and Deborah Glik are with the Community Health Sciences Department, University of California, Los Angeles Fielding School of Public Health, Los Angeles. Joie Acosta is with the RAND Corporation, Arlington, VA. Matthew Chinman is with the RAND Corporation, Pittsburgh, PA
| | - Michael Prelip
- David P. Eisenman, Rachel M. Adams, Cathy M. Lang, Michael Prelip, Alina Dorian, and Deborah Glik are with the Community Health Sciences Department, University of California, Los Angeles Fielding School of Public Health, Los Angeles. Joie Acosta is with the RAND Corporation, Arlington, VA. Matthew Chinman is with the RAND Corporation, Pittsburgh, PA
| | - Alina Dorian
- David P. Eisenman, Rachel M. Adams, Cathy M. Lang, Michael Prelip, Alina Dorian, and Deborah Glik are with the Community Health Sciences Department, University of California, Los Angeles Fielding School of Public Health, Los Angeles. Joie Acosta is with the RAND Corporation, Arlington, VA. Matthew Chinman is with the RAND Corporation, Pittsburgh, PA
| | - Joie Acosta
- David P. Eisenman, Rachel M. Adams, Cathy M. Lang, Michael Prelip, Alina Dorian, and Deborah Glik are with the Community Health Sciences Department, University of California, Los Angeles Fielding School of Public Health, Los Angeles. Joie Acosta is with the RAND Corporation, Arlington, VA. Matthew Chinman is with the RAND Corporation, Pittsburgh, PA
| | - Deborah Glik
- David P. Eisenman, Rachel M. Adams, Cathy M. Lang, Michael Prelip, Alina Dorian, and Deborah Glik are with the Community Health Sciences Department, University of California, Los Angeles Fielding School of Public Health, Los Angeles. Joie Acosta is with the RAND Corporation, Arlington, VA. Matthew Chinman is with the RAND Corporation, Pittsburgh, PA
| | - Matthew Chinman
- David P. Eisenman, Rachel M. Adams, Cathy M. Lang, Michael Prelip, Alina Dorian, and Deborah Glik are with the Community Health Sciences Department, University of California, Los Angeles Fielding School of Public Health, Los Angeles. Joie Acosta is with the RAND Corporation, Arlington, VA. Matthew Chinman is with the RAND Corporation, Pittsburgh, PA
| |
Collapse
|
10
|
Hoehne CG, Hondula DM, Chester MV, Eisenman DP, Middel A, Fraser AM, Watkins L, Gerster K. Heat exposure during outdoor activities in the US varies significantly by city, demography, and activity. Health Place 2018; 54:1-10. [PMID: 30199773 DOI: 10.1016/j.healthplace.2018.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/12/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
Environmental heat is a growing public health concern in cities. Urbanization and global climate change threaten to exacerbate heat as an already significant environmental cause of human morbidity and mortality. Despite increasing risk, very little is known regarding determinants of outdoor urban heat exposure. To provide additional evidence for building community and national-scale resilience to extreme heat, we assess how US outdoor urban heat exposure varies by city, demography, and activity. We estimate outdoor urban heat exposure by pairing individual-level data from the American Time Use Survey (2004-2015) with corresponding meteorological data for 50 of the largest metropolitan statistical areas in the US. We also assess the intersection of activity intensity and heat exposure by pairing metabolic intensities with individual-level time-use data. We model an empirical relationship between demographic indicators and daily heat exposure with controls for spatiotemporal factors. We find higher outdoor heat exposure among the elderly and low-income individuals, and lower outdoor heat exposure in females, young adults, and those identifying as Black race. Traveling, lawn and garden care, and recreation are the most common outdoor activities to contribute to heat exposure. We also find individuals in cities with the most extreme temperatures do not necessarily have the highest outdoor heat exposure. The findings reveal large contrasts in outdoor heat exposure between different cities, demographic groups, and activities. Resolving the interplay between exposure, sensitivity, adaptive capacity, and behavior as determinants of heat-health risk will require advances in observational and modeling tools, especially at the individual scale.
Collapse
Affiliation(s)
- Christopher G Hoehne
- Civil, Environmental, and Sustainable Engineering, Arizona State University, Tempe, AZ, USA.
| | - David M Hondula
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA; Global Institute of Sustainability, Arizona State University, Tempe, AZ, USA
| | - Mikhail V Chester
- Civil, Environmental, and Sustainable Engineering, Arizona State University, Tempe, AZ, USA; Global Institute of Sustainability, Arizona State University, Tempe, AZ, USA
| | - David P Eisenman
- David Geffen School of Medicine at UCLA and the UCLA Center for Public Health and Disasters, Los Angeles, CA, USA
| | - Ariane Middel
- Geography and Urban Studies Department, Temple University, Philadelphia, PA, USA; Global Institute of Sustainability, Arizona State University, Tempe, AZ, USA; School of Arts, Media and Engineering and School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Andrew M Fraser
- Civil, Environmental, and Sustainable Engineering, Arizona State University, Tempe, AZ, USA
| | - Lance Watkins
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA
| | - Katrina Gerster
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA
| |
Collapse
|
11
|
Springgate BF, Arevian AC, Wennerstrom A, Johnson AJ, Eisenman DP, Sugarman OK, Haywood CG, Trapido EJ, Sherbourne CD, Everett A, McCreary M, Meyers D, Kataoka S, Tang L, Sato J, Wells KB. Community Resilience Learning Collaborative and Research Network (C-LEARN): Study Protocol with Participatory Planning for a Randomized, Comparative Effectiveness Trial. Int J Environ Res Public Health 2018; 15:E1683. [PMID: 30720791 PMCID: PMC6121437 DOI: 10.3390/ijerph15081683] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/04/2018] [Indexed: 11/16/2022]
Abstract
This manuscript presents the protocol and participatory planning process for implementing the Community Resilience Learning Collaborative and Research Network (C-LEARN) study. C-LEARN is designed to determine how to build a service program and individual client capacity to improve mental health-related quality of life among individuals at risk for depression, with exposure to social risk factors or concerns about environmental hazards in areas of Southern Louisiana at risk for events such as hurricanes and storms. The study uses a Community Partnered Participatory Research (CPPR) framework to incorporate community priorities into study design and implementation. The first phase of C-LEARN is assessment of community priorities, assets, and opportunities for building resilience through key informant interviews and community agency outreach. Findings from this phase will inform the implementation of a two-level (program-level and individual client level) randomized study in up to four South Louisiana communities. Within communities, health and social-community service programs will be randomized to Community Engagement and Planning (CEP) for multi-sector coalition support or Technical Assistance (TA) for individual program support to implement evidence-based and community-prioritized intervention toolkits, including an expanded version of depression collaborative care and resources (referrals, manuals) to address social risk factors such as financial or housing instability and for a community resilience approach to disaster preparedness and response. Within each arm, the study will randomize individual adult clients to one of two mobile applications that provide informational resources on services for depression, social risk factors, and disaster response or also provide psychoeducation on Cognitive Behavioral Therapy to enhance coping with stress and mood. Planned data collection includes baseline, six-month and brief monthly surveys for clients, and baseline and 12-month surveys for administrators and staff.
Collapse
Affiliation(s)
- Benjamin F Springgate
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
- LSU Health Sciences Center, New Orleans School of Public Health, New Orleans, LA 70112, USA.
| | - Armen C Arevian
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | | | - Arthur J Johnson
- Center for Sustainable Engagement and Development, New Orleans, LA 70117, USA.
| | - David P Eisenman
- David Geffen School of Medicine at UCLA and UCLA Center for Public Health and Disasters, Los Angeles, CA 90095, USA.
| | - Olivia K Sugarman
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
- LSU Health Sciences Center, New Orleans School of Public Health, New Orleans, LA 70112, USA.
| | | | - Edward J Trapido
- LSU Health Sciences Center, New Orleans School of Public Health, New Orleans, LA 70112, USA.
| | | | - Ashley Everett
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
| | - Michael McCreary
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | - Diana Meyers
- St. Anna's Episcopal Church, New Orleans, LA 70116, USA.
| | - Sheryl Kataoka
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | - Lingqi Tang
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | - Jennifer Sato
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
| | - Kenneth B Wells
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
- The RAND Corporation, Santa Monica, CA 90401, USA.
| |
Collapse
|
12
|
Kalkstein AJ, Kalkstein LS, Vanos JK, Eisenman DP, Grady Dixon P. Heat/mortality sensitivities in Los Angeles during winter: a unique phenomenon in the United States. Environ Health 2018; 17:45. [PMID: 29724242 PMCID: PMC5934864 DOI: 10.1186/s12940-018-0389-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/25/2018] [Indexed: 05/19/2023]
Abstract
BACKGROUND Extreme heat is often associated with elevated levels of human mortality, particularly across the mid-latitudes. Los Angeles, CA exhibits a unique, highly variable winter climate, with brief periods of intense heat caused by downsloping winds commonly known as Santa Ana winds. The goal is to determine if Los Angeles County is susceptible to heat-related mortality during the winter season. This is the first study to specifically evaluate heat-related mortality during the winter for a U.S. city. METHODS Utilizing the Spatial Synoptic Classification system in Los Angeles County from 1979 through 2010, we first relate daily human mortality to synoptic air mass type during the winter season (December, January, February) using Welch's t-tests. However, this methodology is only somewhat effective at controlling for important inter- and intra-annual trends in human mortality unrelated to heat such as influenza outbreaks. As a result, we use distributed lag nonlinear modeling (DLNM) to evaluate if the relative risk of human mortality increases during higher temperatures in Los Angeles, as the DLNM is more effective at controlling for variability at multiple temporal scales within the human mortality dataset. RESULTS Significantly higher human mortality is uncovered in winter when dry tropical air is present in Los Angeles, particularly among those 65 years and older (p < 0.001). The DLNM reveals the relative risk of human mortality increases when above average temperatures are present. Results are especially pronounced for maximum and mean temperatures, along with total mortality and those 65 + . CONCLUSIONS The discovery of heat-related mortality in winter is a unique finding in the United States, and we recommend stakeholders consider warning and intervention techniques to mitigate the role of winter heat on human health in the County.
Collapse
Affiliation(s)
- Adam J. Kalkstein
- Department of Geography and Environmental Engineering, Center for Languages, Cultures, and Regional Studies, United States Military Academy, 745 Brewerton Rd; 6th Floor, West Point, NY 10996 USA
| | - Laurence S. Kalkstein
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Jennifer K. Vanos
- Scripps Institution of Oceanography & School of Medicine, University of California San Diego, La Jolla, CA USA
| | - David P. Eisenman
- UCLA Center for Public Health and Disasters, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - P. Grady Dixon
- Department of Geosciences, Fort Hays State University, Hays, KS USA
| |
Collapse
|
13
|
Riley K, Wilhalme H, Delp L, Eisenman DP. Mortality and Morbidity during Extreme Heat Events and Prevalence of Outdoor Work: An Analysis of Community-Level Data from Los Angeles County, California. Int J Environ Res Public Health 2018; 15:ijerph15040580. [PMID: 29570664 PMCID: PMC5923622 DOI: 10.3390/ijerph15040580] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 02/07/2023]
Abstract
Heat is a well-recognized hazard for workers in many outdoor settings, yet few investigations have compared the prevalence of outdoor work at the community level and rates of heat-related mortality and morbidity. This analysis examines whether heat-related health outcomes occur more frequently in communities with higher proportions of residents working in construction, agriculture, and other outdoor industries. Using 2005–2010 data from Los Angeles County, California, we analyze associations between community-level rates of deaths, emergency department (ED) visits, and hospitalizations during summer heat events and the prevalence of outdoor work. We find generally higher rates of heat-related ED visits and hospitalizations during summer heat events in communities with more residents working outdoors. Specifically, each percentage increase in residents working in construction resulted in an 8.1 percent increase in heat-related ED visits and a 7.9 percent increase in heat-related hospitalizations, while each percentage increase in residents working in agriculture and related sectors resulted in a 10.9 percent increase in heat-related ED visits. The findings suggest that outdoor work may significantly influence the overall burden of heat-related morbidity at the community level. Public health professionals and healthcare providers should recognize work and employment as significant heat risk factors when preparing for and responding to extreme heat events.
Collapse
Affiliation(s)
- Kevin Riley
- UCLA Labor Occupational Safety and Health Program, Los Angeles, CA 90095, USA.
| | - Holly Wilhalme
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
| | - Linda Delp
- UCLA Labor Occupational Safety and Health Program, Los Angeles, CA 90095, USA.
| | - David P Eisenman
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90024, USA.
- Center for Public Health and Disasters, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA 90024, USA.
| |
Collapse
|
14
|
Adams RM, Karlin B, Eisenman DP, Blakley J, Glik D. Who Participates in the Great ShakeOut? Why Audience Segmentation Is the Future of Disaster Preparedness Campaigns. Int J Environ Res Public Health 2017; 14:ijerph14111407. [PMID: 29149064 PMCID: PMC5708046 DOI: 10.3390/ijerph14111407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 11/12/2017] [Accepted: 11/15/2017] [Indexed: 11/30/2022]
Abstract
Background: In 2008, the Southern California Earthquake Center in collaboration with the U.S. Geological Survey Earthquake Hazards Program launched the first annual Great ShakeOut, the largest earthquake preparedness drill in the history of the United States. Materials and Methods: We collected online survey data from 2052 campaign registrants to assess how people participated, whether audience segments shared behavioral patterns, and whether these segments were associated with five social cognitive factors targeted by the ShakeOut campaign. Results: Participants clustered into four behavioral patterns. The Minimal cluster had low participation in all activities (range: 0–39% participation). The Basic Drill cluster only participated in the drop, cover and hold drill (100% participation). The Community-Oriented cluster, involved in the drill (100%) and other interpersonal activities including attending disaster planning meetings (74%), was positively associated with interpersonal communication (β = 0.169), self-efficacy (β = 0.118), outcome efficacy (β = 0.110), and knowledge about disaster preparedness (β = 0.151). The Interactive and Games cluster, which participated in the drill (79%) and two online earthquake preparedness games (53% and 75%), was positively associated with all five social cognitive factors studied. Conclusions: Our results support audience segmentation approaches to engaging the public, which address the strengths and weaknesses of different segments. Offering games may help “gamers” gain competencies required to prepare for disasters. Targeting the highly active Community-Oriented cluster for leadership roles could help build community resilience by encouraging others to become more involved in disaster planning. We propose that the days of single, national education campaigns without local variation should end.
Collapse
Affiliation(s)
- Rachel M Adams
- Center for Public Health and Disasters, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA 90095, USA.
| | - Beth Karlin
- The Norman Lear Center, Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA 90089, USA.
| | - David P Eisenman
- Center for Public Health and Disasters, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA 90095, USA.
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA.
| | - Johanna Blakley
- The Norman Lear Center, Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA 90089, USA.
| | - Deborah Glik
- Center for Public Health and Disasters, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA 90095, USA.
| |
Collapse
|
15
|
Bromley E, Eisenman DP, Magana A, Williams M, Kim B, McCreary M, Chandra A, Wells KB. How Do Communities Use a Participatory Public Health Approach to Build Resilience? The Los Angeles County Community Disaster Resilience Project. Int J Environ Res Public Health 2017; 14:ijerph14101267. [PMID: 29065491 PMCID: PMC5664768 DOI: 10.3390/ijerph14101267] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022]
Abstract
Community resilience is a key concept in the National Health Security Strategy that emphasizes development of multi-sector partnerships and equity through community engagement. Here, we describe the advancement of CR principles through community participatory methods in the Los Angeles County Community Disaster Resilience (LACCDR) initiative. LACCDR, an initiative led by the Los Angeles County Department of Public Health with academic partners, randomized 16 community coalitions to implement either an Enhanced Standard Preparedness or Community Resilience approach over 24 months. Facilitated by a public health nurse or community educator, coalitions comprised government agencies, community-focused organizations and community members. We used thematic analysis of data from focus groups (n = 5) and interviews (n = 6 coalition members; n = 16 facilitators) to compare coalitions’ strategies for operationalizing community resilience levers of change (engagement, partnership, self-sufficiency, education). We find that strategies that included bidirectional learning helped coalitions understand and adopt resilience principles. Strategies that operationalized community resilience levers in mutually reinforcing ways (e.g., disseminating information while strengthening partnerships) also secured commitment to resilience principles. We review additional challenges and successes in achieving cross-sector collaboration and engaging at-risk groups in the resilience versus preparedness coalitions. The LACCDR example can inform strategies for uptake and implementation of community resilience and uptake of the resilience concept and methods.
Collapse
Affiliation(s)
- Elizabeth Bromley
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.
- West Los Angeles VA Healthcare Center, Los Angeles, CA 90073, USA.
- RAND Corporation, Santa Monica, CA 90401, USA.
| | - David P Eisenman
- Division of General Internal Medicine, David Geffen School of Medicine at UCLA; Los Angeles, CA 90095, USA.
- UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA.
| | - Aizita Magana
- Los Angeles County Department of Public Health, 313 N Figueroa St, Los Angeles, CA 90012, USA.
| | | | - Biblia Kim
- School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA.
| | - Michael McCreary
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.
- West Los Angeles VA Healthcare Center, Los Angeles, CA 90073, USA.
- UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA.
- RAND Corporation, Santa Monica, CA 90401, USA.
| |
Collapse
|
16
|
Abstract
This paper asks what programmes and policies for preventing violent extremism (also called 'countering violent extremism', or CVE) can learn from the public health violence prevention field. The general answer is that addressing violent extremism within the wider domain of public health violence prevention connects the effort to a relevant field of research, evidence-based policy and programming, and a broader population reach. This answer is reached by examining conceptual alignments between the two fields at both the case-level and the theoretical level. To address extremist violence within the wider reach of violence prevention, having a shared model is seen as a first step. The World Health Organization uses the social-ecological framework for assessing the risk and protective factors for violence and developing effective public-health based programmes. This study illustrates how this model has been used for gang violence prevention and explores overlaps between gang violence prevention and preventing violent extremism. Finally, it provides policy and programme recommendations to align CVE with public health violence prevention.
Collapse
Affiliation(s)
- David P Eisenman
- a Division of General Internal Medicine and Health Services Research , David Geffen School of Medicine, University of California Los Angeles , Los Angeles , CA , USA
| | - Louise Flavahan
- b Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine , Washington DC , USA
| |
Collapse
|
17
|
Abstract
Recent high-profile cases and scientific research on lone actor terrorist attackers have indicated that there may be an association with mental illness. Simultaneously, countering violent extremism (CVE) initiatives have recently been placing more emphasis on building intervention (aka secondary prevention) programmes to address this matter, with mental health professionals possibly playing important roles in preventing lone actor terrorist attacks. Mental health professionals can contribute to intervention programmes, as practitioners and as leaders, but more so by drawing upon the threat assessment model, than because of a possible association with mental illness. A public-private partnership in Los Angeles, based on a well-regarded, community-based service for addressing targeted school violence, is attempting to further develop such services. A tabletop exercise was used as a strategy for jumpstarting interventions, so as to engage mental health and other community partners, build trust between stakeholders, and identify capacities and gaps that need to be addressed to ensure successful implementation. Further progress and future success will depend upon equitable, ethical, evidence-based, and community collaborative practices.
Collapse
Affiliation(s)
- Stevan Weine
- a Department of Psychiatry, College of Medicine , University of Illinois at Chicago , Chicago , IL , USA
| | - David P Eisenman
- b Department of Medicine, Division of General Internal Medicine and Health Services Research , David Geffen School of Medicine, University of California Los Angeles , Los Angeles , CA , USA
| | - La Tina Jackson
- c Los Angeles County Department of Mental Health , Los Angeles , CA , USA
| | - Janni Kinsler
- b Department of Medicine, Division of General Internal Medicine and Health Services Research , David Geffen School of Medicine, University of California Los Angeles , Los Angeles , CA , USA
| | - Chloe Polutnik
- d Department of Psychiatry, College of Medicine , University of Illinois at Chicago , Chicago , IL , USA
| |
Collapse
|
18
|
Abstract
Community resilience programs require metrics for evaluation but none exist for measuring outcomes at the household and neighborhood level. Objectives: We develop and describe a new index, the LACCDR index of community resilience, to examine how resilience varied across communities at baseline, prior to implementation of the Los Angeles County Community Disaster Resilience Project (LACCDR). Methods: We surveyed 4700 adult residents in the sixteen LACCDR communities in English, Spanish and Korean. Each of the survey domains were selected a priori as outcome indicators aligned to the theoretical levers of community resilience. Survey questions were drawn and adapted from published studies and national surveys. Results: Factor analysis demonstrated five separate factors composed from 18 items and explaining 46.7% of the variance. The factors were characterized as community engagement, emergency supplies, communication with neighbors, civic engagement, and collective efficacy. Baseline results for the 16 communities are provided. Conclusions: We conclude that the LACCDR community resilience index can be used to measure resilience program outcomes at the neighborhood and household levels.
Collapse
Affiliation(s)
- David P Eisenman
- David Geffen School of Medicine & Fielding School of Public Health, Center for Public Health and Disasters, University of California, Los Angeles, Los Angeles, California, USA
| | - Rachel M Adams
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | | |
Collapse
|
19
|
Eisenman DP, Wilhalme H, Tseng CH, Chester M, English P, Pincetl S, Fraser A, Vangala S, Dhaliwal SK. Heat Death Associations with the built environment, social vulnerability and their interactions with rising temperature. Health Place 2016; 41:89-99. [PMID: 27583525 DOI: 10.1016/j.healthplace.2016.08.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/30/2016] [Accepted: 08/03/2016] [Indexed: 11/28/2022]
Abstract
In an extreme heat event, people can go to air-conditioned public facilities if residential air-conditioning is not available. Residences that heat slowly may also mitigate health effects, particularly in neighborhoods with social vulnerability. We explored the contributions of social vulnerability and these infrastructures to heat mortality in Maricopa County and whether these relationships are sensitive to temperature. Using Poisson regression modeling with heat-related mortality as the outcome, we assessed the interaction of increasing temperature with social vulnerability, access to publicly available air conditioned space, home air conditioning and the thermal properties of residences. As temperatures increase, mortality from heat-related illness increases less in census tracts with more publicly accessible cooled spaces. Mortality from all internal causes of death did not have this association. Building thermal protection was not associated with mortality. Social vulnerability was still associated with mortality after adjusting for the infrastructure variables. To reduce heat-related mortality, the use of public cooled spaces might be expanded to target the most vulnerable.
Collapse
Affiliation(s)
- David P Eisenman
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 911 Broxton Plaza, Los Angeles, CA 90095-1736, USA; Center for Public Health and Disasters, UCLA-Fielding School of Public Health, 650 Young Drive South, Los Angeles, CA 90095-1772, USA.
| | - Holly Wilhalme
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 911 Broxton Plaza, Los Angeles, CA 90095-1736, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 911 Broxton Plaza, Los Angeles, CA 90095-1736, USA
| | - Mikhail Chester
- Civil, Environmental, and Sustainable Engineering, 660 S College Ave, Tempe, AZ 85287, USA
| | - Paul English
- California Department of Public Health, Environmental Health Investigations Branch, 580 Marina Bay Parkway, Building P-3, Richmond, CA 94804-6403, USA
| | - Stephanie Pincetl
- Institute of the Environment, UCLA, Life Sciences 5362, Los Angeles, CA 90095, USA
| | - Andrew Fraser
- Civil, Environmental, and Sustainable Engineering, 660 S College Ave, Tempe, AZ 85287, USA
| | - Sitaram Vangala
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 911 Broxton Plaza, Los Angeles, CA 90095-1736, USA
| | - Satvinder K Dhaliwal
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 911 Broxton Plaza, Los Angeles, CA 90095-1736, USA
| |
Collapse
|
20
|
Meredith LS, Eisenman DP, Han B, Green BL, Kaltman S, Wong EC, Sorbero M, Vaughan C, Cassells A, Zatzick D, Diaz C, Hickey S, Kurz JR, Tobin JN. Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial. J Gen Intern Med 2016; 31:509-17. [PMID: 26850413 PMCID: PMC4835392 DOI: 10.1007/s11606-016-3588-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/04/2015] [Accepted: 01/04/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs). OBJECTIVE We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM). DESIGN This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year. PARTICIPANTS We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD. MAIN MEASURES The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months. KEY RESULTS Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7% for PCM patients and 60.6% for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14% higher (p < 0.01) and mental health medication prescription rates that were 15.2% higher (p < 0.01) than patients with no engagement. CONCLUSIONS A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.
Collapse
Affiliation(s)
- Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA. .,VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Sepulveda, CA, USA.
| | - David P Eisenman
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.,Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | - Bonnie L Green
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
| | - Stacey Kaltman
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
| | - Eunice C Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Christine Vaughan
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Scot Hickey
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Jonathan N Tobin
- Clinical Directors Network (CDN), New York, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA.,Center for Clinical & Translational Science, The Rockefeller University, New York, NY, USA
| |
Collapse
|
21
|
Grinshteyn EG, Eisenman DP, Cunningham WE, Andersen R, Ettner SL. Individual- and Neighborhood-Level Determinants of Fear of Violent Crime Among Adolescents. Fam Community Health 2016; 39:103-112. [PMID: 26882413 DOI: 10.1097/fch.0000000000000095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Fear of violent crime is common among adolescents in urban settings; however, little is known about individual- and neighborhood-level determinants of fear. A generalized ordered logit model was used to analyze individual- and neighborhood-level variables among 2474 adolescents. Seeing violence significantly reduced the probability of feeling unafraid, as did higher levels of social disorder. The more block faces where police were visible, the higher the probability of feeling unafraid and lower the probability of feeling very afraid. Reducing fear could affect more people than just reducing crime. Fear-reduction strategies should target those most at risk of becoming fearful.
Collapse
Affiliation(s)
- Erin G Grinshteyn
- School of Community Health Sciences, University of Nevada, Reno (Dr Grinshteyn); Divisions of General Internal Medicine (Dr Eisenman) and General Internal Medicine and Health Services Research (Drs Cunningham and Ettner), David Geffen School of Medicine at University of California, Los Angeles (UCLA); Department of Community Health Sciences, UCLA Center for Public Health and Disasters (Dr Eisenman), and Department of Health Policy and Management (Drs Cunningham, Ettner, and Andersen), UCLA Fielding School of Public Health, Los Angeles, California
| | | | | | | | | |
Collapse
|
22
|
Vaughan CA, Miles JN, Eisenman DP, Meredith LS. Longitudinal Associations Among Pain, Posttraumatic Stress Disorder Symptoms, and Stress Appraisals. J Trauma Stress 2016; 29:176-9. [PMID: 26915724 PMCID: PMC4862951 DOI: 10.1002/jts.22083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 12/15/2015] [Accepted: 12/31/2015] [Indexed: 11/11/2022]
Abstract
Comorbidity of posttraumatic stress disorder (PTSD) and pain is well documented, but the mechanisms underlying their comorbidity are not well understood. Cross-lagged regression models were estimated with 3 waves of longitudinal data to examine the reciprocal associations between PTSD symptom severity, as measured by the Clinician-Administered PTSD Scale (CAPS), and pain, as measured by a brief self-report measure of pain called the PEG (pain intensity [P], interference with enjoyment of life [E], and interference with general activity [G]). We evaluated stress appraisals as a mediator of these associations in a sample of low-income, underserved patients with PTSD (N = 355) at federally qualified health centers in a northeastern metropolitan area. Increases in PTSD symptom severity between baseline and 6-month and 6- and 12-month assessments were independently predicted by higher levels of pain (β = .14 for both lags) and appraisals of life stress as uncontrollable (β = .15 for both lags). Stress appraisals, however, did not mediate these associations, and PTSD symptom severity did not predict change in pain. Thus, the results did not support the role of stress appraisals as a mechanism underlying the associations between pain and PTSD.
Collapse
Affiliation(s)
| | | | - David P. Eisenman
- RAND Corporation, Santa Monica, California, USA,Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Lisa S. Meredith
- RAND Corporation, Santa Monica, California, USA,VA HSR&D Center for the Study of Healthcare Provider Behavior, Sepulveda, California, USA
| |
Collapse
|
23
|
Abstract
This study examined coercive conditions experienced by trafficked persons in the context of Biderman's theory of coercion. We conducted semi-structured interviews with 12 adult women trafficked into Los Angeles County, from 10 countries, for domestic work and/or sex work. Participants described health problems they experienced in relation to their trafficking experience and their perceptions of conditions that caused health problems. Utilizing a framework analysis approach, we analyzed themes using Biderman's framework. Participants reported experiencing the range of nonphysical coercive tactics outlined by Biderman, including isolation, monopolization of perception, induced debility or exhaustion, threats, occasional indulgences, demonstration of omnipotence, degradation, and enforcement of trivial demands. Our analysis demonstrates how these coercion tactics reinforced the submission of trafficked persons to their traffickers even in the absence of physical force or restraints. Such psychological abuse creates extreme stress that can lead to acute and chronic, physical and mental health problems.
Collapse
Affiliation(s)
- Susie B Baldwin
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | | | - David P Eisenman
- University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
24
|
Glik DC, Eisenman DP, Donatello I, Afifi A, Stajura M, Prelip ML, Sammartinova J, Martel A. Reliability and validity of the Assessment for Disaster Engagement with Partners Tool (ADEPT) for local health departments. Public Health Rep 2014; 129 Suppl 4:77-86. [PMID: 25355978 DOI: 10.1177/00333549141296s411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study presents reliability and validity findings for the Assessment for Disaster Engagement with Partners Tool (ADEPT), an instrument that can be used to monitor the frequency and nature of collaborative activities between local health departments (LHDs) and community-based organizations (CBOs) and faith-based organizations (FBOs) for disaster preparedness, response, and recovery. METHODS We used formative research to develop the instrument by ranking LHDs according to their disaster outreach and engagement activities. We validated the scale through a 2011 national survey of disaster preparedness coordinators (n=273) working in LHDs. We reduced the original measure of 25 items to a final measure comprising 15 items with four dimensions: (1) communication outreach and coordination, (2) resource mobilization, (3) organizational capacity building, and (4) partnership development and maintenance. We used internal consistency reliability m correlation and factor analysis to validate the measure. RESULTS Using internal consistency reliability, we found reasonable inter-item reliability for the four hypothesized dimensions (Cronbach's alpha: 0.71-0.88). These four dimensions were confirmed through correlation and factor analysis (Varimax rotation). CONCLUSION Higher scores on all four dimensions of ADEPT for organizational respondents suggest that more activities were conducted for inter-organizational preparedness in those organizations than in organizations whose respondents had lower scores. This finding implies that organizations with higher ADEPT scores have more active relationships with CBOs/FBOs in the realm of preparedness, a key element for creating community resilience for emergencies and disaster preparedness.
Collapse
Affiliation(s)
- Deborah C Glik
- University of California, Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA
| | - David P Eisenman
- University of California, Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA ; University of California, Los Angeles, David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, Los Angeles, CA
| | - Ian Donatello
- University of California, Los Angeles, Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA
| | - Abdelmonem Afifi
- University of California, Los Angeles, Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA
| | - Michael Stajura
- University of California, Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA
| | - Michael L Prelip
- University of California, Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA
| | - Jitka Sammartinova
- University of California, Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA
| | - Andrea Martel
- University of California, Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA
| |
Collapse
|
25
|
Carameli KA, Eisenman DP, Blevins J, d'Angona B, Glik DC. Planning for chronic disease medications in disaster: perspectives from patients, physicians, pharmacists, and insurers. Disaster Med Public Health Prep 2014; 7:257-65. [PMID: 23103395 DOI: 10.1001/dmp.2010.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Recent US disasters highlight the current imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. We examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves. METHODS A mixed methods design included evaluation of insurance pharmacy benefits, focus group interviews with patients, and key informant interviews with physicians, pharmacists, and insurers. RESULTS AND DISCUSSION Most prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days. For patients to acquire 14- to 30-day disaster medication reserves, health professionals interviewed supported 60- to 100-day dispensing units. Barriers included restrictive insurance benefits, patients' resistance to mail order, and higher copay-ments. Physicians, pharmacists, and insurers also varied widely in their preparedness planning and collective mutual-aid plans, and most believed pharmacists had the primary responsibility for patients' medication continuity during a disaster. CONCLUSIONS To strengthen prescription drug continuity in disasters, recommendations include the following: (1) creating flexible drug-dispensing policies to help patients build reserves, (2) training professionals to inform patients about disaster planning, and (3) building collaborative partnerships among system stakeholders.
Collapse
Affiliation(s)
- Kelley A Carameli
- University of California Los Angeles, School of Public Health, Los Angeles
| | - David P Eisenman
- University of California Los Angeles, Division of General Internal Medicine and Health Services Research, Los Angeles
| | - Joy Blevins
- Los Angeles County Department of Public Health, Emergency Preparedness and Response Program, Los Angeles
| | - Brian d'Angona
- University of California Los Angeles, School of Public Health, Los Angeles
| | - Deborah C Glik
- University of California Los Angeles, School of Public Health, Los Angeles
| |
Collapse
|
26
|
Meredith LS, Eisenman DP, Green BL, Kaltman S, Wong EC, Han B, Cassells A, Tobin JN. Design of the Violence and Stress Assessment (ViStA) study: a randomized controlled trial of care management for PTSD among predominantly Latino patients in safety net health centers. Contemp Clin Trials 2014; 38:163-72. [PMID: 24747932 DOI: 10.1016/j.cct.2014.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/06/2014] [Accepted: 04/09/2014] [Indexed: 11/24/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a common problem in primary care. Although effective treatments are available, little is known about whether such treatments are effective within the context of Federally Qualified Health Centers (FQHCs) that serve as national "safety nets" for providing primary care for low income and underinsured patients. The Violence and Stress Assessment (ViStA) study is the first randomized controlled trial (RCT) to test the impact of a care management intervention for treating PTSD in FQHCs. To develop a PTSD management intervention appropriate for lower resource FQHCs and the predominantly Latino patients they serve, formative work was conducted through a collaborative effort between researchers and an FQHC practice-based research network. This article describes how FQHC stakeholders were convened to review, assess, and prioritize evidence-based strategies for addressing patient, clinician, and system-level barriers to care. This multi-component care management intervention incorporates diagnosis with feedback, patient education and activation; navigation and linkage to community resources; clinician education and medication guidance; and structured cross-disciplinary communication and continuity of care, all facilitated by care managers with FQHC experience. We also describe the evaluation design of this five-year RCT and the characteristics of the 404 English or Spanish speaking patients enrolled in the study and randomized to either the intervention or to usual care. Patients are assessed at baseline, six months, and 12 months to examine intervention effectiveness on PTSD, other mental health symptoms, health-related quality-of-life, health care service use; and perceived barriers to care and satisfaction with care.
Collapse
Affiliation(s)
- Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA; VA HSR&D Center for the Study of Healthcare Provider Behavior, 16111 Plummer Street (152), North Hills, CA 91343, USA.
| | - David P Eisenman
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Bonnie L Green
- Department of Psychiatry, Georgetown University Medical School, 4000 Reservoir Road NW Suite 120, Washington, DC 20007, USA
| | - Stacey Kaltman
- Department of Psychiatry, Georgetown University Medical School, 4000 Reservoir Road NW Suite 120, Washington, DC 20007, USA
| | - Eunice C Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Andrea Cassells
- Clinical Directors Network (CDN), 5W 37th St # 10, New York, NY 10018, USA
| | - Jonathan N Tobin
- Clinical Directors Network (CDN), 5W 37th St # 10, New York, NY 10018, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Ave, Bronx, NY 10461, USA; Center for Clinical and Translational Sciences, The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| |
Collapse
|
27
|
Glik DC, Eisenman DP, Zhou Q, Tseng CH, Asch SM. Using the Precaution Adoption Process model to describe a disaster preparedness intervention among low-income Latinos. Health Educ Res 2014; 29:272-283. [PMID: 24399266 DOI: 10.1093/her/cyt109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Only 40-50% of households in the United States are currently disaster prepared. In this intervention study, respondent-driven sampling was used to select a sample (n = 187) of low income, Latino residents of Los Angeles County, randomly assigned into two treatment conditions: (i) household preparedness education received through 'promotora' (community health worker) led small group meetings, and (ii) household preparedness education received through print media. Weinstein's Precaution Adoption Process, a stage model appropriate for risk communication guided the intervention. Outcomes are conceptualized as stages of decision making linked to having disaster supplies and creating a family communication plan. Quantitative results showed a significant shift over time from awareness to action and maintenance stages for disaster communication plans and supplies in both study arms; however, the shift in stage for a communication plan for those in the 'platica' study arm was (P < 0.0001) than for those in the media arm. For changes in stage linked to disaster supplies, people in both media and 'platica' study arms improved at the same rate. Simple media-based communications may be sufficient to encourage disadvantaged households to obtain disaster supplies; however, adoption of the more complex disaster family communication requires interpersonal education.
Collapse
Affiliation(s)
- Deborah C Glik
- Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 South Charles E. Young Drive, PO Box 95-1772, Los Angeles, CA 90095-1772, USA, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1736, USA, Department of Medicine, VA, Greater Los Angeles Health Care System, Los Angeles, CA 90073, USA
| | | | | | | | | |
Collapse
|
28
|
Asch SM, Damberg CL, Hiatt L, Teleki SS, Shaw R, Hill TE, Benjamin-Johnson R, Eisenman DP, Kulkarni SP, Wang E, Williams B, Yesus A, Grudzen CR. Selecting performance indicators for prison health care. J Correct Health Care 2011; 17:138-49. [PMID: 21525117 DOI: 10.1177/1078345810397712] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Improving prison health care requires a robust measurement dashboard that addresses multiple domains of care. We sought to identify tested indicators of clinical quality and access that prison health managers could use to ascertain gaps in performance and guide quality improvement. We used the RAND/UCLA modified Delphi method to select the best indicators for correctional health. An expert panel rated 111 indicators on validity and feasibility. They voted to retain 79 indicators in areas such as access, cardiac conditions, geriatrics, infectious diseases, medication monitoring, metabolic diseases, obstetrics/gynecology, screening/prevention, psychiatric disorders/substance abuse, pulmonary conditions, and urgent conditions. Prison health institutions, like all other large health institutions, need robust measurement systems. The indicators presented here provide a basic library for prison health managers developing such systems.
Collapse
|
29
|
Baldwin SB, Eisenman DP, Sayles JN, Ryan G, Chuang KS. Identification of human trafficking victims in health care settings. Health Hum Rights 2011; 13:E36-E49. [PMID: 22772961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND An estimated 18,000 individuals are trafficked into the United States each year from all over the world, and are forced into hard labor or commercial sex work. Despite their invisibility, some victims are known to have received medical care while under traffickers' control. Our project aimed to characterize trafficking victims' encounters in US health care settings. METHODS The study consisted of semi-structured interviews with six Key Informants who work closely with trafficking victims (Phase I) and 12 female trafficking survivors (Phase II). All survivors were recruited through the Coalition to Abolish Slavery and Trafficking, an NGO in Los Angeles, and all were trafficked into Los Angeles. Interviews were conducted in English and six other languages, with the assistance of professional interpreters. Using a framework analysis approach that focused on victims' encounters in health care settings, we assessed interview transcript content and coded for themes. We used an exploratory pile-sorting technique to aggregate similar ideas and identify overarching domains. RESULTS The survivors came from 10 countries. Eight had experienced domestic servitude, three had survived sex trafficking, and one had experienced both. Half the survivors reported that they had visited a physician while in their traffickers' control, and another worked in a health care facility. All Key Informants described other victims who had received medical care. For domestic servants, medical visits were triggered by injury and respiratory or systemic illness, while sex trafficking victims were seen by health professionals for sexually transmitted infections and abortion. Trafficking victims were prevented from disclosing their status to health care providers by fear, shame, language barriers, and limited interaction with medical personnel, among other obstacles. DISCUSSION This exploration of survivors' experiences in health care settings supports anecdotal reports that US health care providers may unwittingly encounter human trafficking victims. Increasing awareness of human trafficking, and modifying practice to facilitate disclosure, could improve victim identification.
Collapse
Affiliation(s)
- Susie B Baldwin
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, CA, USA.
| | | | | | | | | |
Collapse
|
30
|
Meredith LS, Eisenman DP, Tanielian T, Taylor SL, Basurto-Davila R, Zazzali J, Diamond D, Cienfuegos B, Shields S. Prioritizing "psychological" consequences for disaster preparedness and response: a framework for addressing the emotional, behavioral, and cognitive effects of patient surge in large-scale disasters. Disaster Med Public Health Prep 2010; 5:73-80. [PMID: 21402830 DOI: 10.1001/dmp.2010.47] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
While information for the medical aspects of disaster surge is increasingly available, there is little guidance for health care facilities on how to manage the psychological aspects of large-scale disasters that might involve a surge of psychological casualties. In addition, no models are available to guide the development of training curricula to address these needs. This article describes 2 conceptual frameworks to guide hospitals and clinics in managing such consequences. One framework was developed to understand the antecedents of psychological effects or "psychological triggers" (restricted movement, limited resources, limited information, trauma exposure, and perceived personal or family risk) that cause the emotional, behavioral, and cognitive reactions following large-scale disasters. Another framework, adapted from the Donabedian quality of care model, was developed to guide appropriate disaster response by health care facilities in addressing the consequences of reactions to psychological triggers. This framework specifies structural components (internal organizational structure and chain of command, resources and infrastructure, and knowledge and skills) that should be in place before an event to minimize consequences. The framework also specifies process components (coordination with external organizations, risk assessment and monitoring, psychological support, and communication and information sharing) to support evidence-informed interventions.
Collapse
Affiliation(s)
- Lisa S Meredith
- RANDCorporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Rodríguez MA, Valentine J, Ahmed SR, Eisenman DP, Sumner LA, Heilemann MV, Liu H. Intimate partner violence and maternal depression during the perinatal period: a longitudinal investigation of Latinas. Violence Against Women 2010; 16:543-59. [PMID: 20388930 DOI: 10.1177/1077801210366959] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assessed the course of perinatal depression among 210 Latinas who were and were not affected by intimate partner violence (IPV) and identified associated psychosocial factors. Peak depression prevalence occurred prenatally among 45.7% of IPV-exposed and 24.6% of non-IPV-exposed Latinas. At each assessment, depression was significantly higher for IPV-exposed compared to non-IPV-exposed mothers. Mastery and social support were associated with lower depression, whereas history of IPV, perceived stress, and avoidant coping behaviors were associated with higher depression. Findings support recommendations for routine depression and IPV screening of Latinas in perinatal clinical settings.
Collapse
Affiliation(s)
- Michael A Rodríguez
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10880 Wilshire Blvd., Suite 1800 Los Angeles, CA 90024, USA.
| | | | | | | | | | | | | |
Collapse
|
32
|
Eisenman DP, Richardson E, Sumner LA, Ahmed SR, Liu H, Valentine J, Rodriguez MA. Intimate partner violence and community service needs among pregnant and postpartum Latina women. Violence Vict 2009; 24:111-21. [PMID: 19297889 PMCID: PMC2791786 DOI: 10.1891/0886-6708.24.1.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Health care providers are advised to refer abused women to needed community services. However, little is known about abused women's perceived need for services, particularly among Latina women. We examined the relationship between intimate partner violence (IPV) and perceived needs for legal, social, and job services among a prospective cohort of 210 pregnant Latinas. IPV was associated with needing social and legal services at most time points. Women with recent IPV experiences reported greater service needs than women with more remote IPV experiences, who in turn reported greater need than women without IPV experiences. We conclude that IPV may be associated with ongoing perceived needs for social and legal services among Latina perinatal patients.
Collapse
Affiliation(s)
- David P. Eisenman
- Division of General Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA; 911 Broxton Plaza, Room 225, Los Angeles, CA 90024; Phone: (310) 794-2452; Fax: (310) 794-3288;
| | | | - Lekeisha A. Sumner
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA; BOX 951759, 300 Medical Center, Rm 1506, Los Angeles, CA 90095; Phone: (310) 267-0515; Fax: 310-206-9137,
| | - Sawssan R. Ahmed
- Department of Family Medicine, David Geffen School of Medicine at UCLA;
| | - Honghu Liu
- Division of General Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA; BOX 951736, 911 Broxton Plz, Los Angeles, CA 90095 Phone: (310) 794-0700; Fax: (310) 794-0732;
| | - Jeannette Valentine
- Center for Health Services Research, Semel Research Institute, David Geffen School of Medicine at UCLA; 3550 w. 6TH Street Suite 500, Los Angeles, CA, 90020; Phone: (213) 427-1651; Fax: (213) 427-2701;
| | | |
Collapse
|
33
|
Eisenman DP, Glik D, Ong M, Zhou Q, Tseng CH, Long A, Fielding J, Asch S. Terrorism-related fear and avoidance behavior in a multiethnic urban population. Am J Public Health 2008; 99:168-74. [PMID: 19008521 DOI: 10.2105/ajph.2007.124206] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine whether groups traditionally most vulnerable to disasters would be more likely than would be others to perceive population-level risk as high (as measured by the estimated color-coded alert level) would worry more about terrorism, and would avoid activities because of terrorism concerns. METHODS We conducted a random digit dial survey of the Los Angeles County population October 2004 through January 2005 in 6 languages. We asked respondents what color alert level the country was under, how often they worry about terrorist attacks, and how often they avoid activities because of terrorism. Multivariate regression modeled correlates of worry and avoidance, including mental illness, disability, demographic factors, and estimated color-coded alert level. RESULTS Persons who are mentally ill, those who are disabled, African Americans, Latinos, Chinese Americans, Korean Americans, and non-US citizens were more likely to perceive population-level risk as high, as measured by the estimated color-coded alert level. These groups also reported more worry and avoidance behaviors because of concerns about terrorism. CONCLUSIONS Vulnerable populations experience a disproportionate burden of the psychosocial impact of terrorism threats and our national response. Further studies should investigate the specific behaviors affected and further elucidate disparities in the disaster burden associated with terrorism and terrorism policies.
Collapse
Affiliation(s)
- David P Eisenman
- David Geffen School of Medicine at UCLA, Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, Los Angeles, CA 90095-1736, USA.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Eisenman DP, Meredith LS, Rhodes H, Green BL, Kaltman S, Cassells A, Tobin JN. PTSD in Latino patients: illness beliefs, treatment preferences, and implications for care. J Gen Intern Med 2008; 23:1386-92. [PMID: 18587619 PMCID: PMC2518000 DOI: 10.1007/s11606-008-0677-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 04/16/2008] [Accepted: 05/02/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about how Latinos with post-traumatic stress disorder (PTSD) understand their illness and their preferences for mental health treatment. OBJECTIVE To understand the illness beliefs and treatment preferences of Latino immigrants with PTSD. DESIGN Semi-structured, face-to-face interviews. PARTICIPANTS Sixty foreign-born, Latino adults recruited from five primary care centers in New York and New Jersey and screened for PTSD. APPROACH Content analytic methods identified common themes, their range, and most frequent or typical responses. RESULTS Participants identified their primary feelings as sadness, anxiety, nervousness, and fear. The most common feeling was "sad" (triste). Other words frequently volunteered were "angry" (enojada), "nervous" (nerviosa), and "scared" (miedo). Participants viewed their PTSD as impairing health and functioning. They ascribed their somatic symptoms and their general medical problems to the "stress" from the trauma and its consequences on their lives. The most common reason participants volunteered for their work and school functioning being impaired was their poor concentration, often due to intrusive thoughts. Most expressed their desire to receive mental health treatment, to receive it within their primary care center, and preferred psychotherapy over psychotropic medications. Among participants who did not report wanting treatment, most said it was because the trauma was "in the past." CONCLUSIONS Clinicians may consider enquiring about PTSD in Latino patients who report feeling sad, anxious, nervous, or fearful. Our study suggests topics clinicians may include in the psychoeducation of patients with PTSD.
Collapse
|
35
|
Cordasco KM, Eisenman DP, Glik DC, Golden JF, Asch SM. "They blew the levee": distrust of authorities among Hurricane Katrina evacuees. J Health Care Poor Underserved 2007; 18:277-82. [PMID: 17483557 DOI: 10.1353/hpu.2007.0028] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
36
|
Meredith LS, Eisenman DP, Rhodes H, Ryan G, Long A. Trust influences response to public health messages during a bioterrorist event. J Health Commun 2007; 12:217-32. [PMID: 17497377 DOI: 10.1080/10810730701265978] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This study builds on recent work describing African Americans' low trust in public health regarding terrorism preparedness by identifying the specific components of trust (fiduciary responsibility, honesty, competency, consistency, faith) that may influence community response to a bioterrorist attack. We used qualitative analysis of data from 75 African American adults living in Los Angeles County who participated in focus group discussions. Groups were stratified by socioeconomic status (SES; up to vs. above 200% of federal poverty guidelines) and age (18-39 years old vs. 40-65 years old). Discussions elicited reactions to information presented in escalating stages of a bioterrorism scenario. The scenario mimicked the events and public health decisions that might occur under such a scenario. Honesty and consistency of information from public health officials were the components most frequently identified as determining trust or distrust. Patterns of trust varied according to the scenario stage; honesty was most important upon initially hearing of a public health crisis, whereas fiduciary responsibility and consistency were important upon confirmation of a smallpox outbreak and the ensuing public health response. Findings can help public health officials design communications that address distrust and enhance trust during a bioterrorist event.
Collapse
|
37
|
Eisenman DP, Cordasco KM, Asch S, Golden JF, Glik D. Disaster planning and risk communication with vulnerable communities: lessons from Hurricane Katrina. Am J Public Health 2007; 97 Suppl 1:S109-15. [PMID: 17413069 PMCID: PMC1855003 DOI: 10.2105/ajph.2005.084335] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We studied the experience of Hurricane Katrina evacuees to better understand factors influencing evacuation decisions in impoverished, mainly minority communities that were most severely affected by the disaster. METHODS We performed qualitative interviews with 58 randomly selected evacuees living in Houston's major evacuation centers from September 9 to 12, 2005. Transcripts were content analyzed using grounded theory methodology. RESULTS Participants were mainly African American, had low incomes, and were from New Orleans. Participants' strong ties to extended family, friends, and community groups influenced other factors affecting evacuation, including transportation, access to shelter, and perception of evacuation messages. These social connections cut both ways, which facilitated and hindered evacuation decisions. CONCLUSIONS Effective disaster plans must account for the specific obstacles encountered by vulnerable and minority communities. Removing the more apparent obstacles of shelter and transportation will likely be insufficient for improving disaster plans for impoverished, minority communities. The important influence of extended families and social networks demand better community-based communication and preparation strategies.
Collapse
Affiliation(s)
- David P Eisenman
- David Geffen School of Medicine, University of California, Los Angeles, Division of General Internal Medicine and Health Services Research, Los Angeles, and the RAND Corporation, Calif 90095-1736, USA.
| | | | | | | | | |
Collapse
|
38
|
Eisenman DP, Wold C, Fielding J, Long A, Setodji C, Hickey S, Gelberg L. Differences in individual-level terrorism preparedness in Los Angeles County. Am J Prev Med 2006; 30:1-6. [PMID: 16414417 DOI: 10.1016/j.amepre.2005.09.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 09/08/2005] [Accepted: 09/09/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Increasing individual preparedness for disasters, including large-scale terrorist attacks, is a significant concern of public health planners. As with natural disasters, individuals can help protect their health and safety by preparing for the emergency situation that may follow a terrorist event. Our study describes variations in preparedness among the population of Los Angeles County after the September 11, 2001 and subsequent anthrax attacks. METHODS In 2004, the data were analyzed from the Los Angeles County Health Survey, a random-digit-dialed telephone survey of the non-institutionalized population in Los Angeles County fielded October 2002 through February 2003. RESULTS Overall, 28.0% of respondents had emergency supplies, and 17.1% developed an emergency plan in the past year in response to the possibility of terrorism. Factors associated with having emergency supplies included African American (adjusted odds ratio [AOR] 1.8, 95% confidence interval [CI]=1.1-3.1) and Latino (AOR=1.5, 95% CI=1.0-2.4) race/ethnicity; having a household dependent aged<or=18 years (AOR=1.4, 95% CI=1.0-2.0); being born outside the United States (AOR=1.9, 95% CI=1.3-2.9); some college or trade school education (AOR=1.9, 95% CI=1.3-2.9); and higher perceived likelihood of a bioterrorist attack (AOR=2.2, 95% CI=1.6-3.0). Factors associated with having an emergency plan included African American (AOR=2.6, 95% CI=1.5-4.6) race/ethnicity; having a household dependent aged<or=18 years (AOR=2.4, 95% CI=1.6-3.5); and physical disability (AOR=1.7, 95% CI=1.1-2.7). CONCLUSIONS Some groups were more likely to adopt some, but not all, recommended preparedness activities. Identifying subpopulation differences in preparedness is important since different public health messages, programs, and distribution channels are required for different subgroups.
Collapse
|
39
|
Abstract
This paper examines primary care physicians' (PCP) roles in helping the nation prepare for, respond to, and recover from the psychologic consequences of chemical, biologic, radiologic, or nuclear (CBRN) terrorism. First, we discuss the psychologic consequences of a CBRN attack and PCPs' roles in responding to these consequences. Second, we analyze these roles in light of the known barriers to delivering high-quality, primary care-based, mental health care. Third, we offer recommendations for mitigating these barriers and preparing PCPs to respond to the psychosocial consequences of a CBRN weapon. Importantly, our recommendations provide dual-use benefits to PCPs faced with the daily concerns of primary care mental health, including improved linkages and electronic connectivity with mental health, information technology, and decision support for providers, and needed education and research.
Collapse
Affiliation(s)
- David P Eisenman
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA, Los Angeles, CA, USA.
| | | | | | | |
Collapse
|
40
|
Eisenman DP, Wold C, Setodji C, Hickey S, Lee B, Stein BD, Long A. Will public health's response to terrorism be fair? Racial/ethnic variations in perceived fairness during a bioterrorist event. Biosecur Bioterror 2005; 2:146-56. [PMID: 15588052 DOI: 10.1089/bsp.2004.2.146] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Public health departments' effectiveness during catastrophic bioterrorism will require trust on the part of diverse communities. This study describes variations in perceptions that the public health system will respond fairly to one's needs in a bioterrorist event, regardless of race/ethnicity, income, or other characteristics. METHODS Using the Los Angeles County Health Survey, a random-digit, population-based, telephone survey, we conducted multivariate logistic regression of race/ethnicity on perceived fairness, adjusting for demographic factors and perceived neighborhood safety. We performed similar analyses stratified by race/ethnicity subgroup. RESULTS Overall, 72.7% of respondents perceived that the public health system will respond fairly in a bioterrorist event. African Americans (AA) and Asian/Pacific Islanders (API) reported the lowest perceived fairness (AA 63.0%, API 68.2%, Latino 73.1%, White 76.6%, p = 0.005 for group differences). Adjusting for demographic factors and neighborhood safety, African Americans had lower perceived fairness compared to whites (adjusted odds ratio, aOR 0.45; 95% confidence intervals, CI 0.26-0.79; p < 0.005). Other factors associated with lower perceived fairness included Asian-language compared to English-language interview (aOR 0.29; 95% CI 0.11-0.76; p < 0.05) and lower compared to higher neighborhood safety (aOR 0.48; 95% CI 0.31-0.74; p < 0.005). Among African Americans, participants aged 18-29 years were less likely to report perceived fairness (aOR 0.06; 95% CI 0.01-0.59) compared to participants older than 60 years of age. Among Asian/Pacific Islanders, Asian-language interview (aOR 0.07; 95% CI 0.01-0.48) and lower perceived neighborhood safety (aOR 0.01; 95% CI <0.01-0.13) were associated with perceived fairness. CONCLUSIONS To strengthen bioterrorism preparedness, public health officials must continue to improve perceived fairness among African American and Asian/Pacific Islander communities.
Collapse
|
41
|
Stein BD, Tanielian TL, Eisenman DP, Keyser DJ, Burnam MA, Pincus HA. Emotional and behavioral consequences of bioterrorism: planning a public health response. Milbank Q 2004; 82:413-55, table of contents. [PMID: 15330972 PMCID: PMC2690224 DOI: 10.1111/j.0887-378x.2004.00317.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Millions of dollars have been spent improving the public health system's bioterrorism response capabilities. Yet relatively little attention has been paid to precisely how the public will respond to bioterrorism and how emotional and behavioral responses might complicate an otherwise successful response. This article synthesizes the available evidence about the likely emotional and behavioral consequences of bioterrorism to suggest what decision makers can do now to improve that response. It examines the emotional and behavioral impact of previous "bioterrorism-like" events and summarizes interviews with experts who have responded to such events or conducted research on the effects of community-wide disasters. The article concludes by reflecting on the evidence and experts' perspectives to suggest actions to be taken now and future policy and research priorities.
Collapse
Affiliation(s)
- Bradley D Stein
- RAND Corporation, 1700 Main Street, Santa Monica, CA 90407, USA.
| | | | | | | | | | | |
Collapse
|
42
|
Eisenman DP, Gelberg L, Liu H, Shapiro MF. Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. JAMA 2003; 290:627-34. [PMID: 12902366 DOI: 10.1001/jama.290.5.627] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Although political violence continues in parts of Central America, South America, and Mexico, little is known about its relationship to the health of Latino immigrants living in the United States. OBJECTIVE To determine (1) rates of exposure to political violence among Latino adult primary care patients who have immigrated to the United States from Central America, South America, and Mexico and its impact on mental health and health-related quality of life and (2) frequency of disclosure of political violence to primary care clinicians. DESIGN, SETTING, AND PARTICIPANTS Two-stage cluster design survey of a systematic sample of Latino immigrant adults in 3 community-based primary care clinics in Los Angeles, conducted from July 2001 to February 2002. MAIN OUTCOME MEASURES Reports of exposure to political violence in home country before immigrating to the United States and communication with clinicians about political violence; self-reported measures of health-related quality of life using the Medical Outcomes Study Short Form 36 (MOS SF-36); symptoms of depression, anxiety, and alcohol disorders using the Primary Care Evaluation of Mental Disorders (PRIME-MD); and symptoms of posttraumatic stress disorder (PTSD) using the PTSD Checklist-Civilian Version (PCL-C). RESULTS A total of 638 (69%) of 919 eligible patients participated. The nonresponse rates did not differ by age, sex, recruitment sites, or clinic sessions. In weighted analyses, 54% of participants reported political violence experiences in their home countries, including 8% who reported torture. Of those exposed to political violence, 36% had symptoms of depression and 18% had symptoms of PTSD vs 20% and 8%, respectively, among those not exposed to political violence. Controlling for age, sex, country, years lived in the United States, acculturation, income, health insurance status, and recruitment site in a subsample of 512 participants (56%), those who reported political violence exposure were more likely to meet symptom criteria for PTSD (adjusted odds ratio [AOR], 3.4; 95% confidence interval [CI], 1.4-8.4) and to have symptoms of depression (AOR, 2.8; 95% CI, 1.4-5.4) and symptoms of panic disorder (AOR, 4.8; 95% CI, 1.6-14.4) than participants not reporting political violence. Those exposed to political violence reported more chronic pain and role limitations due to physical problems, as well as worse physical functioning and lower perceptions of general health than those who were not exposed to political violence. Only 3% of the 267 patients who had experienced political violence reported ever telling a clinician about it after immigrating; none reported their current physician asking about political violence. CONCLUSION Latino immigrants in primary care in Los Angeles have a high prevalence of exposure to political violence before immigrating to the United States and associated impairments in mental health and health-related quality of life.
Collapse
Affiliation(s)
- David P Eisenman
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles 90095-1736, USA.
| | | | | | | |
Collapse
|
43
|
Abstract
We analyzed the HIV Costs and Service Utilization Study data to determine the association of violence, assessed at baseline, with utilization of and access to health care at follow-up, among gay/bisexual male, heterosexual female, and heterosexual male HIV/AIDS patients. In multivariate analyses, male gay/bisexual violence victims had increased odds of reporting emergency department visits (odds ratio [OR], 1.74; 95% confidence interval [95% CI], 1.20 to 2.52), going without needed medical care because of expense (OR, 1.83; 95% CI, 1.06 to 3.18), and having poor ability to access medical specialists (OR, 1.96; 95% CI, 1.05 to 3.67). Further research is required to understand the association of violence with health care among gay/bisexual men with HIV/AIDS.
Collapse
Affiliation(s)
- David P Eisenman
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California-Los Angeles, Los Angeles, Calif., USA.
| | | | | | | | | |
Collapse
|
44
|
Abstract
OBJECTIVES To measure the frequency of people reporting torture among patients in a medical outpatient clinic and to determine primary care physicians' awareness of their patients' exposure to torture. DESIGN Cross-sectional survey followed by selected in-depth interviews of participants reporting a history of torture. Medical record review and interview of torture survivors' primary care physicians. SETTING The internal medicine clinic of a large, urban medical center. PARTICIPANTS A convenience sample of 121 adult patients who were not born in the United States and who were attending the adult ambulatory care clinic. INTERVENTIONS All participants were interviewed using the Detection of Torture Survivors Survey, a validated instrument that asks about exposure to torture according to the World Medical Association definition of torture. Participants who reported a history of torture were interviewed in depth to confirm that they had been tortured. We reviewed the medical records of participants who reported a history of torture and interviewed their primary care physicians. MAIN OUTCOME MEASURES Self-reported history of torture. The awareness of primary care physicians of this history. RESULTS Eight of 121 participants (6.6% [95% confidence interval: 3.1%-13.1%]) reported a history of torture. None of the survivors of torture had been identified as such by their primary care physician. CONCLUSIONS Physicians of patients who have not been born in the United States and who attend urban general medical clinics frequently are unaware that their patients are survivors of torture. Primary care physicians can be the locus of intervention in the care of torture survivors. The first step is for physicians to recognize the possibility of torture survivors among their patients.
Collapse
|
45
|
Abstract
Survivors of torture can present with multiple health consequences, both physical and psychological, which can persist even years after the abuse. The authors developed a multidisciplinary program in the primary care medical clinic of an urban municipal hospital in New York City serving an ethnically diverse population to provide multidisciplinary care to survivors of torture and their families.
Collapse
Affiliation(s)
- A S Keller
- Department of Medicine, New York University School of Medicine, USA
| | | | | |
Collapse
|
46
|
|
47
|
Affiliation(s)
- D P Eisenman
- Montefiore Medical Center, Department of Medicine, Bronx, NY 10467
| | | |
Collapse
|