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Green G, Barragan NC, Abraham J, Chen S, Kuo T. Delivery of Comprehensive Medication Management and Other Clinical Services via Telehealth by Pharmacy Type. J Pharm Pract 2024; 37:625-631. [PMID: 36803060 DOI: 10.1177/08971900231158934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Background: The recent coronavirus pandemic accelerated the need to deliver pharmacy-related services remotely. Objective: To describe experiences with providing comprehensive medication management (CMM) and other clinical services via telehealth by pharmacy type, before and during the COVID-19 pandemic. Methods: An online survey of pharmacists, representing 27 pharmacies, was conducted to capture telehealth usage in three pharmacy types: independently owned, integrated into a clinical setting, and retail chain. A sub-analysis was performed to assess if providing CMM services via telehealth helped, resulted in no change, or worsened the care of different patient groups (e.g., those with diabetes, were low-income, aged 65+ years). Results: During the pandemic, telehealth usage among independently owned pharmacies and those integrated into a clinical setting increased, but no change occurred among retail chain pharmacies. This usage increase in the first two pharmacy types occurred despite limited investments in connectivity-related resources to support telehealth services. Pharmacists from both independently owned pharmacies (63%) and those integrated into a clinical setting (89%) reported CMM via telehealth reached patients they would not otherwise have been able to reach during the pandemic. Most pharmacists/pharmacies found telehealth to be a feasible and acceptable method of delivering CMM. Conclusion: Pharmacists and pharmacies are now experienced with and have interest in continuing CMM via telehealth, even as the pandemic recedes. However, investments in telecommunications resources, training support, technical assistance, and continued telehealth reimbursement from health plans are needed to sustain this service delivery model.
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Affiliation(s)
- Gabrielle Green
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Jessica Abraham
- University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, CA, USA
| | - Steven Chen
- University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, CA, USA
| | - Tony Kuo
- Department of Family Medicine, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
- Population Health Program, University of California, Los Angeles Clinical and Translational Science Institute, Los Angeles, CA, USA
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DeFosset AR, Barragan NC, Green G, Morrison JL, Kuo T. Building bi-directional referral and communication pathways across the community-clinic divide: Experiences from a systems-informed innovation project in Los Angeles. Healthc (Amst) 2023; 11:100671. [PMID: 36508993 DOI: 10.1016/j.hjdsi.2022.100671] [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] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
Bi-directional communication and referral pathways (BCRPs) between clinics and community-based organizations could promote well-being among vulnerable populations with complex and overlapping health and social needs. While BCRPs are promising, establishing them is complex, involving system and process changes across diverse organizational settings. To date, few models have been implemented or empirically tested. This article describes an innovation and planning project to build a BCRP, linking patients in safety net primary care clinics to a comprehensive suite of community-based health and wellness supports in Los Angeles. During a year-long process, a multi-sector team iteratively engaged data to facilitate learning and improvement. The project proceeded through three distinct, but overlapping, phases: (1) Discovery, (2) Systems Mapping, and (3) BCRP Re-design and Testing, which were coordinated through frequent collaborative meetings. By using a stepwise systems-informed approach to collect and examine data, the team was able to generate new change ideas, dispel assumptions, and make transparent and informed decisions. It was critical to have engagement from both internal partners with knowledge of "on-the-ground" practice realities, and external stakeholders with the fresh perspective needed to identify opportunities and define an improvement agenda. These efforts represent first steps towards implementing sustainable BCRPs and realizing their full potential to dynamically bridge the community-clinic divide and improve population health. Other jurisdictions can learn from and adapt the practical data-driven approach used in Los Angeles to build BCRPs that will be thoroughly operationalized, consistently implemented, and optimized within their own unique contexts.
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Affiliation(s)
- Amelia R DeFosset
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina-Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC, 27516, USA.
| | - Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA, 90010, USA
| | - Gabrielle Green
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA, 90010, USA
| | - Janina L Morrison
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA, 90010, USA; The Wellness Center at the Historic General Hospital, 1200 N. State Street, Los Angeles, CA, 90033, USA; LAC+USC Medical Center, Los Angeles County Department of Health Services, Outpatient Department (Building B), 2010 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA, 90010, USA; Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA, 90024, USA; Department of Epidemiology, UCLA Fielding School of Public Health, P.O. Box 951772, Los Angeles, CA, 90095, USA; Population Health Program, UCLA Clinical and Translational Science Institute, BE-144 Center of Health Sciences, Los Angeles, CA, 90095, USA
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Abstract
CONTEXT The coupling of health care services with complementary resources that address unmet social needs is a progressively popular approach for improving health outcomes among low-income populations. Community health workers are increasingly recognized as a helpful intermediary for clients navigating community and clinical services. PROGRAM The Wellness Center at the Historic General Hospital in East Los Angeles employs a team of community health workers, referred to as Health Navigators, who are trained to link low-income clients to resources such as chronic disease management programs, food pantries, free or low-cost legal aid, health insurance enrollment, group fitness classes, and counseling and peer support services. IMPLEMENTATION The Center's model of practice has evolved over time, continuously increasing the breadth and depth of services provided by the Health Navigator team. Its goal has been to address clients' unmet social needs while optimizing their health outcomes through the building of stronger community-clinical linkages. EVALUATION A program review showed that Health Navigators serve as a critical bridge for clients navigating a complex network of health and social services. They actively engage, recruit, and deliver services to clients. Since 2014, the Health Navigator team has connected more than 28 000 unique clients to resources for health and well-being. DISCUSSION By using Health Navigators to assist clients with community resource engagement, the Center has prototyped and promoted an approach that complements clinical care, strengthening the community-clinical linkages that are needed to meaningfully manage chronic disease outside of the hospital or clinic setting.
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Affiliation(s)
- Telma Menendez
- Departments of Community Health Sciences (Ms Menendez) and Epidemiology (Dr Kuo), UCLA Fielding School of Public Health, Los Angeles, California; The Wellness Center at the Historic General Hospital, Los Angeles, California (Ms Menendez and Dr Morrison); Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California (Ms Barragan and Drs Morrison and Kuo); Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Dr Kuo); and Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, California (Dr Kuo)
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Kuo T, Chen S, Oh SM, Barragan NC. Comprehensive Medication Management as a Standard of Practice for Managing Uncontrolled Blood Pressure. Front Med (Lausanne) 2021; 8:693171. [PMID: 34414204 PMCID: PMC8369150 DOI: 10.3389/fmed.2021.693171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tony Kuo
- Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States.,Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, Los Angeles, CA, United States.,Population Health Program, University of California, Los Angeles Clinical and Translational Science Institute, Los Angeles, Los Angeles, CA, United States
| | - Steven Chen
- Associate Dean for Clinical Affairs, University of Southern California School of Pharmacy, Los Angeles, CA, United States
| | - Sang-Mi Oh
- Western States, American Heart Association, Burlingame, CA, United States
| | - Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States
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Kuo T, Barragan NC, Kim-Farley R. Letter Regarding: Policy and Other Opportunities to Intervene on Firearm Injury in the United States. J Surg Res 2020; 253:252-253. [PMID: 32388387 DOI: 10.1016/j.jss.2020.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/15/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Tony Kuo
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California; Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, California.
| | - Noel C Barragan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Robert Kim-Farley
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
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Kuo T, Barragan NC, Readhead H. Public Health Investment in Team Care: Increasing Access to Clinical Preventive Services in Los Angeles County. Front Public Health 2018; 6:17. [PMID: 29473030 PMCID: PMC5809468 DOI: 10.3389/fpubh.2018.00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 01/17/2018] [Indexed: 11/20/2022] Open
Abstract
As part of federal and local efforts to increase access to high quality, clinical preventive services (CPS) in underserved populations, the Los Angeles County Department of Public Health (DPH) partnered with six local health system and community organization partners to promote the use of team care for CPS delivery. Although these partners were at different stages of organizational capacity, post-program review suggests that each organization advanced team care in their clinical or community environments, potentially affecting >250,000 client visits per year. Despite existing infrastructure and DPH’s funding support of CPS integration, partner efforts faced several challenges. They included lack of sustainable funding for prevention services; limited access to community resources that support disease prevention; and difficulties in changing health-care provider behavior. Although team care can serve as a catalyst or vehicle for delivering CPS, downstream sustainability of this model of practice requires further state and national policy changes that prioritize prevention. Public health is well positioned to facilitate these policy discussions and to assist health system and community organizations in strengthening CPS integration.
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Affiliation(s)
- Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- *Correspondence: Tony Kuo,
| | - Noel C. Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
| | - Heather Readhead
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States
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Barragan NC, DeFosset AR, Torres J, Kuo T. Pharmacist-Driven Strategies for Hypertension Management in Los Angeles: A Community and Stakeholder Needs Assessment, 2014-2015. Prev Chronic Dis 2017; 14:E54. [PMID: 28682744 PMCID: PMC5510301 DOI: 10.5888/pcd14.160423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In 2014, the Los Angeles County Department of Public Health received federal funding to improve the prevention and control of hypertension in the population through team-based health care delivery models, such as pharmacist-led medication therapy management. To inform this work, the department conducted a 3-part needs assessment consisting of 1) a targeted context scan of regional policies and efforts, 2) a key stakeholder survey, and 3) a public opinion internet-panel survey of Los Angeles residents. Results suggest that political will and professional readiness exists for expansion of pharmacist-led medication management strategies in Los Angeles. However, several infrastructure and economic barriers, such as a lack of sufficient payment or reimbursement mechanisms for these services, impede progress. The department is using assessment results to address barriers and shape efforts in scaling up pharmacist-led programming in Los Angeles.
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Affiliation(s)
- Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010.
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - Amelia R DeFosset
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California
| | - Jennifer Torres
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
- Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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Barragan NC, Moschetti K, Smith LV, Sorvillo F, Kuo T. Differential declines in syphilis-related mortality in the United States, 2000-2014. Am J Infect Control 2017; 45:417-420. [PMID: 28007309 DOI: 10.1016/j.ajic.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND After reaching an all time low in 2000, the rate of syphilis in the United States has been steadily increasing. Parallel benchmarking of the disease's mortality burden has not been undertaken. METHODS Using ICD-10 classification, all syphilis-related deaths in the national Multiple Cause of Death dataset were examined for the period 2000-2014. Descriptive statistics and age-adjusted mortality rates were generated. Poisson regression was performed to analyze trends over time. A matched case-control analysis was conducted to assess the associations between syphilis-related deaths and comorbid conditions listed in the death records. RESULTS A total of 1,829 deaths were attributed to syphilis; 32% (n = 593) identified syphilis as the underlying cause of death. Most decedents were men (60%) and either black (48%) or white (39%). Decedents aged ≥85 years had the highest average mortality rate (0.47 per 100,000 population; 95% confidence interval [CI], 0.42-0.52). For the sampled period, the average annual decline in mortality was -2.90% (95% CI, -3.93% to -1.87%). However, the average annual percent change varied across subgroups of interest. CONCLUSIONS Declines in U.S. syphilis mortality suggest early detection and improved treatment access likely helped attenuate disease progression; however, increases in the disease rate since 2000 may be offsetting the impact of these advancements.
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Affiliation(s)
- Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA; Department of Social Welfare, University of California, Los Angeles Luskin School of Public Affairs, Los Angeles, CA.
| | - Kristin Moschetti
- University of California, San Francisco Benioff Children's Hospital, Oakland, CA
| | - Lisa V Smith
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, CA; Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - Frank Sorvillo
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA; Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA; Department of Family Medicine, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA
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Gase LN, Barragan NC, Simon PA, Jackson RJ, Kuo T. Public awareness of and support for infrastructure changes designed to increase walking and biking in Los Angeles County. Prev Med 2015; 72:70-5. [PMID: 25572622 DOI: 10.1016/j.ypmed.2014.12.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 08/07/2014] [Revised: 12/18/2014] [Accepted: 12/26/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Policies to promote active transportation are emerging as a best practice to increase physical activity, yet relatively little is known about public opinion on utilizing transportation funds for such investments. This study sought to assess public awareness of and support for investments in walking and biking infrastructure in Los Angeles County. METHOD In the fall of 2013, the Los Angeles County Department of Public Health conducted a telephone survey with a random sample of registered voters in the region. The survey asked respondents to report on the presence and importance of walking and biking infrastructure in their community, travel behaviors and preferences, and demographics. RESULTS One thousand and five interviews were completed (response rate 20%, cooperation rate 54%). The majority of participants reported walking, biking, and bus/rail transportation investments as being important. In addition, participants reported a high level of support for redirecting transportation funds to active transportation investment - the population average was 3.28 (between 'strongly' and 'somewhat' support) on a 4 point Likert scale. CONCLUSION Voters see active transportation infrastructure as being very important and support redirecting funding to improve the infrastructure. These findings can inform policy-decisions and planning efforts in the jurisdiction.
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Affiliation(s)
- Lauren N Gase
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010, USA.
| | - Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010, USA
| | - Paul A Simon
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010, USA; Department of Epidemiology, UCLA Fielding School of Public Health, 640 Charles E Young Dr S, Los Angeles, CA 90024, USA
| | - Richard J Jackson
- Department of Environmental Health Sciences, UCLA Fielding School of Public Health, 640 Charles E Young Dr S, Los Angeles, CA 90024, USA
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010, USA; Department of Epidemiology, UCLA Fielding School of Public Health, 640 Charles E Young Dr S, Los Angeles, CA 90024, USA; Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Ste. 1800, Los Angeles, CA 90024-4142, USA
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Barragan NC, Chang M, Felderman J, Readhead H, Kuo T. A case study of a hepatitis B screening and blood pressure assesment program in Los Angeles County, 2012-2013. Prev Chronic Dis 2015; 12:E19. [PMID: 25674678 PMCID: PMC4329954 DOI: 10.5888/pcd12.140373] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The Los Angeles County Department of Public Health teamed with a culturally tailored, community-based organization to augment their hepatitis B screening program with blood pressure assessments. During 6 months, 2,298 people were served by the program; descriptive statistics and models were generated to describe demographics and screening and assessment results. Despite the program having good reach, sustainability was challenging. This experience draws attention to the need for invested desire to change at both the organizational and patient levels to sustain interdisciplinary provision of clinical preventive services.
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Affiliation(s)
- Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010.
| | - Mimi Chang
- Asian Pacific Liver Center at St. Vincent Medical Center, Los Angeles, California
| | - Jennifer Felderman
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California
| | - Heather Readhead
- The Wellness Center at the Historic General Hospital, Los Angeles, California
| | - Tony Kuo
- Los Angeles County Department of Public Health, Los Angeles, California, David Geffen School of Medicine at UCLA, Los Angeles, California, and UCLA Fielding School of Public Health, Los Angeles, California
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Barragan NC, Sorvillo F, Kuo T. Cryptococcosis-related deaths and associated medical conditions in the United States, 2000-2010. Mycoses 2014; 57:741-6. [PMID: 25135153 DOI: 10.1111/myc.12238] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 11/29/2022]
Abstract
Cryptococcosis is an invasive mycotic infection primarily affecting immunocompromised individuals. The objective of this study was to describe cryptococcosis mortality and associated medical conditions in the US for the period 2000-2010. Cryptococcosis-related deaths were identified from the national multiple-cause-of-death dataset. Mortality trends and comparison analyses were performed on overall cases of cryptococcosis and by subset [i.e. clinical manifestations of disease and human immunodeficiency virus (HIV) status]. A matched case-control analysis was also conducted to describe the associations between this disease and comorbid medical conditions. A total of 3210 cryptococcosis-related deaths were identified. Cerebral cryptococcosis was the most commonly reported clinical manifestation of the disease. Approximately one-fifth of the decedents (n = 616) had a co-diagnosis of HIV. Mortality rates were highest among men, blacks, Hispanics, Native Americans and older adults. Poisson regression analysis indicated a 6.52% annual decrease in mortality rates for the study period. HIV (MOR = 35.55, 95% CI 27.95-45.22) and leukaemia (MOR = 16.10, 95% CI 11.24-23.06) were highly associated with cryptococcosis-related deaths. Cryptococcosis mortality declined significantly during 2000-2010. However, the disease continues to cause appreciable mortality in the US. With the majority of decedents having no HIV co-diagnosis, there is still much to be learned about the epidemiology of this mycosis.
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Affiliation(s)
- Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
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Gase LN, Barragan NC, Robles B, Leighs M, Kuo T. A Mixed-Methods Evaluation of the Choose Less, Weigh Less Portion Size Health Marketing Campaign in Los Angeles County. Am J Health Promot 2014; 29:e214-24. [PMID: 24968181 DOI: 10.4278/ajhp.131210-quan-623] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the impact of the Choose Less, Weigh Less portion size health marketing campaign. DESIGN A mixed-methods, cross-sectional evaluation. SETTING A quantitative Internet panel survey was administered through an online sampling vendor and qualitative interviews were conducted by street intercept. SUBJECTS The panel survey included 796 participants, weighted to represent Los Angeles County. Street intercept interviews were conducted with 50 other participants. INTERVENTION The Choose Less, Weigh Less campaign included print media on transit shelters, bus and rail cars, and billboards; radio and online advertising; and Web site content and social media outreach. MEASURES The panel survey measured self-reported campaign exposure and outcomes, including knowledge of recommended daily calorie limits, attitudes toward portion sizes, and intent to reduce calories and portion size. Intercept interviews assessed campaign appeal, clarity, and utility. ANALYSIS Weighted survey data were analyzed using logistic regression to assess the association between campaign exposure and outcomes. Interview data were analyzed for themes. RESULTS The campaign reached 19.7% of the Los Angeles County population. Significant differences were seen for 2 of the 10 outcomes assessed. Participants who saw the campaign were more likely than those who did not to report fast-food portion sizes as being too large (adjusted odds ratio [Adj. OR]: 1.89; 95% confidence interval [CI]: 1.16, 3.07) and intention to choose a smaller portion (Adj. OR: 1.99; 95% CI: 1.20, 3.31). Qualitative data revealed three themes about appeal, clarity, and utility. CONCLUSION Health marketing efforts targeting portion size can have relatively broad reach and limited but positive impacts on consumer attitudes and intent to select smaller portions.
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Affiliation(s)
- Lauren N Gase
- Lauren N. Gase, MPH; Noel C. Barragan, MPH; Brenda Robles, MPH; Michael Leighs, MPP; and Tony Kuo, MD, MSHS, are with the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California. Tony Kuo, MD, MSHS, is with the Department of Family Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Noel C Barragan
- Lauren N. Gase, MPH; Noel C. Barragan, MPH; Brenda Robles, MPH; Michael Leighs, MPP; and Tony Kuo, MD, MSHS, are with the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California. Tony Kuo, MD, MSHS, is with the Department of Family Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Brenda Robles
- Lauren N. Gase, MPH; Noel C. Barragan, MPH; Brenda Robles, MPH; Michael Leighs, MPP; and Tony Kuo, MD, MSHS, are with the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California. Tony Kuo, MD, MSHS, is with the Department of Family Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Michael Leighs
- Lauren N. Gase, MPH; Noel C. Barragan, MPH; Brenda Robles, MPH; Michael Leighs, MPP; and Tony Kuo, MD, MSHS, are with the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California. Tony Kuo, MD, MSHS, is with the Department of Family Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Tony Kuo
- Lauren N. Gase, MPH; Noel C. Barragan, MPH; Brenda Robles, MPH; Michael Leighs, MPP; and Tony Kuo, MD, MSHS, are with the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California. Tony Kuo, MD, MSHS, is with the Department of Family Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
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Gase LN, Robles B, Barragan NC, Kuo T. Relationship Between Nutritional Knowledge and the Amount of Sugar-Sweetened Beverages Consumed in Los Angeles County. Health Educ Behav 2014; 41:431-9. [DOI: 10.1177/1090198114529128] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although consumption of sugar-sweetened beverages (SSBs) is associated with many negative health outcomes, including obesity, diabetes, and cardiovascular disease, the relationship between consumer nutritional knowledge and the amount consumed is poorly understood. The objective of this study was to examine the relationship between knowledge of daily calorie recommendations and the amount of SSBs consumed in a large, economically and racially diverse sample of adults recruited at selected Metro subway and bus shelters in Los Angeles County. In June 2012, the Los Angeles County Department of Public Health conducted street intercept surveys to assess food attitudes and consumption behaviors and public opinions related to a recent 8-week health marketing campaign targeting SSB consumption. Descriptive and comparative analyses were conducted, including a negative binomial regression model, to examine the relationship between knowledge of the daily calorie recommendations and the amount of SSBs consumed. Among survey respondents ( n = 1,041), less than one third correctly identified the daily calorie recommendations for a typical adult. After controlling for sociodemographics and weight status, respondents who correctly identified recommended calorie needs reported, on average, drinking nine fewer SSBs per month than respondents who did not. Results suggest that efforts to reduce SSB consumption might benefit from the inclusion of educational interventions that empower consumers to make healthy choices.
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Affiliation(s)
- Lauren N. Gase
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Brenda Robles
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Noel C. Barragan
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Tony Kuo
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
- David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
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Barragan NC, Noller AJ, Robles B, Gase LN, Leighs MS, Bogert S, Simon PA, Kuo T. The “Sugar Pack” Health Marketing Campaign in Los Angeles County, 2011-2012. Health Promot Pract 2013; 15:208-16. [DOI: 10.1177/1524839913507280] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As part of a comprehensive approach to combating the obesity epidemic, the Los Angeles County Department of Public Health launched the “Sugar Pack” health marketing campaign in fall 2011. Carried out in three stages, the campaign sought to educate and motivate the public to reduce excess calorie intake from sugar-sweetened beverage consumption. The primary Sugar Pack creative concepts provided consumers with information about the number of sugar packs contained in sugary drinks. Data from formative market research as well as lessons from previous campaigns in other U.S. jurisdictions informed the development of the materials. These materials were disseminated through a multipronged platform that included paid outdoor media on transit and billboards and messaging using social media (i.e., Twitter, Facebook, YouTube, and sendable e-cards). Initial findings from a postcampaign assessment indicate that the Sugar Pack campaign reached broadly into targeted communities, resulting in more than 515 million impressions. Lessons learned from the campaign suggest that employing health marketing to engage the public can lead to increased knowledge, favorable recognition of health messages, and self-reported intention to reduce sugar-sweetened beverage consumption, potentially complementing other obesity prevention strategies in the field.
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Affiliation(s)
- Noel C. Barragan
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Ali J. Noller
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Brenda Robles
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Lauren N. Gase
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Michael S. Leighs
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Suzanne Bogert
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Paul A. Simon
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
- UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Tony Kuo
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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