Publications by authors named "William J McCarthy"

87 Publications

Prevalence and Correlates of Successful Smoking Cessation in Bladder Cancer Survivors.

Urology 2021 Jul 13;153:236-243. Epub 2021 Jan 13.

Department of Urology, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA.

Objective: To assess the prevalence and correlates of successful smoking cessation in bladder cancer survivors.

Materials And Methods: A population-based sample of bladder cancer survivors diagnosed over a 3 year period was obtained from the California Cancer Registry. Respondents completed a survey about their tobacco use and attempts at smoking cessation. Contingency tables and logistic regression analyses were used to evaluate for correlates of successful smoking cessation.

Results: Of total survey respondents, 19% (151 of 790) were active smokers at bladder cancer diagnosis and made up our analytic cohort. The majority of included respondents were male, older than 60, and had smoked for >40 years prior to diagnosis. After diagnosis, 76% (115 of 151) of active smokers made a quit attempt and 56% (65 of 115) were successful. Success with smoking cessation was more frequent among those who attempted to quit around the time of initial bladder cancer diagnosis. The majority (66%) of successful quitters did so "cold turkey" without pharmacotherapy or behavioral therapy. After adjustment for demographic and tobacco-related factors, quit attempts specifically motivated by the bladder cancer diagnosis were highly associated with smoking cessation success (OR 11.6; 95% CI 3.73-35.8). Use of pharmacologic or behavioral therapies in the quit attempt were not significantly associated with successful smoking cessation.

Conclusion: Our data underscore the importance of motivation, timing, and the role of the urologist in the quit attempts of bladder cancer survivors. Emphasis should be placed on ensuring the newly diagnosed make a timely quit attempt informed by the causal role of smoking in their malignancy.
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http://dx.doi.org/10.1016/j.urology.2020.12.033DOI Listing
July 2021

Incorporating an Increase in Plant-Based Food Choices into a Model of Culturally Responsive Care for Hispanic/Latino Children and Adults Who Are Overweight/Obese.

Int J Environ Res Public Health 2020 07 6;17(13). Epub 2020 Jul 6.

Department of Family Medicine, Adventist Health White Memorial Medical Center, Los Angeles, CA 90033, USA.

The national rate of obesity in US Hispanic/Latinos exceeds all other major ethnic subgroups and represents an important health disparity. Plant-based diet interventions that emphasize whole plant foods with minimal processing and less refined grains and sugar have shown great promise in control of obesity, but there is a paucity of data translating this treatment effect to disparate populations. The objective of our study was to evaluate the efficacy of the Healthy Eating Lifestyle Program (HELP) for accomplishing weight management in a hospital-based, family centered, culturally tailored, plant-based diet intervention for Hispanic/Latino children who were overweight or obese. Our mixed methods evaluation included: (1) A one arm study to measure changes in body mass index (BMI) from pre- to post-intervention, and (2) A stakeholder analysis of the program staff. For children ages 5-12 years who were overweight/obese, we found no evidence of excess weight gain evidenced by BMI Z scores (Z = -0.02, = 0.11). Among the parent/guardians who were overweight or obese, we found a decrease in BMI that was stronger in men (BMI = -0.75 kg/m, = 0.01) than in women (BMI = -0.12 kg/m, = 0.30). A program strength was the cultural tailoring of the plant-based diet choices. : The evaluation raises the possibility that incorporating intervention components of HELP (plant-based food choices, family-based, cultural tailoring) into pediatric weight management can improve the standard of care.
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http://dx.doi.org/10.3390/ijerph17134849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370208PMC
July 2020

Undergraduate support for university smoke-free and vape-free campus policies and student engagement: a quasi-experimental intervention.

J Am Coll Health 2020 Jul 1:1-9. Epub 2020 Jul 1.

Fielding School of Public Health, University of California, Los Angeles, CA, USA.

: College campuses have policies restricting smoking/vaping on campus. Previous studies involving mostly European-American students showed smoking prevalence declines following implementation of such policies. To evaluate a social media campaign promotive of stronger campus support for an existing campus no-smoking/no-vaping policy where most (∼75%) of the undergraduates were non-European-American. A demographically comparable university served as a no-intervention control. Target was 200 random intercept surveys at each university during fall 2016, spring 2017. Of 800 respondents, 681 were undergraduates. Baseline and post-intervention surveys assessed awareness of and support for campus-wide smoke-free/vape-free policies. Staged smoke-free/vape-free policy violations assessed students' propensity to intervene in support of the policy. Respondent support for the no-smoking/no-vaping policy did not change. The social media campaign and Policy Ambassadors program did not increase support for the campus no-smoking/no-vaping policy. Most (∼90%) respondents agreed that the campus no-smoking/no-vaping policy was important for public health.
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http://dx.doi.org/10.1080/07448481.2020.1782920DOI Listing
July 2020

Cross-Sectional and Longitudinal Construct Validity of the Generic KINDL-A(dult)B(rief) Questionnaire in Adults with Thrombophilia or with Hereditary and Acquired Bleeding Disorders.

Acta Haematol 2021 5;144(2):166-175. Epub 2020 Jun 5.

Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany,

Background/aims: The newly adapted generic KINDL-A(dult)B(rief) questionnaire showed satisfactory cross-sectional psychometric properties in adults with bleeding disorders or thrombophilia. This investigation aimed to evaluate its cross-sectional and longitudinal construct validity.

Methods: After ethical committee approval and written informed consent, 335 patients (mean age 51.8 ± 16.6 years, 60% women) with either predominant thrombophilia (n = 260) or predominant bleeding disorders (n = 75) participated. At baseline, patients answered the KINDL-AB, the MOS 36-item Short-Form Health Survey (SF-36), and the EQ-5D-3L. A subgroup of 117 patients repeated the questionnaire after a median follow-up of 2.6 years (range: 0.4-3.5). A priori hypotheses were evaluated regarding convergent correlations between KINDL-AB overall well-being and specific subscales, EQ-5D-3L index values (EQ-IV), EQ-5D visual analog scale (EQ-VAS), and SF-36 subscales.

Results: Contrary to hypothesis, baseline correlations between the KINDL-AB and EQ-IV/EQ-VAS were all moderate while, as hypothesized, several KINDL-AB subscales and SF-36 subscales correlated strongly. At follow-up, no significant changes in all three instruments occurred. Correlations between instruments over the follow-up were mostly moderate and partially strong. Contrary to hypothesis but consistent with no significant changes in health-related quality of life, convergent correlations between changes in KINDL-AB overall well-being, physical and psychological well-being, and EQ-IV/EQ-VAS were all weak.

Conclusions: While repeated measures of KINDL-AB showed moderate to strong correlations, changes in KINDL-AB overall well-being and subscales correlated more weakly than expected with changes involving two established instruments of generic health status.
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http://dx.doi.org/10.1159/000507602DOI Listing
April 2021

Risk of developing pre-diabetes or diabetes over time in a cohort of Mexican health workers.

PLoS One 2020 25;15(3):e0229403. Epub 2020 Mar 25.

Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Ciudad de México, México.

Aim: To determine the association between known risk factors (e.g., obesity, metabolic syndrome and its components) and the development of pre-diabetes or diabetes over time in a cohort of Mexican health workers.

Methods: Participants in the Mexican Health Worker Cohort Study with complete information at two waves of data collection, 2004-2006 (W1) and 2011-2013 (W2), were included in the analysis (n = 1,174). Multivariable binary and multinomial logistic regression were used to examine the cross-sectional associations between specific risk factors and diabetes status (diabetes, pre-diabetes, or neither) at W1 and the longitudinal associations between changes in risk factors and progression of diabetes status from W1 to W2, respectively.

Results: Mean time between waves was 7.0 years (SD 1.1). Prevalence of pre-diabetes and diabetes was 16% and 10% at W1 and increased to 30% and 16% at W2, respectively. The cross-sectional prevalence of pre-diabetes and diabetes was significantly higher among men, participants over the age of 45 years, and individuals who were overweight or obese or had metabolic syndrome (MS), three or more components of the MS, elevated alanine aminotransferase (ALT) levels, or elevated uric acid. In longitudinal analyses, remaining obese or gaining weight between waves was associated with an increased risk of developing pre-diabetes. A greater risk of developing pre-diabetes or diabetes was also observed among individuals who either maintained or acquired MS, elevated ALT, or elevated uric acid (only for diabetes) from W1 to W2.

Conclusions: Weight gain and acquiring or maintaining MS, elevated ALT levels, or elevated uric acid were associated with a significant risk of developing pre-diabetes or diabetes. Our findings, especially in the context of the obesity epidemic in Mexico, point towards an urgent need for initiatives to help reduce excess weight in order to avert future cases of pre-diabetes and diabetes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229403PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094846PMC
June 2020

Secondary analysis of an RCT on Emergency Department-Initiated Tobacco Control: Repeatedly assessed point-prevalence abstinence up to 12 months and extension of results through a 10-year follow-up.

Tob Induc Dis 2019 5;17:26. Epub 2019 Apr 5.

Department of Anesthesiology and Intensive Care Medicine, Charité- Universitätsmedizin Berlin, Berlin, Germany.

Introduction: Emergency departments (EDs) are opportune places for tobacco control interventions. The 'Tobacco Control in an Urban Emergency Department' (TED) study, ISRCTN41527831, originally evaluated the effect of motivational interviewing on-site plus up to four booster telephone calls on 12-month abstinence. This study's aim was to evaluate the effect of the intervention on 7-day point-prevalence abstinence at 10 years follow-up (primary outcome) as well as on repeated point-prevalence abstinence at 1, 3, 6, 12 months and at 10 years (continual smoking abstinence, secondary outcome).

Methods: At the 10 years follow-up and after informed consent, study participants responded to a mailed questionnaire. The primary outcome was analyzed in observed-only and in all-cases analyses. The secondary outcomes were analyzed using a multiple adjusted GLMM for binary outcomes.

Results: Out of 1012 TED-study participants, 986 (97.4%) were alive and 231 (23.4% of 986) responded to the follow-up at 10 years. For observed-only and all-cases analyses, the effect of the baseline intervention on 7-day point-prevalence abstinence at the 10 years follow-up was statistically non-significant. However, when taking into account all repeated measures, the intervention significantly influenced continual abstinence with odds ratio 1.32 (95% CI: 1.01-1.73; p=0.042). Baseline motivation, perceived self-efficacy to stop smoking, and nicotine dependency were independently associated with long-term continual smoking abstinence (all p<0.05).

Conclusions: A conventional analysis failed to confirm a significant effect of the ED-initiated tobacco control intervention on the point-prevalence abstinence at 10 years. Results from a more integrative analysis nonetheless indicated an enduring intervention effect on continual abstinence among smokers first encountered in the emergency department setting 10 years earlier.
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http://dx.doi.org/10.18332/tid/105579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751984PMC
April 2019

Evidence for the Full Potential of Daily Food Choices to Minimize Premature Mortality.

JAMA Intern Med 2019 08;179(8):1148-1149

Department of Digestive Diseases, David Geffen School of Medicine at UCLA, University of California, Los Angeles.

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http://dx.doi.org/10.1001/jamainternmed.2019.2205DOI Listing
August 2019

Comparative effectiveness trial comparing MyPlate to calorie counting for mostly low-income Latino primary care patients of a federally qualified community health center: study design, baseline characteristics.

BMC Public Health 2019 Jul 24;19(1):990. Epub 2019 Jul 24.

UCLA Fielding School of Public Health, A2-125 CHS, mc 690015, 650 Charles Young Drive, Los Angeles, CA, 90095, USA.

Background: Primary care-based behavior change obesity treatment has long featured the Calorie restriction (CC), portion control approach. By contrast, the MyPlate-based obesity treatment approach encourages eating more high-satiety/high-satiation foods and requires no calorie-counting. This report describes study methods of a comparative effectiveness trial of CC versus MyPlate. It also describes baseline findings involving demographic characteristics and their associations with primary outcome measures and covariates, including satiety/satiation, dietary quality and acculturation.

Methods: A comparative effectiveness trial was designed to compare the CC approach (n = 130) versus a MyPlate-based approach (n = 131) to treating patient overweight. Intervenors were trained community health workers. The 11 intervention sessions included two in-home health education sessions, two group education sessions, and seven telephone coaching sessions. Questionnaire and anthropometric assessments occurred at baseline, 6- and 12 months; food frequency questionnaires were administered at baseline and 12 months. Participants were overweight adult primary care patients of a federally qualified health center in Long Beach, California. Two measures of satiety/satiation and one measure of post-meal hunger comprised the primary outcome measures. Secondary outcomes included weight, waist circumference, blood pressure, dietary quality, sugary beverage intake, water intake, fruit and vegetable fiber intake, mental health and health-related quality of life. Covariates included age, gender, nativity status (U.S.-born, not U.S.-born), race/ethnicity, education, and acculturation.

Analysis: Baseline characteristics were compared using chi square tests. Associations between covariates and outcome measures were evaluated using multiple regression and logistic regression.

Results: Two thousand eighty-six adult patients were screened, yielding 261 enrollees who were 86% Latino, 8% African American, 4% White and 2% Other. Women predominated (95%). Mean age was 42 years. Most (82%) were foreign-born; 74% chose the Spanish language option. Mean BMI was 33.3 kg/m; mean weight was 82 kg; mean waist circumference was 102 cm. Mean blood pressure was 122/77 mm. Study arms on key baseline measures did not differ except on dietary quality and sugary beverage intake. Nativity status was significantly associated with dietary quality.

Conclusions: The two treatment arms were well-balanced demographically at baseline. Nativity status is inversely related to dietary quality.

Trial Registration: NCT02514889 , posted on 8/4/2015.
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http://dx.doi.org/10.1186/s12889-019-7294-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6651946PMC
July 2019

Corrigendum: Plant-Based Diets Are Associated With Lower Adiposity Levels Among Hispanic/Latino Adults in the Adventist Multi-Ethnic Nutrition (AMEN) Study.

Front Nutr 2019 12;6:88. Epub 2019 Jun 12.

Health Policy and Management, School of Public Health, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States.

[This corrects the article DOI: 10.3389/fnut.2019.00034.].
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http://dx.doi.org/10.3389/fnut.2019.00088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581749PMC
June 2019

Healthy diets and sustainable food systems.

Lancet 2019 07 21;394(10194):214. Epub 2019 Jun 21.

Division of Clinical Nutrition, Geffen School of Medicine, The University of California, Los Angeles, CA 90095, USA.

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http://dx.doi.org/10.1016/S0140-6736(19)31109-2DOI Listing
July 2019

Plant-Based Diets Are Associated With Lower Adiposity Levels Among Hispanic/Latino Adults in the Adventist Multi-Ethnic Nutrition (AMEN) Study.

Front Nutr 2019 9;6:34. Epub 2019 Apr 9.

Health Policy and Management, School of Public Health, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States.

The Hispanic/Latino population in the US is experiencing high rates of obesity and cardio-metabolic disease that may be attributable to a nutrition transition away from traditional diets emphasizing whole plant foods. In the US, plant-based diets have been shown to be effective in preventing and controlling obesity and cardio-metabolic disease in large samples of primarily non-Hispanic subjects. Studying this association in US Hispanic/Latinos could inform culturally tailored interventions. To examine whether the plant-based diet pattern that is frequently followed by Hispanic/Latino Seventh-day Adventists is associated with lower levels of adiposity and adiposity-related biomarkers. The Adventist Multiethnic Nutrition Study (AMEN) enrolled 74 Seventh-day Adventists from five Hispanic/Latino churches within a 20 mile radius of Loma Linda, CA into a cross-sectional study of diet (24 h recalls, surveys) and health (anthropometrics and biomarkers). Vegetarian diet patterns (Vegan, Lacto-ovo vegetarian, Pesco-vegetarian) were associated with significantly lower BMI (24.5 kg/m vs. 27.9 kg/m, = 0.006), waist circumference (34.8 in vs. 37.5 in, = 0.01), and fat mass (18.3 kg vs. 23.9 kg, = 0.007), as compared to non-vegetarians. Adiposity was positively associated with pro-inflammatory cytokines (Interleukin-6) in this sample, but adjusting for this effect did not alter the associations with vegetarian diet. Plant-based eating as practiced by US-based Hispanic/Latino Seventh-day Adventists is associated with BMI in the recommended range. Further work is needed to characterize this type of diet for use in obesity-related interventions among Hispanic/Latinos in the US.
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http://dx.doi.org/10.3389/fnut.2019.00034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465543PMC
April 2019

Eating Veggies Is Fun! An Implementation Pilot Study in Partnership With a YMCA in South Los Angeles.

Prev Chronic Dis 2018 11 1;15:E132. Epub 2018 Nov 1.

Center for Cancer Prevention and Control Research, University of California, Los Angeles, Fielding School of Public Health, and Jonsson Comprehensive Cancer Center, Los Angeles, California.

Purpose And Objectives: Children eat less than recommended amounts of vegetables. Repeated taste exposure can increase children's acceptance of initially disliked vegetables. However, implementation of this strategy is lacking. We conducted a pilot study to assess the feasibility of implementing an evidence-based intervention to promote liking of initially disliked vegetables among children enrolled in a YMCA summer camp.

Intervention Approach: We adapted a research-tested intervention to promote child liking of vegetables for implementation in small groups. In summer 2015, 50 children aged 7 to 12 years were invited to taste 5 initially disliked vegetables daily for 10 days.

Evaluation Methods: Children rated how much they liked vegetables on a 5-point emoji-like faces Likert scale at baseline and 2- and 4-week follow-up. The mean ratings for liked and initially disliked vegetables were estimated over time using mixed effects modeling.

Results: We achieved excellent participation of parents and children; however, we experienced nonstudy-related attrition caused by disenrollment of some children from the weekly camp program. The average liking increased over time (linear trend, P = .003) for the 5 targeted vegetables but not for the other nontargeted vegetables, as predicted.

Implications For Public Health: This pilot study suggests that repeated vegetable tasting opportunities offered by community programs may be a practical strategy for introducing low-income, young children to new or initially disliked vegetables. The study demonstrates the feasibility of implementing a health promotion strategy that has the potential to improve population health in a community setting in an underresourced neighborhood.
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http://dx.doi.org/10.5888/pcd15.180150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219845PMC
November 2018

Psychometric Properties of a Modified KINDL-R Questionnaire for Adolescents and Adults, and Construction of a Brief Version, the KINDL-A(dult)B(rief) Questionnaire, KINDL-AB.

Acta Haematol 2018 13;140(1):1-9. Epub 2018 Jul 13.

Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany.

Background/aims: The generic quality of life KINDL-R -questionnaire is validated for use in children/adolescents ≤16 years. The aim of this cross-sectional investigation was to modify the KINDL-R questionnaire for use in adults and to validate its psychometric properties.

Methods: Five items of the KINDL-R questionnaire were adapted and the newly developed KINDL-A(dult) questionnaire administered to 255 patients with hereditary and acquired bleeding disorders (mean age 53 years). Its internal consistency and convergent and divergent construct validity were investigated and confirmatory factor analysis was used to evaluate the latent factor structure.

Results: The KINDL-A questionnaire showed satisfactory reliability, varying construct validity, but inconclusive factor structure. The KINDL-AB(rief) was developed by removing half of the items and combining 2 sub-axes. This led to factor loadings between 0.62 and 0.91 and increased overall fit (Goodness of fit > 0.8 and Root Mean Square Error of Approximation, RMSEA, < 0.08). Results were validated in 966 healthy blood donors (mean age 38 years). In this group, the KINDL-AB questionnaire showed factor loadings between 0.43 and 0.77, Goodness of fit > 0.95 and RMSEA < 0.05.

Conclusions: The new KINDL-AB suggests sufficient to good psychometric properties in adult patients with hereditary and acquired bleeding disorders.
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http://dx.doi.org/10.1159/000490408DOI Listing
June 2019

Longitudinal study of adolescent tobacco use and tobacco control policies in India.

BMC Public Health 2018 07 3;18(1):815. Epub 2018 Jul 3.

Department of Health Policy and Management, University of California, Los Angeles, USA.

Background: This project will use a multilevel longitudinal cohort study design to assess whether changes in Community Tobacco Environmental (CTE) factors, measured as community compliance with tobacco control policies and community density of tobacco vendors and tobacco advertisements, are associated with adolescent tobacco use in urban India. India's tobacco control policies regulate secondhand smoke exposure, access to tobacco products and exposure to tobacco marketing. Research data about the association between community level compliance with tobacco control policies and youth tobacco use are largely unavailable, and are needed to inform policy enforcement, implementation and development.

Methods: The geographic scope will include Mumbai and Kolkata, India. The study protocol calls for an annual comprehensive longitudinal population-based tobacco use risk and protective factors survey in a cohort of 1820 adolescents ages 12-14 years (and their parent) from baseline (Wave 1) to 36-month follow-up (Wave 4). Geographic Information Systems data collection will be used to map tobacco vendors, tobacco advertisements, availability of e-cigarettes, COTPA defined public places, and compliance with tobacco sale, point-of-sale and smoke-free laws. Finally, we will estimate the longitudinal associations between CTE factors and adolescent tobacco use, and assess whether the associations are moderated by family level factors, and mediated by individual level factors.

Discussion: India experiences a high burden of disease and mortality from tobacco use. To address this burden, significant long-term prevention and control activities need to include the joint impact of policy, community and family factors on adolescent tobacco use onset. The findings from this study can be used to guide the development and implementation of future tobacco control policy designed to minimize adolescent tobacco use.
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http://dx.doi.org/10.1186/s12889-018-5727-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029385PMC
July 2018

Compliance with point-of-sale tobacco control policies and student tobacco use in Mumbai, India.

Tob Control 2019 03 9;28(2):220-226. Epub 2018 May 9.

Healis Sekhsaria Institute for Public Health, Mumbai, India.

Background: We measured how student tobacco use and psychological risk factors (intention to use and perceived ease of access to tobacco products) were associated with tobacco vendor compliance with India's Cigarettes and Other Tobacco Products Act provisions regulating the point-of-sale (POS) environment.

Methods: We conducted a population-based cross-sectional survey of high school students (n=1373) and tobacco vendors (n=436) in school-adjacent communities (n=26) in Mumbai, India. We used in-class self-administered questionnaires of high school students, face-to-face interviews with tobacco vendors and compliance checks of tobacco POS environments. Logistic regression models with adjustments for clustering were used to measure associations between student tobacco use, psychological risk factors and tobacco POS compliance.

Results: Compliance with POS laws was low overall and was associated with lower risk of student current tobacco use (OR 0.48, 95% CI 0.26 to 0.91) and current smokeless tobacco use (OR 0.40, 95% CI 0.21 to 0.77), when controlling for student-level and community-level tobacco use risk factors. Compliance was not associated with student intention to use tobacco (OR 0.50; 95% CI 0.21 to 1.18) and perceived ease of access to tobacco (OR 0.73; 95% CI 0.53 to 1.00).

Conclusions: Improving vendor compliance with tobacco POS laws may reduce student tobacco use. Future studies should test strategies to improve compliance with tobacco POS laws, particularly in low-income and middle-income country settings like urban India.
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http://dx.doi.org/10.1136/tobaccocontrol-2018-054290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6411039PMC
March 2019

Smoke-Free Car Legislation and Student Exposure to Smoking.

Pediatrics 2018 01;141(Suppl 1):S40-S50

Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California.

Background: Policies protecting children from exposure to secondhand smoke (SHS) may help prevent SHS-related negative health outcomes in children and discourage them from intending to smoke in the future. In this study, we assess the impact of California's 2007 smoke-free vehicle law on changes in middle and high school students' reported exposure to smoking in cars. Secondary aims included assessing the association of student-reported exposure to smoking in vehicles and lifetime asthma diagnosis and future intentions to smoke.

Methods: Population-weighted data from the California Student Tobacco Survey and the National Youth Tobacco Survey were used to evaluate California and national trends, respectively. Weighted logistic regression models using California Student Tobacco Survey 2011 data assessed the association between the number of days of exposure to smoking in cars and student-reported lifetime asthma diagnosis as well as intention to smoke in the future.

Results: The proportion of California students reporting exposure to smoking in cars in the last 7 days declined <1% annually from 2001 through 2005, but declined 12% annually from 2007 to 2011. National trends did not show comparable declines after 2006. Students reporting exposure to smoking in vehicles were more likely to report having ever been diagnosed with asthma and intending to smoke in the future than students who were not exposed to SHS.

Conclusions: These findings support the legislative intent that public policies that are designed to protect children from exposure to smoking in vehicles will yield better adolescent health outcomes and a lower risk of future adolescent cigarette smoking.
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http://dx.doi.org/10.1542/peds.2017-1026HDOI Listing
January 2018

How can we help African American substance users stop smoking? client and agency perspectives.

J Ethn Subst Abuse 2019 Jul-Sep;18(3):428-444. Epub 2017 Dec 19.

a Department of Health Policy and Management , UCLA Fielding School of Public Health , Los Angeles , California.

Research is needed to better understand barriers to smoking cessation and sustained abstinence among racial/ethnic minority polydrug users. We conducted community dialogue groups involving 49 clients in substance use treatment programs with predominantly ethnic minority clientele and individual dialogues/interviews with seven program providers (stakeholders). Most clients were African American, under 40 years old, women, current smokers, and high school graduates. Smoking cessation services in these programs were considered inadequate and community programs insufficiently culturally tailored and economically and geographically inaccessible. Participants discussed individual "willpower" and choice; agency tobacco-related programs and policies; the relationships between smoking, smoking cessation, and treatment goals; and steps needed to reshape agency services and policies to provide greater support for smoking cessation in this at-risk population.
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http://dx.doi.org/10.1080/15332640.2017.1404955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237654PMC
June 2020

Emergency Department-Initiated Tobacco Control: Update of a Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Prev Chronic Dis 2017 10 5;14:E89. Epub 2017 Oct 5.

Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany. Email:

Introduction: A 2012 systematic review and meta-analysis of randomized controlled trials on emergency department-initiated tobacco control (ETC) showed only short-term efficacy. The aim of this study was to update data through May 2015.

Methods: After registering the study protocol on the international prospective register of systematic reviews (PROSPERO) in May 2015, we searched 7 databases and the gray literature. Our outcome of interest was the point prevalence of tobacco-use abstinence at 1-month, 3-month, 6-month, or 12-month follow-up. We calculated the relative risk (RR) of tobacco-use abstinence after ETC at each follow-up time separately for each study and then pooled Mantel-Haenszel RRs by follow-up time. These results were pooled with results of the 7 studies included in the previous review. We calculated the effect of ETC on the combined point prevalence of tobacco-use abstinence across all follow-up times by using generalized linear mixed models.

Results: We retrieved 4 additional studies, one published as an abstract, comprising 1,392 participants overall. The 1-month follow-up point prevalence of tobacco-use abstinence after ETC resulted in an RR of 1.49 (95% confidence interval [CI], 1.08-2.05) across 3 studies; 3-month follow-up, an RR of 1.38 (95% CI, 1.12-1.71) across 9 studies; 6-month follow-up, an RR of 1.09 (95% CI, 0.84-1.41) across 6 studies; and 12-month follow-up, an RR of 1.26 (95% CI, 1.00-1.59) across 3 studies. The effect on the combined point prevalence of abstinence was an RR of 1.40 (95% CI, 1.06-1.86) (P = .02).

Conclusion: ETC is effective in promoting continual tobacco-use abstinence up to 12 months after intervention. ETC may be a critically important public health strategy for engaging hard-to-reach smokers in tobacco-use cessation.
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http://dx.doi.org/10.5888/pcd14.160434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645196PMC
October 2017

Contextual Factors Related to Conventional and Traditional Tobacco Use Among California Asian Indian Immigrants.

J Community Health 2018 04;43(2):280-290

Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA.

California's tobacco control program contracted for tobacco use surveillance of Asian Indian Americans to address the paucity of information about tobacco use in this community, given their growing proportion of California's population. This study examined correlates of conventional (CTU) and Asian Indian traditional tobacco use (TTU) in a population-based sample of predominantly immigrant Asian Indian adults residing in California (N = 3228). The analytic sample (n = 2140) was limited to self-identified immigrants from India. Descriptive statistics, bivariate analyses, and multivariate logistic regressions were conducted to examine correlates of tobacco use among Asian Indian immigrants related to their acculturation and religious affiliation. While 65% of the sample had ever used traditional tobacco products (paan masala, gutka, bidis), only 25% had ever used conventional tobacco (cigarettes, cigar, pipe, chewing tobacco, snuff). Less than 5% reported tobacco use in the past 30 days. Rates of ever TTU and CTU were higher among men than women. Ethnic enclave residence was not associated with tobacco use. Impaired mental health was associated with CTU, and number of years spent in the U.S. was positively associated with both CTU and TTU. Individuals affiliated with Sikhism were less likely to use tobacco than individuals affiliated with Hinduism. Few population-based studies in the U.S. address both CTU and TTU use among Asian Indian immigrants. Tobacco use in Asian Indian immigrants may be seriously underestimated if surveillance is limited to conventional tobacco products. Interventions to reduce tobacco use should address mental health issues and consider religious affiliation.
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http://dx.doi.org/10.1007/s10900-017-0419-3DOI Listing
April 2018

E-cigarette specialty retailers: Data to assess the association between retail environment and student e-cigarette use.

Data Brief 2017 Apr 7;11:32-38. Epub 2017 Jan 7.

UCLA Fielding School of Public Health, Center for Cancer Prevention & Control Research, A2-125 CHS, 650 Charles Young Drive, Los Angeles 90095-6900, USA.

The retail environment is a major social determinant of health, yet little is known about the e-cigarette specialty retailer environment. The e-cigarette specialty retail environment may be associated with e-cigarette use by middle and high school students, an issue that was addressed in a recent article entitled, "E-cigarette use among students and e-cigarette specialty retailer presence near schools," by Bostean and colleagues (G. Bostean, C.M. Crespi, P. Vorapharuek, W.J. McCarthy, 2016 [1]). We present data relating to e-cigarette specialty retailers in Orange County, California. We describe the data collection method (including the search methodology to identify e-cigarette specialty retailers), present descriptive retailer data including school proximity, and provide data from multi-level regressions predicting individual-level student use of e-cigarettes based on presence of an e-cigarette specialty retailer in proximity to schools.
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http://dx.doi.org/10.1016/j.dib.2016.12.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247279PMC
April 2017

E-cigarette use among students and e-cigarette specialty retailer presence near schools.

Health Place 2016 11 19;42:129-136. Epub 2016 Oct 19.

UCLA Fielding School of Public Health, Center for Cancer Prevention & Control Research, A2-125 CHS, 650 Charles Young Drive, Los Angeles 90095-6900, United States. Electronic address:

Objective: This study examined the association between presence of e-cigarette specialty retailers near schools and e-cigarette use among middle and high school students in Orange County (OC), CA.

Methods: The OC subsample of the 2013-2014 California Healthy Kids Survey (N=67,701) was combined with geocoded e-cigarette retailers to determine whether a retailer was present within one-quarter mile of each public school in OC. Multilevel logistic regression models evaluated individual-level and school-level e-cigarette use correlates among middle and high school students.

Results: Among middle school students, the presence of an e-cigarette retailer within one-quarter mile of their school predicted lifetime e-cigarette use (OR=1.70, 95% CI=1.02, 2.83), controlling for confounders but no effect for current use. No significant effect was found for high school students.

Conclusions: E-cigarette specialty retailers clustered around schools may be an environmental influence on student e-cigarette experimentation.
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http://dx.doi.org/10.1016/j.healthplace.2016.09.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126978PMC
November 2016

Trends of Child's Weight Perception by Children, Parents, and Healthcare Professionals during the Time of Terminology Change in Childhood Obesity in the United States, 2005-2014.

Child Obes 2016 12 6;12(6):463-473. Epub 2016 Oct 6.

3 UCLA Center for Cancer Prevention and Control Research , Los Angeles, CA.

Objective: To investigate the changes on self- and parental weight perceptions and parental communication with healthcare professionals (HCPs) in the United States during the mid-2000s period when the terminology changed for classifications of childhood obesity/overweight.

Methods: A repeated cross-sectional study was conducted with 6799 children aged 8-15 years with the National Health and Nutrition Examination Survey 2005-2014. BMI was calculated from objectively measured heights and weights, and children were classified as normal/underweight, overweight or obese, using the new terminology. Children reported their own weight status. Parents reported their child's weight status and reported how HCPs described their children's weight status. Logistic regressions were used to investigate changes in weight perceptions among overweight/obese children themselves and their parents and parental communication with HCPs about children's overweight/obesity status during the time of the terminology change.

Results: The proportion of parents told by HCPs about children's weight status increased for overweight children [6.8% in 2005-2006 to 18.8% in 2013-2014, p for trend (p = 0.02)], and marginally increased between 2005-2006 (37.1%) and 2007-2008 (45.4%) for obese children (p = 0.09). However, parental perceptions for obese/overweight children did not change. Also, obese children's weight perception did not change, and the proportion of overweight children who perceived their weight status accurately declined in 2005-2012 (25.9%-16.4%, p = 0.02).

Conclusions: Although the terminology change about childhood obesity/overweight was associated with increased communication about child's weight status by HCPs, the accuracy of weight perceptions among obese/overweight children or their parents did not improve or declined.
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http://dx.doi.org/10.1089/chi.2016.0128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107670PMC
December 2016

Training the Next Generation of Latino Health Researchers: A Multilevel, Transdisciplinary, Community-Engaged Approach.

Health Promot Pract 2017 07 8;18(4):497-504. Epub 2016 Sep 8.

1 UCLA Center for Population Health and Health Disparities, Los Angeles, CA, USA.

Reducing health disparities is a national public health priority. Latinos represent the largest racial/ethnic minority group in the United States and suffer disproportionately from poor health outcomes, including cardiovascular disease risk. Academic training programs are an opportunity for reducing health disparities, in part by increasing the diversity of the public health workforce and by incorporating training designed to develop a skill set to address health disparities. This article describes the Training and Career Development Program at the UCLA Center for Population Health and Health Disparities: a multilevel, transdisciplinary training program that uses a community-engaged approach to reduce cardiovascular disease risk in two urban Mexican American communities. Results suggest that this program is effective in enhancing the skill sets of traditionally underrepresented students to become health disparities researchers and practitioners.
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http://dx.doi.org/10.1177/1524839916665091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548049PMC
July 2017

The Association of Religious Affiliation with Overweight/Obesity Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study.

J Relig Health 2018 Feb;57(1):33-46

UCSF Division of General Internal Medicine, 1545 Divisadero Street, Suite 311, San Francisco, CA, 94115, USA.

Religiosity has been associated with greater body weight. Less is known about South Asian religions and associations with weight. Cross-sectional analysis of the MASALA study (n = 906). We examined associations between religious affiliation and overweight/obesity after controlling for age, sex, years lived in the USA, marital status, education, insurance status, health status, and smoking. We determined whether traditional cultural beliefs, physical activity, and dietary pattern mediated this association. The mean BMI was 26 kg/m. Religious affiliation was associated with overweight/obesity for Hindus (OR 2.12; 95 % CI: 1.16, 3.89), Sikhs (OR 4.23; 95 % CI: 1.72, 10.38), and Muslims (OR 2.79; 95 % CI: 1.14, 6.80) compared with no religious affiliation. Traditional cultural beliefs (7 %), dietary pattern (1 %), and physical activity (1 %) mediated 9 % of the relationship. Interventions designed to promote healthy lifestyle changes to reduce the burden of overweight/obesity among South Asians need to be culturally and religiously tailored.
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http://dx.doi.org/10.1007/s10943-016-0290-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269531PMC
February 2018

Adult Intake of Minimally Processed Fruits and Vegetables: Associations with Cardiometabolic Disease Risk Factors.

J Acad Nutr Diet 2016 09 10;116(9):1387-1394. Epub 2016 May 10.

Background: The US Department of Agriculture launched ChooseMyPlate.gov nutrition recommendations designed to encourage increased fruit and vegetable intake, in part, as a strategy for improving weight control through the consumption of high-satiation foods.

Objective: The purpose of this cross-sectional study was to assess the relationship between adults' reported daily intake of fruits and nonstarchy vegetables (ie, those thought to have the lowest energy density) expressed as a proportion of their total daily food intake and objectively measured cardiovascular and metabolic disease risk factors using data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES). Physical activity was included as a moderator variable.

Design: This study employed a cross-sectional examination of 2009-2010 NHANES data to assess how daily fruit and nonstarchy vegetable intake was associated with anthropometric measures and cardiometabolic blood chemistry markers.

Participants/setting: Adults free of cardiac or metabolic disease (n=1,197) participated in 24-hour dietary recalls; a variety of cardiometabolic biomarkers and anthropometric measures were also collected from participants.

Main Outcome Measures: Among participants with complete data on all variables, the ratio of the combined cup-equivalents of fruit and nonstarchy vegetable intake to the total gram weight of all foods consumed daily (F/V ratio) served as the primary independent variable. Main dependent measures included fasting glucose, insulin, glycosylated hemoglobin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, total cholesterol, waist circumference, and body mass index.

Statistical Analyses Performed: Demographic and behavioral predictors of the F/V ratio and the association between the F/V ratio and cardiometabolic disease risk factors were examined using multivariate regression.

Results: Body mass index (β=-2.58; 95% CI -3.88 to -1.28), waist circumference (β=-6.33; 95% CI -9.81 to -2.84), and insulin (β=-0.21; 95% CI -0.37 to -0.05) were inversely associated with the F/V ratio. These associations were weakened for the subset that adhered to federal physical activity recommendations. No other statistically significant associations were found between F/V ratio and main dependent measures.

Conclusions: In this nationally representative sample, predicted inverse associations between the proportion of daily fruit and nonstarchy vegetable intake relative to total intake and measures reflective of body fat composition and fasting insulin were confirmed. Future research should examine whether a similar association is observed for other sources of resistant starch, such as whole grains, which are arguably more strongly linked with satiety and host insulin levels.
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http://dx.doi.org/10.1016/j.jand.2016.03.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034720PMC
September 2016

Bostean et al. Respond.

Am J Public Health 2016 May;106(5):e13-4

Georgiana Bostean is with the Sociology Department and Environmental Science and Policy Program, Chapman University, Orange, CA. Dennis R. Trinidad is with the Department of Family Medicine and Public Health, University of California, San Diego. William J. McCarthy is with the Center for Cancer Prevention and Control Research, Fielding School of Public Health, University of California, Los Angeles.

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http://dx.doi.org/10.2105/AJPH.2016.303165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985114PMC
May 2016

Characterizing Community Health Workers on Research Teams: Results From the Centers for Population Health and Health Disparities.

Am J Public Health 2016 Apr 21;106(4):664-70. Epub 2016 Jan 21.

Sarah D. Hohl and Beti Thompson are with the Cancer Prevention Program at the Fred Hutchinson Cancer Research Center, and the Department of Health Services, School of Public Health, University of Washington, Seattle. Jessica L. Krok-Schoen, Rory C. Weier, and Electra D. Paskett are with the Comprehensive Cancer Center at The Ohio State University (OSU), Columbus. Molly Martin is with the Department of Pediatrics, University of Illinois at Chicago. Lee Bone is with the Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. William J. McCarthy and Nancy E. Calderón are with the Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health. Sabrina E. Noel is with the Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts, Lowell. Beverly Garcia is with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill.

Objectives: To quantify the characteristics of community health workers (CHWs) involved in community intervention research and, in particular, to characterize their job titles, roles, and responsibilities; recruitment and compensation; and training and supervision.

Methods: We developed and administered a structured questionnaire consisting of 25 closed- and open-ended questions to staff on National Institutes of Health-funded Centers for Population Health and Health Disparities projects between March and April 2014. We report frequency distributions for CHW roles, sought-after skills, education requirements, benefits and incentives offered, and supervision and training activities.

Results: A total of 54 individuals worked as CHWs across the 18 research projects and held a diverse range of job titles. The CHWs commonly collaborated on research project implementation, provided education and support to study participants, and collected data. Training was offered across projects to bolster CHW capacity to assist in intervention and research activities.

Conclusions: Our experience suggests national benefit in supporting greater efforts to recruit, retain, and support the work of CHWs in community-engagement research.
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http://dx.doi.org/10.2105/AJPH.2015.302980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986058PMC
April 2016

Evaluating Policy, Systems, and Environmental Change Interventions: Lessons Learned From CDC's Prevention Research Centers.

Prev Chronic Dis 2015 Oct 15;12:E174. Epub 2015 Oct 15.

Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia.

Introduction: The field of public health is increasingly implementing initiatives intended to make policies, systems, and environments (PSEs) more supportive of healthy behaviors, even though the evidence for many of these strategies is only emerging. Our objective was 3-fold: 1) to describe evaluations of PSE-change programs in which the evaluators followed the steps of the Centers for Disease Control and Prevention's (CDC's) Framework for Program Evaluation in Public Health, 2) to share the resulting lessons learned, and 3) to assist future evaluators of PSE-change programs with their evaluation design decisions.

Methods: Seven Prevention Research Centers (PRCs) applied CDC's framework to evaluate their own PSE-change initiatives. The PRCs followed each step of the framework: 1) engage stakeholders, 2) describe program, 3) focus evaluation design, 4) gather credible evidence, 5) justify conclusions, and 6) ensure use and share lessons learned.

Results: Evaluation stakeholders represented a range of sectors, including public health departments, partner organizations, and community members. Public health departments were the primary stakeholders for 4 of the 7 evaluations. Four PRCs used logic models to describe the initiatives being evaluated. Their evaluations typically included both process and outcome questions and used mixed methods. Evaluation findings most commonly focused on contextual factors influencing change (process) and the adoption or implementation of PSE-change strategies (outcome). Evaluators shared lessons learned through various channels to reach local stakeholders and broader public health audiences.

Conclusion: Framework for Program Evaluation in Public Health is applicable to evaluations of PSE-change initiatives. Using this framework to guide such evaluations builds practice-based evidence for strategies that are increasingly being used to promote healthful behaviors.
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http://dx.doi.org/10.5888/pcd12.150281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4611860PMC
October 2015

E-Cigarette Use Among Never-Smoking California Students.

Am J Public Health 2015 Dec 15;105(12):2423-5. Epub 2015 Oct 15.

Georgiana Bostean is with the Sociology Department and Environmental Science & Policy Program, Chapman University, Orange, CA. Dennis R. Trinidad is with the Department of Family Medicine and Public Health, University of California, San Diego. William J. McCarthy is with the Center for Cancer Prevention & Control Research, Fielding School of Public Health, University of California, Los Angeles.

We determined the extent to which adolescents who have never used tobacco try e-cigarettes. Data on the prevalence and correlates of e-cigarette use among 482,179 California middle and high school students are from the 2013-2014 California Healthy Kids Survey. Overall, 24.4% had ever used e-cigarettes (13.4% have never used tobacco and 11.0% have used tobacco), and 12.9% were current e-cigarette users (5.9% have never used tobacco). Among those who have never used tobacco, males and older students were more likely to use e-cigarettes than females and younger students. Hispanics (odds ratio [OR] = 1.60; confidence interval [CI] = 1.53, 1.67) and those of other races (OR = 1.24; CI = 1.19, 1.29) were more likely than Whites to have ever used e-cigarettes, but only among those who had never used smokeless tobacco and never smoked a whole cigarette. E-cigarette use is very prevalent among California students who have never smoked tobacco, especially among Hispanic and other race students, males, and older students.
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http://dx.doi.org/10.2105/AJPH.2015.302899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638243PMC
December 2015

A Mixed Methods Comparison of Urban and Rural Retail Corner Stores.

AIMS Public Health 2015 26;2(3):554-582. Epub 2015 Aug 26.

UCLA Fielding School of Public Health, University of California, Los Angeles, CA.

Efforts to transform corner stores to better meet community dietary needs have mostly occurred in urban areas but are also needed in rural areas. Given important contextual differences between urban and rural areas, it is important to increase our understanding of the elements that might translate successfully to similar interventions involving stores in more rural areas. Thus, an in-depth examination and comparison of corner stores in each setting is needed. A mixed methods approach, including windshield tours, spatial visualization with analysis of frequency distribution, and spatial regression techniques were used to compare a rural North Carolina and large urban (Los Angeles) food environment. Important similarities and differences were seen between the two settings in regards to food environment context, spatial distribution of stores, food products available, and the factors predicting corner store density. Urban stores were more likely to have fresh fruits (Pearson chi2 = 27.0423; < 0.001) and vegetables (Pearson chi2 = 27.0423; < 0.001). In the urban setting, corner stores in high income areas were more likely to have fresh fruit (Pearson chi2 = 6.00; = 0.014), while in the rural setting, there was no difference between high and low income area in terms of fresh fruit availability. For the urban area, total population, no vehicle and Hispanic population were significantly positively associated ( < 0.05), and median household income ( < 0.001) and Percent Minority ( < 0.05) were significantly negatively associated with corner store count. For the rural area, total population ( < 0.05) and supermarket count were positively associated ( < 0.001), and median household income negatively associated ( < 0.001), with corner store count. Translational efforts should be informed by these findings, which might influence the success of future interventions and policies in both rural and urban contexts.
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http://dx.doi.org/10.3934/publichealth.2015.3.554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690250PMC
August 2015
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