Hypertension Prevalence, Awareness, Treatment, and Control Among Adults Aged ≥18 Years - Los Angeles County, 1999-2006 and 2007-2014.

Hypertension is an important and common risk factor for heart disease and stroke, two of the leading causes of death in adults in the United States. Despite considerable improvement in increasing the awareness, treatment, and control of hypertension, undiagnosed and uncontrolled hypertension remain public health challenges (1). Data from the National Health and Nutrition Examination Survey (NHANES) were used to estimate the prevalence of hypertension, as well as awareness, treatment, and control of hypertension among adults aged ≥18 years in Los Angeles County compared with adults aged ≥18 years in the United States during 1999-2006 and 2007-2014. During 2007-2014, the prevalence of hypertension was 23.1% among adults in Los Angeles County, lower than the prevalence of 29.6% among all U.S. adults. Among adults with hypertension in Los Angeles County, substantial improvements from 1999-2006 to 2007-2014 were found in hypertension awareness (increase from 73.8% to 84.6%), treatment (61.3% to 77.2%), and control (28.5% to 48.3%). Similar improvements were also seen among all U.S. adults. Although the prevalence of hypertension among adults in Los Angeles County meets the Healthy People 2020 (https://www.healthypeople.gov/) goal of ≤26.9%, continued progress is needed to meet the Healthy People 2020 goal of ≥61.2% for control of hypertension.

Framing the Local Context and Estimating the Health Impact of CPPW Obesity Prevention Strategies in Los Angeles County, 2010-2012.

CONTEXT: Few studies have described the range and health impacts of obesity prevention strategies in local communities supported by the Communities Putting Prevention to Work program. OBJECTIVE: To address this gap, we reviewed implemented strategies in Los Angeles County (LAC) for 3 program focus areas: physical activity-promotion, health marketing, and creation of healthy food environments. Local context and results from an impact simulation are presented. DESIGN: Information on population reach and program milestones was synthesized to describe historical and programmatic progress of the obesity prevention efforts during 2010-2012. To forecast health impacts, the Prevention Impacts Simulation Model (PRISM) was used to simulate population health outcomes, including projected changes in obesity burden and health behaviors 30 years into the future. SETTING: LAC with more than 9.8 million residents. PARTICIPANTS: Low-income adults and youth who were the intended audiences of the Communities Putting Prevention to Work program in LAC. INTERVENTION: Implemented strategies for the 3 focus areas. MAIN OUTCOME MEASURES: Documentation of program reach and PRISM forecasting of obesity rates and health impacts. RESULTS: Implemented strategies in LAC ranged from best practices in healthy food procurement (estimated reach: 600 000 students, 300 000 meals per day) to completed shared-use agreements (10+ agreements across 5 school districts) to a series of strategically designed health marketing campaigns on healthy eating (>515 million impressions). On the basis of PRISM simulations, these highlighted program activities have the potential to reduce by 2040 the number of youth (-29 870) and adults (-94 136) with obesity, youth (-112 453) and adults (-855 855) below recommended levels of physical activity, and youth (-14 544) and adults (-28 835) who consumed excess junk food, as compared with baseline (2010-2011). CONCLUSIONS: Program context and PRISM-simulated health impacts showed modest but promising results in LAC, which may lead to further population health improvements in the future. Downstream health and behavioral surveillance data are needed to confirm these estimates.

Public awareness of and support for infrastructure changes designed to increase walking and biking in Los Angeles County.

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.

Stemming the tide: rising diabetes prevalence and ethnic subgroup variation among Asians in Los Angeles County.

OBJECTIVE: The primary objective of this analysis was to examine the burden of diabetes among Asians and Asian subgroups in Los Angeles County, which has the largest county population of Asians in the U.S. METHOD: Data were analyzed from 6cycles of the Los Angeles County Health Survey, 1997-2011 (n=47,282). Asian adults (n=4672) were categorized into the following ethnic subgroups: Chinese, Filipino, Korean, Japanese, Vietnamese, South Asian, and Other Asian. Descriptive and multivariable logistic regression analyses were conducted to examine trends in prevalence, prevalence among Asian subgroups, and factors associated with diabetes. RESULTS: In 2005, we observed a rapid increase in diabetes prevalence among Asians compared to whites despite consistently lower BMI relative to other racial/ethnic groups. Diabetes prevalence was significantly higher among Filipinos and South Asians (>10%) compared to East Asians and Vietnamese (<7%). After adjusting for all covariates, Asians who were older, non-drinkers, insured, and overweight or obese were found to have increased odds of diabetes. CONCLUSION: Diabetes prevalence is increasing more rapidly among Asians compared to whites despite overall lower BMI. The significant heterogeneity among Asian subgroups highlights the need for disaggregated data and additional research to develop culturally appropriate interventions for diabetes prevention and control.

Public opinion on nutrition-related policies to combat child obesity, Los Angeles County, 2011.

We assessed public opinion on nutrition-related policies to address child obesity: a soda tax, restrictions on advertising unhealthy foods and beverages to children, and restrictions on siting fast food restaurants and convenience stores near schools. We analyzed data from 998 adults (aged ≥18 years) in the 2011 Los Angeles County Health Survey. Support was highest for advertising restrictions (74%), intermediate for a soda tax (60%), and lowest for siting restrictions on fast food restaurants and convenience stores (44% and 37%, respectively). Support for food and beverage advertising restrictions and soda taxation is promising for future policy efforts to address child obesity.

The "sugar pack" health marketing campaign in Los Angeles County, 2011-2012.

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.

Declines in sugar-sweetened beverage consumption among children in Los Angeles County, 2007 and 2011.

This study assessed changes in consumption of sugar-sweetened beverages (SSBs) among children (aged≤17 years) in Los Angeles County. We analyzed children's data from the 2007 (n=5,595) and 2011 (n=5,934) Los Angeles County Health Survey. The percentage of children who consumed 1 or more SSB per day decreased from 43.3% in 2007 to 38.3% in 2011 (P<.001); this decrease was seen across most sociodemographic subgroups. Despite measurable progress in reducing SSB consumption among children in Los Angeles County, consumption remains high, highlighting the need for additional policy and programmatic interventions.

Estimating the potential health impact and costs of implementing a local policy for food procurement to reduce the consumption of sodium in the county of Los Angeles.

OBJECTIVES: We examined approaches to reduce sodium content of food served in settings operated or funded by the government of the County of Los Angeles, California. METHODS: We adapted health impact assessment methods to mathematically simulate various levels of reduction in the sodium content of food served by the County of Los Angeles and to estimate the reductions' potential impacts on mean systolic blood pressure (SBP) among food-service customers. We used data provided by county government food-service vendors to generate these simulations. RESULTS: Our analysis predicted that if the postulated sodium-reduction strategies were implemented, adults would consume, on average, 233 fewer milligrams of sodium each day. This would correspond to an average decrease of 0.71 millimeters of mercury in SBP among adult hypertensives, 388 fewer cases of uncontrolled hypertension in the study population, and an annual decrease of $629,724 in direct health care costs. CONCLUSIONS: Our findings suggest that a food-procurement policy can contribute to positive health and economic effects at the local level. Our approach may serve as an example of sodium-reduction analysis for other jurisdictions to follow.

Facilitators and barriers to implementing a local policy to reduce sodium consumption in the County of Los Angeles government, California, 2009.

INTRODUCTION: This qualitative study explores facilitators and barriers to a proposed food procurement policy that would require food purchasers, distributors, and vendors of food service in the County of Los Angeles government to meet specified nutrition standards, including limits on sodium content. METHODS: We conducted 30 key informant interviews. Interviewees represented 18 organizations from the County of Los Angeles government departments that purchased, distributed, or sold food; public and private non-County entities that had previously implemented food procurement policies in their organizations; and large organizations that catered food to the County. RESULTS: Study participants reported 3 key facilitators: their organization's authority to impose nutrition standards, their organization's desire to provide nutritious food, and the opportunity to build on existing nutrition policies. Eight key barriers were identified: 1) unique features among food service settings, 2) costs and unavailability of low-sodium foods, 3) complexity of food service arrangements, 4) lack of consumer demand for low-sodium foods, 5) undesirable taste of low-sodium foods, 6) preference for prepackaged products, 7) lack of knowledge and experience in operationalizing sodium standards, and 8) existing multiyear contracts that are difficult to change. Despite perceived barriers, several participants indicated that their organizations have successfully implemented nutritional standards that include limits on sodium. CONCLUSION: Developing or changing policies for procuring food represents a potentially feasible strategy for reducing sodium consumption in food service venues controlled by the County of Los Angeles. The facilitators and barriers identified here can inform the formulation, adoption, implementation, and evaluation of sodium reduction policies in other jurisdictions.

A midpoint process evaluation of the Los Angeles Basin Racial and Ethnic Approaches to Community Health Across the US (REACH US) Disparities Center, 2007-2009.

BACKGROUND: Racial/ethnic minority groups have higher risks for disease resulting from obesity. COMMUNITY CONTEXT: The University of California, Los Angeles, and the Los Angeles County Department of Public Health partnered with community organizations to disseminate culturally targeted physical activity and nutrition-based interventions in worksites. METHODS: We conducted community dialogues with people from 59 government and nonprofit health and social service agencies to develop wellness strategies for implementation in worksites. Strategies included structured group exercise breaks and serving healthy refreshments at organizational functions. During the first 2 years, we subcontracted with 6 community-based organizations (primary partners) who disseminated these wellness strategies to 29 organizations within their own professional networks (secondary worksites) through peer modeling and social support. We analyzed data from the first 2 years of the project to evaluate our dissemination approach. OUTCOME: Primary partners had difficulty recruiting organizations in their professional network as secondary partners to adopt wellness strategies. Within their own organizations, primary partners reported significant increases in implementation in 2 of the 6 core organizational strategies for promoting physical activity and healthy eating. Twelve secondary worksites that completed organizational assessments on 2 occasions reported significant increases in implementation in 4 of the 6 core organizational strategies. INTERPRETATION: Dissemination of organizational wellness strategies by trained community organizations through their existing networks (train-the-trainer) was only marginally successful. Therefore, we discontinued this dissemination approach and focused on recruiting leaders of organizational networks.

Asians and Pacific Islanders and the growing childhood obesity epidemic.

OBJECTIVE: To investigate differences in childhood overweight and obesity prevalence among Asian/Pacific Islander (API) subgroups. DESIGN: Cross-sectional secondary data analysis. SETTING: California public school children participating in an annual state-mandated physical fitness testing program which included measured height and weight. PARTICIPANTS: 5th, 7th and 9th grade students attending public schools in Los Angeles County (LAC) in 2006 and 2007 (n=670,352). MAIN OUTCOME MEASURES: Overweight and obesity prevalence, where overweight is categorized between the 85th to <95th BMI-forage percentile, and obese is defined at the 95th BMI-for-age percentile and above according to the Centers for Disease Control and Prevention Growth Charts. RESULTS: The overall prevalence of obesity among LAC students was 22.9%, and was 19.4% for overweight. For API students, the prevalence of obesity was markedly different between Asians and Pacific Islanders (PIs) (12.1% vs. 35.6%, P<0.01). Obesity also differed noticeably among ethnic subgroups, ranging from 8.4% to 17.5% among Asians, and from 17.2% to 48.6% among PIs. The prevalence of overweight students ranged from 12.8% to 17.3% among Asians and from 16.4% to 21.1% among PIs. CONCLUSIONS: Childhood obesity and overweight prevalence in the API population varies widely among ethnic subgroups, strongly indicating a need for disaggregating data relating to APIs. Recognizing the heterogeneity of the API population will allow more effective prioritization of community intervention and outreach efforts within API communities and improve recognition and treatment by healthcare providers of API children who may be at higher risk for obesity.

Diabetes and Prediabetes Among Adults in Los Angeles County and the United States, 1999-2006 and 2007-2014.

Objective-This report presents the prevalence of diagnosed diabetes, undiagnosed diabetes, total diabetes, and prediabetes among adults aged 20 and over in Los Angeles County and the United States in 1999-2006 and 2007-2014. The prevalence of diagnosed diabetes, total diabetes, and prediabetes in 2007-2014 are presented by age, sex, and race and Hispanic origin. Methods-Data are from in-home interviews and laboratory testing conducted as part of the National Health and Nutrition Examination Survey (NHANES). Los Angeles County has been selected with certainty in every NHANES cycle since 1999. Sample persons in Los Angeles County were selected and sample weights constructed so that estimates represent the county. Prevalence and 95% confidence intervals for diagnosed, undiagnosed, total diabetes, and prediabetes were estimated using self-reported diagnosis of diabetes, plasma fasting glucose, and hemoglobin A1c. Differences in prevalence were tested between Los Angeles County and the United States, between 1999-2006 and 2007-2014, and among demographic subgroups. Results-The age-adjusted prevalence of total diabetes among adults in Los Angeles County increased from 10.5% in 1999-2006 to 14.4% in 2007-2014. In 2007-2014, 40.2% of adults in Los Angeles County had prediabetes. There were no significant differences in the overall prevalence of diagnosed diabetes, undiagnosed diabetes, total diabetes, or prediabetes between Los Angeles County and the United States in 1999-2006 or 2007-2014. The prevalence of diagnosed diabetes, total diabetes, and prediabetes increased with age in both Los Angeles County and the United States. The prevalence of total diabetes was higher in non-Hispanic black adults, Hispanic adults, and Mexican-American adults than in non-Hispanic white adults in both Los Angeles County and the United States.

Proximity of fast food restaurants to schools: do neighborhood income and type of school matter?

OBJECTIVES: To investigate the proximity of fast food restaurants to public schools and examine proximity by neighborhood income and school level (elementary, middle, or high school). METHODS: Geocoded school and restaurant databases from 2005 and 2003, respectively, were used to determine the percentage of schools with one or more fast food restaurants within 400 m and 800 m of all public schools in Los Angeles County, California. Single-factor analysis of variance (ANOVA) models were run to examine fast food restaurant proximity to schools by median household income of the surrounding census tract and by school level. Two-factor ANOVA models were run to assess the additional influence of neighborhood level of commercialization. RESULTS: Overall, 23.3% and 64.8% of schools had one or more fast food restaurants located within 400 m and 800 m, respectively. Fast food restaurant proximity was greater for high schools than for middle and elementary schools, and was inversely related to neighborhood income for schools in the highest commercial areas. No association with income was observed in less commercial areas. CONCLUSIONS: Fast food restaurants are located in close proximity to many schools in this large metropolitan area, especially high schools and schools located in low income highly commercial neighborhoods. Further research is needed to assess the relationship between fast food proximity and student dietary practices and obesity risk.

School-based physical fitness testing identifies large disparities in childhood overweight in Los Angeles.

Few data are available on the epidemic of childhood overweight in local jurisdictions. To determine the prevalence and identify demographic and socioeconomic correlates of childhood overweight, we assessed height and weight data on 281,630 Los Angeles County, CA, public school students collected during school-based physical fitness testing in 2001. Overweight prevalence was 20.6% overall and varied by race/ethnicity: 25.2% among Latinos, 20.0% among Pacific Islanders, 19.4% among blacks, 17.6% among American Indians, 13.0% among whites, and 11.9% among Asians. By using multilevel analysis, we found that school-level percentage of students enrolled in free or reduced-price meal programs was independently associated with overweight, after controlling for school-level median household income and student-level demographic characteristics. When local overweight prevalence data are unavailable, percentage enrollment in free or reduced-price meal programs might be a useful indicator to identify schools where focused overweight prevention and control interventions are most needed.

Risk factors for community-associated methicillin-resistant Staphylococcus aureus skin infections among HIV-positive men who have sex with men.

We investigated community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections among HIV-positive men who have sex with men. We performed a matched case-control study of 35 case patients and 76 control subjects. CA-MRSA skin infections were associated with high-risk sex and drug-using behaviors and with environmental exposures but not with immune status.

Impact of restaurant hygiene grade cards on foodborne-disease hospitalizations in Los Angeles County.

Although health departments routinely inspect restaurants to assess compliance with established hygienic standards, few data are available on the effectiveness of these efforts in preventing foodborne disease. The study reported here assessed the impact on foodborne-disease hospitalizations in Los Angeles County of a restaurant hygiene grading system that utilized publicly posted grade cards. The grading systm was introduced in January 1998. Hospital discharge data on foodborne-disease hospitalizations were analyzed for Los Angeles County and, as a control, for the rest of California during the period 1993-2000. Ordinary least-squares regression analysis was done to measure the effect of the grading progam on these hospitalizations. After baseline temporal and geographic trends were adjusted for, the restaurant hygiene grading program was associated with a 13.1 percent decrease (p < .01) in the number of foodborne-disease hospitalizations in Los Angeles County in the year following implementation the program (1998). This decrease was sustained over the next two years (1999-2000). The results suggest that restaurant hygiene grading with public posting of results is an effective intervention for reducing the burden of foodborne disease.

Physical inactivity and overweight among Los Angeles County adults.

OBJECTIVES: The present study examines sociodemographic, health status, health behavioral, and health-related self-perception correlates of physical inactivity in a large, multiethnic urban population. METHODS: A random-digit-dialed telephone survey of a representative sample of 8353 Los Angeles County adults aged >/= 18 years was conducted between September 17, 1999 and December 31, 2000. Data were analyzed to assess the prevalence and identify independent correlates of physical inactivity, defined as <10 minutes of continuous physical activity weekly ("sedentary"). RESULTS: Overall, the prevalence of sedentary adults was 41%. Lower educational attainment, female gender, advancing age, non-U.S. birthplace, poorer self-perceived health status, self-perceived depression, smoking, leisure-time television watching/computer use, and receiving a diabetes diagnosis were significantly related to sedentariness in both bivariate and multivariate analyses. CONCLUSIONS: Mental and physical health status were prominent correlates of sedentariness. Lower socioeconomic class was also associated with sedentary behavior. Further research is needed to understand the relationship between self-perceived overweight and sedentary behavior.

Assessing the burden of disease and injury in Los Angeles County using disability-adjusted life years.

OBJECTIVE: This study was designed to assess the burden of disease and injury in the Los Angeles County population using Disability-Adjusted Life Years (DALYs), a composite measure of premature mortality and disability that equates to years of healthy life lost. METHODS: DALYs, stratified by gender and race/ethnicity, were calculated for 105 health conditions and aggregated groups of conditions for the Los Angeles County population for 1997. Years of Life Lost (YLLs) were calculated using 1997 county mortality statistics and published life tables. Years Lived with Disability (YLDs) were derived from age- and gender-specific disease incidence and disability data from the Global Burden of Disease Study. RESULTS: DALYs produced a substantially different ranking of disease and injury burden than did mortality rates alone. The leading five causes of DALYs for males in the county were ischemic heart disease, violence, alcohol dependence, drug overdose and other intoxications, and depression. For females, the leading five causes were ischemic heart disease, alcohol dependence, diabetes, depression, and osteoarthritis. Differences in the rank order were also observed by race/ethnicity. The age-adjusted rate of DALYs for all health conditions combined was highest in African Americans (190 per 1,000), followed by American Indians (149 per 1,000), whites (113 per 1,000), Latinos (94 per 1,000), and Asians/Pacific Islanders (77 per 1,000). CONCLUSIONS: The DALYs measure is a promising new tool to improve the capacity of local health departments and other health agencies to assess population health and establish an evidence base for public health decisions.

Health of adults in Los Angeles County: findings from the National Health and Nutrition Examination Survey, 1999-2004.

OBJECTIVE: Los Angeles County has the largest population of any county in the nation. Population-based estimates of health conditions for Los Angeles County are based primarily on telephone surveys, which are known to underestimate conditions of public health importance. This report presents the prevalence of selected health conditions for civilian noninstitutionalized adults aged 20 and over living in Los Angeles County households and group quarters, based on survey data using direct physical measurements. METHODS: Combined data from the 1999-2000, 2001-2002, and 2003-2004 National Health and Nutrition Examination Surveys (NHANES), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, were used for this report. Sample weights were recalculated for participants examined in Los Angeles County using population totals provided by the Los Angeles County Department of Public Health, excluding the institutionalized population. RESULTS: Compared with the nation as a whole, adults in Los Angeles County had similar rates of health conditions even after age and age-race adjustment, with a few exceptions. A significantly smaller proportion of Los Angeles County adults were obese (age-adjusted rate, 23.8%) compared with the United States (31.0%); this difference held after age-race adjustment. The age-adjusted rate of diagnosed diabetes for men was higher in Los Angeles County (9.1%) than in the nation (7.3%); however, this difference did not hold after age-race adjustment. The rates of total diabetes adjusted for age and age-race were similar for men in Los Angeles County and the United States. CONCLUSIONS: The rates of selected health conditions in this report were similar for adults in Los Angeles County compared with adults in the United States, with the exception of obesity. The rates of obesity adjusted for age and age-race were lower among Los Angeles County adults compared with national rates. Health estimates based on direct physical measurements can be useful for local public health programs and prevention efforts.