Psychological Coercion in Human Trafficking: An Application of Biderman's Framework.

This study examined coercive conditions experienced by trafficked persons in the context of Biderman's theory of coercion. We conducted semi-structured interviews with 12 adult women trafficked into Los Angeles County, from 10 countries, for domestic work and/or sex work. Participants described health problems they experienced in relation to their trafficking experience and their perceptions of conditions that caused health problems. Utilizing a framework analysis approach, we analyzed themes using Biderman's framework. Participants reported experiencing the range of nonphysical coercive tactics outlined by Biderman, including isolation, monopolization of perception, induced debility or exhaustion, threats, occasional indulgences, demonstration of omnipotence, degradation, and enforcement of trivial demands. Our analysis demonstrates how these coercion tactics reinforced the submission of trafficked persons to their traffickers even in the absence of physical force or restraints. Such psychological abuse creates extreme stress that can lead to acute and chronic, physical and mental health problems.

Perceptions of HIV/AIDS in one's community predict HIV testing.

Using a subsample of respondents to the 2005 Los Angeles County health survey, we examined the relationship between perceptions of the seriousness of HIV/AIDS in one's community and HIV testing. We constructed a propensity score-based matched sample of three groups with differing perceptions of the seriousness of HIV in their community: high perceived seriousness, low perceived seriousness, and uncertain about seriousness. We compared HIV testing behavior in the three groups before and after using propensity score matching to control for selection on observed covariates. The unadjusted comparison showed a testing rate of 30.2 % among those perceiving high seriousness, 11.4 percentage points higher than the 18.8 % testing rate among those perceiving low seriousness. After propensity score matching, the adjusted testing difference was 7.0 percentage points (p < 0.05). Those uncertain about the seriousness of HIV did not differ significantly in their testing behavior from those perceiving high seriousness.

Small area estimates reveal high cigarette smoking prevalence in low-income cities of Los Angeles county.

Los Angeles County has among the lowest smoking rates of large urban counties in the USA. Nevertheless, concerning disparities persist as high smoking prevalence is found among certain subgroups. We calculated adult smoking prevalence in the incorporated cities of Los Angeles County in order to identify cities with high smoking prevalence. The prevalence was estimated by a model-based small area estimation method with utilization of three data sources, including the 2007 Los Angeles County Health Survey, the 2000 Census, and the 2007 Los Angeles County Population Estimates and Projection System. Smoking prevalence varied considerably across cities, with a more than fourfold difference between the lowest (5.3%) and the highest prevalence (21.7%). Higher smoking prevalence was generally found in socioeconomically disadvantaged cities. The disparities identified here add another layer of data to our knowledge of the health inequities experienced by low-income urban communities and provide much sought data for local tobacco control. Our study also demonstrates the feasibility of providing credible local estimates of smoking prevalence using the model-based small area estimation method.

Knowledge and perceptions of human trafficking among community-based and faith-based organization members in South Los Angeles.

The objectives of this study were (1) to assess the knowledge and perceptions of human trafficking (HT) among leaders and staff from 11 community-based organizations (CBOs) and faith-based organizations (FBOs) in South Los Angeles, and (2) to identify gaps in knowledge of HT and inform community organizations regarding possible best practices in health promotion for addressing this emerging public health problem. A self-administered survey was conducted during the period from 4 December 2015 to 28 January 2016. Descriptive statistics were generated and a logistic regression model was constructed using SAS 9.3. A total of 277 CBO and FBO leaders and staff completed the survey. Participants demonstrated high levels of knowledge of HT but their knowledge was not comprehensive, as gaps exist in recognizing the context in which HT usually takes place; understanding the local laws that govern this activity; and ways to follow related policies/procedures when the problem is suspected. A majority (a) believed there were not enough services in Los Angeles County to help survivors of HT, (b) could not recognize the signs of HT, and (c) did not know what steps to take if they suspected this criminal activity. A statistically significant association was found between education and participants' knowledge of HT, and with their beliefs and attitudes toward this violation of human rights. Study findings suggest that, generally, CBO/FBO leaders and staff in South Los Angeles have good knowledge about HT. However, notable gaps in knowledge and misperceptions remain, suggesting opportunities for Public Health to further educate and intervene.

Is incarceration a contributor to health disparities? Access to care of formerly incarcerated adults.

Despite the disproportionate prevalence of incarceration in communities of color, few studies have examined its contribution to health disparities. We examined whether a lifetime history of incarceration is associated with recent access to medical and dental care. We performed a secondary data analysis of the 2007 Los Angeles County Health Survey, a population-based random-digit-dialing telephone survey of county households. Any history of incarceration in a prison/jail/detention center as an adult was assessed for a random subsample. Bivariate and multivariate logistic regression analyses examined whether incarceration history was associated with access to care, controlling for other characteristics. Ten percent of our study population reported a history of incarceration. While persons with an incarceration history were similar to their peers with regard to health and insurance status, their access to medical and dental care was worse. Incarceration history was independently associated with disparities in access to care. Interventions to improve the health of communities affected by high rates of incarceration could include efforts that enable access to care for formerly incarcerated adults.

Who is using emergency contraception? Awareness and use of emergency contraception among California women and teens.

INTRODUCTION: Emergency contraception (EC) reduces women's risk for pregnancy after unprotected intercourse, and women's awareness of the method is increasingly important for expanding access. However, knowledge of EC alone does not predict use, and few population data exist to describe EC use among those aware of the method. METHODS: Using data from the 2003 California Health Interview Survey, we measured EC awareness among 11,392 women ages 15-44, and EC use among 7,178 respondents who were aware of EC and at risk for pregnancy. Using chi(2) analyses and multivariable logistic regression, we examined population characteristics that epidemiologically predict EC awareness and use, including age, race/ethnicity, income, health insurance status, usual source of health care, immigration status, languages spoken at home, and urban versus rural residence. RESULTS: Nearly 76% of respondents had heard of EC, but awareness was lower among teens, women of color, poor women, women with publicly funded health insurance, those without a usual source of care, immigrants, non-English-language speakers, and rural residents. Among women aware of EC, about 4% reported having used the method in the previous year; young age, low income, attending a community/government clinic for care or not having a source of care, and living in an urban area significantly increased the odds for using EC. CONCLUSIONS: Among California women in 2003, awareness and use of EC remained low. However, similar rates of use were reported among racial, ethnic, and linguistic subgroups. Those most likely to report use of the method included population groups at high risk for unintended pregnancy.

Disparities in parental human papillomavirus (HPV) vaccine awareness and uptake among adolescents.

Trends in HPV vaccine awareness among parents of adolescent girls and boys (ages 13-17) and HPV vaccine uptake (≥1 dose) among girls (ages 13-17) were evaluated in Los Angeles County, California. Between 2007 and 2011, parental HPV vaccine awareness increased from 72% to 77% overall, with significant increases among mothers, Latinos, and respondents with daughters and Medi-Cal insured children. In 2011, parents who were male, older, less educated, Asian/Pacific Islander, and had sons remained significantly less likely to be aware. HPV vaccine initiation among daughters nearly doubled from 25% in 2007 to 48% in 2011, and girls who were older, uninsured, and had access-related barriers showed the largest improvements. In 2011, daughters who were younger and who had older and African American parents were at risk for low uptake. Thus, initiatives targeting male and younger adolescents, culturally-relevant information, and access to vaccination may help to reduce identified disparities.

Hypertension among Asians in Los Angeles County: Findings from a multiyear survey.

Few studies have examined the prevalence of hypertension among Asians living in the United States. Multiyear data from the Los Angeles County Health Survey were used to investigate the prevalence of hypertension among Asians and Asian subgroups, and risk factors associated with the disease, using descriptive analysis and multivariate logistic regression. Age-adjusted prevalence of hypertension in Asians was 23.4%. Among Asian subgroups, age-adjusted prevalence of hypertension was lowest among Chinese (20.0%), and highest among Filipinos (32.7%), and several factors were identified as associated with hypertension. Hypertension among Asian-Americans is a serious public health concern, requiring culturally sensitive best practices, and evidence-based approaches to improve prevention and control among Asians.

Health Care and Human Trafficking: We are Seeing the Unseen.

OBJECTIVES: This study aimed to build the evidence base around human trafficking (HT) and health in the U.S. by employing a quantitative approach to exploring the notion that health care providers encounter this population. Furthermore, this study sought to describe the health care settings most frequented by victims of human trafficking. METHODS: This was an anonymous, retrospective study of survivors of U.S.-based human trafficking. RESULTS: One hundred and seventy-three participants who endured U.S.-based human trafficking were surveyed. The majority (68%, n=117) of participants were seen by a health care provider while being trafficked. Respondents most frequently reported visiting emergency/urgent care practitioners (56%), followed by primary care providers, dentists, and obstetricians/gynecologists (OB/GYNs). CONCLUSIONS: While health care providers are serving this patient population, they do not consistently identify them as victims of human trafficking.

Vitamin A, carotenoids, and risk of persistent oncogenic human papillomavirus infection.

Oncogenic human papillomavirus (HPV) infection is the main etiologic factor for cervical neoplasia, although infection alone is insufficient to produce disease. Cofactors such as nutritional factors may be necessary for viral progression to neoplasia. Results from previous studies have suggested that higher dietary consumption and circulating levels of certain micronutrients may be protective against cervical neoplasia. This study evaluated the role of vitamin A and carotenoids on HPV persistence comparing women with intermittent and persistent infections. As determined by the Hybrid Capture II system, oncogenic HPV infections were assessed at baseline and at approximately 3 and 9 months postbaseline. Multivariate logistic regression analysis was used to determine the risk of persistent HPV infection associated with each tertile of dietary and circulating micronutrients. Higher levels of vegetable consumption were associated with a 54% decrease risk of HPV persistence (adjusted odds ratio, 0.46; 95% confidence interval, 0.21-0.97). Also, a 56% reduction in HPV persistence risk was observed in women with the highest plasma cis-lycopene concentrations compared with women with the lowest plasma cis-lycopene concentrations (adjusted odds ratio, 0.44; 95% confidence interval, 0.19-1.01). These data suggest that vegetable consumption and circulating cis-lycopene may be protective against HPV persistence.

Human papillomavirus persistence and nutrients involved in the methylation pathway among a cohort of young women.

Persistent oncogenic human papillomavirus (HPV) infection is associated with cervical dysplasia. Cofactors, such as nutrient status, may be required for the progression of HPV infection to neoplasia. HPV DNA methylation patterns in vitro have been shown to be associated with viral transcriptional activity. Folate, vitamin B12, vitamin B6, and methionine may function to prevent cervical cancer through their role in DNA methylation. This study was conducted to examine the relationship of dietary intake of folate, vitamin B12, vitamin B6, and methionine, as well as circulating levels of folate and vitamin B12 to HPV persistence. Oncogenic HPV status was determined at baseline and at approximately 3 and 9 months postbaseline. Multivariate logistic regression analysis was used to determine the adjusted odds ratios for persistent HPV infection associated with each tertile of individual nutrient among 201 women with a persistent or intermittent HPV infection. Circulating vitamin B12 levels were inversely associated with HPV persistence (P for trend, 0.037) after adjusting for age, age at first intercourse, marital status, cigarette smoking status, race, and body mass index. In addition, women with circulating levels in the highest tertile (>493.2 pg/ml) of vitamin B12 were less likely to have a persistent infection (adjusted odds ratio = 0.4; 95% confidence interval = 0.17-0.96). No significant associations were observed between HPV persistence and dietary intake of folate, vitamin B12, vitamin B6, or methionine from food alone or from food and supplements combined or from circulating folate. These data suggest a role for circulating vitamin B12 in early cervical carcinogenesis.

Effective birth control use among women at risk for unintended pregnancy in Los Angeles, California.

CONTEXT: Identifying sociodemographic and health-related risk factors associated with more effective versus less effective birth control use can help to identify barriers to effective birth control use and decrease risk for unintended pregnancy. METHODS: Data used were from the 2007 Los Angeles County Health Survey. More effective birth control use was assessed among women ages 18 to 49, who were at risk for unintended pregnancy, residing in Los Angeles County. The study population consisted of 849 women. Multivariate associations of more effective birth control use with sociodemographic and health factors were assessed in logistic regression models. All analyses used weighted data. RESULTS: Women who used a more effective birth control method at last act of coitus were less likely to be Black (odds ratio [OR], 0.33) or Asian/Pacific Islander (OR, 0.49), have less than a high school education (OR, 0.33), be a smoker (OR, 0.52), and have public insurance (OR, 0.47) than women using a less effective birth control method. They were more likely to have received a pap test (OR, 2.66), describe their health as fair or poor (OR, 2.39), and have a household income of 200% to 299% of the federal poverty level (OR, 2.25) than women using a less effective birth control method. CONCLUSIONS: Sociodemographic factors, some of which underlie cultural diversity, predict the use of more effective birth control methods and should be considered when providing family planning services and preconception health counseling to unique populations.

Identification of human trafficking victims in health care settings.

BACKGROUND: An estimated 18,000 individuals are trafficked into the United States each year from all over the world, and are forced into hard labor or commercial sex work. Despite their invisibility, some victims are known to have received medical care while under traffickers' control. Our project aimed to characterize trafficking victims' encounters in US health care settings. METHODS: The study consisted of semi-structured interviews with six Key Informants who work closely with trafficking victims (Phase I) and 12 female trafficking survivors (Phase II). All survivors were recruited through the Coalition to Abolish Slavery and Trafficking, an NGO in Los Angeles, and all were trafficked into Los Angeles. Interviews were conducted in English and six other languages, with the assistance of professional interpreters. Using a framework analysis approach that focused on victims' encounters in health care settings, we assessed interview transcript content and coded for themes. We used an exploratory pile-sorting technique to aggregate similar ideas and identify overarching domains. RESULTS: The survivors came from 10 countries. Eight had experienced domestic servitude, three had survived sex trafficking, and one had experienced both. Half the survivors reported that they had visited a physician while in their traffickers' control, and another worked in a health care facility. All Key Informants described other victims who had received medical care. For domestic servants, medical visits were triggered by injury and respiratory or systemic illness, while sex trafficking victims were seen by health professionals for sexually transmitted infections and abortion. Trafficking victims were prevented from disclosing their status to health care providers by fear, shame, language barriers, and limited interaction with medical personnel, among other obstacles. DISCUSSION: This exploration of survivors' experiences in health care settings supports anecdotal reports that US health care providers may unwittingly encounter human trafficking victims. Increasing awareness of human trafficking, and modifying practice to facilitate disclosure, could improve victim identification.

Human papillomavirus vaccine among adult women: disparities in awareness and acceptance.

BACKGROUND: Human papillomavirus (HPV) vaccines have been shown to be safe and highly effective in young and middle-aged women. PURPOSE: This study aimed to assess vaccine awareness and desire for vaccination among adult women aged 18-55 years residing in Los Angeles County CA. METHODS: This study is nested in the 2007 Los Angeles County Health Survey. Included in the analyses were 2295 women aged 18-55 years. Logistic regression was used to evaluate vaccine awareness and intention to become vaccinated in association with various factors. All analyses employed weighted data and were conducted in 2009. RESULTS: Only 5% of women aged 18-26 years had received the HPV vaccine in its first year on the market. Overall, 67% of women aged 18-55 years had heard of the vaccine. Among those who knew of the vaccine but had not received it, 61% reported they were likely to receive the vaccine. Latina, black, and Asian/Pacific Islander women were only half as likely to have heard of the vaccine as white women, but Latinas and Asian/Pacific Islander women were more willing to be vaccinated than white or black women. Education was associated positively with awareness, but inversely associated with intention to be vaccinated. Awareness and desire for vaccination also varied substantially by other factors such as language spoken at home. CONCLUSIONS: This population-based study of diverse women reveals important disparities in HPV vaccine awareness and intention to be vaccinated. Culturally and linguistically competent educational campaigns about HPV immunization are warranted, and should target high-risk populations.

Comparison of type-specific human papillomavirus data from self and clinician directed sampling.

OBJECTIVE(S): To compare the type-specific human papillomavirus (HPV) recovery from physician and patient-collected samples. METHODS: Three hundred thirty-four (334) women attending colposcopy clinics in three countries were enrolled in this cross-sectional study. Cervicovaginal samples were collected by patients and physicians and processed with polymerase chain reaction and reverse line blot genotyping. McNemar's Chi-squared tests and Kappa statistics were utilized to determine statistical associations between physician- versus patient-collected samples. RESULTS: Oncogenic HPV infection was identified in 23.2% of patient-collected specimens compared to 34.9% of physician-collected specimens. Physician sampling detected significantly more infections with type 16 and 52 than did self-sampling and significantly more oncogenic HPV infection overall. For non-oncogenic HPV detection, there was no statistical difference between physician- and patient-collected samples. CONCLUSION(S): Patient sampling for HPV using a single vaginal brush does not identify all oncogenic HPV subtypes.