Association of Race-Ethnicity Intersection With Disparities in Cigarette Smoking in U.S. Adults.

INTRODUCTION: Detailed estimates of disparities in cigarette smoking across single- and multi-race groups and their intersections with ethnicity are lacking. This study estimates the prevalence of self-reported current smoking among intersecting adult race-ethnicity groups in the United States. AIMS AND METHODS: The analysis uses 2018-2019 data from the Tobacco Use Supplement-Current Population Supplement (TUS-CPS; n = 137 471). Self-reported Hispanic origin and race were recoded into 19 mutually exclusive race-by-ethnicity intersecting groups. Weighted race-ethnicity group smoking prevalence were compared to the overall population prevalence and one another. RESULTS: Compared to the U.S. population current smoking prevalence (11.4% [95% CI = 11.2% to 11.6%]), smoking was particularly higher in non-Hispanic American Indian/Alaska Native (AI/AN) groups (20.7% [95% CI = 17.8% to 24.0%]) and non-Hispanic multiracial AI/AN/White (24.4% [95% CI = 20.3% to 29.1%]) and AI/AN/Black (22.4% [95% CI = 14.4% to 33.2%]) groups. Non-Hispanic single-race Asian (5.0% [95% CI = 4.4% to 5.6%]) and Hispanic single-race White (7.2% [95% CI = 6.7% to 7.7%]) smoking prevalence undercut the overall U.S. population prevalence. In pairwise comparisons, smoking prevalence was higher in various non-Hispanic single- and multi-race AI/AN groups than non-AI/AN groups and was lower in various Hispanic groups than non-Hispanic groups. CONCLUSIONS: Smoking prevalence disparities are not monolithic across complex diversity of race and ethnicity in the United States. Accurate identification of priority populations in need of targeted tobacco control efforts may benefit by acknowledging multinomial heterogeneity across intersecting racial and ethnic identities. IMPLICATIONS: Understanding racial and ethnic disparities in cigarette smoking can inform national strategies for reducing health inequities. This study examines cigarette smoking disparities among 19 adult intersecting race-ethnicity groups in the United States using the 2018-2019 TUS-CPS data. Results show higher smoking rates in some non-Hispanic American Indian/Alaska Native and Black groups, while lower rates are seen in Asian and Hispanic individuals. These findings emphasize the need for disaggregated data to tackle smoking disparities and guide targeted prevention efforts.

Adult Familial Influences on Rural Native Hawaiian and Pacific Islander Youths' E-Cigarette Use.

Background: Over the past decade, youth e-cigarette use has grown into a national epidemic, with Native Hawaiian and Pacific Islander (NHPI) youths' rates among some of the highest in the nation. Family factors significantly contribute to NHPI youths' decisions to engage in or resist substance use, yet few studies have specifically examined familial influences on NHPI youths' substance use decision-making and behaviors. Objective: The objective of this study is to examine adult familial influences on rural NHPI youths' decisions to engage in e-cigarette use. Method: Seventeen gender-specific focus groups with NHPI youths (N = 69) from eight public schools on Hawai'i Island were conducted. Results: Two family-related themes emerged from the data: 1) parental substance use permissiveness, and 2) family normalization of e-cigarette use. Conclusions: Examining adult familial contributors to NHPI youths' e-cigarette use needs to be part of a comprehensive effort to address NHPI health and substance use disparities. Prevention interventions should be explicit in addressing the family and relational context of NHPI youths' substance use.

CRISPR in Public Health: The Health Equity Implications and Role of Community in Gene-Editing Research and Applications.

CRISPR (clustered regularly interspaced short palindromic repeats) is a Nobel Prize-winning technology that holds significant promise for revolutionizing the prevention and treatment of human disease through gene editing. However, CRISPR's public health implications remain relatively uncertain and underdiscussed because (1) targeting genetic factors alone will have limited influence on population health, and (2) minority populations (racial/ethnic, sexual and gender)-who bear the nation's greatest health burdens-historically suffer unequal benefits from emerging health care innovations and tools. This article introduces CRISPR and its potential public health benefits (e.g., improving virus surveillance, curing genetic diseases that pose public health problems such as sickle cell anemia) while outlining several major ethical and practical threats to health equity. This includes minorities' grave underrepresentation in genomics research, which may lead to less effective and accepted CRISPR tools and therapies for these groups, and their anticipated unequal access to these tools and therapies in health care. Informed by the principles of fairness, justice, and equitable access, ensuring gene editing promotes rather than diminishes health equity will require the meaningful centering and engagement of minority patients and populations in gene-editing research using community-based participatory research approaches. (Am J Public Health. 2023;113(8):874-882. https://doi.org/10.2105/AJPH.2023.307315).

Asian American child-parent cultural value discrepancies, family conflict, life satisfaction, and self-esteem.

We examined Asian American college students' adherence to traditional values that are salient in Asian cultures, the students' perceptions of their mother's and father's adherence to the same values, and the discrepancies between the students and their mothers and fathers on the levels of adherence to these values. Based on the data from 301 participants who self-identified as Asian Americans, paired-samples t tests revealed that the child-parent cultural value discrepancies were present across all generational statuses of the participants with the children adhering less strongly to most of the value dimensions than their parents. The results based on correlational analyses showed that many types of value discrepancies were positively associated with the likelihood and seriousness of conflict. Several types of value discrepancies also were inversely associated with the participants' life satisfaction and self-esteem. In addition, the results from the PROCESS Macro for mediation analysis revealed significant mediation role of family conflict on the relationships between various types of value discrepancies and life satisfaction. The significant mediators were the likelihood and seriousness of family conflict and the family conflict about education and career decisions, and the value discrepancies centered on the values of conformity to norms, family recognition through achievement, and humility. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Mental Health, Substance Use, Physical Health, and Mental Health Treatment Need of Community Individuals Experiencing Homelessness in Hawai'i.

Limited research has examined the mental health of individuals experiencing homelessness in Hawai'i, which bears the nation's second highest homelessness rate. Mental health, substance use, treatment need, and health data were collected from 162 unhoused individuals in Hawai'i County by visiting community locations where they congregate (e.g., beaches, vacant buildings). 77% of participants were Native Hawaiian/Pacific Islander (NH/PI) with participants demonstrating severe rates of mental and substance use disorders including 57% experiencing major depressive disorder (MDD), 56% experiencing generalized anxiety disorder (GAD), and 64%, 74%, and 12% experiencing alcohol, methamphetamine, and opioid use disorders, respectively-heightening overdose risk. Treatment need was high (62%) but health was poor (85% reporting fair/poor health), with MDD and GAD predicting reduced general health (p < 0.05). Study findings indicate Hawai'i unhoused individuals are disproportionately Indigenous NH/PI, enduring striking mental and physical health disparities that may be reduced by increasing access/utilization of community mental health programs/services.

Clinical characteristics associated with increased wound size in patients with recessive dystrophic epidermolysis bullosa.

As more therapeutic clinical trials focus on treatment of individual wounds in patients with recessive dystrophic epidermolysis bullosa, it has become crucial to understand the baseline clinical characteristics of these wounds. To investigate these features, we administered an RDEB-specific wound survey. Forty participants reported on location, size, pain, infection frequency, wound type, and duration of 189 wounds; a subset of 22 participants reported on pruritus in 63 wounds. Increased wound size was significantly associated with increased pain, increased pruritus, longer wound duration, increased infection frequency, and patients with mutations resulting in truncated type VII collagen.

Addressing Health Disparities Through Deliberative Methods: Citizens' Panels for Health Equity.

Health disparities adversely affect millions of people living in disadvantaged communities, resisting public health interventions that do not address the specific conditions, driving forces, or health problems in these communities. Drawing from the underutilized science of deliberative methods, we introduce the innovative citizens' panels for health equity approach-a novel methodology that engages public expertise and knowledge of community health needs, risks, and priorities to tailor public health research and interventions for greater relevance and impact on disadvantaged communities.By engaging affected residents and stakeholders in informed deliberation and decision-making about community health disparities, citizens' panels provide important guidance for (1) designing research studies to target the major health disparities affecting disadvantaged communities and (2) tailoring evidence-based interventions to the perspectives, practices, and preferences of disadvantaged residents.Employed as the primary methodology in 2 federally funded projects conducted in California and Arkansas between 2017 and 2019, citizens' panels offer a systematic method for obtaining rich community insight into health disparities, shaping community-informed solutions, and affording disadvantaged communities influence over public health decision-making to stimulate grassroots change and health equity.

COVID-19 treatment resource disparities and social disadvantage in New York City.

Black and Hispanic communities in the U.S. have endured a disproportionate burden of COVID-19-related morbidity and mortality. Racial and ethnic health disparities such as these are frequently aggravated by inequitable access to healthcare resources in disadvantaged communities. Yet, no known studies have investigated disadvantaged communities' access to COVID-19-related healthcare resources. The current study accordingly examined racial and ethnic differences in (1) April 2020 COVID-19 total and positive viral test rates across 177 New York City (NYC) ZIP Code Tabulation Areas (ZCTA); and (2) November 2019-April 2020 licensed and intensive care unit (ICU) hospital bed access across 194 NYC ZCTAs. Pairwise analyses indicated higher COVID-19 total and positive test rates per 1000 persons in majority Black and Hispanic vs. majority White ZCTAs (CI [0.117, 4.55]; CI [2.53, 5.14]). Multiple linear regression analyses indicated that higher percentage of Black and Hispanic residents predicted more total COVID-19 tests per 1000 persons (p < 0.05). In contrast, majority Black and Hispanic ZCTAs had fewer licensed and ICU beds (CI [6.50, 124.25]; CI [0.69, 7.16]), with social disadvantage predicting lower licensed and ICU bed access per 1000 persons (p < 0.01). While news reports of inequitable access to COVID-19-related healthcare resources in ethnocultural minority communities have emerged, this is the first study to reveal that social disadvantage may be a major driver of hospital resource inequities in Black and Hispanic communities. Thus, it will be imperative to enact policies that ensure equitable allocation of healthcare resources to socially disadvantaged communities to address current and future public health crises.

Using Participatory Mapping to Diagnose Upstream Determinants of Health and Prescribe Downstream Policy-Based Interventions.

Participatory mapping is a powerful methodology for working with community residents to examine social and environmental determinants of public health disparities. However, this empowering methodology has only been applied sparingly in public health research and practice, with limited examples in the literature. To address this literature gap, we 1) review participatory mapping approaches that may be applied to exploring place-based factors that affect community health, and 2) present a mixed-methods participatory geographic information systems (PGIS) examination of neighborhood assets (eg, streetlights) and challenges (eg, spaces of crime and violence) related to access to public parks in South Los Angeles, California. By taking a participatory, fine-grained spatial approach to examining public park access with input from 40 South Los Angeles adolescent and adult residents, our community-engaged PGIS approach identified tobacco shops as previously unrecognized community institutions that are associated with increased neighborhood crime and violence. Our investigation revealed unique challenges in community-level public park access that would likely have been overlooked by conventional spatial epidemiology and social science methods, such as surveys and questionnaires. Furthermore, our granular community-informed approach supported resident and stakeholder advocacy efforts toward reducing the proliferation of tobacco shops through community organizing and policy change initiatives. We thus contend that it would benefit public health research and practice to further integrate empowering, grassroots-based participatory mapping approaches toward informing advocacy efforts and policies that promote health and well-being in disadvantaged communities.

Electronic Cigarette Use and Associated Risk Factors in U.S.-Dwelling Pacific Islander Young Adults.

Background: E-cigarette use is rapidly increasing among US young adults, heightening their risk for vaping-related illnesses. Yet, little is known about e-cigarette use among young adult Native Hawaiians and Pacific Islanders (NHPI): an indigenous-colonized US racial group rarely described in research literature. This exploratory study provides the first known data on e-cigarette use and potential risk factors in NHPI young adults. Method: Self-report data were collected from 143 NHPI young adults (age 18-30 years) living in two large NHPI communities: Samoans in urban Los Angeles County and Marshallese in rural Arkansas. We assessed rates of e-cigarette, cigarette, alcohol, and marijuana use, and positive and negative outcome expectancies from e-cigarettes, that is expected outcomes from e-cigarette use. To identify potential risk factors for NHPI e-cigarette use, regressions explored associations between participants' current e-cigarette use with current cigarette, alcohol, and marijuana use, and e-cigarette outcome expectancies. Results: Among NHPI young adults, lifetime e-cigarette use rate was 53% and current use rate was 39%. Current rate of dual e-cigarette/cigarette, e-cigarette/alcohol, and e-cigarette/marijuana use was 38%, 35%, and 25%, respectively. In our regression models, current marijuana use and positive e-cigarette outcome expectancies were significantly associated with current e-cigarette use. Conclusions: E-cigarette use is common among NHPI young adults, exceeding rates for other at-risk racial groups. Marijuana use and positive expectations about e-cigarette use may represent potential e-cigarette use risk factors. Collectively, findings underscore the need for additional research to further explore the scope of, and risk and protective factors for, e-cigarette use in this understudied high-risk population.

The geography of crime and violence surrounding tobacco shops, medical marijuana dispensaries, and off-sale alcohol outlets in a large, urban low-income community of color.

Tobacco shops, medical marijuana dispensaries (MMD), and off-sale alcohol outlets are legal and prevalent in South Los Angeles, California-a high-crime, low-income urban community of color. This research is the first to explore the geographic associations between these three legal drug outlets with surrounding crime and violence in a large low-income urban community of color. First, spatial buffer analyses were performed using point-location and publically accessible January-December 2014 crime data to examine the geography of all felony property and violent crimes occurring within 100, 200, 500, and 1000-foot buffers of these three legal drug outlet types across South Los Angeles. Next, spatial regression analyses explored the geographic associations between density of these outlets and property and violent crimes at the census tract level. Results indicated that mean property and violent crime rates within 100-foot buffers of tobacco shops and alcohol outlets-but not MMDs-substantially exceeded community-wide mean crime rates and rates around grocery/convenience stores (i.e., comparison properties licensed to sell both alcohol and tobacco). Spatial regression analyses confirmed that tobacco shops significantly positively associated with property and violent crimes after controlling for key neighborhood factors (poverty, renters, resident mobility, ethnic/racial heterogeneity). Thus, study findings provide the first empirical evidence that tobacco shops may constitute public health threats that associate with crime and violence in U.S. low-income urban communities of color. Implementing and enforcing control policies that regulate and monitor tobacco shops in these communities may promote community health by improving public safety.

Social and environmental determinants of physical activity in urban parks: Testing a neighborhood disorder model.

The current study examined the nexus of neighborhood disorder-in the form of physical disorder (e.g., broken glass and vandalism) and social disorder (e.g., public drinking and lewd conduct)-and physical activity (PA) in urban public parks to inform public policy addressing chronic disease in at-risk populations. Five hundred and twenty-two unique observations were conducted in 22 public parks from March to September 2016. The study utilized the System for Observing Play and Recreation in Communities (SOPARC) to document age, gender, ethnicity, and PA level of park users. The Physical Activity Resource Assessment (PARA) was used to document observed physical and social disorder incivilities in public parks included in the current study. Males, adults, and Latina/os accounted for the largest number of park users, respectively. Significant PA differences were observed across gender, age, and ethnicity. Multiple linear regression controlling for gender, age, and ethnicity found physical disorder, but not social disorder, generally predicted PA reductions. While it has been demonstrated that physical disorder predicts PA reductions in low-income communities of color, this is the first study to reveal that physical disorder may lead to decreased PA in urban public parks. Thus, remediation of public park incivilities characterized by physical disorder, paired with community outreach, may lead to increased PA in at-risk communities.

Predicting the Mental Health and Functioning of Torture Survivors.

The psychological effects of war represent a growing public health concern as more refugees and asylum seekers migrate across borders. This study investigates whether sociodemographic, premigration and postmigration, and psychosocial factors predict adverse psychiatric symptoms in refugees and asylum seekers exposed to torture (N = 278). Hierarchical linear regressions revealed that female sex, older age, and unstable housing predicted greater severity of anxiety, posttraumatic stress disorder (PTSD), and depression. Cumulative exposure to multiple torture types predicted anxiety and PTSD, while mental health, basic resources (access to food, shelter, medical care), and external risks (risk of being victimized at home, community, work, school) were the strongest psychosocial predictors of anxiety, PTSD, and depression. Also, time spent in the United States before presenting for services significantly predicted anxiety, PTSD, and depression. Consequently, public-sector services should seek to engage this high-risk population immediately upon resettlement into the host country using a mental health stepped care approach.

Communities of Color Creating Healthy Environments to Combat Childhood Obesity.

Ethnic and racial health disparities present an enduring challenge to community-based health promotion, which rarely targets their underlying population-level determinants (e.g., poverty, food insecurity, health care inequity). We present a novel 3-lens prescription for using community organizing to treat these determinants in communities of color based on the Robert Wood Johnson Foundation's Communities Creating Healthy Environments initiative, the first national project to combat childhood obesity in communities of color using community organizing strategies. The lenses--Social Justice, Culture-Place, and Organizational Capacity-Organizing Approach--assist health professional-community partnerships in planning and evaluating community organizing-based health promotion programs. These programs activate community stakeholders to alter their community's disease-causing, population-level determinants through grassroots policy advocacy, potentially reducing health disparities affecting communities of color.

Disentangling depression and anxiety in relation to neuroticism, extraversion, suicide, and self-harm among adult psychiatric inpatients with serious mental illness.

OBJECTIVES: Little is known about depression-anxiety comorbidity and its association with personality traits and suicide/self-harm in adult psychiatric inpatients with serious mental illness (SMI), impacting clinical assessment and treatment. This study sought to determine the symptom structure of depression-anxiety comorbidity and its relation to neuroticism, extraversion, and suicide/self-harm behaviour in this high-risk population. DESIGN: Nine hundred and sixty-two adults receiving inpatient care at a private psychiatric hospital completed questionnaires at admission. METHODS: Confirmatory factor analyses compared a bifactor solution specifying a general distress factor and two specific depression and anxiety factors against unidimensional and correlated factors solutions. The bifactor solutions' factors were subsequently correlated with neuroticism and extraversion subscales and pre-hospitalization suicide/self-harm behaviours. RESULTS: The bifactor model rendered superior fit to sample data and a robust general factor - accounting for 77.61% of common item variance - providing the first evidence for a tripartite structure of depression and anxiety among adult inpatients. The bifactor solution-outputted independent general distress, depression, and anxiety factors positively correlated with neuroticism, the personality dimension corresponding to trait negative affectivity. The general distress and depression factors associated with recent self-harm, but factors showed no associations with prior suicidal behaviour. CONCLUSIONS: In adult psychiatric inpatients, general distress substantially underlies comorbid depression and anxiety symptom variation and may contribute to recent incidence of self-harm. Transdiagnostic assessments and interventions targeting general distress may temper depression, anxiety, and self-harm in adult inpatients. PRACTITIONER POINTS: Clinical implications Depression-anxiety comorbidity symptomology in adult psychiatric inpatients is primarily composed of general distress. General distress and specific depression are associated with recent self-harm but not suicidal behaviour. Assessing and treating general distress rather than depression or anxiety specifically may best mitigate comorbid depression and anxiety, and reduce self-harm behaviour in this clinical population. Cautions and limitations The large sample lacked ethnocultural diversity, and data were cross-sectional. The use of brief self-report measures to assess depression and anxiety may have reduced measurement range.

Empowerment Praxis: Community Organizing to Redress Systemic Health Disparities.

Social and environmental determinants of childhood obesity present a public health dilemma, particularly in low-income communities of color. Case studies of two community-based organizations participating in the Robert Wood Johnson Foundation's Communities Creating Healthy Environments (CCHE) childhood obesity initiative demonstrate multilevel, culturally situated community organizing strategies to address the root causes of this public health disparity. Informed by a 3-lens prescription-Social Justice, Culture-Place, and Organizational Capacity-contained in the CCHE Change Model and Evaluation Frame, we present examples of individual, organizational, and community empowerment to redress systemic inequities that manifest in poor health outcomes for people of color. These case studies offer compelling evidence that public health disparities in these communities may effectively be abated through strategies that employ bottom-up, community-level approaches for (a) identifying proximal and distal determinants of public health disparities, and (b) empowering communities to directly redress these inequities. Guided by this ecological framework, application of the CCHE evaluation approach demonstrated the necessity to document the granularity of community organizing for community health, adding to the community psychology literature on empowering processes and outcomes.

Psychological distress in torture survivors: pre- and post-migration risk factors in a US sample.

PURPOSE: To investigate the relationships between sociodemographic, pre- and post-migration variables with prevalence of psychological distress and global functioning in a heterogeneous sample of torture survivors. METHODS: Clients referred from resettlement agencies via the Office of Refugee Resettlement (ORR) to a community clinic in the United States (N = 278) were interviewed with structured, translated questionnaires. Univariate and multivariate logistic regression analyses determined the associations of sociodemographic, pre-, and post-migration risk factors with posttraumatic stress disorder (PTSD), depression, anxiety, and global functioning. RESULTS: Regression data indicate that length of time between arrival in US and clinical services was significantly associated with PTSD and depression; participants receiving services after 1 year of resettlement were more likely to experience PTSD (adjusted OR = 3.29) and depression (adjusted OR = 4.50) than participants receiving services within 1 year. Anxiety was predicted by female gender (adjusted OR = 3.43), age over 40 years (adjusted OR = 3.12), Muslim religion (adjusted OR = 2.64), and receiving medical services (AOR 3.1). Severely impaired global functioning was associated with female gender (adjusted OR = 2.75) and unstable housing status (adjusted OR = 2.21). CONCLUSION: Findings highlight the importance of examining post-migration variables such as length of time in country prior to receiving services in addition to pre-migration torture history upon relocated torture survivors. Clinicians and policy-makers should be aware of the importance of early mental health screening and intervention on reducing the psychiatric burden associated with torture and forced relocation.

A cross-sectional survey of factors related to inpatient assault of staff in a forensic psychiatric hospital.

AIM: To understand staff factors associated with patient aggression towards the staff of an inpatient forensic psychiatric hospital. BACKGROUND: Violence by patients is a serious concern in psychiatric hospitals and staff are the most frequent targets of physical and verbal assault. Assault and its consequences can severely disrupt the hospital environment and impair the functioning of staff members and patients. This study examined the interplay of staff dispositional and interpersonal factors associated with patient violence. DESIGN: This cross-sectional study surveyed the staff of a large public forensic hospital. METHODS: A sample of 348 psychiatric staff participated in an online survey about their workplace experiences, psychosocial characteristics and well-being. Data were collected from November - December 2011. FINDINGS: Nearly all staff reported verbal conflict with patients (99%) and 70% reported being assaulted during the previous 12 months. Verbal conflict with other staff (92%) was also high. Multiple regression analyses indicated that in addition to static risk factors (i.e. staff position, years of experience and gender), the risk of assault was associated with the frequency of conflicts with staff and patients, which in turn was moderated by personal stress reactivity. CONCLUSION: Physical violence by patients was a pervasive threat for a high proportion of staff. Frequent conflict interactions with volatile patients contributed the most risk, but reactivity to conflict was a dynamic risk factor. The strain associated with assault risk and stress reactivity could be prospectively mitigated by resilience enhancement programming for staff.

Depression and family interaction among low-income, predominantly hispanic cancer patients: a longitudinal analysis.

PURPOSE: Among cancer patients, family interaction has been associated with depression. According to the stress generation theory, depression among cancer patients triggers stressful interpersonal events that contribute to poor family interactions and additional depression. This conflict may occur with a spouse/partner or other family member, including extended family. This study evaluated the longitudinal association between depression and marital and family conflict among low-income, predominantly Hispanic cancer patients. METHODS: Data were collected during a randomized controlled clinical trial of depression treatment among 472 low-income cancer patients with baseline depression scores of 10 or more on the Patient Health Questionnaire-9 and whose depression symptoms and negative family interactions were assessed at baseline and at 6, 12, 18, and 24 months. Considering that not all participants were in an intimate relationship, only 237 participants were included in the analysis of marital conflict. Mixed linear modeling with and without decomposition of between- and within-person variability was conducted to examine the longitudinal association between family interaction and depression. RESULTS: Overall, family conflict was significantly associated with changes in depression over time, and marital conflict was significantly associated with mean depression levels over 2 years. In addition, within-subject change in both marital and family conflict was significantly associated with within-patient deviation from average depression levels. CONCLUSIONS: Findings provide evidence of an association between depression and negative family interaction among depressed cancer patients. Cancer patients with clinically significant depressive symptoms may benefit from clinical assessment and psychotherapy relevant to family interaction.

State of spirituality-infused mental health services in Los Angeles County wellness and client-run centers.

Spiritual coping is associated with positive mental health outcomes for individuals with serious mental illness, yet spirituality-infused services are seldom offered in public sector mental health agencies. The Los Angeles County Department of Mental Health introduced a policy addressing spirituality in 2012. This study explored the breadth and degree to which spirituality-infused activities were being offered in 53 Los Angeles wellness and recovery centers after the policy was widely disseminated. More than 98 % of the centers offered options for spirituality-infused activities; one-third offered spirituality-focused groups. Los Angeles's progress may guide implementation of spirituality-infused services in other state or local public mental health systems.