The harms of racial miscategorization: Comparing multiracial individuals' well-being in the continental U.S. versus Hawai'i.

OBJECTIVE: The current work explores the effects of racial miscategorization (incongruence between other people's racial categorization of an individual and that individual's racial self-identification) and subjective well-being of multiracial individuals in Hawai'i versus California. We set out to examine how multiracial individuals experience racial miscategorization in more or less ethnically diverse environments and how this experience shapes the extent to which they feel a sense of belonging and inclusion. METHOD: The study consisted of interviews with 55 multiracial undergraduate and graduate students conducted in Hawai'i (20 self-identified women and 9 self-identified men, with ages ranging from 18 to 47 years; M = 22.93, SD = 6.40) and California (16 self-identified women, 9 self-identified men, and 1 self-identified gender nonbinary person, with ages ranging from 18 to 31 years; M = 20.96, SD = 2.76). RESULTS: Thematic analysis identified two central themes relevant to subjective well-being: (a) racial miscategorization and its consequences and (b) contextual differences in the experiences of miscategorization. Results suggest that racial miscategorization is a pervasive experience among multiracial people and is associated with negative psychological well-being. We also found that environments with greater representation of multiracial individuals, such as Hawai'i, are associated with less racial miscategorization, more inclusion, and better psychological well-being among multiracial individuals. CONCLUSIONS: Racial miscategorization is a prominent and aversive experience among multiracial individuals, but multiracial environments can serve as a psychological buffer. Racial miscategorization has important theoretical and practical implications for racial and ethnic identity research, which we discuss. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sub-County Life Expectancy: A Tool to Improve Community Health and Advance Health Equity.

Compared with people in other developed countries, Americans live shorter lives, have more disease and disability, and lag on most population health measures. Recent research suggests that this poor comparative performance is primarily driven by profound local place-based disparities. Several initiatives successfully used sub-county life expectancy estimates to identify geographic disparities, generate widespread interest, and catalyze multisector actions. To explore the feasibility of scaling these efforts, the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists initiated a multiphase project - the Sub-County Assessment of Life Expectancy. Phase I participants reviewed the literature, assessed and identified appropriate tools, calculated locally relevant estimates, and developed methodological guidance. Phase I results suggest that most state and local health departments will be able to calculate actionable sub-county life expectancy estimates despite varying resources, expertise, and population sizes, densities, and geographies. To accelerate widespread scaling, we describe several successful case examples, identify user-friendly validated tools, and provide practical tips that resulted from lessons learned.

Turning the Curve on Obesity Prevalence Among Fifth Graders in the Los Angeles Unified School District, 2001-2013.

INTRODUCTION: After multiple decades of increasing childhood obesity prevalence in the United States, findings from recent studies suggest that prevalence has leveled or is decreasing in some populations. However, demographic and socioeconomic disparities in prevalence remain and may be increasing. METHODS: To assess recent trends and disparities in childhood obesity prevalence in Los Angeles County, we analyzed data from 2001 through 2013 in fifth graders in the Los Angeles Unified School District (LAUSD). Obesity was defined as a body mass index at or above the 95th percentile for children of the same age and sex as compared with Centers for Disease Control and Prevention growth charts, on the basis of measured height and weight. Trends were examined by sex, race/ethnicity, and socioeconomic status (SES). SES was determined by using school-level data on the percentage of students participating in a free and reduced-price meal program. RESULTS: Obesity prevalence increased from 27.5% in 2001 to 31.6% in 2005, was stable from 2005 through 2010, and decreased from 31.6% in 2010 to 28.5% in 2013. Similar trajectories in prevalence were observed for all demographic and SES subgroups, although the decline in prevalence began earlier among whites and students attending schools in the highest SES group. Disparities in prevalence by race/ethnicity and SES were observed during the entire study period but narrowed slightly from 2010 through 2013. CONCLUSION: Although obesity prevalence among fifth graders in LAUSD declined from 2010 through 2013, prevalence remains higher than in 2001, and demographic and socioeconomic disparities in prevalence persist. Future interventions in the county should prioritize Latinos and students attending low SES schools.

Building and Sustaining Strong Public Health Agencies: Determinants of Workforce Turnover.

CONTEXT: Workforce shortages have been identified as a priority for US public health agencies. Voluntary turnover results in loss of expertise and institutional knowledge as well as high costs to recruit and train replacement workers. OBJECTIVE: To analyze patterns and predictors of voluntary turnover among public health workers. DESIGN: Descriptive analysis and linear probability regression models. PARTICIPANTS: Employees of state health agencies in the United States who participated in the Public Health Workforce Interests and Needs Survey (PH WINS). MAIN OUTCOME MEASURES: Intended retirement and voluntary departure; pay satisfaction; job satisfaction. RESULTS: Nearly 25% of workers reported plans to retire before 2020, and an additional 18% reported the intention to leave their current organization within 1 year. Four percent of staff are considering leaving their organization in the next year for a job at a different health department. There was significant heterogeneity by demographic, socioeconomic, and job characteristics. Areas such as administration/management, health education, health services, social services, and epidemiology may be particularly vulnerable to turnover. The strongest predictors of voluntary departure were pay and job satisfaction, which were associated with 9 (P < .001) and 24 (P < .001) percentage-point decreases, respectively, in the probability to report the intention to leave. Our findings suggest that if all workers were satisfied with their job and pay, intended departure would be 7.4%, or less than half the current 18% rate. Controlling for salary levels, higher levels of education and longer work experience were associated with lower pay satisfaction, except for physicians, who were 11 percentage points (P = .02) more likely to be satisfied with their pay than employees with doctoral degrees. Several workplace characteristics related to relationships with supervisors, workplace environment, and employee motivation/morale were significantly associated with job satisfaction. CONCLUSIONS: Our findings suggest that public health agencies may face significant pressure from worker retirement and voluntary departures in coming years. Although retirement can be addressed through recruitment efforts, addressing other voluntary departures will require focusing on improving pay and job satisfaction.

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.

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.

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.

Power and the confrontation of sexism: the impact of measured and manipulated power on confronting behavior.

The confrontation of prejudicial acts and comments promotes multiple benefits, most notably the prevention of future prejudicial remarks and the reduction of stereotype use. Research, however, consistently shows low rates of confronting prejudice, particularly regarding sexism. Here, we examine whether personal sense of power, known to increase action and activate the behavioral approach system, increases the likelihood of confronting a sexist remark. In Study 1, we demonstrate that for both women and men, self-reported power is associated with a higher frequency of confronting sexism. In Study 2, we manipulate women's sense of power (i.e., high power, low power, or control) and subsequently present an opportunity to confront a sexist remark. Results show that women primed to feel powerful were more likely to confront the sexist remark and expressed greater disagreement with the comment, compared to women primed to feel powerless. Implications for the confronting literature and behavior are discussed.

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.

Targets as perceivers: how people determine when they will be negatively stereotyped.

Research on stereotype threat has demonstrated that when targets are forced to contend with the threat of being negatively stereotyped, their academic performance suffers (C. M. Steele & J. Aronson, 1995). The present research explored how the targets of negative stereotypes determine when they must contend with this threat. Across 5 experiments, the authors manipulated both the possibility and probability that Black and female students would be stereotyped as unintelligent prior to taking an analytical test. Collectively, these experiments showed that these students contended with stereotype threat only when they perceived that it was both possible and probable that they would be negatively stereotyped. The authors discuss the implications of these findings on the experience of being the target of negative stereotypes and on the academic achievement of Blacks and women.

Juggling multiple racial identities: malleable racial identification and psychological well-being.

The authors examined the link between malleable racial identification and psychological well-being among self-identified multiracial adults. Malleable racial identification refers to the tendency to identify with different racial identities across different social contexts. Results across three studies suggested that malleable racial identification was associated with lower psychological well-being. Study 2 found that unstable regard (i.e., fluctuating private regard about their multiracial background) was the mechanism through which malleable racial identification predicted lower psychological health. Results of Study 3 suggested that dialectical self-views played an important moderating role that determines whether malleability is associated with negative psychological outcomes. The present studies uniquely show that malleable racial identification among multiracial people is maladaptive for psychological health, but that this may depend on whether or not people have tolerance for ambiguity and inconsistency in the self.

Prevalence and sociodemographic disparities in ever E-cigarette use among adults in Los Angeles County.

E-cigarette use has increased rapidly among U.S. adults. Few studies have examined the prevalence and risk factors of e-cigarette use among adults in the United States. We conducted descriptive analyses to identify characteristics of ever e-cigarette users among adults (18 years and older) living in Los Angeles (LA) County, the most populous county in the U.S., using data from the 2015 LA County Health Survey. We used logistic regression to examine independent factors associated with ever e-cigarette use. Age-adjusted prevalence of ever e-cigarette use was 8.4%. A significant interaction between conventional cigarette smoking status and gender was found (p < 0.05), and several factors were identified as associated with ever e-cigarette use in models stratified by gender. Various social and demographic factors are associated with ever e-cigarette use and should be incorporated into evidence-based interventions.

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.

The social construction of race: biracial identity and vulnerability to stereotypes.

Multiracial individuals are more likely to have a heightened awareness of race as a social construct than monoracial individuals. This article examines the impact that a heightened awareness of race as a social construct has on the relationship between racial stereotypes and performance. Study 1 finds that multiracial individuals reported subscribing less to the notion that race biologically determines ability. Study 2 finds that monoracial individuals show stereotype activation, whereas multiracial individuals show stereotype inhibition in reaction to race salience. Study 3 draws on the work on stereotypes and performance to test the susceptibility of multiracial individuals to racial stereotypes about ability. The authors find that Asian/White and Black/White multiracial individuals were less susceptible to racial stereotypes than monoracial individuals. Whereas monoracial participants showed significant performance changes in reaction to race salience, multiracial individuals did not. Study 4 finds that emphasizing the social construction of race buffers individuals from stereotype threat effects.

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.

Serious psychological distress in U.S. adults with arthritis.

BACKGROUND: Arthritis and mental health disorders are leading causes of disability commonly seen by health care providers. Several studies demonstrate a higher prevalence of anxiety and depression in persons with arthritis versus those without arthritis. OBJECTIVES: Determine the national prevalence of serious psychological distress (SPD) and frequent anxiety or depression (FAD) in adults with arthritis, and in adults with arthritis, identify risk factors associated with SPD. METHODS: Cross-sectional data from the 2002 National Health Interview Survey, an in-person household interview survey, were used to estimate the prevalence of SPD and FAD in adults with (n=6,829) and without (n=20,676) arthritis. In adults with arthritis, the association between SPD and sociodemographic, clinical, and functional factors was evaluated using multivariable logistic regression. RESULTS: The prevalence of SPD and FAD in adults with arthritis is significantly higher than in adults without arthritis (5.6% vs 1.8% and 26.2% vs 10.7%, P<.001, respectively). In adults with arthritis, SPD was significantly associated with younger age, lower socioeconomic status, divorce/separation, recurrent pain, physical inactivity, having functional or social limitations, and having comorbid medical conditions. Adults aged 18 to 44 years were 6.5 times more likely to report SPD than those 65 years or older, and adults with recurrent pain were 3 times more likely to report SPD than those without recurrent pain. CONCLUSIONS: Serious psychological distress and FAD affect persons with arthritis and should be addressed in their treatment. Younger adults with arthritis, and those with recurrent pain or either functional or social limitations, may be at higher risk for SPD.

Physical activity in men and women with arthritis National Health Interview Survey, 2002.

BACKGROUND: Regular physical activity in persons with arthritis has been shown to decrease pain, improve function, and delay disability. This study estimates the national prevalence of leisure-time physical activity and identifies factors associated with physical inactivity in adults with arthritis. METHODS: Data from the 2002 National Health Interview Survey were analyzed in 2004-2005 to estimate the proportion of adults with arthritis meeting four physical activity recommendations put forward in Healthy People 2010 and one arthritis-specific recommendation established by a national expert panel in arthritis and physical activity. Multivariate logistic regression was used to evaluate the association between inactivity and sociodemographic factors, body mass index, functional limitations, social limitations, need for special equipment, frequent anxiety/depression, affected joint location, joint pain, physical activity counseling, and access to a fitness facility. RESULTS: Adults with arthritis were significantly less likely than adults without arthritis to engage in recommended levels of moderate or vigorous physical activity, and 37% of adults with arthritis were inactive. In both men and women with arthritis, inactivity was associated with older age, lower education, and having functional limitations; having access to a fitness facility was inversely associated with inactivity. Among women, inactivity was also associated with being Hispanic, non-Hispanic black, having frequent anxiety/depression or social limitations, needing special equipment, and not receiving physical activity counseling. Among men, inactivity was also associated with severe joint pain. CONCLUSIONS: Although physical activity is a recommended therapy for people with arthritis, levels among adults with arthritis are insufficient, and those with arthritis have worse activity profiles than their peers without arthritis. Efforts to promote physical activity should include expanding access to evidence-based interventions and recreational facilities/programs. The importance of physical activity counseling and associated pain management measures by healthcare providers should be emphasized.

Synergistic affective analgesic interaction between delta-9-tetrahydrocannabinol and morphine.

Evidence for an analgesic interaction between delta-9-tetrahydrocannabinol (Delta(9)-THC) and morphine was sought using an experimental pain model applied to normal volunteers. The study incorporated a double blinded, four treatment, four period, four sequence, crossover design. Subjects received Delta(9)-THC 5 mg orally or placebo and 90 min later morphine 0.02 mg/kg intravenously or placebo. Fifteen minutes later subjects rated the pain associated with the application of thermal stimuli to skin using two visual analog scales, one for the sensory and one for the affective aspects of pain. Among sensory responses, neither morphine nor Delta(9)-THC had a significant effect at the doses used, and there was no significant interaction between the two. Among affective responses, although neither morphine nor Delta(9)-THC had a significant effect, there was a positive analgesic interaction between the two (p = 0.012), indicating that the combination had a synergistic affective analgesic effect. The surprisingly limited reported experimental experience in humans does not support a role for Delta(9)-THC as an analgesic or as an adjunct to cannabinoid analgesia, except for our finding of synergy limited to the affective component of pain. Comparison of our results with those of others suggests that extrapolation from experimental pain models to the clinic is not likely to be a straight-forward process. Future studies of Delta(9)-THC or other cannabinoids in combination with opiates should focus upon clinical rather than experimental pain.

Potential Gains in Life Expectancy from Reductions in Leading Causes of Death, Los Angeles County: a Quantitative Approach to Identify Candidate Diseases for Prevention and Burden Disparities Elimination.

Despite overall gains in life expectancy at birth among Los Angeles County residents, significant disparities persist across population subgroups. The purpose of this study was to quantify the potential sex- and race/ethnicity-specific gains in life expectancy had we been able to fully or partially eliminate the leading causes of death in Los Angeles County. Complete annual life tables for local residents were generated by applying the same method used for the National Center of Health Statistics US life tables published in 1999. Based on 2010 Los Angeles County mortality records, sex- and race/ethnicity-specific potential gains in life expectancy were calculated using scenarios of 10, 20, 50, and 100 % elimination of 12 major causes of death. Coronary heart disease, the leading cause of death, was found to be most impactful on life expectancy. Its hypothetical full elimination would result in life expectancy gains ranging from 2.2 years among white females to 3.7 years among black males. Gains from complete elimination of lung cancer and stroke ranked second, with almost an additional year of life for each gender. However, marked disparities across racial/ethnic groups were noted from the elimination of several other causes of death, such as homicide, from which the gain among black males exceeded 13 times more than their white counterparts. By differentially targeting specific causes of death in disease prevention, not only can findings of this study aid in efficiently narrowing racial/ethnic disparities, they can also provide a quantitative means to identify and rank priorities in local health policymaking.