Archived Projects

The following is an overview of past projects led by Center staff, affiliates, and community partners.

Alcohol Outlets, Broken Windows, Gonorrhea and HIV, funded by NICHD. Deborah Cohen (PI). The 1992 Civil Unrest in Los Angeles resulted in the burning of more than 600 buildings and the closure of 221 alcohol outlets. These events served as a natural experiment to test the influence of community institutions (alcohol outlets and CBOs) on HIV risk in a longitudinal, ecological study. We analyzed data from the 1990 Census, the 2000 Census, and LADHS to determine: (1) if gonorrhea rates dropped in local neighborhoods where alcohol outlets were closed; (2) if there was an association between changes in neighborhood deterioration (or reconstruction) and changes in rates of gonorrhea; and (3) if there was an association between changes in alcohol outlets, neighborhood deterioration and changes in AIDS case rates at the census tract level. In addition, we conducted two studies: (1) a qualitative study of the efforts both prior to and since 1992 of CBOs to prevent the relicensure of alcohol outlets that assisted in the interpretation of our quantitative study; (2) an evaluation of the environmental characteristics associated with alcohol abuse. The findings are available for future HIV prevention interventions and will guide CBOs as to whether control of alcohol outlets and neighborhood development enhances the prevention of HIV transmission.

Bridging Community Strengths, funded by the Association of Schools of Public Health (ASPH), the CDC, and CDC core Center Grant. Raphael Travis (PI). In an effort to promote adolescent health, many community agencies have implemented after school activities. These programs and activities are often based on models of positive youth development. Previously, evaluation efforts have focused on outcomes. Few studies have evaluated the developmental quality of these programs or identified their strengths and areas in need of improvement. This study helped determine the external characteristics necessary to support positive youth development. We helped programs unable to afford comprehensive evaluations in the area of our primary community partner, Carson and Wilmington (CW). This study: (1) provided a profile including the location, scope and content of after school, community-based youth programs within Carson, California; (2) determined whether the measures for program developmental quality and its indicators, developed by the Community Network for Youth Development (CNYD), were appropriate among the sampled organizations; (3) identified staff perceptions of operational practices that moderated (facilitated or hindered) the programs ability to provide an environment that facilitated positive youth development; and (4) described the relationship between program characteristics and staff perception of ability to provide an environment high in developmental quality. Exploring programs within a youth development framework bore direct public health relevance as we sought to provide the necessary developmental building blocks for youth in regard to physical, social, and emotional health.

Bullies and Victims in Middle School: A Social-Cognitive and Contextual Analysis of Peer Victimization Across Middle School Years, funded by the CDC, National Science Foundation, W.T. Grant Foundation. Jaana Juvonen (PI). We examined the relationships between bullying and a range of adjustment indices among an ethnically diverse group of young adolescents. The sample consisted of 12,000 sixth grade students from eight urban public schools in predominately low socioeconomic status (SES) communities in the greater LA area. Bullies, victims, and bully-victims were identified based on peer nominations and compared with classmates who were uninvolved in bullying. Data included self-reports of depression, loneliness, and social anxiety; peer-reports of rejection, likeability, and popularity; teacher-ratings of social behavior and school engagement, and school record data on grades. The results showed that victims reported the highest level of distress and were regarded as least likeable and popular, whereas bullies did not manifest any psychological adjustment difficulties and were considered most popular by both their peers and their teachers. Bully-victims displayed some adjustment difficulties; they were most rejected by their peers and rated by their teachers as most disruptive. Compared to youth who were not involved in bullying, bullies, victims, and bully-victims were all less engaged in school and received lower grades in academic subjects.

Cognitive Behavioral Intervention for Trauma in Schools (CBITS), funded by LAUSD, NIMH, Robert Wood Johnson Clinical Scholars Program, and SAMHSA, and the Mark S. Taper Foundation. Bradley Stein (PI), Marleen Wong (PI), Lisa Jaycox (PI). This study was a collaborative project with LAUSD to develop, implement, and rigorously evaluate a school-based mental health program to identify and intervene with traumatized children who have been exposed to community violence. We developed a manualized cognitive-behavioral intervention program, the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), that targeted psychological, emotional, and behavioral problems in traumatized children. We aimed to reduce trauma-related symptoms, reduce functional impairment, and enhance school performance in traumatized children. The children in our first study were from the general school population in LAUSD, which had a large percentage of recent immigrant children, particularly Latino immigrants. We implemented the program in other areas of the LAUSD. The program was also adapted and implemented in a number of other communities across the nation, including Baltimore, Madison, Yakima, and several Native American reservations. We evaluated the effectiveness of the MHIP by analyzing data on school attendance, communication/social skills, classroom relationships with teachers and peers, and scholastic achievement.

Community Characteristics and Physical Activity Among Adolescent Girls, funded by NHLBI. Deborah Cohen (PI). Because environmental factors can influence the likelihood that a person will engage in physical activity (PA), we investigated the role of community characteristics in PA levels. The research formed an ancillary study to the NHLBI-funded multi-centered Trial of Activity for Adolescent Girls (TAAG), a randomized controlled intervention trial (by schools) to increase PA among a cohort of sixth grade girls over 2.5 years. The parent TAAG study collected measures of physical activity using both self-report and CSA accelerometers, small monitors worn at the hip that record acceleration and deceleration of movement without the need for any reporting from the participants. In addition, by following girls over time, we planned to investigate whether the effect of the TAAG intervention would be modified by community characteristics. This study was unique in its scope: we explored the role of community environments in physical activity across six very different urban, suburban, and rural areas: San Diego, CA, Minneapolis, MN, Baltimore, MD, New Orleans, LA, Tucson, AZ, and Columbia, SC.

Delivery of Preventative Health Care for Children, funded by Commonwealth Fund. Mark Schuster (PI). We reviewed existing literature that examined: (1) the quality of preventive health care received by children and adolescents in the United States and (2) barriers that may explain disparities in preventive health care quality. We defined preventive care as not only immunizations and screening, but also developmental surveillance and anticipatory guidance. The review was based on a conceptual model that viewed preventive health care as the result of patient and provider factors that interact through a patient-provider relationship within the constraints of the larger health care system. We conducted a semi-systematic literature search and screening of potentially relevant English-language articles in Medline. We supplemented the literature review with semi-structured interviews of leading researchers in the field. The final product was a manuscript that reviewed the current literature and provided direction for future public policy and research.

Developing Public Health Quality Indicators for Local Health Departments: Experience in Los Angeles County, funded by the Public Health Division of the Los Angeles County Department of Health Services, and the CDC. Mark Schuster (PI). We developed public health quality indicators for the Los Angeles County Health Department (LHD) by utilizing public health quality measurement concepts, reviewing existing quality measurement-related initiatives, and conducting interviews with LHD staff. We developed sixty-one recommended and fifty acceptable (i.e., scientifically sound but less useful) indicators, with an emphasis on measuring process quality in services delivery. Preexisting indicators from external sources, when available, were often not well-suited to the Health Department's needs. The indicator development process clarified conceptual issues, highlighted strengths and limitations of potential indicators, and revealed implementation barriers. We concluded that a limited number of generally available, quantitative indicators of local public health quality existed. Indicators addressing the delivery of LHD services could be locally developed to fill an important gap in public health quality improvement efforts. However, implementation of quality measurement was difficult due to limited evidence on public health practices, sparse data resources, unclear accountability, and inconsistent organizational motivation. In the future, evaluation of this new system will determine the quality of care in Los Angeles County and identify approaches to improving quality of care.

Filipino-American Family Communication and Teen HIV Risk Reduction Study, funded by the University-wide AIDS Research Program (UARP). Mark Schuster (PI). We studied the communication between Filipino-American parents and their adolescents about sensitive issues like sexual development and risk reduction. We were particularly interested in understanding the role acculturation plays in influencing parent-adolescent relationships and adolescent behaviors. This study was conducted in three phases. In the first phase, we interviewed leaders in the Filipino-American community (key informants) to gain an understanding of how best to conduct the study and to learn more about the needs of the Filipino-American community. In the second phase, we conducted focus groups with Filipino adolescents, parents, and grandparents. The goals of the focus groups were to obtain a better understanding of varying perspectives on parent-adolescent communication, the issues that are important in the community, and what might be done to address any problems. The final phase of the study involved surveying Filipino-American adolescents and their parents about the various aspects of communication and relationships, as well as adolescent sexual knowledge, attitudes, and behaviors. See Section III for a detailed description of the community involvement on this project.

Firearm Storage in U.S. Homes, funded through CDC core Center Grant. Mark Schuster (PI). In this study we determined the prevalence and storage patterns of firearms in U.S. homes with children. We analyzed data from the 1994 National Health Interview Survey (NHIS) and Year 2000 objectives supplement, and used a multistage sample design to represent the civilian, non-institutionalized U.S. population. Respondents from 35% of the homes with children younger than 18 years old (representing more than 22 million children) reported having at least one firearm. Among homes with children and firearms, 43% had at least one unlocked firearm. Overall, 9% kept firearms unlocked and loaded, and 4% kept them unlocked, unloaded, and stored with ammunition; thus, a total of 13% of homes with children and firearms—1.4 million homes with 2.6 million children—stored firearms in a manner most accessible to children. In contrast, 39% of these families kept firearms locked, unloaded, and separate from ammunition. Because so many children live in homes with firearms that are stored in an accessible manner, it is clear that efforts to prevent children's access to firearms are needed.

In the Mix, funded by the University AIDS Research Program (UARP). Matt Mutchler (PI). In collaboration with the AIDS Project Los Angeles (APLA), this study surveyed an ethnically diverse group of HIV+ men who have sex with men and women (MSMW). Results of the surveys are available for use to understand disclosure practices to their male and female partners so that service providers can better address the needs of both HIV+ MSMW and their partners.

Mental Health Effects of Terrorism, A National Survey of the Mental Health Effects of September 11th Attack and War on Terrorism, funded by the CDC core Center Grant, NICHD, and RAND Health. Bradley Stein (PI), Mark Schuster (PI). This project conducted a longitudinal examination of the mental health effects of the September 11th terrorist attacks and war on terrorism in adults and children across the country. On September 14th-16th, RAND conducted a national random-digit-dial telephone survey of 560 adults 19 or older within the United States. From November 9th through November 28th, as the second in a series of ongoing surveys, RAND re-interviewed 395 of the 560 participants (71%) of the September survey about their current terrorism-related stress symptoms, behaviors, and response to the attacks. We analyzed the data from the second wave of interviews. We also pursued funding for future waves of interviews. This study was cited in a U.S. House of Representative's Bill, the National Resilience Act of 2003.

Mental Health Intervention Program for Violence Exposure (MHIP), funded by LAUSD, NIMH, Robert Wood Johnson Clinical Scholars Program, and SAMHSA. Bradley Stein (PI), Marleen Wong (PI). This study was a collaborative project with LAUSD to develop, implement, and rigorously evaluate a school-based mental health program to identify and intervene with traumatized children who have been exposed to community violence. We developed a cognitive-behavioral intervention program, the Mental Health Intervention Program (MHIP), that targeted psychological, emotional, and behavioral problems in traumatized children. We aimed to reduce trauma-related symptoms, reduce functional impairment, and enhance school performance in traumatized children. The children in our first study were from the general school population in LAUSD, which had a large percentage of recent immigrant children, particularly Latino immigrants. We implemented the program among primarily African-American children in LAUSD and Washington, DC, and explored implementation in Baltimore, and Seattle, WA. We evaluated the effectiveness of the MHIP by analyzing data on school attendance, communication/social skills, classroom relationships with teachers and peers, and scholastic achievement.

Neighborhood Characteristics and Health Disparities, funded by HRSA MCH. Deborah Cohen (PI). We investigated the causes of class, ethnic, racial disparities in physical, mental health, and access to and use of services. Our focus was on health problems of increasing importance to youth and adolescents: obesity, injury, asthma, and teen pregnancy. All of these problems disproportionately affect low-income populations of minority status and may, in part, be related to neighborhood level factors. We used data collected from: (1) the Los Angeles Family and Neighborhood Survey (LAFANS), a study carried out in a representative sample of 65 neighborhoods in Los Angeles County; (2) data from the US Census 2000; (3) land use information including alcohol outlet locations and health department surveillance data on injury mortality and teen pregnancy at the census tract level. This study was among the first to test whether neighborhood structural variables, defined and measured independently of the neighborhood residents, were associated with social processes, with individual level health risk behaviors, with health care utilization, and with population level health outcomes.

Oral Sex and Vaginal Intercourse in Late Adolescence: Gender Differences in Attitudes, Norms, and Intentions, dissertation research by Lisa Carlstrom, funded by CDC core Center Grant. Studies of adolescent sexual behavior predominantly focus on vaginal intercourse. Historically, this focus results from concern over teenage pregnancy and sexually transmitted infections (STIs). However, oral sex is common among adolescents. Even though oral sex carries no risk of pregnancy, adolescents who engage in oral sex place themselves at risk for STIs. Very few studies assessed the prevalence of oral sex among adolescents, and even less work was done to establish the reasons that adolescents engage in oral sex. In this study, we (1) compared adolescents' beliefs about oral sex with their beliefs about vaginal intercourse, (2) examined gender differences in adolescents' beliefs about oral sex and vaginal intercourse, and (3) examined how adolescents' beliefs about oral sex and vaginal intercourse are related to their intentions to engage in these behaviors. Results have important implications for the development of sex education curricula focused on promoting healthy sexual behavior among adolescents.

Smoking Patterns in Homes with Children, funded through CDC core Center Grant. Mark Schuster (PI). In this study we determined the prevalence and pattern of environmental tobacco smoke (ETS) exposure in U.S. homes with children younger than 18 years. We analyzed data from the 1994 National Health Interview Survey and Year 2000 Objectives supplement. We used a multistage sample design to represent the civilian, non-institutionalized U.S. population. We found that 35% of children in the U.S. — 21 million — lived in homes where residents or visitors smoke in the home on a regular basis (≥ 1 d/wk). In 92% of homes with children where residents smoked at home, they did so every day. In 6% of the homes where no residents smoked, there was regular smoking by visitors. In multivariate regression analysis, the prevalence of regular smoking in homes with children varied by age of youngest child, race/ethnicity, number of parents in the home, parental educational level, income, and region of the country. Given that many children live in homes with ETS, clinicians who take care of children can advise parents, whether or not they smoke, on how to limit their children's ETS exposure.

Supervised After School Activities and Health Risk among Youth, funded through CDC core Center Grant. Deborah Cohen (PI). We examined the association that existed between opportunities for supervised after school activities in public high schools and community level health outcomes, including teen pregnancy, sexually transmitted diseases (STDs), and crime. We used a survey to assess available opportunities for after school supervision and numbers of youth served in 177 public high schools in LA County. The survey documented the number of after school activities available, the number of boys and girls who particpated, and the number of hours that the activity occured by season. We obtained population-level data from the US census at the census tract level and matched each school catchment area with its respective census tracts. We determined whether the number of served and underserved youth correlated with the prevalence of risk behaviors in each community, after controlling for community-level socioeconomic status (SES) (income, employment, and education). More specifically, we examined whether the age-appropriate opportunities for supervised activities correlated with objective outcome measures including community rates of teenage pregnancy, STDs among adolescents, and juvenile crime. We found that although there was a wide variety of after school opportunities available to youth, fewer activities were available in schools that served primarily disadvantaged youth, even within the same school districts. In our models to examine whether extracurricular activities were associated with health and social outcomes, we found a modest association between the number of sports activities available and the rate of juvenile arrests per square mile of the school catchment area. We found no associations between extra-curricular activities and academic performance index, dropout rates, STDs by gender or type of STD, and teen birthrates. We disseminated these findings to schools, policymakers, and CBOs across LA County.

Teen Photovoice and Food Intervention Study, funded by the Robert Wood Johnson Clinical Scholars Program. Jonathan Necheles (PI). This study was developed to use an innovative CBPR methodology, we provided cameras to a stratified random sample of middle school students (including an oversample of obese youth) to photograph what they ate, where they got it, and what they believe influenced their diet. They kept diaries and presented their stories in a photo-narrative format to increase their awareness of their own nutrition and eating habits. Content analyses were used to analyze their responses, and pre-surveys and post-surveys with intervention and control groups were also used to assess the impact on the youth of participating in this project.

Major Projects Led by Community Partners

Integrated, Multi-Level Interventions to Prevent Adolescent STDs/HIV and Teen Pregnancy (LADHS). Peter Kerndt (PI). The CDC Adolescent Health study was an eight-year multi-level, integrated, prospective intervention study designed to reduce the incidence of teen pregnancy and STD infection, including HIV, among adolescents in Los Angeles County. The project research team was a collaboration between Health Research Association (HRA), RAND Corporation, the University of California, Los Angeles (UCLA), Los Angeles County Sexually Transmitted Disease Program (STDP), Centers for Disease Control and Prevention (CDC), and the Los Angeles Unified School District (LAUSD). The study developed and tested the efficacy of a multiple component pregnancy and STD prevention intervention for adolescents aged 11 to 19 years. Levels of intervention included communities, schools, parents, and health care providers. The study was conducted in 12 LAUSD high schools, paired based on ethnic composition, STD and birth rates, and the 24 middle schools that fed into these high schools. Within each high school pair, one school complex area was assigned to the intervention arm and the other to the comparison arm of the study. Goals of the intervention were to increase parents’ supervision of and communication with adolescents about STD and pregnancy prevention; increase health care providers’ knowledge of and adherence to appropriate adolescent health care and pregnancy/STD prevention practices; increase access to and utilization of school condom availability programs, after school programs and other alternatives to sexual activity; and, within the surrounding communities, increase and echo prevention messages and social norms, and increase access to condoms and supervised activities for adolescents. Participating students completed yearly surveys, and in years 3 and 7, older students were asked to provide a urine sample for confidential Chlamydia testing.