Ninez Ponce - Profile on Academia.edu (original) (raw)

Papers by Ninez Ponce

Health & Place, Mar 1, 2019

There has been mounting evidence for the beneficial effect of green space on mental health among ... more There has been mounting evidence for the beneficial effect of green space on mental health among adults, but studies on the same topics are lacking for teens in the US. This study aimed to fill in this research gap by utilizing data from California Health Interview Survey (CHIS) 2011-2014. A total of 81,102 households (composed of 4538 teens and 81,102 adults) were retained for main analyses. Surrounding greenness was assessed by the Normalized Difference Vegetation Index (NDVI) within varying buffers of home residence. Survey logistic regressions accounted for sampling weights and design were conducted to examine the effects of greenness on serious psychological distress (SPD), adjusted for major socio-demographic factors, neighborhood socioeconomic status (SES) and co-respondent's psychological distress level within the same household. An inter-quartile increment of NDVI in 350 m buffer predicted decreased odds of SPDs by 36% in teens (OR = 0.64, 95% CI = [0.46, 0.91]). Mediation analyses revealed that this association remained almost unchanged even after adjusting for social cohesion. The NDVI-SPD association of adults was found to be significant only in the older group (OR = 0.81, 95% CI = [0.68, 0.95]). This study is one of the first population-based US studies extending the epidemiological evidence for benefits of green space on mental health from adults to teens.

Gerontologist, Sep 23, 2017

Background and Objectives: Growing literature documents that where you live has an impact on your... more Background and Objectives: Growing literature documents that where you live has an impact on your health, due in part to social capital. Building on social capital literature, we assess how subjective appraisals of neighborhood quality are associated with self-reported health (SRH) for older adults. Research Design and Methods: Cross-sectional analysis of the 2014 California Health Interview Survey, a representative survey of diverse, noninstitutionalized California residents. We use three measures of neighborhood quality: trustworthy neighbors, helpful neighbors, and feeling safe. Using weighted ordinary least squares regression, we assess the associations of trust, helpfulness, and safety to SRH, controlling for neighborhood, demographic, and health care variables. We then examine how these associations vary by household income. Results: We find that characterizing neighbors as helpful and feeling safe are associated with better SRH, even controlling for community, demographic, and health care variables. However, the importance of these dimensions varies across household income: helpfulness is positively associated, whereas trust is negatively associated with SRH for lower income residents; safety is positively associated with SRH in all but the lowest income residents. These findings show that social capital dimensions work differently from one another, and differentially affect the health of older adults. Discussion and Implications: Scholarly analyses of neighborhood effects should include a range of social capital measures and stratify by household income. Our findings may also inform priority setting for social capital programs, especially for older adults with limited economic resources. Policies and programs should consider actions that raise perceptions of helpfulness and safety.

Addressing discriminatory benefit design for people living with HIV: a California case study

Aids Care-psychological and Socio-medical Aspects of Aids/hiv, Apr 9, 2017

Concern is growing in the United States regarding the potential for health insurance benefit desi... more Concern is growing in the United States regarding the potential for health insurance benefit designs to discriminate against persons living with HIV as research demonstrates that such practices are occurring. A recent complaint filed against health insurers in seven states alleges that some health insurance companies have been using benefit designs that discourage enrollment of people living with HIV either by not covering essential HIV medications or by requiring cost-sharing for these prohibitively expensive medications. Legislators across the country have reacted by introducing legislation to address these growing problems. This paper describes Assembly Bill 339, legislation passed in California in 2015 and going into effect on 1 January 2017, which provides protection for people living with HIV by requiring coverage for single-tablet regimens to manage HIV while placing a cap on patient cost-sharing. Given California's size and influence, and the uncertainty of the future of the Affordable Care Act, this legislation has the potential to influence the national policy debate.

Race and Social Problems, Nov 3, 2016

Contact with the justice system can lead to a range of poor health and social outcomes. While per... more Contact with the justice system can lead to a range of poor health and social outcomes. While persons of color are disproportionately represented in both the juvenile and criminal justice systems, reasons for these patters remain unclear. This study sought to examine the extent and sources of differences in arrests during adolescence and young adulthood among blacks, whites, and Hispanics in the USA. Multilevel cross-sectional logistic regression analyses were conducted using data from waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 12,752 respondents). Results showed significantly higher likelihood of having ever been arrested among blacks, when compared to whites, even after controlling for a range of delinquent behaviors (odds ratio = 1.58, 95 % confidence interval = 1.27, 1.95). These black-white disparities were no longer present after accounting for racial composition of the neighborhood, supporting the growing body of research demonstrating the importance of contextual variables in driving disproportionate minority contact with the justice system.

AB 339 would reduce cost sharing for prescription drugs through a number of mechanisms, such as: ... more AB 339 would reduce cost sharing for prescription drugs through a number of mechanisms, such as: • Cost-sharing limits, per 30-day prescription, to 1/24 of the annual OOP; • Coverage of both single-and extended-release regimens; AT A GLANCE Assembly Bill AB 339 (amended April 7, 2015) would reduce cost sharing for prescription drugs by imposing a variety of restrictions and requirements on health insurers, including limiting cost sharing per 30-day prescription to 1/24 of the total annual out-of-pocket (OOP) maximum, and the placement of drugs on tiers to differentiate tiers beyond cost sharing. The bill does not take into account the underlying cost of prescription drugs.  Enrollees covered. CHBRP estimates that 70% of enrollees with state-regulated health insurance (17.1 million enrollees) would be affected by AB 339.  Impact on expenditures. For the bill provision that limits cost sharing per 30-day prescription to 1/24 of the annual OOP, CHBRP estimates the net increase in overall expenditures would be $322.3 million, or 0.24%. Increases in premium costs would be offset by reductions in enrollees OOP expenses.  EHBs. AB 339 does not appear to exceed essential health benefits (EHBs).  Medical effectiveness. As cost sharing increases, adherence to drug regimens decreases. Decreased adherence is related to worse health outcomes.  Benefit coverage. No change in benefit coverage.  Utilization. CHBRP estimates postmandate 133,675 enrollees will have a prescription drug claim in a year with cost sharing that would have exceeded 1/24 of the annual out-of-pocket maximum for a 30-day supply premandate. This is an increase of 3,174 enrollees (2.43%) who previously did not use these prescription drugs. Postmandate, CHBRP estimates enrollees will refill 0.18 more qualifying prescription drugs (2.75%).  Public health. No measurable impact due to the small number of enrollees with a reduction in cost sharing for prescription drugs, though AB 339 may yield important health and quality of life impacts for some persons.  Long-term impacts. AB 339 would increase the use of existing and newly developed high-cost prescription drugs, and lead to an increase in overall expenditures. AB 339 may provide significant quality of life improvements on a case-by-case basis.  Interaction with existing state mandates. State regulators require coverage of medically necessary prescriptions and have requirements around "reasonable" cost sharing or "economic value."  Background on cost sharing and prescription drugs. Health insurance carriers require different levels of costsharing for drugs, depending on whether they are generic, brand, or specialty. Specific formularies vary.

Background: The diverse Asian American population has been impacted by the COVID-19 pandemic, but... more Background: The diverse Asian American population has been impacted by the COVID-19 pandemic, but due to limited data and other factors, disparities experienced by this population are hidden. Objective: This study aims to describe the Asian American community's experiences during the COVID-19 pandemic, focusing on the Greater San Francisco Bay Area, California, and to better inform a Federally Qualified Health Center's (FQHC) health care services and response to challenges faced by the community. Methods: We conducted a cross-sectional survey between May 20 and June 23, 2020, using a multipronged recruitment approach, including word-of-mouth, FQHC patient appointments, and social media posts. The survey was self-administered online or administered over the phone by FQHC staff in English, Cantonese, Mandarin, and Vietnamese. Survey question topics included COVID-19 testing and preventative behaviors, economic impacts of COVID-19, experience with perceived mistreatment due to their race/ethnicity, and mental health challenges. Results: Among 1297 Asian American respondents, only 3.1% (39/1273) had previously been tested for COVID-19, and 46.6% (392/841) stated that they could not find a place to get tested. In addition, about two-thirds of respondents (477/707) reported feeling stressed, and 22.6% (160/707) reported feeling depressed. Furthermore, 5.6% (72/1275) of respondents reported being treated unfairly because of their race/ethnicity. Among respondents who experienced economic impacts from COVID-19, 32.2% (246/763) had lost their regular jobs and 22.5% (172/763) had reduced hours or reduced income. Additionally, 70.1% (890/1269) of respondents shared that they avoid leaving their home to go to public places (eg, grocery stores, church, and school). Conclusions: We found that Asian Americans had lower levels of COVID-19 testing and limited access to testing, a high prevalence of mental health issues and economic impacts, and a high prevalence of risk-avoidant behaviors (eg, not leaving the house) in the early months of the COVID-19 pandemic. These findings provide preliminary insights into the impact of the COVID-19 pandemic on Asian American communities served by an FQHC and underscore the longstanding need for culturally and linguistically appropriate approaches to providing mental health, outreach, and education services. These findings led to the establishment of the first Asian multilingual and multicultural COVID-19 testing sites in the local area where the study was conducted, and laid the groundwork for subsequent COVID-19 programs, specifically contact tracing and vaccination programs.

Journal of General Internal Medicine, Jan 28, 2022

BACKGROUND: The number of Californians covered by MediCal increased more than 50% between 2013 an... more BACKGROUND: The number of Californians covered by MediCal increased more than 50% between 2013 and 2018, largely due to expansion under the Affordable Care Act (ACA). This rapid expansion of Medicaid rolls prompted concerns that MediCal enrollees would face greater difficulty accessing health care. OBJECTIVE: Examine whether gaps in access to care between MediCal and employer-sponsored insurance (ESI) present in 2013 (prior to ACA implementation) had changed by 2018 (several years post implementation). DESIGN: Secondary analysis of data from the 2013 and 2018 California Health Interview Survey. The sample included adults of ages 18-64 insured all year and covered by ESI or MediCal at time of interview. Logistic regressions were used to examine variation across years in the association between access to care and insurance type. MAIN MEASURES: Five access to care outcomes were assessed: no usual source of care, not accepted as new patient in past year, insurance not accepted in past year, delayed medical care in past year, and difficulty getting timely appointment. The main predictors of interest were type of insurance (Medi-Cal or ESI) and survey year (2013 or 2018). KEY RESULTS: The association between insurance type and access to care changed significantly over time for three outcomes: not accepted as new patient in past year (OR = 0.55, 95% CI = 0.32-0.97), delayed medical care in past year (OR = 1.55, 95% CI = 1.06-2.25), and difficulty getting timely appointment (OR = 0.41, 95% CI = 0.23-0.74). Predicted probabilities indicate gaps between MediCal and ESI narrowed for not accepted as new patient in past year and difficulty getting timely appointment, but widened for delayed medical care. CONCLUSIONS: Despite the rapid expansion in the number of Californians covered by MediCal , most gaps in access to care between MediCal and ESI enrollees improved or did not significantly change between 2013 and 2018.

Evolving academic and research partnerships in global health: a capacity-building partnership to assess primary healthcare in the Philippines

Global Health Action

Supplemental Table 1 from Racial/Ethnic Differences in the Impact of Neighborhood Social and Built Environment on Breast Cancer Risk: The Neighborhoods and Breast Cancer Study

Associations between neighborhood contextual characteristics and breast cancer risk by race/ethni... more Associations between neighborhood contextual characteristics and breast cancer risk by race/ethnicity and nativity, the Neighborhoods and Breast Cancer Study, 1995-2002.

Association of Cost-Driven Residential Moves With Health-Related Outcomes Among California Renters

JAMA network open, Mar 14, 2023

Undocumented Latino Immigrants and the Latino Health Paradox

American Journal of Preventive Medicine

Selective mortality and nonresponse in the Health and Retirement Study: implications for health services and policy research

Health Services and Outcomes Research Methodology

Frontiers in Public Health

BackgroundDuring COVID-19, anti-Asian discrimination increased in attention. Hate and unfair trea... more BackgroundDuring COVID-19, anti-Asian discrimination increased in attention. Hate and unfair treatment are related but do not completely overlap. We expect those who report a hate incident would also report race-based unfair treatment, yet feelings of social desirability or self-blame may lead to under-reporting of unfair treatment.ObjectivesTo describe reporting of an experience of race-based hate but not an experience of race-based unfair treatment among Asians in California and explore the association between this reporting discordance with (1) serious psychological distress, (2) forgoing needed medical care, (3) increased household interpersonal conflict, and (4) feeling unsafe in their neighborhood.MethodsWe used the 2020 California Health Interview Survey's AANHPI COVID Module, conducted weighted descriptive and multivariate analyses, and computed adjusted relative risks (RR). The multivariate models controlled for Asian subgroup, age, gender, immigrant status, education l...

Cigarette, electronic cigarette, and marijuana use among young adults under policy changes in California

Addictive Behaviors Reports

Frontiers in Public Health

A critical component for health equity lies in the inclusion of structurally excluded voices, suc... more A critical component for health equity lies in the inclusion of structurally excluded voices, such as Filipina/x/o Americans (FilAms). Because filam invisibility is normalized, denaturalizing these conditions requires reimagining power relations regarding whose experiences are documented, whose perspectives are legitimized, and whose strategies are supported. in this community case study, we describe our efforts to organize a multidisciplinary, multigenerational, community-driven collaboration for FilAm community wellness. Catalyzed by the disproportionate burden of deaths among FilAm healthcare workers at the onset of the COVID-19 pandemic and the accompanying silence from mainstream public health leaders, we formed the Filipinx/a/o Community Health Association (FilCHA). FilCHA is a counterspace where students, faculty, clinicians, and community leaders across the nation could collectively organize to resist our erasure. By building a virtual, intellectual community that centers ou...

The impact of soaring food prices on obesity in women: A longitudinal analysis in 31 developing countries

The FASEB Journal, Oct 3, 2018

COVID-19 Rapid Response: How the California Health Interview Survey Adapted During the Global Pandemic

American Journal of Public Health, 2021

Place Matters. Data Matters. AA & NHPI Hotspots

Does income inequality make us sick

HIPP C ALIFORNIA ’ S U NINSURED C HILDREN : A C LOSER L OOK AT THE L OCAL L EVEL Ninez Ponce, Ph.... more HIPP C ALIFORNIA ’ S U NINSURED C HILDREN : A C LOSER L OOK AT THE L OCAL L EVEL Ninez Ponce, Ph.D., Stephanie Teleki, MPH, and E. Richard Brown, Ph.D. UCLA Center for Health Policy Research POLICY ALERT March 2000 The Problem More than 2 million children in California do not have any form of health insurance. The proportion of uninsured children in the state has increased over the past several years (from 17% in 1995 to 21% in 1998) and is significantly higher than in the rest of the na- tion (15% in 1998). Under new eligibility provisions approved in November 1999, approximately 1.48 mil- lion of California’s uninsured children are eligible for either the Healthy Families or Medi-Cal program. Many, however, are not enrolled. EXHIBIT 1: ELIGIBILITY FOR HEALTHY FAMILIES AND MEDI-CAL AMONG CALIFORNIA’S 2,024,000 UNINSURED CHILDREN, AGES 0-18, CALIFORNIA, 1998 Healthy Families Eligible 9% in Northern California, 10% in the Greater Bay Area, and 7% in the Central Valley. Policy Options...

Health & Place, Mar 1, 2019

There has been mounting evidence for the beneficial effect of green space on mental health among ... more There has been mounting evidence for the beneficial effect of green space on mental health among adults, but studies on the same topics are lacking for teens in the US. This study aimed to fill in this research gap by utilizing data from California Health Interview Survey (CHIS) 2011-2014. A total of 81,102 households (composed of 4538 teens and 81,102 adults) were retained for main analyses. Surrounding greenness was assessed by the Normalized Difference Vegetation Index (NDVI) within varying buffers of home residence. Survey logistic regressions accounted for sampling weights and design were conducted to examine the effects of greenness on serious psychological distress (SPD), adjusted for major socio-demographic factors, neighborhood socioeconomic status (SES) and co-respondent's psychological distress level within the same household. An inter-quartile increment of NDVI in 350 m buffer predicted decreased odds of SPDs by 36% in teens (OR = 0.64, 95% CI = [0.46, 0.91]). Mediation analyses revealed that this association remained almost unchanged even after adjusting for social cohesion. The NDVI-SPD association of adults was found to be significant only in the older group (OR = 0.81, 95% CI = [0.68, 0.95]). This study is one of the first population-based US studies extending the epidemiological evidence for benefits of green space on mental health from adults to teens.

Gerontologist, Sep 23, 2017

Background and Objectives: Growing literature documents that where you live has an impact on your... more Background and Objectives: Growing literature documents that where you live has an impact on your health, due in part to social capital. Building on social capital literature, we assess how subjective appraisals of neighborhood quality are associated with self-reported health (SRH) for older adults. Research Design and Methods: Cross-sectional analysis of the 2014 California Health Interview Survey, a representative survey of diverse, noninstitutionalized California residents. We use three measures of neighborhood quality: trustworthy neighbors, helpful neighbors, and feeling safe. Using weighted ordinary least squares regression, we assess the associations of trust, helpfulness, and safety to SRH, controlling for neighborhood, demographic, and health care variables. We then examine how these associations vary by household income. Results: We find that characterizing neighbors as helpful and feeling safe are associated with better SRH, even controlling for community, demographic, and health care variables. However, the importance of these dimensions varies across household income: helpfulness is positively associated, whereas trust is negatively associated with SRH for lower income residents; safety is positively associated with SRH in all but the lowest income residents. These findings show that social capital dimensions work differently from one another, and differentially affect the health of older adults. Discussion and Implications: Scholarly analyses of neighborhood effects should include a range of social capital measures and stratify by household income. Our findings may also inform priority setting for social capital programs, especially for older adults with limited economic resources. Policies and programs should consider actions that raise perceptions of helpfulness and safety.

Addressing discriminatory benefit design for people living with HIV: a California case study

Aids Care-psychological and Socio-medical Aspects of Aids/hiv, Apr 9, 2017

Concern is growing in the United States regarding the potential for health insurance benefit desi... more Concern is growing in the United States regarding the potential for health insurance benefit designs to discriminate against persons living with HIV as research demonstrates that such practices are occurring. A recent complaint filed against health insurers in seven states alleges that some health insurance companies have been using benefit designs that discourage enrollment of people living with HIV either by not covering essential HIV medications or by requiring cost-sharing for these prohibitively expensive medications. Legislators across the country have reacted by introducing legislation to address these growing problems. This paper describes Assembly Bill 339, legislation passed in California in 2015 and going into effect on 1 January 2017, which provides protection for people living with HIV by requiring coverage for single-tablet regimens to manage HIV while placing a cap on patient cost-sharing. Given California's size and influence, and the uncertainty of the future of the Affordable Care Act, this legislation has the potential to influence the national policy debate.

Race and Social Problems, Nov 3, 2016

Contact with the justice system can lead to a range of poor health and social outcomes. While per... more Contact with the justice system can lead to a range of poor health and social outcomes. While persons of color are disproportionately represented in both the juvenile and criminal justice systems, reasons for these patters remain unclear. This study sought to examine the extent and sources of differences in arrests during adolescence and young adulthood among blacks, whites, and Hispanics in the USA. Multilevel cross-sectional logistic regression analyses were conducted using data from waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 12,752 respondents). Results showed significantly higher likelihood of having ever been arrested among blacks, when compared to whites, even after controlling for a range of delinquent behaviors (odds ratio = 1.58, 95 % confidence interval = 1.27, 1.95). These black-white disparities were no longer present after accounting for racial composition of the neighborhood, supporting the growing body of research demonstrating the importance of contextual variables in driving disproportionate minority contact with the justice system.

AB 339 would reduce cost sharing for prescription drugs through a number of mechanisms, such as: ... more AB 339 would reduce cost sharing for prescription drugs through a number of mechanisms, such as: • Cost-sharing limits, per 30-day prescription, to 1/24 of the annual OOP; • Coverage of both single-and extended-release regimens; AT A GLANCE Assembly Bill AB 339 (amended April 7, 2015) would reduce cost sharing for prescription drugs by imposing a variety of restrictions and requirements on health insurers, including limiting cost sharing per 30-day prescription to 1/24 of the total annual out-of-pocket (OOP) maximum, and the placement of drugs on tiers to differentiate tiers beyond cost sharing. The bill does not take into account the underlying cost of prescription drugs.  Enrollees covered. CHBRP estimates that 70% of enrollees with state-regulated health insurance (17.1 million enrollees) would be affected by AB 339.  Impact on expenditures. For the bill provision that limits cost sharing per 30-day prescription to 1/24 of the annual OOP, CHBRP estimates the net increase in overall expenditures would be $322.3 million, or 0.24%. Increases in premium costs would be offset by reductions in enrollees OOP expenses.  EHBs. AB 339 does not appear to exceed essential health benefits (EHBs).  Medical effectiveness. As cost sharing increases, adherence to drug regimens decreases. Decreased adherence is related to worse health outcomes.  Benefit coverage. No change in benefit coverage.  Utilization. CHBRP estimates postmandate 133,675 enrollees will have a prescription drug claim in a year with cost sharing that would have exceeded 1/24 of the annual out-of-pocket maximum for a 30-day supply premandate. This is an increase of 3,174 enrollees (2.43%) who previously did not use these prescription drugs. Postmandate, CHBRP estimates enrollees will refill 0.18 more qualifying prescription drugs (2.75%).  Public health. No measurable impact due to the small number of enrollees with a reduction in cost sharing for prescription drugs, though AB 339 may yield important health and quality of life impacts for some persons.  Long-term impacts. AB 339 would increase the use of existing and newly developed high-cost prescription drugs, and lead to an increase in overall expenditures. AB 339 may provide significant quality of life improvements on a case-by-case basis.  Interaction with existing state mandates. State regulators require coverage of medically necessary prescriptions and have requirements around "reasonable" cost sharing or "economic value."  Background on cost sharing and prescription drugs. Health insurance carriers require different levels of costsharing for drugs, depending on whether they are generic, brand, or specialty. Specific formularies vary.

Background: The diverse Asian American population has been impacted by the COVID-19 pandemic, but... more Background: The diverse Asian American population has been impacted by the COVID-19 pandemic, but due to limited data and other factors, disparities experienced by this population are hidden. Objective: This study aims to describe the Asian American community's experiences during the COVID-19 pandemic, focusing on the Greater San Francisco Bay Area, California, and to better inform a Federally Qualified Health Center's (FQHC) health care services and response to challenges faced by the community. Methods: We conducted a cross-sectional survey between May 20 and June 23, 2020, using a multipronged recruitment approach, including word-of-mouth, FQHC patient appointments, and social media posts. The survey was self-administered online or administered over the phone by FQHC staff in English, Cantonese, Mandarin, and Vietnamese. Survey question topics included COVID-19 testing and preventative behaviors, economic impacts of COVID-19, experience with perceived mistreatment due to their race/ethnicity, and mental health challenges. Results: Among 1297 Asian American respondents, only 3.1% (39/1273) had previously been tested for COVID-19, and 46.6% (392/841) stated that they could not find a place to get tested. In addition, about two-thirds of respondents (477/707) reported feeling stressed, and 22.6% (160/707) reported feeling depressed. Furthermore, 5.6% (72/1275) of respondents reported being treated unfairly because of their race/ethnicity. Among respondents who experienced economic impacts from COVID-19, 32.2% (246/763) had lost their regular jobs and 22.5% (172/763) had reduced hours or reduced income. Additionally, 70.1% (890/1269) of respondents shared that they avoid leaving their home to go to public places (eg, grocery stores, church, and school). Conclusions: We found that Asian Americans had lower levels of COVID-19 testing and limited access to testing, a high prevalence of mental health issues and economic impacts, and a high prevalence of risk-avoidant behaviors (eg, not leaving the house) in the early months of the COVID-19 pandemic. These findings provide preliminary insights into the impact of the COVID-19 pandemic on Asian American communities served by an FQHC and underscore the longstanding need for culturally and linguistically appropriate approaches to providing mental health, outreach, and education services. These findings led to the establishment of the first Asian multilingual and multicultural COVID-19 testing sites in the local area where the study was conducted, and laid the groundwork for subsequent COVID-19 programs, specifically contact tracing and vaccination programs.

Journal of General Internal Medicine, Jan 28, 2022

BACKGROUND: The number of Californians covered by MediCal increased more than 50% between 2013 an... more BACKGROUND: The number of Californians covered by MediCal increased more than 50% between 2013 and 2018, largely due to expansion under the Affordable Care Act (ACA). This rapid expansion of Medicaid rolls prompted concerns that MediCal enrollees would face greater difficulty accessing health care. OBJECTIVE: Examine whether gaps in access to care between MediCal and employer-sponsored insurance (ESI) present in 2013 (prior to ACA implementation) had changed by 2018 (several years post implementation). DESIGN: Secondary analysis of data from the 2013 and 2018 California Health Interview Survey. The sample included adults of ages 18-64 insured all year and covered by ESI or MediCal at time of interview. Logistic regressions were used to examine variation across years in the association between access to care and insurance type. MAIN MEASURES: Five access to care outcomes were assessed: no usual source of care, not accepted as new patient in past year, insurance not accepted in past year, delayed medical care in past year, and difficulty getting timely appointment. The main predictors of interest were type of insurance (Medi-Cal or ESI) and survey year (2013 or 2018). KEY RESULTS: The association between insurance type and access to care changed significantly over time for three outcomes: not accepted as new patient in past year (OR = 0.55, 95% CI = 0.32-0.97), delayed medical care in past year (OR = 1.55, 95% CI = 1.06-2.25), and difficulty getting timely appointment (OR = 0.41, 95% CI = 0.23-0.74). Predicted probabilities indicate gaps between MediCal and ESI narrowed for not accepted as new patient in past year and difficulty getting timely appointment, but widened for delayed medical care. CONCLUSIONS: Despite the rapid expansion in the number of Californians covered by MediCal , most gaps in access to care between MediCal and ESI enrollees improved or did not significantly change between 2013 and 2018.

Evolving academic and research partnerships in global health: a capacity-building partnership to assess primary healthcare in the Philippines

Global Health Action

Supplemental Table 1 from Racial/Ethnic Differences in the Impact of Neighborhood Social and Built Environment on Breast Cancer Risk: The Neighborhoods and Breast Cancer Study

Associations between neighborhood contextual characteristics and breast cancer risk by race/ethni... more Associations between neighborhood contextual characteristics and breast cancer risk by race/ethnicity and nativity, the Neighborhoods and Breast Cancer Study, 1995-2002.

Association of Cost-Driven Residential Moves With Health-Related Outcomes Among California Renters

JAMA network open, Mar 14, 2023

Undocumented Latino Immigrants and the Latino Health Paradox

American Journal of Preventive Medicine

Selective mortality and nonresponse in the Health and Retirement Study: implications for health services and policy research

Health Services and Outcomes Research Methodology

Frontiers in Public Health

BackgroundDuring COVID-19, anti-Asian discrimination increased in attention. Hate and unfair trea... more BackgroundDuring COVID-19, anti-Asian discrimination increased in attention. Hate and unfair treatment are related but do not completely overlap. We expect those who report a hate incident would also report race-based unfair treatment, yet feelings of social desirability or self-blame may lead to under-reporting of unfair treatment.ObjectivesTo describe reporting of an experience of race-based hate but not an experience of race-based unfair treatment among Asians in California and explore the association between this reporting discordance with (1) serious psychological distress, (2) forgoing needed medical care, (3) increased household interpersonal conflict, and (4) feeling unsafe in their neighborhood.MethodsWe used the 2020 California Health Interview Survey's AANHPI COVID Module, conducted weighted descriptive and multivariate analyses, and computed adjusted relative risks (RR). The multivariate models controlled for Asian subgroup, age, gender, immigrant status, education l...

Cigarette, electronic cigarette, and marijuana use among young adults under policy changes in California

Addictive Behaviors Reports

Frontiers in Public Health

A critical component for health equity lies in the inclusion of structurally excluded voices, suc... more A critical component for health equity lies in the inclusion of structurally excluded voices, such as Filipina/x/o Americans (FilAms). Because filam invisibility is normalized, denaturalizing these conditions requires reimagining power relations regarding whose experiences are documented, whose perspectives are legitimized, and whose strategies are supported. in this community case study, we describe our efforts to organize a multidisciplinary, multigenerational, community-driven collaboration for FilAm community wellness. Catalyzed by the disproportionate burden of deaths among FilAm healthcare workers at the onset of the COVID-19 pandemic and the accompanying silence from mainstream public health leaders, we formed the Filipinx/a/o Community Health Association (FilCHA). FilCHA is a counterspace where students, faculty, clinicians, and community leaders across the nation could collectively organize to resist our erasure. By building a virtual, intellectual community that centers ou...

The impact of soaring food prices on obesity in women: A longitudinal analysis in 31 developing countries

The FASEB Journal, Oct 3, 2018

COVID-19 Rapid Response: How the California Health Interview Survey Adapted During the Global Pandemic

American Journal of Public Health, 2021

Place Matters. Data Matters. AA & NHPI Hotspots

Does income inequality make us sick

HIPP C ALIFORNIA ’ S U NINSURED C HILDREN : A C LOSER L OOK AT THE L OCAL L EVEL Ninez Ponce, Ph.... more HIPP C ALIFORNIA ’ S U NINSURED C HILDREN : A C LOSER L OOK AT THE L OCAL L EVEL Ninez Ponce, Ph.D., Stephanie Teleki, MPH, and E. Richard Brown, Ph.D. UCLA Center for Health Policy Research POLICY ALERT March 2000 The Problem More than 2 million children in California do not have any form of health insurance. The proportion of uninsured children in the state has increased over the past several years (from 17% in 1995 to 21% in 1998) and is significantly higher than in the rest of the na- tion (15% in 1998). Under new eligibility provisions approved in November 1999, approximately 1.48 mil- lion of California’s uninsured children are eligible for either the Healthy Families or Medi-Cal program. Many, however, are not enrolled. EXHIBIT 1: ELIGIBILITY FOR HEALTHY FAMILIES AND MEDI-CAL AMONG CALIFORNIA’S 2,024,000 UNINSURED CHILDREN, AGES 0-18, CALIFORNIA, 1998 Healthy Families Eligible 9% in Northern California, 10% in the Greater Bay Area, and 7% in the Central Valley. Policy Options...