Health | 89.3 KPCC

CDC: Nearly 15 percent were uninsured in 2012; South LA rate is more than double

José Martinez — Wed, 19 Jun 2013 12:50:33 -0700

Receptionist Stephany Bustillo processes information for patients at UMMA Community Clinic in South Los Angeles, where an estimated 38 percent of adults are uninsured. A new report from the Centers for Disease Control and Prevention indicates that in 2012, nearly 15 percent of the American population lacked health insurance.; Credit: Christopher Okula/KPCC

More than 45 million people in the U.S. had no health insurance in 2012, and the number of people who'd spent at least part of the previous year uninsured approached 58 million.

That's according to a new report from the Centers for Disease Control and Prevention (CDC), which also noted that when the data was gathered, more than 34 million people had been uninsured for more than a year.

That means in 2012, nearly 15 percent of the American population didn't have health insurance. Double that percentage and it's still a ways off from where South Los Angeles is: According to the latest data from the L.A. County Department of Public Health, more than 38 percent of the area's adults are uninsured.

The same goes for almost 9 percent of South L.A.'s children and teenagers.

Both of those rates are the highest of any area in Los Angeles County, where overall, about 29 percent of adults and 5 percent of children are uninsured.

That certainly contributes to the high rate of children and adults who live on the southside and "have difficulty accessing medical care": about 18 and 45 percent, respectively. Nearly 1 in 10 children and 1 in 5 adults in South L.A. reported not seeing a doctor over the previous year when needed because they could not afford it.

The CDC report sheds light on the state of the uninsured in the U.S. as health officials nationwide continue rolling out the Affordable Care Act. Starting in October, U.S. residents will have the option of enrolling in statewide health insurance marketplaces, called exchanges, where they'll be able to compare and buy plans at prices officials say will be competitive. California's exchange is Covered California.

Medicaid, called Medi-Cal in California, is also set to expand and take on more beneficiaries as part of health care reform.

Also among the CDC's findings for 2012:

Nearly 5 million – that's about 7 percent – of children under 18 were uninsured.
More than 26 percent of young adults, meaning those between the ages of 19 and 25, were uninsured.
With regard to California's population, more than 17 percent were uninsured, more than 1 in 3 were covered by a public health plan and more than 54 percent had private coverage.
More than 40 percent of those whom the government classified as "poor" were uninsured in 2012. That rate is virtually identical to what it was in 1997.
Men were more likely to be uninsured than women.
The rate of the uninsured among Latinos (about 29 percent) was disparately high compared to the percentage of uninsured among whites (about 11 percent), blacks (more than 16 percent) and Asians (about 15 percent).
Folks who didn't graduate from high school, as well as those who were unemployed, were more likely to be uninsured.

The agency used data from the 2012 National Health Interview Survey to arrive at its conclusions.

AMA says it's time to call obesity a disease

Scott Hensley | NPR — Wed, 19 Jun 2013 10:08:21 -0700

; Credit: /NPR

While the American Medical Association may not have the clout it once did, it's still the largest single group of doctors making waves about health and the practice of medicine.

So it's not nothing when the AMA's House of Delegates approves a measure to label obesity a disease. The group's deliberative democratic body passed a measure in Chicago Tuesday that broadly, if vaguely, says obesity is a medical condition:

"RESOLVED, That our American Medical Association recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention."

The AMA isn't vested with legally binding authority on what's a disease and what's not. And, in fact, when it comes to the labeling of diseases, there's a whole other global ball of wax called the International Classification of Diseases, which already has a range of categories covering obesity — from the type "due to excess calories" to the kind that's a side effect of prescription drugs.

RELATED: Is obesity a disease?

So what's the big dea with the AMA? The group still has a considerable bully pulpit. And the vote could give more oomph to efforts to have obesity interventions paid for by insurers and to get the public focused on the problem.

"We felt it's time to take a stance and say we're going to identify this as a disease," Dr. Douglas Martin, chairman of the AMA public health committee that referred the resolution for vote, told MedPage Today. "We think that's going to send a message not only to the public but to the physician community that we really need to make it a priority and put it in our cross hairs."

Before the voice vote, Dr. Virginia Hall, an obstetrician from Hershey, Pa., said the AMA should call obesity disease so "insurers can stop ducking their responsibility" in paying for obesity treatments, according to a Forbes report by Bruce Japsen.

After the vote, the AMA cited board member Dr. Patrice Harris praising the measure: "Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans."

But even within the AMA there was some uneasiness about the disease label. A report on the proposed resolution from the group's Council on Science and Public Health didn't support it. The analysis noted the lack of a clear definition of what constitutes a disease and whether obesity would fit, in any case. The report also raised practical concerns:

"Similarly, a sensitive and clinically practical diagnostic indicator of obesity remains elusive. Obesity, measured by [body mass index], is clearly associated with a number of adverse health outcomes, with greater consistency across populations at the highest BMI levels. However, given the existing limitations of BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a 'condition' or 'disorder,' will result in improved health outcomes. The disease label is likely to improve health outcomes for some individuals, but may worsen outcomes for others."

In January, NPR talked with sociologist Abigail Saguy about the perils of defining obesity as an illness. "People think that being obese means being sick, and there are some health risks, but risk is not the same thing as illness," Saguy said.

She also criticized the typical tool doctors use to assess the health aspects of weight: body mass index. A BMI of 30 or more puts a person in the obese category. "It's a very arbitrary threshold," Saguy said. "There are plenty of people with BMI well over 30 who are perfectly healthy, and plenty of people at 'normal' weight with metabolic issues."

Study suggests link between food commercials and obesity in Latino youth

José Martinez — Tue, 18 Jun 2013 11:50:04 -0700

Researchers found that about 50 percent of Spanish-language TV food advertisements are trying to sell fast food, candy or cereal.; Credit: Matt Cardy/Getty Images

The average Latino child or teen probably viewed upwards of 4,200 food commercials on TV in 2010.

That's about 12 food ads daily, according to the authors of a new study appearing in JAMA Pediatrics, who suggest that may have something to do with the high rates of obesity among Latino youth.

The latest data on South Los Angeles from the county's Department of Public Health indicates that more than two-thirds of the area's total population is Latino. It also notes that nearly 30 percent of southside children between 2 and 17 years of age watch at least three hours of TV daily.

Both of those rates are among the highest in the county.

South L.A. also has the dubious distinction of possessing the highest child obesity rate in Los Angeles County: Almost 30 percent of children in the fifth, seventh and ninth grades are clinically obese.

Using Nielsen data from 2010, the authors of the JAMA Pediatrics study found Latino preschoolers, children and teenagers viewed between 4,218 to 4,542 food and drink ads on TV annually – around 12 ads a day. They also noted Latino preschoolers see more Spanish-language food ads than their older counterparts.

Researchers explained that because there are fewer food ads on Spanish-langauge TV overall, non-Latino youth viewed more food ads on average. But food ads comprised a larger proportion of Spanish-language TV ads, with about 50 percent of those commercials advertising fast food, candy and cereal:

Both Hispanic and non-Hispanic youth view large numbers of television advertisements for nutrient-poor categories of food and beverage. Although Hispanic children and adolescents see somewhat fewer of these ads, the higher obesity rates among Hispanic youth, the greater exposure by Hispanic preschoolers, and the potential enhanced effects of targeted advertising on Hispanic youth suggest that this exposure may pose additional risks for Hispanic youth.

As such, lead author Frances Fleming-Milici said in a statement that "continued monitoring" of how food companies reach out to Latino youth is important. With children in general, the authors wrote, "exposure to large numbers of television advertisements for foods and beverages with little or no nutritional value likely contributes to poor diet among youth," which in turn may account for high rates of obesity among certain groups.

Harvard's School of Public Health says Latino youth have higher rates of obesity (21 percent) than their white peers (14 percent).

Black, Latino children with autism seem less likely to get certain kinds of specialty care

José Martinez — Tue, 18 Jun 2013 09:22:38 -0700

Eight year-old Michael Dedrick-Dwyer, who has cerebral palsy and autism, rides a horse with therapist Rebecca Reubens and a volunteer. A new study appearing in Pediatrics found racial differences in the ways children with autism used specialty care – for example, like that a neurologist would provide.; Credit: Tom Ervin/Getty Images

Black and Latino children living with autism appear to be using certain specialty care services less often than their white counterparts, according to a new report.

The study, published in the journal Pediatrics, found that minority children are less likely to see doctors who specialize in the brain, the mind or the digestive system, and as a result are less likely to undergo the tests those doctors can perform.

In South Los Angeles, early identification and intervention often doesn't happen for autism because of a widespread lack of access to health care, particularly to those providers who are qualified to diagnose the condition.

Areva Martin, the president and co-founder of Special Needs Network, Inc. said in an interview in March that the ideal window for diagnosis is when a child is 1 or 2 years old:

"If a child doesn't get identified before kindergarten or first grade, they've missed four or five years of that kind of intensive therapy," said Martin. "That can have a substantial impact on educational outcomes and the development of social skills."

Instead, said Martin, children often aren't diagnosed until they're 5 or 6. Late diagnosis is just one item on a list of challenges affecting South L.A. children with autism:

"You are talking about a community that is plagued with a lot of health issues," said Martin. "Today it's diabetes, obesity, cancer – unfortunately, African-Americans and Latinos in low-income communities are already on the wrong side of these health crises. All these disparities in terms of access to care and quality of care with autism have been no different."

The study, which looked at more than 3,600 young patients, echoed Martin and noted that "racial differences in use of care exist for many pediatric conditions." The disparities highlighted by their study could be due to several factors, wrote the authors:

It could be that minority children's autism presents itself differently and, as a result, requires different services.
"Physician referral bias" could also play a role – that is, if doctors believe white children are more likely to have autism, that could mean they'll refer white children at higher rates.
Because many patients with autism are self-referred to the doctor – in this case, that would mean a parent takes her or his child – families with better access to specialty medical care are more likely to see the proper doctors to get a timely diagnosis. White children "have better access" to that care than do their black and Latino counterparts, said researchers.
It could also be that white children are following up with doctor referrals at higher rates than minority children; the latter's parents may not fully grasp the seriousness of a referral to specialty care due to certain cultural beliefs.

Here's how the study's authors summed up the implications of their findings:

If nonwhite children use needed subspecialty care less frequently than white children, greater outreach to clinicians and minority communities may be necessary to inform them of needed subspecialty care. Alternatively, if white patients are receiving unnecessary referrals and procedures, then there is a need for better education regarding what care is appropriate.

California Healthline reports that state advocates were dealt a blow last week when the California Legislature voted to exclude coverage of applied behavioral analysis, a type of autism therapy, from Medi-Cal, which will be extended to more than a million additional state residents next year as part of the Affordable Care Act.

California faces unique obstacles in implementing Affordable Care Act

Stephanie O'Neill | Take Two — Fri, 14 Jun 2013 09:01:11 -0700

US President Barack Obama makes a statement to reporters on the Affordable Care Act at Fairmont Hotel in San Jose, California, on June 7, 2013.; Credit: JEWEL SAMAD/AFP/Getty Images

During his visit to California last week, President Obama hailed the state’s leading role in implementing the Affordable Care Act. Among the achievements he highlighted was the recent announcement that 13 health plans would be providing Californians affordable health insurance in the soon-to-open state-run marketplace called, Covered California.

But as KPCC’s Stephanie O’Neill tells us, California still faces challenges in implementing the law, including some that are unique to the Golden State.

It’s widely accepted that the biggest hurdle facing successful implementation of the federal health law in California is rampant confusion about it among pretty much everybody.

The Affordable Care Act takes full effect on January 1, 2014 and requires nearly every American to have health insurance. Those who don't have to pay a penalty, which starts out $95 a year in 2014 or 1 percent of income then grows to $695 a year or 2.5 percent of income.

"The immediate challenge is educating people and having people become aware that if you’re uninsured or underinsured, you now have an opportunity to get health insurance coverage and you’re actually mandated to get it as well," said Assemblyman Richard Pan (D-Sacramento), chairman of the Assembly Health Committee.

But informing the masses won’t be easy. A recent poll by the Kaiser Family Foundation found four out of 10 Americans have no idea that President Obama’s health care law is the law.

Health policy Analyst Jeff Goldsmith, president of Health Futures, Inc. says getting the word out in a state as large and diverse as California — where an estimated 5.3 million uninsured people will be required to buy health coverage — poses a unique challenge.

"This is an incredibly diverse complex state," said Goldsmith. "All the complexities of a large industrial nation resides here. You’ve got all of the language issues, you’ve got the tremendous ethnic and cultural diversity…There’s no such thing as 'a' Californian."

Peter Lee, executive director of Covered California, agrees. To begin addressing that he last month announced $37 million in federal grants to fund grass-roots education of consumers and small businesses. The goal, he says, is to reach everyone from non-English speakers to people who are geographically isolated.

"Because what it’s going to take on January one 2014 is partnership," said Lee. "It's going to be a huge task, but it's a task that's doable because Californians are coming together to make this change happen."

It’s also going to take translating the basics of the new law into the more than 100 languages spoken statewide.

"We have a lot of people who are spending a lot of time going through those details and planning to make sure we have language interpretation services available," said Andrea Rosen, interim health plan management director for Covered California.

Rosen says she's confident that no matter what language a person speaks they’ll have the help they need in choosing a health plan when the statewide marketplace open on October 1.

While that won’t be an easy task, far more challenging will be getting the young and healthy to buy health insurance.

"One of the things that we need to be sure happens is that we have actually a sufficient pool of healthy people to sign up for these insurance products because if it’s just the sick people who go in then that’s going to drive the costs up," said Pan.

Encouraging the young and healthy to buy insurance is going to take some innovative marketing.

Step one requires helping the "Young Invincibles" – as they’re coming to be known – to understand that even though they may not need day-to-day health care, the risk of accident or disease is always present.

Susan Dentzer, senior policy advisor for the Robert Wood Johnson Foundation, says one way to reach the estimated two million uninsured Californians between the ages of 19 and 34 is by marketing to women.

"To have their mothers and their aunts and their grandmothers talk to them about it," said Dentzer. "Because we know most of the health care decisions, frankly, are made in the country by women on behalf of their families and their loved ones."

As these broad challenges take center stage in California, many more subtle ones are percolating to the surface. Doctors groups and hospitals, for instance, are anxiously awaiting word on who among them will be included as providers in the 13 health plans chosen by Covered California.

There’s also concern about whether there are going to be enough doctors. California already faces a shortage of primary care physicians, and the massive influx of newly-insured patients is certain to make things even worse.

Lawmakers in Sacramento are responding by trying to expand what nurse practitioners and others can do. But it’s not clear those efforts will succeed, and even if they do, there still may not be enough medical practitioners to go around come January first.

CA insurance commissioner wants to bar Anthem Blue Cross from health exchange over rate hikes

AP — Fri, 14 Jun 2013 07:50:05 -0700

Then-Assembylman Dave Jones, D-Sacramento, chair of the Assembly Health Committee, questions Leslie Margolin, president of Anthem Blue Cross, about rising premium costs during a hearing at the Capitol in Sacramento, Tuesday, Feb. 23, 2010.; Credit: Rich Pedroncelli/AP

California’s insurance commissioner wants to exclude Anthem Blue Cross from the state’s new health exchange for small businesses, saying it’s made excessive rate hikes.

Dave Jones says three increases this year — including one of nearly 18 percent — were unreasonable. However, under state law he couldn’t block them.

The state-run exchange stems from the federal health care overhaul. Small businesses owners are expected to buy insurance for some 200,000 workers.

Covered California, the state agency involved, says it will consider Jones’ request.

Anthem told the Los Angeles Times that its rate hikes reflect rising medical costs and barring it from the exchange would hamper competition.

Anthem’s already been chosen to join another exchange offering coverage to 5 million Californians who lack health coverage through work.

Primary care doctor shortage continues, impact felt in South LA

José Martinez — Fri, 14 Jun 2013 06:02:11 -0700

The lead author of a new study describes the U.S. rate of primary care doctor production as "abysmal."; Credit: Joe Raedle/Getty Images

Fewer than 1 in 4 new doctors are going into the field of primary care, according to a new study – which is to say the primary care doctor shortage isn't going away anytime soon.

That's particularly true in under-resourced South Los Angeles, where doctors in general come at a premium. The low- or no-cost health centers that provide safety-net care to the area's largely uninsured population can't pay a doctor as much as a private practice would, which is part of the reason why so much of the care provision falls on the shoulders of mid-level providers, like nurses and physician assistants.

But the shortage isn't unique to South Los Angeles. Earlier this year, a U.S. Senate report said the country needs 16,000 additional primary care doctors to meet the current need. One problem: It's not the most alluring field of medicine. Doctors who become specialists (e.g. cardiologists, neurologists, orthopedists) tend to have lower patient loads than those of primary care providers – and tend to make much more money.

Andy Gausepohl graduated this year from the Keck School of Medicine of USC, and recently learned he'd be starting an emergency medicine residency. In March, he explained to KPCC how finances can become a concern for med students:

"I have friends who have hit half-a-million dollars in student loans just from undergrad and medical school … You're starting to move toward a period in your life where you have to take care of a family, possibly start looking into retirement and just financial stability. Some people have to make those decisions."

The new study, which was published in the journal Academic Medicine, found that out of 759 medical residency sites, 283 didn't graduate a single doctor who'd practice at a Federally Qualified Health Center – places like UMMA Community Clinic, St. John's Well Child and Family Center or T.H.E. Clinic, all of which serve the southside.

It also found that of the nearly 9,000 doctors graduating from those 759 residency sites, only about 25 percent were going into primary care.

Dr. Candice Chen, the study's lead author, said in a statement that the U.S. is producing primary care physicians at "abysmally low" rates. And, she added, unless something changes, the shortage will only get worse once the Affordable Care Act expands health care coverage to millions more.

Dr. Felix Aguilar, the president and CEO of UMMA Clinic, has emphasized that it won't be doctors who fix the problems brought about by the doctor shortage.

"The future is not with physicians," he said in April. "The future of primary care will be with what we call mid-level providers."

Judge reluctantly approves government plan for morning-after pill

Julie Rovner | NPR — Thu, 13 Jun 2013 15:45:28 -0700

This brand may have a near-monopoly in emergency contraception.; Credit: /AP

An obviously unhappy Judge Edward Korman has approved the Obama administration's proposal to make just one formulation of the morning-after birth control pill available over the counter without age restrictions.

But in a testily worded six-page memorandum, the federal district judge made it clear he is not particularly pleased with the outcome. He has been overseeing the case in one way or another for more than eight years.

The deal, Korman wrote in his Wednesday night memorandum, makes it likely that the version called Plan B One-Step will for now be the only product available on retail shelves. That's even though it is the most expensive, at a cost of between $40 and $50. The deal proposed by the administration, he wrote, "confers a near-monopoly that will only result in making a one-pill emergency contraceptive more expensive and less accessible to many poor women."

Late Monday, the administration said it would drop its appeal of Korman's April ruling that would have made all products using the hormone levonorgestrel available within 30 days without age or prescription restrictions.

Up to that point the products, mostly sold under the "Plan B" label, were available to those age 17 and over without a prescription, but were kept behind the pharmacy shelf. Younger teens still needed a prescription. And those old enough not to need a prescription could obtain the products only when a pharmacy was open. They also had to request them, and show proof of age.

On April 30, just days before the judge's deadline, the FDA proposed what appeared to be a compromise. It approved a new label for Plan B One-Step that would make it available on pharmacy shelves, rather than behind the counter. But it would still require a prescription for those younger than 15. And the agency appealed Korman's ruling.

But when the Justice Department asked Korman for a stay of his ruling while it appealed, he said not only said no but excoriated the government for behavior he called "something out of an alternate reality."

It was a surprise last week when a panel of the federal 2nd Circuit Court of Appeals also denied a stay of Korman's ruling, at least in part. The appeals court would have required that generic two-pill versions of the emergency contraceptive pills be made immediately available.

That signaled that the government was not likely to succeed in its appeal and led to Monday's proposal. But the idea that only Plan B One-Step, and not any of its generic equivalents, would be immediately available made the plaintiffs in the lawsuit very unhappy.

"Exclusive over-the-counter access to a single pharmaceutical company will allow for exorbitant monopoly prices, placing emergency contraception financially out of reach of millions of women and girls," said Mara Verheyden-Hilliard, executive director of the Partnership for Civil Justice Fund, which brought the original lawsuit. "Imposing unjust financial barriers to access sacrifices the rights of millions of poor and young women solely to benefit a pharmaceutical company."

In his memo, Korman urged the FDA not to grant additional "exclusivity" to Teva Pharmaceuticals, the patent owner of Plan B One-Step, even though the company conducted a study that under drug law should make it eligible for protection from generic competition.

"Whatever expense Teva incurred, it did not mount a legal challenge to the FDA's denial" of its original request to allow the drug to be sold without age restrictions in 2011, Korman wrote. "Instead, it entered into an agreement with the FDA which allowed it to market Plan B One-Step to women 15 and over, thus leaving in place burdensome point-of-sale and photo identification requirements."

Korman also made it clear that if the FDA does not act "without delay" to approve Plan B One-Step without age restrictions, as it promised, "the plaintiffs will have a remedy available." Presumably meaning they could go back to court.

Bob Tur, legendary chopper pilot, has Gender Identity Disorder, is becoming Zoey, and is happy at last

John Rabe | Off-Ramp — Thu, 13 Jun 2013 15:11:50 -0700

Off-Ramp host John Rabe with Bob Tur, who's begun treatment for Gender Identity Disorder, and will soon be Zoey; Credit: Todd Johnson

"I'm happy. I've not been this happy. I've had a great life; Bob Tur needs to die now. And he'll be dead within three to four months." —Bob Tur, soon to be Zoey Tur

Bob Tur is a man you know, even if you don't know his name. He's the TV helicopter pilot who hovered above the Reginald Denny beating. He found O.J. in his white Bronco and followed the slow-speed chase. He's flown daring rescue missions, saving dozens of hotel guests from a Pacific storm.

He's a hero in one of the most macho professions, but Thursday he announced he's transitioning from Robert to Zoey because he has GID, Gender Identity Disorder, also called gender dysphoria, which many people who have it describe as being "trapped in the wrong body."

We talked for half an hour. Our interview — the long version is posted here — includes very candid talk about GID and sexuality and graphic clinical descriptions of the surgery he'll be undergoing.

Here's how Bob writes about his new life on his Facebook page.

What's Gender Identity Disorder like? It's weird. I know I'm female, despite being born male. When watching a movie, for example, I identify with the female lead character. When looking at my reflection in the mirror I hate what I see. I think I'm ugly and despise my body hair. So much so, I have shaved it off throughout my adult life. I've even gone as far as using Photoshop to feminize my pictures, including a series of nude photos we shot as far back as 13 years ago. What about the stereotypical things women do, like shopping? Love it. I was the only male I knew that didn't mind shopping with their wife.

Domestic violence survivors often don't get the mental health care they need

José Martinez — Wed, 12 Jun 2013 11:37:45 -0700

According to Elena Fernandez, the behavioral health director for St. John's Well Child and Family Center in South Los Angeles, there's "a lot of shame" that comes with being the target of domestic violence.
; Credit: Hibr/Flickr Creative Commons

Women who have experienced domestic violence often don't get the mental health services they need, according to a new study.

Elena Fernandez, the director of behavioral health at St. John's Well Child and Family Center in South Los Angeles, can name at least one reason why.

"You have to remember that it's very stigmatizing," she said. "There's a lot of shame that comes with disclosing that 'I am a victim of domestic violence.'"

That's what researchers found in their study, which was published in the journal Social Work in Mental Health. In a statement, lead researcher Mansoo Yu said stigma, shame, concerns about privacy, health care costs and a lack of information were all found to play a role in preventing survivors from getting needed mental health services – even if they had access to them.

Fernandez says in South L.A., access to those services aren't a given.

"Domestic violence is very prevalent in many communities, but I would argue it's more prevalent in impoverished communities," she said. "And the reason for that is there are a lot of psychosocial stressors that play a role in this."

That could mean a lack of affordable health care, housing or food. It could also mean working several low-paying jobs or having no job at all.

She explained that although domestic violence is often thought of in physical terms, it can be emotional, sexual or financial – an abusive partner's limiting a person's income, for example. That creates an "impoverished sense of self," said Fernandez.

"They don't have the ability to talk about it," she said. "There aren't enough resources in the community, and often they're told by some of our churches or even their parents that they have to stay in this relationship for their kids."

Remaining in an abusive relationship, though, can lead to further corrosion of someone's ego and self-esteem – and that usually makes it more difficult to muster up the strength and resources to leave an unhealthy relationship, said Fernandez. She added that it's best for people experiencing domestic violence to have a plan in terms of where they'll go and how they'll get by before they leave the relationship.

Without follow-up mental health services after leaving an abusive relationship, the "majority of individuals who are victims of domestic violence tend to return back to their abuser," explained Fernandez.

"They feel they can't make it without them," she said. "Again, this goes back to the level of codependency that's established. It goes back to what's happened to this individual, which is a very poor sense of self, feeling they can't survive [without their abuser]."

Researchers on the Social Work in Mental Health study found that overall usage of mental health services by domestic violence survivors was low, but that once those survivors had used some sort of service, they found it helpful.

Feds drop effort to restrict sale of morning-after pill based on age, point of sale

José Martinez — Tue, 11 Jun 2013 11:43:15 -0700

Emergency contraception like Plan B One-Step is a "way of chipping away" at South L.A.'s high teen pregnancy rates, said Jim Mangia, the president and CEO of St. John's Well Child and Family Center in South Los Angeles.; Credit: Justin Sullivan/Getty Images

The Obama Administration will cease its efforts to restrict who can buy the morning-after pill, it said on Monday, and will comply with a judge's order to allow girls of any age to buy the emergency contraception without a prescription.

That marks a reversal from its decision on May 1 to appeal the order from U.S. District Judge Edward Korman of New York's Eastern District.

Jim Mangia, the president and CEO of St. John's Well Child and Family Center, has said the morning-after pill is a critical tool for family planning in South Los Angeles:

"With such high rates of teen pregnancy, and all that is involved with that – including an increasing likelihood of a life of poverty, an inability to finish school and develop a career, all of the things that happen with the high teen pregnancy rate – this is a way of chipping away at that," he said.

South L.A. has the highest teen pregnancy rate in the county, according to the L.A. County Department of Public Health: about 59 births for every 1,000 teenage girls. Compare that to the countywide average: about 31 births per 1,000 teen girls.

In another recent interview, Mangia also described the Obama Administration's early-May decision to appeal as "short-sighted":

"Pregnancy is a beautiful and it's a wonderful thing," he said. "It needs to be a planned aspect of someone's life. And it needs to be done when folks are ready for it, and when people are prepared, and when girls have finished high school and have gone to college and have a future ahead of them, and we really need to give them the support they need and reduce teen pregnancy rates in South L.A. and across the country."

If taken within 24 hours of unprotected sexual intercourse, the emergency contraceptive pill Plan B One-Step can prevent unintended pregnancy with an effectiveness rate of up to 95 percent. It remains highly effective if taken within 72 hours of unprotected sex. Experts note, however, that using emergency contraception as a go-to for pregnancy prevention isn't preferable to a regular birth control regimen, such as taking birth control pills daily or using an IUD.

The battle over Plan B

Plan B has been at the center of a long and complex battle between federal health officials, the Obama Administration and the courts in recent years.

In late 2011, Food and Drug Administration (FDA) Commissioner Margaret Hamburg said she was convinced "there is adequate and reasonable, well-supported, and sciences-based evidence that Plan B One-Step is safe and effective and should be approved for nonprescription use for all females of child-bearing potential."

Virtually in the same breath, though, she said U.S. Secretary of Health and Human Services Kathleen Sebelius didn't agree with her, and thus the nonprescription use of the contraceptive in girls younger than 17 would remain unlawful.

On April 5, Judge Korman overruled Sebelius' and said the FDA had to make the contraceptive available without a prescription and without point-of-sale or age restrictions within a 30-day period. (The judge also skewered Sebelius in his opinion.)

On May 1, five days before the ruling went into effect, the Obama Adminstration appealed the order, requesting that Judge Korman stay his order until the appeal had been processed.

On June 5, the U.S. Court of Appeals for the 2nd Circuit denied that request, ordering that certain morning-after pills be made available over the counter immediately.

Five days later, the Obama Administration announced it was dropping its appeal of Korman's ruling, and that it would make the morning-after pill available over the counter with no restrictions.

NPR notes a couple caveats to that: First, there will likely be a waiting period before the generic (and cheaper) equivalents of Plan B One-Step hit store shelves.

Second, the two-pill versions of emergency contraception, including Plan B and its generic equivalents, will remain behind the counter and only available with a prescription for people younger than 17 – at least for now.

A recent study from the Centers for Disease Control and Prevention reported that nearly 6 million U.S. women reported using the morning-after pill at least once in their lives.

Where South LA kids can get a free lunch when school's out this summer

Hayley Fox — Tue, 11 Jun 2013 06:00:25 -0700

Over the summer months, kids can get free lunches five days a week at participating local parks, community centers and churches.; Credit: Maya Sugarman/KPCC

School's out for many K-12 students in South L.A., which means they may also be out of a free meal. With almost 80 percent of Los Angeles Unified School District (LAUSD) students qualifying for free or reduced price meals, the summer can leave a hole in their daily diet.

So local and federal organizations have launched lunch programs to bridge the three-month gap and provide needy kids with a daily meal. Scroll down to see a list of locations.

The Los Angeles Regional Food Bank began serving lunches on Monday at 86 different locations throughout the city. The food bank gives out about 3,500 meals per day, at local libraries, community centers, Salvation Army locations and summer schools.

“For these kids, the lunch may be their first and last meal of the day,” said Maricelle Ranola, the Food Bank’s nutrition director, in a statement. “When they are enjoying something as simple as an apple – something that people who are not food insecure take for granted – it is an amazing sight.”

While participating libraries provide a free lunch to any child who wants it, other food bank locations require students to be enrolled in a program to be eligible for the free meal.

The City of L.A.'s Department of Recreation and Parks also provides free summer lunches to anyone up to age 18. Those 19 or older who have a disability and are enrolled in a school or private, non-profit program are also eligible. This lunch program began Monday and is serving meals at about 100 different parks throughout the city.

The parks program will continue until August 9 and serve nearly 5,000 meals per day. Lunches are available five days a week and feature "nutritious and balanced meals."

And LAUSD isn't completely closing their kitchens for the summer. It expects to serve about one million meals. All students under the age of 18 are eligible for a free summer lunch served at select area schools.

Although local organizations are hosting these summer lunch programs, many of them are bankrolled by federal funds. The United States Department of Agriculture (USDA) sponsors a Summer Food Service Program that partners with community and educational organizations to feed 3.5 million children across the country every day.

"When school is out during the summer months, many families struggle to feed their children even one nutritious meal a day," said Agriculture Secretary Tom Vilsack in a statement. "Government cannot address this challenge alone, which is why, this week, we join our valued partners to raise awareness about the nutrition gap low-income children face when schools close for the summer.

Most participating locations serve meals between between 11:30 a.m. and 12:30 p.m., but exact times may vary depending on the site.

Locations in and around South L.A. serving free summer lunches include:

Fred Roberts Recreation Center: 4700 South Honduras St., Los Angeles, 90011

Gilbert Lindsay Community Center: 425 E. 42nd Place, Los Angeles, 90011

Central Recreation Center: 1357 E. 22nd St., Los Angeles, 90011

Ross Snyder Recreation Center: 1501 East 41st St., CA 90011

Downtown's Central Library: 630 W. 5th St., Los Angeles, 90071

Jefferson High School: 1319 E 41st St, Los Angeles, 90011

Manual Arts High School: 4131 S Vermont Ave., Los Angeles, 90037

Clinton Middle School: 3500 S Hill St, Los Angeles, 90007

For more information on summer lunch programs or to find out what time lunch is served, contact the location. For more details on the L.A. Food Bank, click here. For a complete list of LAUSD schools participating in the free summer lunch program, click here. For a complete list of L.A. parks serving free meals, click here.

Editors Note: The story originally said that students up to age 19 could receive free LAUSD summer lunches. In fact, it is only students up to age 18 that are eligible.

Clay Russell breaks the taboo, talks about his suicide attempt

John Rabe | Off-Ramp — Mon, 10 Jun 2013 16:30:15 -0700

Clay Russell, Gov. Arnold Schwarzenegger's body man, who has written candidly and openly about his October 2012 suicide attempt on mariashriver.com.; Credit: John Rabe

On Nov. 19, Clay Russell wrote on mariashriver.com:

“Do you want to be here?”
“Here, the hospital, or here, Planet Earth?”
“Here, the hospital.”
“No, but I don’t think I’m in any condition to drive home right now.”

That’s an exchange I had recently with an Emergency Room physician. I don’t remember the conversation because I was pretty much unconscious when it occurred and I only heard about it later.

I was unconscious because I had swallowed 50 Ambien tablets and 10 Vicodin, all washed down with a bottle of very good 2004 Meursault. There’s a lot about that evening I don’t remember but I do remember being glad when I finally woke up the next morning. Some people might not have been so glad.

Much later, after attending a cocktail party, he got word that, since he was looking for work, he shouldn't be talking his suicide in public. That struck him as dumb. As he told me, "It would be perfectly normal dinner party conversation to talk about your colonoscopy, but you talk about mental illness and people get freaked out." Not talking about it, the stigma of suicide continues.

In our long interview for Off-Ramp, the 51-year old talked about his diagnosis (bipolar 2), the day he attempted suicide, his treatment strategy, and what it's OK to ask him about at a cocktail party (pretty much everything). In the last six months, Russell says he's learned a lot.

I’ve learned about the National Suicide Prevention Lifeline – 1-800-273-TALK (8255) – where the people who answer the phone just want to help folks get past moments of hopelessness. I called them today and had a chat. They’re a great resource. They save lives. I don’t have all the answers, but I have begun to learn about myself and frame my problem. It’s a start.

Clay Russell, by the way, was not only Maria Shriver's personal assistant, but also Gov. Arnold Schwarzenegger's body man for many years. "I think Maria got me in the divorce," he jokes.

KPCC launches searchable database of California health care costs by hospital

Chris Keller — Mon, 10 Jun 2013 15:15:50 -0700

Nurse Allison Miller (L) checks the blood pressure of Keri Anderson as nurses and physicians give free basic health screenings and call attention to what they say is the ongoing healthcare emergency despite the decision of the U.S. Supreme Court to uphold the Affordable Care Act, on July 10, 2012, in Los Angeles.; Credit: David McNew/Getty Images

KPCC has created this searchable database that will allow you to compare the costs of the 100 most frequently billed procedures paid under Medicare in 2011, which you can view by hospital or as a statewide average.

It's based on data released in May by the Centers for Medicare and Medicaid Services as a way to make it easier for patients to comparison shop for hospital services by price.

The Centers for Medicare & Medicaid Services released the data. Agency officials touted it as a way to make hospitals more accountable for inflated billing procedures that result in wide price variations among facilities.

For instance, the list shows that if you suffer kidney failure with major complications, the bill could be as much as $241,000 at Garfield Medical Center in Monterey Park, or as little as $32,000 at Arrowhead Regional Medical Center in Colton.

Preventive dental care 'not at the front' of South LA patients' minds

José Martinez — Fri, 07 Jun 2013 07:00:30 -0700

A set of dentures sits in a lab at Watts Health Clinic. Dr. Frazier Moore, the clinic's dental director, said tooth decay is the oral health problem he encounters most, and that by the time patients get to him, the only option left is extraction.; Credit: José Martinez/KPCC

Dr. Frazier Moore, the dental director at Watts Health Clinic, isn't trying to fool anybody about the popularity of his trade. He's actually surprisingly honest about it.

"We provide a service no one really wants," he said with a knowing smile. "But eventually they have to come see us."

Moore's department tends to a patient population that's scattered throughout South Los Angeles and in dire need of dental care.

"The most common problem is tooth decay," he said. "We see that from early childhood all the way to adulthood."

Part of the reason is that people don't come in for preventive care. They only come "when they're in pain," explains Moore – for "acute, episodic care."

"The whole thing about preventive dentistry is not really something at the front of patients' mind to get routine care," said William Hobson, the president and CEO of the clinic and Watts Healthcare Corporation. "That's what's needed."

A worldwide problem

A new U.K.-based study published in the Journal of Dental Research estimates that nearly 4 billion people worldwide have "untreated oral conditions." That's more than half the international population.

Researchers found that dental cavities were the most common of 291 major diseases and injuries in 2010, affecting 35 percent of the world's population.

"There are close to 4 billion people in the world who suffer from untreated oral health conditions that cause toothache and prevent them from eating and possibly sleeping properly, which is a disability," said Professor Wagner Marcenes, the study's head researcher, in a statement. "This total does not even include small cavities or mild gum diseases, so we are facing serious problems in the population's oral health."

The study found that between 1990 and 2010, the global burden of oral disease rose 20 percent, mostly because of population growth and aging.

The access obstacle

Preventive care could alleviate a good number of those problems. But Dr. Moore says in addition to not wanting to come in to the dentist's office, or not thinking about it, many patients in the South L.A. area simply can't.

"The numbers are overwhelming for us," he said. While Watts Health Clinic will give same-day care to anyone who comes in complaining of pain, the staff has to be a bit more methodical in scheduling routine preventive care.

"We open up our schedules two months at a time, and we tell our patients to call in on the first of that particular month," said Moore. "Appointments are gone within four hours."

Watts and some of the area's other federally-qualified health centers offer dental services; so does L.A. County, to some extent. But safety-net dental care is difficult to find. The latest data from the county's public health department says in South L.A., nearly 15 percent of children and 35 percent of adults didn't obtain dental care over the previous year because they couldn't afford it.

In 2012, Watts' dental wing tended to nearly 4,500 patients over more than 12,600 appointments. Of those, 88 percent were at or below poverty, and 67 percent were either uninsured or on Medi-Cal.

Hobson, the CEO, says they can take care of most Medi-Cal patients, and can find programs to help cover the uninsured. But plenty of other people in the area get "priced out of dental care," he said.

"We don't turn anyone away because they can't pay," Hobson said.

Myths

Moore attributes the high rate of dental decay in the area to two factors: "poor nutritional choices and just a lot of neglect."

Poor nutritional choices refers in big part to overconsumption of sugar, and sugary drinks in particular, he said. But the reasons for neglect are a bit more complicated.

"People still have this concept of dentistry being such a painful visit," Moore said. "I'm not saying an injection is comfortable, but with our techniques now we make it pretty [non-traumatic]."

He described a few misconceptions he's heard regarding dental care: that the baby teeth don't matter because they're going to fall out anyway, or that people only need to come to the dentist when they're in pain.

One of the older myths Moore doesn't hear much of anymore is where women who'd just given birth would attribute rotten teeth to the fact that their bodies were taking calcium away from their teeth so it could nourish their unborn babies.

The goal is getting patients into a preventive mindset when it comes to dental health, he said.

"It's just getting them to understand that, if they can get in early enough, we can restore these teeth and they don't wind up seeing me," said Moore. He's an oral surgeon, and when he sees patients, it's almost always for a tooth extraction.

That means young children – babies, too – should start seeing a dentist as soon as possible, he said.

"A good portion of our patient population probably feels that their primary care on the medical side would be at a higher [priority] level than the oral health care," said Moore. "That's another thing we're trying to educate the population on: You can't separate the two."

Moore explained that "there's definitely a correlation between oral health and general health," noting, for example, that diabetics have a much harder time fighting off oral infections.

The Journal of Dental Research study was carried out as part of a study on the global burden of disease, injury and risk factors.

Global Burden of Oral Conditions in 1990-2010 - A Systematic Analysis