Health Justice Network May 11, 2009

Agenda Welcome and Introductions Host Welcome: Asian Pacific AIDS Intervention Team May 19th Special Election UCLA Children’s Health In Focus: Older Adults Health (w/ Speaker) Advocacy Update New Program Initiative: Older Adults Taskforce/ South Asian Network Announcements and Organizational Updates

Host Welcome ASIAN PACIFIC AIDS INTERVENTION TEAM “APAIT positively affects the quality of life for Asian and Pacific Islanders living with or at-risk for HIV/AIDS by providing a continuum of prevention, health and social services, community leadership and advocacy to the Southern California region.” MISSION STATEMENT:

May 19 th Special Election Hala Masri Asian Pacific American Legal Center

February’s Massive Budget Deal Addressed This and Next Year’s Budgets Placed Propositions 1A-F on the Ballot

Proposition 1A Caps State Spending Builds the State Budget Reserve Extends Revenue Increases Concerns Spending cap would be based on insufficient revenue levels Governor’s authority for mid-year cuts Spending cap does not consider the rising cost of health care and the needs of our aging population

Proposition 1D Diverts First 5 Funds for 5 Budget Years Shifted Dollars Would Support Programs for Children Under 5 Years of Age Concerns: Permanently limits First 5 to direct services Shifts funds away from services for immigrant children

Proposition 1E Diverts Mental Health Money from Proposition 63 for Two Years Shifted Dollars Would Fund Mental Health Services for Medi-Cal Recipients Under 21 Years of Age Concerns: Shifted dollars will decrease funds needed to address cultural and linguistic barriers to mental health services

All Things Considered… If the Propositions Fail, Our State Deficit Will Increase by $6 Billion Possibility of Further Cuts to Safety Net Services After the Special Election If Approved, the Propositions Would Likely Pose a Continual Threat to California’s Safety Net

UCLA Children’s Health Celia Brugman Senior Community Liaison National Children’s Study - LAVSC

National Children’s Study Los Angeles – Ventura Counties Neal Halfon MD, MPH (PI) Professor of Pediatrics, Public Health, & Public Policy Director, Center for Healthier Children, Families & Communities UCLA Calvin J. Hobel, MD (Co-PI) Miriam Jacobs Chair in Maternal Fetal Medicine, Cedars Sinai Professor of Obstetrics, Gynecology & Pediatrics, UCLA The National Children Study – Los Angeles Ventura Study Center (NCS- LAVSC) Health Justice Network May 11, 2009

What is the National Children’s Study (NCS)? Largest long-term study of children’s health in the United States Authorized by the Children’s Health Act of 2000 $110.9 million appropriated for FY 2008

NCS Lead Supporting Agencies National Institute of Health (NIH) Center for Disease Control And Prevention (CDC) Environmental Protection Agency (EPA)

What is the focus of the NCS? How children’s genes and their environments interact to affect their health and development - From before birth through age ,000 children nationwide - Possible answers to: birth defects and pregnancy related problems injuries asthma obesity and diabetes behavior, learning and mental health disorders

Rationale for the NCS Children are especially vulnerable to environmental exposures Existing research too limited in size and scope to answer the questions Preconception, prenatal, and/or postnatal exposures Potential for serious developmental effects Exposures of high frequency Pesticides Violence Media Life-course design needed to understand the origins of disease and how multiple factors interrelate to cause them

What will the NCS Mean to our Children’s Well-Being? Understanding the biology and genetics of health, development and behavior Evidence-based information on which to base decisions about practice and policy regarding children’s physical and mental health Economic benefits: cost avoidance Resource for future research

Priority Health Exposures, Outcomes Priority ExposuresExamples Physical Environment Housing quality, neighborhood Chemical Exposures Pesticides, phthalates, heavy metals Biologic Environment Infectious agents, endotoxins, diet Genetics Interaction between genes and environment Psychosocial milieu Family structure, socio-economic status, parenting style, social networks, exposure to media and violence Priority Health Outcomes Examples Pregnancy OutcomesPreterm, Birth defects Neurodevelopment & Behavior Autism, learning disabilities, schizophrenia, conduct and behavior problems Injury Head trauma, Injuries requiring hospitalizations Asthma Asthma incidence and exacerbation Obesity & Physical Development Obesity, diabetes, altered puberty

Study Sample 105 Locations Selection of neighborhoods All or a sample of households within neighborhoods All eligible women in the household ~4 million births in 3,141 counties All Births in the Nation Sample of Study Locations Sample of Study Segments Study Households Study Women

Overview of Sampling in Los Angeles County Based on birth rates LA County first divided into 14 large areas Further subdivided into small areas/locations Random selection of locations 2011 sample: 14 locations Different small areas in LA County Randomly selected

Recruitment Household recruitment Women who are in their 1 st trimester of pregnancy (enumeration period) Women at high probability of becoming pregnant All births (after enumeration completed) Recruitment goals Preconception: 25% of sample First trimester and subsequent births: 75% of sample Supplemental mechanisms Prenatal care sites, birthing centers, hospitals

Proposed Schedule of Visits Screening12 months (Home) Preconception18 months (Home) 1 st Trimester (home)3 years (Clinic) 2 nd Trimester (clinic)5 years (Clinic) 3 rd Trimester (clinic)7 years (Home) Delivery- Birth9 years (Clinic) Delivery- Pre-discharge12 years (Clinic) 1 month (Home)16 years (Home) 6 months (Home)20 years (Clinic) Prenatal contactPostnatal contact

Data Collection Types of Data: Interviews/assessments/questionnaires Diaries/medical visit logs Environmental samples and assessments Physical exams Biospecimens Other (medical records, child care, community, etc...)

Community Outreach and Engagement NCS-LAVSC will adhere to principles of community partnership Inclusive of all children and families Shared responsibilities with community members Useful to local communities and participants

Building community relations Building Community Relationships

Community and the NCS Community Engagement throughout the Study Solicit input and support Provide information on an ongoing basis Promote study ownership Recruitment & Retention Build on pre-established community relationships Hire culturally appropriate/culturally competent staff Establish mechanisms for incorporating participant feedback

Where do you fit in? Work with the Los Angeles NCS team to build trust in the community Provide guidance and expertise in your specific area of work Publicize the study to potential participants to enhance study participation Incorporate NCS information in your organization’s newsletter/listserv/mail-outs, aka help “Spread the Word”

Contact Information Check the Web site: Join the local listserv for news and communication Ask us questions Celia Brugman, Sr. Community Liaison: (310)

Biospecimen collection Mothers: blood, saliva, urine, nails, hair, vaginal swabs, placenta, umbilical cord, breast milk Children: blood, urine, cord blood, blood spots, meconium, hair, saliva Fathers: blood, urine, hair, nails, saliva

Questionnaire overview Household composition and demographics Indices of perceived stress Social support and family process Health behaviors, diet, and activity Mental health and cognition Parenting style and attachment Medicines and medical history Housing Child care Neurobehavioral assessments

What Data will be Collected? Data types Questionnaire data Physical/medical examination data (blood pressure, sonogram, height, weight) Biological specimen (blood, hair, urine, saliva, placenta) Environmental samples (dust, air, water, soil) Videos or still photographs Medical record abstraction

In Focus: Older Adults Health Imelda Padilla-Frausto UCLA Center for Health Policy Research

Advocacy Update: AB 324 and SB 1 Hala Masri Asian Pacific American Legal Center

New Program Initiative: Older Adults Task Force/South Asian Network Health Justice Network

Announcements & Organizational Updates Health Justice Network

Reminder: API Policy Summit is May 26th & 27th in Sacramento Health Justice Network

Next Meeting: August 10th, :00AM to 12:00PM Health Justice Network