California Counties Research Articles

Managing Eating Disorders Within Medicaid-Funded Health Care Systems in California.

This study describes the current management of patients with eating disorders (EDs) served by publicly-funded Medicaid behavioral health systems. Behavioral health leaders across nine counties in California met on a quarterly basis to share experiences, challenges, and lessons in the management of EDs within publicly-funded service systems. Detailed notes were taken, and a qualitative content analysis was undertaken to identify key themes. County leadership noted insufficient outpatient capacity and difficulty building capacity for ED treatment, in addition to extraordinary challenges when facilitating admission to out-of-network higher level of care programs, at significant expense. Several challenges were identified in building an internal ED workforce, including the fact that many providers weren't eager to treat EDs due to training burden, patient complexity, and high levels of clinician burnout. When a higher level of care was required due to lack of outpatient resources or patient symptom severity or complexity, leaders dedicated significant resources to identify and contract with an appropriate program and secure the necessary funds. Our study supports the need for specialized ED treatment and case management, as well as standardized processes and centralized resources, in Medicaid-managed care. Findings also indicate the importance of protecting against clinician burnout, possibly through reduced caseload expectations, financial incentives, or increased support. Future policy change could reduce administrative burden and clinician burnout by facilitating admission to and reimbursement for higher levels of care.

Evaluation of the Friday Night Live Mentoring Program on Supporting Positive Youth Development Outcomes.

The use of alcohol, tobacco, and other drugs (ATOD) is a leading cause of preventable morbidity and mortality among adolescents. While traditional interventions have targeted specific health-risk behaviors (e.g., substance use, initiation of sexual intercourse, truancy, etc.), the evidence suggests that using a positive youth development (PYD) framework may have positive impacts across a number of domains. Friday Night Live Mentoring (FNLM) is a PYD-based, cross-age peer mentoring program that engages teams of older high school-aged youth to mentor teams of middle school-aged youth in a structured, ongoing, one-on-one relationship. While studies have demonstrated significant but small effect sizes of intergenerational youth mentoring programs in which an adult mentor is paired with the youth mentee, research on cross-age mentoring programs is limited. The purpose of the current study is to evaluate FNLM on its ability to improve participants' knowledge, attitudes, skills, opportunities to develop caring relationships, school engagement, and academic performance. A retrospective, pre-post survey was administered online to FNLM participants across 13 California counties. Participants rated their knowledge and attitudes about ATOD, skills, relationships with peers and adults, and academic indicators. Open-ended questions gathered information about participants' experiences in FNLM. Non-parametric related-samples Wilcoxon signed rank tests (an alternative to paired t-test) were used to compare pre-post differences. Participants were also asked two open-ended questions: "What are the best parts of FNLM?" and "What, if anything, would you change?". The responses to each question were reviewed, coded, and analyzed according to key themes. A total of 512 participants completed the survey (287 mentors and 225 protégés). There were small but statistically significant improvements across all items for both mentors and protégés. Qualitative analyses showed that most mentors and protégés especially enjoyed getting to know and spend time with one another. Several mentors added that it was rewarding to be a positive influence on or to make a positive difference in the protégé's life. Many youth stated that the relationships formed, especially with their partner, and the activities were the best part of FNLM. The overwhelming majority would not change anything about the program. Those who provided recommendations for program improvement suggested more activities or more hands-on and engaging activities and more or longer meetings. FNLM actively engages youth and provides them with support and opportunities that promote knowledge, skill development, positive relationships, academic engagement, and success and raise awareness of the harms that the use of alcohol, tobacco, and other drugs (ATOD) can cause. While ATOD use was low prior to program participation, it was significantly lower after participating in the program.

First report of tomato ringspot virus infection of Krymsk 86 (Prunus cerasifera × P. persica), a hybrid rootstock, in California.

California produces 99% of prunes (Prunus domestica) in the U.S.A., valued at $148 million and accounting for 40% of world prune production. In the last decade, the rootstock Krymsk 86 (K86; P. cerasifera x P. persica) is increasingly used in prune production because of its high vigor, excellent anchorage and graft compatibility with a wide variety of Prunus crops. An estimated >50% of new prune plantings in the Sacramento Valley are on K86. In late spring of 2023, 'Improved French' prune trees in two Northern California counties, grafted on K86 and Lovell (P. persica) rootstocks, were declining with a pale colored canopy. One orchard was ~ 9-years-old and in the other, trees varied from ~ 20 years to newly planted. The percentage of affected trees in one orchard was 3.6% (n=1,824) and 4.6% (n=1,295) in trees on K86 and Lovell, respectively. Symptomatic trees were scattered throughout this orchard, with a higher density of affected trees in the northeast quadrant. Examination of the trunk revealed a necrotic brown line at the graft union, typical of prune brown line (PBL) disease (Mircetich and Hoy, 1981), caused by infection of rootstock by tomato ringspot virus (ToRSV), a member species of Nepovirus lycopersici (family Secoviridae. The virus is vectored by dagger nematodes (Teliz et al. 1967) and its presence was confirmed in one of the orchards. To confirm infection by ToRSV in declining trees, total RNA from leaf samples, feeder roots, and cambial tissue from bark samples from scion and rootstock of one tree each on K86 and Lovell, was obtained using RNeasy Plant Mini kit (www.qiagen.com) and tested by one step reverse transcription-polymerase chain reaction (RT-PCR) assay using primers previously described (Tang et al., 2014). The reaction conditions included RT at 54oC using random hexamers and Superscript III (Thermo Fisher Scientific, USA), followed by a denaturation step at 95°C for 5 min, and 35 amplification cycles of 95°C for 30 s, 55°C for 30 s, and 72°C for 45 sec; and a final extension of 72°C for 5 min. The expected size amplicons (176 bp) were visualized by agarose gel electrophoresis only from RNA obtained from the cambial tissue below the graft union confirming the ToRSV infection in K86 rootstock. Extracts from bark scrapings of the rootstocks of three symptomatic trees also tested positive for ToRSV with immunostrips (www.agdia.com). In subsequent RT-PCR tests, RNA extracts from cambial tissue from 9 of 10 symptomatic trees on K86 tested positive for ToRSV. The amplicons were purified using a gel extraction kit (Qiagen Inc., Valencia, CA), and subjected to Sanger sequencing (Azenta Life Sciences (South Plainfield, NJ, USA). The sequence of the ToRSV isolates 316 (GenBank accession PQ282959) and 318 (GenBank accession PQ2829560 exhibited 99.4% (175/176 base pairs) and 98.9 % (175/177) sequence identity, respectively, with ToRSV isolate Rasp1-2014 segment RNA2 (GenBank accession KM083895). Our results indicate that ToRSV can infect K86 and cause PBL. ToRSV and its nematode vectors have a wide host range that includes several crop plants and weeds, but this virus is not currently part of registration and phytosanitory certification of Prunus species in the state of California. This is the first report of ToRSV infection of the K86 rootstock. This information is important for the selection of a rootstock in prune orchards where the virus is endemic.

Persistent Environmental Injustice due to Brake and Tire Wear Emissions and Heavy-Duty Trucks in Future California Zero-Emission Fleets.

The adoption of zero-emission vehicles (ZEVs) offers multiple benefits for the climate, air quality, and public health by reducing tailpipe emissions. However, the environmental justice implications of the nonexhaust emissions from future ZEV fleets for near-roadway communities remain unclear. Here, we model the on-road fine particulate matter (PM2.5) emissions across all California counties and assess the near-roadway exposure disparities at the census block group level in the Los Angeles County in 2050, when almost all passenger vehicles are projected to be ZEVs. We found that promoting zero-emission heavy-duty trucks generates more air quality benefits for disadvantaged communities than light-duty passenger vehicles. Persistent disparities in near-roadway PM2.5 levels, however, exist due to the remaining brake and tire wear emissions and increased truck traffic in disadvantaged communities. We recommend implementing fleet-specific ZEV policies to address brake and tire wear emissions and optimizing freight structures to address these persistent environmental justice issues in California.

2024 AMCA MEMORIAL LECTURE HONOREE: MIR SUBHAN MULLA 1925-20231.

From 1979 to 2024, 51 individuals have been recognized as AMCA honorees for their lifetime achievements in mosquito and vector control. Mir Subhan Mulla (1925-2023) was the most recent honoree recognized in March 2024. Mulla received a scholarship in 1948 to attend Cornell University, where he obtained his bachelor's degree in entomology and parasitology. Mulla received his Ph.D. in entomology at the University of California, Berkeley in 1956, and then joined the University of California, Riverside (UC Riverside) faculty the same year. He retired in 2006 after 50 years of service. As one of the founding faculty in entomology at UC Riverside, Mulla created undergraduate and graduate courses and seminars in medical and veterinary entomology. As a leader in UC Riverside's world-renowned medical entomology graduate program, he advised 27 Ph.D. students, three master's students, 20 postdoctoral fellows, and 30 visiting scholars from many countries. Mulla contributed significantly to research and developments in biology, ecology, and control of arthropods of public health and economic importance, including but not limited to mosquitoes, flies, eye gnats, midges, blackflies, and stored product beetles. His work on biorational pesticides was remarkable. He published more than 550 scientific papers in peer-reviewed journals. Mulla served the scientific community as a consultant, advisor, member, or chairman with numerous national and international organizations. He guided many universities in the development of their medical entomology programs. Mulla also served as one of the founding scientists of the Society for Vector Ecology (SOVE). He also provided financial support for facilities, faculty, and students at UC Riverside. Additionally, Mulla served as a leader in the Riverside Muslim community. He and his wife Lelia founded the Islamic Society of Riverside and Orange Counties in California. In recognition of Mulla's excellence in teaching, mentorship, and research, he received numerous prestigious recognitions from universities, communities, and professional organizations. He will be greatly missed by his loving and devoted family, friends, former students, and colleagues here in the USA and abroad.

Reference genome for the endangered, genetically subdivided, northern tidewater goby, Eucyclogobius newberryi.

The federally endangered sister species, Eucyclogobius newberryi (northern tidewater goby) and E. kristinae (southern tidewater goby) comprise the California endemic genus Eucyclogobius, which historically occurred in all coastal California counties. Isolated lagoons that only intermittently connect to the sea are their primary habitat. Reproduction occurs during lagoon closure, minimizing marine dispersal and generating the most genetically subdivided vertebrate genus on the California coast. We present a new genome assembly for E. newberryi using HiFi long reads and Hi-C chromatin-proximity sequencing. The 980Mb E. newberryi reference genome has an N50 of 34Mb with 22 well-described scaffolds comprising 88% of the genome and a complete BUSCO score of 96.7%. This genome will facilitate studies addressing selection, drift, and metapopulation genetics in subdivided populations, as well as the persistence of the critically endangered E. kristinae, where reintroduction will be an essential element of conservation actions for recovery. It also provides tools critical to the recovery of the genetically distinct management units in the northern tidewater goby, as well as broader ecological and evolutionary studies of gobies, the most speciose family of fishes in the world.

Internet-based surveillance to track trends in seasonal allergies across the United States.

Over a quarter of adults in the United States suffer from seasonal allergies, yet the broader spatiotemporal patterns in seasonal allergy trends remain poorly resolved. This knowledge gap persists due to difficulties in quantifying allergies as symptoms are seldom severe enough to warrant hospital visits. We show that we can use machine learning to extract relevant data from Twitter posts and Google searches to examine population-level trends in seasonal allergies at high spatial and temporal resolution, validating the approach against hospital record data obtained from selected counties in California, United States. After showing that internet-derived data can be used as a proxy for aeroallergen exposures, we demonstrate the utility of our approach by mapping seasonal allergy-related online activity across the 144 most populous US counties at daily time steps over an 8-year period, highlighting the spatial and temporal dynamics in allergy trends across the continental United States.

Students or prisoners: Contrasting approaches to rural economic development

AbstractObjectiveWe examine the economic consequences of choosing between higher education and correctional facilities for rural communities seeking economic development. Because rural areas have lagged behind urban areas in their pursuit of economic development, some areas rely on the employment boost from attracting prisons and other incarceration facilities, while others try to attract or expand facilities of higher learning.MethodsUsing Census and QCEW data, we employ a quasi‐experimental analysis to examine the relative merits of both approaches for economic development for rural California. Evaluating average wage per worker along with industrial diversity and employment measures, we compare rural California counties that have prisons to those that have higher education versus a control group without such public investments.ResultsOur results show that while correctional facilities can generate regional growth, the economic development offered by higher education appears to have more substantive long‐term benefits stemming from larger population growth, wealthier proprietorships, and a decline in a county's dependence upon government as a source of its income.ConclusionsWe conclude that universities help build regional coalitions and linkages that reenforce economic development for a rural community as well as providing a skilled labor force and cultural opportunities that a rural prison does not.

Living on the edge: identifying demographic bottlenecks in an isolated sage‐grouse population

The greater sage‐grouse (Centrocercus urophasianus: hereafter sage‐grouse) population in Modoc County California is geographically isolated and contains a single lek (from 56 leks in the 1940s), despite significant efforts to increase the population through translocations and habitat improvement. Repeated wildfire within the landscape has led to an increase in invasive annual grasses and a decrease in sagebrush (Artemisia sp.) cover in important nesting and brood‐rearing habitat. We estimated survival for adult females, nests, and chicks and assessed biotic characteristics that may influence these survival estimates to identify factors that may be limiting population growth. We monitored 37 female sage‐grouse marked with GPS PTTS, 39 nests, and 8 broods for 3 years (2019–2021). We measured vegetation characteristics for nests at the microsite and landscape scale to evaluate effects on daily nest survival (DNS). We used survival rates from all life stages to parameterize matrix models and estimate population growth rate. Mean nest success over 3 years was 29% (95% CI: 17.1–44.8) across a 29‐day incubation period and DNS declined as the proportion of both medusahead Taeniatherum caput‐medusae and Japanese brome Bromus japonicus around the nest increased. Across all three years, mean chick survival across a 54‐day period was 44% (95% CI: 0.9–72.3) and mean annual survival for adult females was 29% (95% CI: 17.8–43.7). Our estimated vital rates were 45–55% lower than distribution‐wide estimates and the projected population growth rate was strongly declining (0.411, 95% CI: 0.30–0.52). Our results suggested recent cover changes associated with wildfire on the study area may have had a detrimental effect on this population across all life stages, and if attention is not given to preventing the transition from sagebrush communities into invasive grasslands, this population and others in degraded landscapes may not persist.

Abstract C127: Patterns of mortality risk in insured patients with cancer by race/ethnicity and socioeconomic status in Southern California

Abstract Purpose. Several factors including, socioeconomic status (SES), access to screening and healthcare coverage, tumor biology, differences in disease management and care delivery in various healthcare settings, and implicit bias among healthcare providers contribute to mortality disparities in individuals with cancer. Further, health insurance is strongly associated with better survival. Previous studies that examined disparities in cancer mortality included patients with and without healthcare coverage, making it difficult to disentangle the effects of health insurance coverage from other SES factors. Thus, we evaluated the influence of race/ethnicity and geocoded SES on all-cause mortality in cancer patients with health insurance. Methods. We identified adults with health insurance coverage diagnosed with eight common cancers from 2009 to 2014 from the California Cancer Registry (stages I-IV) and followed them through 2017 (8 years maximum). Specifically, we identified those who lived in southern California counties. Patients had managed care, preferred provider organization, Medicare, Medicaid, dual Medicare and Medicaid, and other private insurance. We calculated person-year mortality rates by race/ethnicity and geocoded SES quintiles. Adjusted hazard ratios for the association between overall mortality and race/ethnicity and SES were estimated using Cox proportional hazards models accounting for other demographics, stage at diagnosis, and cancer treatments. Results. 164,197 adults were diagnosed with cancer originating from breast, prostate, lung, colon, skin melanoma, uterus, kidney, and bladder. For all racial/ethnic groups combined, the mortality rates from lowest to highest SES groups were 112.1/1000 PY (lowest); 100.2/1000 PY (lower-middle); 91.2/1000 PY (middle); 79.1/1000 PY (upper-middle); and 63.5/1000 PY (upper). These rates suggest that people with the lowest SES have a markedly increased mortality risk after cancer diagnosis even if they have health insurance. In multivariable analyses, those in the lowest SES group had a 40–78% increased risk of all-cause mortality compared to those in the upper SES group across all races/ethnicities. For example, within African Americans, the adjusted mortality risk was up to 61% higher (HR 1.61, 95% CI 1.41–1.83) in the lowest SES group compared to the highest SES group. Conclusion. This study suggests disparities in overall mortality risk after cancer diagnoses persist even in a cohort with health insurance, and that SES is an important driver of this disparity. Issues related to travel distance, access to transportation to cancer care facilities, and access to telemedicine may be magnified among those with lower SES during cancer care where optimal management becomes more complex. To potentially mitigate the effects of these social determinants, healthcare systems must either implement programs to support patients, or have partnerships with local community organizations to do so. All of this requires systems level support through social work, patient navigation, and cancer case management. Citation Format: Reina Haque, Amrita Mukherjee, Robert M. Cooper. Patterns of mortality risk in insured patients with cancer by race/ethnicity and socioeconomic status in Southern California [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C127.

Modeling the impact of a supervised consumption site on HIV and HCV transmission among people who inject drugs in three counties in California, USA

Supervised consumption sites (SCS) have been shown to reduce receptive syringe sharing among people who inject drugs (PWID) in the United States and elsewhere, which can prevent HIV and hepatitis C virus (HCV) transmission. PWID are at risk of disease transmission and may benefit from SCS, however legislation has yet to support their implementation. This study aims to determine the potential impact of SCS implementation on HIV and HCV incidence among PWID in three California counties. A dynamic HIV and HCV joint transmission model among PWID (sexual and injecting transmission of HIV, injecting transmission of HCV) was calibrated to epidemiological data for three counties: San Francisco, Los Angeles, and San Diego. The model incorporated HIV and HCV disease stages and HIV and HCV treatment. Based on United States data, we assumed access to SCS reduced receptive syringe sharing by a relative risk of 0.17 (95 % CI: 0.04-1.03). This model examined scaling-up SCS coverage from 0 % to 20 % of the PWID population within the respective counties and assessed its impact on HIV and HCV incidence rates after 10 years. By increasing SCS from 0 % to 20 % coverage among PWID, 21.8 % (95 % CI: -1.2-32.9 %) of new HIV infections and 28.3 % (95 % CI: -2.0-34.5 %) of new HCV infections among PWID in San Francisco County, 17.7 % (95 % CI: -1.0-30.8 %) of new HIV infections and 29.8 % (95 % CI: -2.1-36.1 %) of new HCV infections in Los Angeles County, and 32.1 % (95 % CI: -2.8-41.5 %) of new HIV infections and 24.3 % (95 % CI: -1.6-29.0 %) of new HCV infections in San Diego County could be prevented over ten years. Our models suggest that SCS is an important intervention to enable HCV elimination and could help end the HIV epidemic among PWID in California. It could also have additional benefits such facilitating pathways into drug treatment programs and preventing fatal overdose.

Irrigation increases and stabilizes mosquito populations and increases West Nile virus incidence

Humans have greatly altered earth’s terrestrial water cycle with the majority of fresh water being used for agriculture. Irrigation changes spatial and temporal water availability and alters mosquito abundance and phenology. Previous studies evaluating the effect of irrigation on mosquito abundance and mosquito-borne disease have shown inconsistent results and little is known about the effect of irrigation on variability in mosquito abundance. We examined the effect of irrigation, climate and land cover on mosquito abundance and human West Nile virus (WNV) disease cases across California. Irrigation made up nearly a third of total water inputs, and exceeded precipitation in some regions. Abundance of two key vectors of several arboviruses, including WNV, Culex tarsalis and the Culex pipiens complex, increased 17–21-fold with irrigation. Irrigation reduced seasonal variability in C. tarsalis abundance by 36.1%. Human WNV incidence increased with irrigation, which explained more than a third (34.2%) of the variation in WNV incidence among California counties. These results suggest that irrigation can increase and decouple mosquito populations from natural precipitation variability, resulting in sustained and increased disease burdens. Shifts in precipitation due to climate change are likely to result in increased irrigation in many arid regions which could increase mosquito populations and disease.

Social mix and social interaction: evidence from Los Angeles County

Research shows that policy tools to reduce residential segregation are also effective to reduce economic inequality and, for decades, achieving the adequate level of 'social mix' has been an important policy goal in housing and community policy fields. Yet whether social mix creates social interactions, thus producing favourable social outcomes, is still disputed. This study aims to expand the empirical record on the modus operandi of social mix and its policy viability, and to provide useful information on relevant contextual factors to prescribe effective social mix policies to improve social interaction. We fit interactive linear models to data from Los Angeles County in California, USA, to test the hypothesis that social mix (measured via residential income mix) promotes social interactions (in the form of civic, daily-life, and political activities and group memberships), and to examine whether arts and recreation centres (i.e. the places where social interactions occur to produce social mix) moderate the effect of residential income mix on favourable social outcomes. Results show that while residential income mix is negatively associated with social interactions, recreation centres help income-mixed communities increase social interactions among their residents. We also find evidence that communities with higher income mix levels manifest higher social interaction as there are more arts and recreation centres in their communities. Our findings shed light on why social mix policy works in some communities but does not work in others, elucidating why previous research displays conflicting claims.

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California

The incidence of opioid-associated out-of-hospital cardiac arrest (OA-OHCA) has grown from less than 1% of OHCA in 2000 to between 7% and 14% of OHCA in recent years; American Heart Association (AHA) protocols suggest that emergency medical service (EMS) clinicians consider naloxone in OA-OHCA. However, it is unknown whether naloxone improves survival in these patients or in patients with undifferentiated OHCA. To evaluate the association of naloxone with clinical outcomes in patients with undifferentiated OHCA. Retrospective cohort study of EMS-treated patients aged 18 or older who received EMS treatment for nontraumatic OHCA in 3 Northern California counties between 2015 and 2023. Data were analyzed using propensity score-based models from February to April 2024. EMS administration of naloxone. The primary outcome was survival to hospital discharge; the secondary outcome was sustained return of spontaneous circulation (ROSC). Covariates included patient and cardiac arrest characteristics (eg, age, sex, nonshockable rhythm, any comorbidity, unwitnessed arrest, and EMS agency) and EMS clinician determination of OHCA cause as presumed drug-related. Among 8195 patients (median [IQR] age, 65 [51-78] years; 5540 male [67.6%]; 1304 Asian, Native Hawaiian, or Pacific Islander [15.9%]; 1119 Black [13.7%]; 2538 White [31.0%]) with OHCA treated by 5 EMS agencies from 2015 to 2023, 715 (8.7%) were believed by treating clinicians to have drug-related OHCA. Naloxone was administered to 1165 patients (14.2%) and was associated with increased ROSC using both nearest neighbor propensity matching (absolute risk difference [ARD], 15.2%; 95% CI, 9.9%-20.6%) and inverse propensity-weighted regression adjustment (ARD, 11.8%; 95% CI, 7.3%-16.4%). Naloxone was also associated with increased survival to hospital discharge using both nearest neighbor propensity matching (ARD, 6.2%; 95% CI, 2.3%-10.0%) and inverse propensity-weighted regression adjustment (ARD, 3.9%; 95% CI, 1.1%-6.7%). The number needed to treat with naloxone was 9 for ROSC and 26 for survival to hospital discharge. In a regression model that assessed effect modification between naloxone and presumed drug-related OHCA, naloxone was associated with improved survival to hospital discharge in both the presumed drug-related OHCA (odds ratio [OR], 2.48; 95% CI, 1.34-4.58) and non-drug-related OHCA groups (OR, 1.35; 95% CI, 1.04-1.77). In this retrospective cohort study, naloxone administration as part of EMS management of OHCA was associated with increased rates of ROSC and increased survival to hospital discharge when evaluated using propensity score-based models. Given the lack of clinical practice data on the efficacy of naloxone in OA-OHCA and OHCA in general, these findings support further evaluation of naloxone as part of cardiac arrest care.

Unveiling Wildfire Dynamics: A Bayesian County-Specific Analysis in California

Recently, the United States has experienced, on average, costs of USD 20 billion due to natural and climate disasters, such as hurricanes and wildfires. In this study, we focus on wildfires, which have occurred more frequently in the past few years. This paper examines how various factors, such as the PM10 levels, elevation, precipitation, SOX, population, and temperature, can influence the intensity of wildfires differently across counties in California. More specifically, we use Bayesian analysis to classify all counties of California into two groups: those with more wildfires and those with fewer wildfires. The Bayesian model incorporates prior knowledge and uncertainty for a more robust understanding of how these environmental factors impact wildfires differently among county groups. The findings show a similar effect of the SOX, population, and temperature, while the PM10, elevation, and precipitation have different implications for wildfires across various groups.

EHR Documentation and Referrals for Intimate Partner Violence and Sexual Assault.

Hospital settings provide a unique opportunity to screen for interpersonal violence (IPV) and sexual assault (SA) yet often lack health IT solutions for generating reliable and valid medico-legal documentation via forensic reports. The objective of the project was to evaluate a pilot, technology "tool" for documenting cases of IPV and SA that could support forensic nurse examiners and related stakeholders in generating high quality documentation and coordinating victim support services. The tool was a digital health intervention implemented for use among forensic nurse examiners, law enforcement, victim support organizations, and more within four counties of California. We conducted a mixed-methods pilot study that captured data around the adoption, use, and impact of having access to the newly implemented tool. The tool successfully went live in all four pilot counties at different time points with different proportions of use by county and form type: exams, referrals, addenda, risk assessments, and other. Participants were motivated to use the tool out of a perceived need for data handling functionalities that went beyond traditional manual (paper) means. Key functionalities included body mapping, data quality controls within validated forms, attaching addenda to already existing case reports, and the means to distribute data to external recipients. Further study and development are needed on functions to incorporate into body maps and forms, and understanding the information needs of law enforcement and victim support organizations. Our evaluation demonstrated the feasibility and acceptability of a health IT tool to support forensic nurse documentation of IPV and SA, and direct information to multiple legal and support-related stakeholders. Areas of future development include integrating IPV and SA-related data standards for digitized forms, enhancements to the body mapping feature, and understanding the needs of those who receive digital data from forensic nurse examiners within the tool.

Do counts of radiocarbon-dated archaeological sites reflect human population density? A preliminary empirical validation examining spatial variation across late Holocene California

AbstractResearchers increasingly rely on aggregations of radiocarbon dates from archaeological sites as proxies for past human populations. This approach has been critiqued on several grounds, including the assumptions that material is deposited, preserved, and sampled in proportion to past population size. However, various attempts to quantitatively assess the approach suggest there may be some validity in assuming date counts reflect relative population size. To add to this conversation, here we conduct a preliminary analysis coupling estimates of ethnographic population density with late Holocene radiocarbon dates across all counties in California. Results show that counts of late Holocene radiocarbon-dated archaeological sites increase significantly as a function of ethnographic population density. This trend is robust across varying sampling windows over the last 5000 BP. Though the majority of variation in dated-site counts remains unexplained by population density. Outliers reveal how departures from the central trend may be influenced by regional differences in research traditions, development-driven contract work, organic preservation, and landscape taphonomy. Overall, this exercise provides some support for the “dates-as-data” approach and offers insights into the conditions where the underlying assumptions may or may not hold.

Building the NHPI Data Policy Platform to Identify the Most Pressing SDOH Policy Domains for the NHPI Community

Abstract: Access to accurate Native Hawaiian and Pacific Islander (NHPI) social drivers of health (SDOH) data is crucial for understanding health needs and shaping effective public health strategies. However, this data often gets obscured within broader racial and ethnic categories making NHPI issues invisible. Moreover, NHPI communities face barriers when published data formats are inaccessible to community-based organization staff. To tackle these challenges, we initiated the Assessing Social Determinants of Health Data Through Local Data Intermediaries Initiative (AHEAD), supported by the federal Office of Minority Health. We developed two community-centered resources: 1. The NH PI Data Policy Platform, shaped by 138 NHPI community leaders from 13 states and Washington, D.C., representing nine NHPI subgroups. This platform highlights NHPI priority issues and provides equitable data policy recommendations for advocates and policymakers. 2. An NHP I SDOH Dashboard for California Counties, tailored to offer accessible data for community-based organization staff, ensuring better-informed interventions and support.

Hospital Presumptive Eligibility Emergency Medicaid Programs: An Opportunity for Continuous Insurance Coverage?

Lack of health insurance is a public health crisis, leading to foregone care and financial strain. Hospital Presumptive Eligibility (HPE) is a hospital-based emergency Medicaid program that provides temporary (up to 60d) coverage, with the goal that hospitals will assist patients in applying for ongoing Medicaid coverage. It is unclear whether HPE is associated with successful longer-term Medicaid enrollment. To characterize Medicaid enrollment 6 months after initiation of HPE and determine sociodemographic, clinical, and geographic factors associated with Medicaid enrollment. This was a cohort study of all HPE approved inpatients in California, using claims data from the California Department of Healthcare Services. The study was conducted across all HPE-participating hospitals within California between January 1, 2016 and December 31, 2017. We studied California adult hospitalized inpatients, who were uninsured at the time of hospitalization and approved for HPE emergency Medicaid. Using multivariable logistic regression models, we compared HPE-approved patients who enrolled in Medicaid by 6 months versus those who did not. HPE emergency Medicaid approval at the time of hospitalization. The primary outcome was full-scope Medicaid enrollment by 6 months after the hospital's presumptive eligibility approval. Among 71,335 inpatient HPE recipients, a total of 45,817 (64.2%) enrolled in Medicaid by 6 months. There was variability in Medicaid enrollment across counties in California (33%-100%). In adjusted analyses, Spanish-preferred-language patients were less likely to enroll in Medicaid (aOR 0.77, P <0.001). Surgical intervention (aOR 1.10, P <0.001) and discharge to another inpatient facility or a long-term care facility increased the odds of Medicaid enrollment (vs. routine discharge home: aOR 2.24 and aOR 1.96, P <0.001). California patients who enroll in HPE often enroll in Medicaid coverage by 6 months, particularly among patients requiring surgical intervention, repeated health care visits, and ongoing access to care. Future opportunities include prospective evaluation of HPE recipients to understand the impact that Medicaid enrollment has on health care utilization and financial solvency.

Exploring the role of temperature and other environmental factors in West Nile virus incidence and prediction in California counties from 2017-2022 using a zero-inflated model.

West Nile virus (WNV) is the most common mosquito-borne disease in the United States, resulting in hundreds of reported cases yearly in California alone. The transmission cycle occurs mostly in birds and mosquitoes, making meteorological conditions, such as temperature, especially important to transmission characteristics. Given that future increases in temperature are all but inevitable due to worldwide climate change, determining associations between temperature and WNV incidence in humans, as well as making predictions on future cases, are important to public health agencies in California. Using surveillance data from the California Department of Public Health (CDPH), meteorological data from the National Oceanic and Atmospheric Administration (NOAA), and vector and host data from VectorSurv, we created GEE autoregressive and zero-inflated regression models to determine the role of temperature and other environmental factors in WNV incidence and predictions. An increase in temperature was found to be associated with an increase in incidence in 11 high-burden Californian counties between 2017-2022 (IRR = 1.06), holding location, time of year, and rainfall constant. A hypothetical increase of two degrees Fahrenheit-predicted for California by 2040-would have resulted in upwards of 20 excess cases per year during our study period. Using 2017-2021 as a training set, meteorological and host/vector data were able to closely predict 2022 incidence, though the models did overestimate the peak number of cases. The zero-inflated model closely predicted the low number of cases in winter months but performed worse than the GEE model during high-transmission periods. These findings suggests that climate change will, and may be already, altering transmission dynamics and incidence of WNV in California, and provides tools to help predict incidence into the future.