California Health Research Articles

Epidemiological Data of Non-Fatal Workplace Violence from Local and State Law Enforcement Samples

Non-fatal incidents of workplace violence, regardless of their prevalence in contrast to fatal incidents, remain largely unexplored. Official criminal incident reports (N = 329) adhering to a well-established definition of workplace violence (excluding robbery cases) were selected from local and state police databases for a jurisdiction covering a Midwestern city (population roughly 200,000) during a 30-month period and examined to explore distinguishing characteristics. These incidents were considered in light of the California Safety and Health Association's workplace violence typology as a means of further delineating between aggressors across business, government, and educational sites. The relevant trends indicate potential considerations related to prevention and risk assessment.

Reductions in Fluvial Sediment Discharge by Coastal Dams in California and Implications for Beach Sustainability

Abstract The long‐term sustainability of California’s beaches depends on periodic deliveries of sand and gravel from coastal rivers and streams. To assess the long‐term health of California’s beaches, this study characterized the current state of fluvial sediment delivery and quantified, on a littoral cell basis, the cumulative impacts of dams in decreasing annual discharge. Presently, more than 500 dams impound more than 42,000 km2 (or 38%) of California’s coastal watershed area. Flow modeling suggests that by diminishing flood hydrographs, these dams have reduced the average annual sand and gravel flux to 20 major littoral cells by 2.8 million m3/yr (or 25%). In 70% of the streams considered in this study, suspended sediment loads during equivalent discharge events have declined over the past three decades, which indicates that dams have also significantly reduced downstream sediment supplies. Approximately 23% (or 274 km) of the 1193 km of beaches in California are downcoast from rivers that have had s...

Improvements in prenatal insurance coverage and utilization of care in California: an unsung public health victory.

To examine trends in prenatal insurance coverage and utilization of care in California over two decades in the context of expansions in Medi-Cal (California's Medicaid) and other public efforts to increase prenatal care utilization. Retrospective univariate and bivariate analysis of prenatal care coverage and utilization data from 10,192,165 California birth certificates, 1980-99; descriptive analysis of California poverty and unemployment data from the U.S. Census Bureau Current Population Survey; review of public health and social policy literature. The proportion of mothers with Medi-Cal coverage for prenatal care increased from 28.2 to 47.5% between 1989 and 1994, and the proportion uninsured throughout pregnancy decreased from 13.2 to 3.2%. Since the mid-1990s, fewer than 3% of women have had no insurance coverage for prenatal care. Between 1989 and 1999, the proportion of women with first trimester initiation of prenatal care increased from 72.6 to 83.6%, reversing the previous decade's trend, and the proportion of women with adequate numbers of visits rose from 70.7 to 83.1%. Improvements in utilization measures were greater among disadvantaged social groups. Improvements in California during the 1990s coincided with a multifaceted public health effort to increase both prenatal care coverage and utilization, and do not appear to be explained by changes in the economy, maternal characteristics, the overall organization/delivery of health care, or other social policies. While this ecologic study cannot produce definitive conclusions regarding causality, these results suggest an important victory for public health in California.

Impeding Earl Warren: California's Health Insurance Plan That Wasn't and What Might Have Been

It is widely believed that the turning point for U.S. health insurance came in 1949 when Congress failed to adopt President Harry Truman's proposal for a national system. The possibility that a system of state-level health plans might have emerged before Truman's plan has received little attention. Yet several attempts to enact such a plan were made in California by Governor Earl Warren in the mid-1940s. Had Warren succeeded, the California example might have been emulated by other states and the United States might have evolved a system similar to Canada's provincial programs.

Mobilizing women for minority health and social justice in california.

Women's Health Leadership is building the leadership capacity of diverse community leaders in California committed to promoting health and social justice in their communities. This program provides opportunities for cross-cultural exchanges of ideas, resources, and expertise. Graduates continue to receive technical support and to engage in peer learning via an alumnae network. The network is dedicated to advancing social justice issues and to addressing health disparities. It is also a way to mobilize trained grassroots leaders to provide expertise to influence policy decisions, to provide technical support and resources to local communities, and to foster new partnerships across the state.

The California Wellness Foundation's grant making in work and health.

The California Wellness Foundation's grant making in work and health.

Simulated effect of tobacco tax variation on latino health in California

Background: Over one fourth of the California population was Latino in 1999, and by 2015 Latinos are expected to be the single largest ethnic group in California. Patterns of smoking and nicotine dependence among Latino smokers may be quite different from those of smokers in other ethnic groups. In addition, Latino smokers may be more sensitive to cigarette prices. Therefore, the effect of an increase in cigarette excise taxes on Latino smoking prevalence may be quite large, and consequently the impact on Latino health may be proportionately greater than on population health in general. Methods: We simulated changes in Latino smoking, morbidity, mortality, and quality-adjusted life years (QALYs) that would result from a range of actual and proposed cigarette excise-tax increases using a range of cigarette price-elasticity estimates specific to Latino smokers. Monte Carlo simulation was used to generate confidence intervals. Results: Assuming a Latino price elasticity of demand for cigarettes of −1.0, reductions in Latino smoking resulting from an additional $0.50/pack tax would produce nearly 3000 Latino QALYs in California in 1999. Greater benefits would accrue each year, until a steady state relative to population size is reached 75 years after the program is initiated. Conclusions: If Latino smokers are more responsive to changes in cigarette prices than other smokers, Latino smokers also stand to gain a disproportionate share of the health benefit from an excise tax increase.

Asian Immigration and Public Health in California: Thalassemia in Newborns in California

This study reviews Asian immigration in California and the effect it has had on public health in the state in terms of genetic disease detection. This is documented in terms of the numbers of cases of thalassemia detected, including Hemoglobin (Hb) E/beta-thalassemia, beta-thalassemia major, and Hb H disease. California has been screening all newborns for hemoglobinopathies since 1990 and tests approximately 530,000 newborns per year. Samples are collected on filter paper during the first I to 2 days of life and sent to one of eight contract laboratories. The screening methodology is cation exchange high-performance liquid chromatography. Confirmatory testing is performed at Children's Hospital Oakland hemoglobin laboratory using a variety of methods. Approximately five to seven cases each of Hb E/beta-thalassemia and beta-thalassemia major are detected annually. Most cases are of Southeast Asian origin. Prevalence rate of Hb E/beta-thalassemia among Southeast Asians is approximately 1 in 2,200 births. A pilot program for Hb H disease screening was successful and this disorder has now been incorporated in newborn screening, detecting approximately 40 cases per year. Increases in Asian immigration and births in the U.S., particularly California, have been dramatic during the past 10 years and have led to detection of previously rare diseases like Hb E/beta-thalassemia. It has also changed the way other thalassemic disorders are viewed, such as Cooley anemia, which previously affected mainly individuals of Mediterranean origin. Now, most affected patients are of Asian origin.

Aging and Employment: Characteristics of Those Working and Retired in California

Little is known about the aging worker's psychological, social, and physiological characteristics. In this study, 447 individuals (working and retired) aged 50 and over completed the California Work and Health survey. Most of the working respondents (n = 150) were employed full-time and worked in education, health care, government, and retail trade. Those working reported being in greater health, being less depressed, and having more energy and activities than those retired. There was no difference between those working and retired in social and psychological characteristics such as number of friendships and ability to control important things in life and overcome difficulties. Educating managers and business professionals about these characteristics is essential given anticipated social security system changes in the future.

Consumption of Foods from the WIC Food Packages of Chinese Prenatal Patients on the US West Coast

Objective To assess consumption of foods from food packages provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among 80 Chinese prenatal WIC recipients living in Oakland or San Francisco, Calif. Design During a single interview, a food frequency questionnaire was used to assess WIC food consumption by the prenatal patients for the period before and after receipt of WIC vouchers. Setting The study was conducted at Asian Health Services, Oakland, and the Chinatown Public Health Center of the San Francisco Department of Public Health in California. Subjects Eighty low-income Chinese prenatal women with limited education and limited ability to speak English, aged 21 to 43 years, with gestational stages of 15 to 38 weeks. Statistical analyses performed Descriptive statistics (frequency and percent distribution) were used to report the findings of the study. Results Subjects reported that before receiving WIC vouchers, milk, eggs, and juice were the only foods in their WIC food package that had been consumed frequently (>5 times/week) in their daily diet. Other WIC foods, including cheese, peanut butter, dried beans, and hot and cold cereals, were consumed infrequently (0 to 1 time/month). Subjects reported that with the availability of WIC vouchers, milk, eggs, and juice remained frequently consumed with 81% to 100% of monthly supply as the most prevalent reported consumption rate. Dried beans and hot and cold cereals were also consumed frequently. Cheese remained poorly consumed (0% to 20% of the monthly supply). As many as 74 of 80 subjects stated that they had shared foods from their own WIC package, except milk, with their families. The use of any WIC foods provided to other children in the family was not assessed in this study. Applications Data from this study indicate that most WIC foods were well used by Chinese prenatal patients. The most notable exception was cheese, which was poorly consumed. The ready consumption of milk by pregnant Chinese WIC recipients in this study suggests that milk may be readily consumed by these women, even though it is atypical of the Asian diet. The WIC food package for Chinese prenatal patients may be improved by omitting cheese and substituting more milk and/or foods such as tofu and dark green leafy vegetables. J Am Diet Assoc. 1999;99:1549–1553.

Discussion

Retail food establishment inspection is a longestablished component of public health efforts to protect the public against foodborne illness. Poor sanitary practices in food storage, handling, and preparation increase risk of foodborne illness, with campylobacter and salmonella the most common bacterial agents thus transmitted. Restaurants with higher restaurant inspection scores have been found to be associated with lower incidence of foodborne infection.1 Retail food establishment inspections are conducted in a variety of food establishments including restaurants, bakeries and retail food processors, retail markets, and mobile venues such as trucks and carts. The core elements of most restaurant inspection programs include assuring practices that maintain stored food free of contamination, food preparation that minimizes potential cross-contamination, storage of prepared foods at required temperatures, and effective sanitation of utensils and dishes used in food preparation and serving. Although core elements of inspections are usually consistent, the specific requirements, frequency of inspection, acceptable practices, and consequences of noncompliance exhibit considerable variation among states and local jurisdictions. There is mixed evidence regarding the effect of either the frequency of inspections or food safety training of managers and food handlers on improving food safety. Riben and colleagues2 found evidence that inspections were beneficial, although it was unclear if three or more inspections per year were better than two. These authors also concluded that training of food handlers results in better inspection scores, suggesting improved establishment sanitation, but this difference is short lived; they found no literature assessing the long-term outcome of such interventions. In a more recent prospective study,3 restaurants for which managers were mandated to attend a training and certification program demonstrated a significant improvement in inspection scores in some areas of food safety, sustained over a two-year follow-up period. Food establishment inspection in Los Angeles County (LAC), excluding the cities of Long Beach, Vernon, and Pasadena, is the responsibility of the Division of Environmental Health Service (EHS) of the Los Angeles Health Department under the California Health and Safety Code. There are approximately 36,000 food establishments covered by this code. Inspection costs are defrayed by fees set by the LAC Board of Supervisors at a level sufficient to cover program costs based on budget projections and audit of prior expenses.

Disparities in Health Indicators for Latinas in California

This study analyzes disparities in selected health indicators for Latinas when compared to non-Latina Whites, and other population groups in the United States, and as available in Mexico. A review and secondary analyses of government and other data were conducted as an extension of previous research. Data revealed that the population of Latinas, although youthful on average, are composed of an increasingly large group of poor women who in their middle years (45-64), and in rural communities, display high cardiac risk, high rates of diabetes, and cervical cancer. This picture calls for special attention, in particular to Latinas without health insurance. Further research, policies that protect women’s health, and culturally competent prevention services are needed to address these health disparities and the complexities of Latina health in California.

Immigration reform and the health of Latino immigrants in California.

This paper examines Latino immigrant health within the context of the current debate over immigration reform and the resulting cultural construction of public health in California. A review of epidemiologic and ethnographic data indicates that the subordinate socioeconomic status of Latino immigrants plays a major role in both disease etiology and access to health services. However, this status does not explain why certain patterns of health services utilization and disease morbidity and mortality persist although political and economic circumstances have changed. These patterns include the reluctance to utilize certain health services despite access to health insurance and the presence of an epidemiologic paradox in which Latinos have health status indicators comparable to or better than that of other ethnic groups despite high poverty, low education, and lack of access to care. An "economy of culture" model is used to explain these inconsistencies in the political economy model of Latino immigrant health.

The California Agricultural Safety and Health Education Training (Cal ASET) Project

ABSTRACT The patterns of agricultural illness and injury in California differ in significant ways from most Midwestern farm states. Since most farm work is performed by hired (i.e., non-family) farmworkers, it is the farmworkers who have the highest incidence of agricultural injury and illness. The majority of these farmworkers are from Mexico, speak only or primarily Spanish, and face cultural/ linguistic barriers in the use of safety information, preventive assistance, and services. The California Agricultural Safety and Health Education Training (Cal ASET) Project was a cooperative effort of three migrant clinics in central California to provide farmworkers with farm safety training as a key step in reducing farmworker on-the-job injuries.

Options for Recovery: Promoting Perinatal Drug and Alcohol Recovery, Child Health, and Family Stability

The perceived magnitude of perinatal chemical dependency in California was the impetus for an interagency partnership within the California Health and Welfare Agency called Options for Recovery (OFR). It offered alcohol and drug treatment and recovery, case management, and recruitment and training of foster parents and relative caregivers to chemically dependent pregnant and parenting women. A 3-year, multi-method evaluation was conducted that included quantitative analyses of secondary data sources, semi-structured interviews with staff and clients, self-administered surveys of staff and clients, client focus groups, and child developmental assessments. Findings indicate that to achieve success, programs structured on the OFR model must recruit chemically dependent women early in their pregnancies, provide mechanisms for retention, offer a continuum of treatment modalities within the service system, make available a comprehensive array of ancillary services, and be responsive to the social, cultural, and familial context within which these women live.

Managed competition and California's health care economy.

There is evidence in California of a broad decline in health care costs to employment groups adopting managed care and managed competition--premium reductions up to 10 percent. National comparisons and utilization data generally confirm the beginning of lower costs. Large California medical groups and health systems have responded to pressure by finding ways to reduce costs and improve quality. While examples are encouraging, there is room for improvement. Two levels of competition have emerged and continue to evolve: carrier competition and delivery system competition. Each model has strengths and limitations, but the existing mix is driving down costs.

Overstory mortality as an indicator of forest health in California

The interagency Forest Health Monitoring Program involves a network of about 4200 forest plots on a triangular grid across the United States. We present data on recent mortality of trees ≥27.9 cm diameter from the first three years of measurements in California (1992-1994). Three plot designs were used to collect data representative of a 1-ha stand at each site; the designs differed primarily in total area sampled (0.067, 0.4 and 1.0 ha). Approximately 50 sites were visited each year yielding a total of about 150. Field tallies showed few cases of recent mortality in the smallest plot size. Cumulative distribution functions of recent dead tree densities in the 0.067-ha plots differed significantly from those generated by tallies from entire 1-ha stands. We conclude that an area of 0.067 ha is unsuitable to assess and monitor overstory mortality in Pacific Coast forests.

Publisher's Letter

From The Publisher Health AffairsVol. 15, No. 1 Publisher's LetterWilliam B. WalshPUBLISHED:Spring 1996Free Accesshttps://doi.org/10.1377/hlthaff.15.1.4AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSEducationGovernment programs and policies California is a state for all seasons. With vast economic, human, and social resources, California has emerged in the waning years of the twentieth century as our most important nation-state. It is almost impossible for a presidential candidate to win election without carrying the Golden State, with its population of thirty-two million and growing. But not all has been golden in recent years. California has suffered through one of its worse economic periods in the past century, in part because the end of the Cold War led Washington to sharply cut defense spending. But other developments have also torn the social fabric of the state: racial strife, a growing population of illegal aliens, and a lessening of political will to provide high-quality public education and health services to all of the citizens of California. In this thematic issue of Health Affairs we shine a spotlight on the rapidly changing nature of California's health insurance system and the status of public health there. We gratefully acknowledge the support that was granted for this volume by the California Center for Health Improvement, a nonprofit health policy and education center headquartered in the state's capital, Sacramento. The center itself was launched with support from The California Wellness Foundation for the purpose of providing a better base of information to those individuals and institutions that are seeking to improve the health and well-being of Californians through public policies and programs. In its short existence the center has conducted opinion surveys, sponsored conferences, held media briefings, provided technical assistance, and developed reports to provide new information about the health of California's citizens and communities. Health Affairs was gratified to have an opportunity to add a substantial amount of new material to this growing information base. We obviously have not been able to cover every issue of concern, but we believe we have illuminated a number of pathbreaking activities that are of great interest to our readers. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 January 1996 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF download

Modifying managed competition to address cost and quality.

California's health care marketplace is undergoing rapid transformation--from one characterized by aggressive but unregulated competition to one that approximates managed competition. The Pacific Business Group on Health purchases health insurance for large employers; the California Public Employees Retirement System acts as a purchasing pool for both state workers and smaller public employers; and The Health Insurance Plan of California is a pool for small employers. Each focuses on price-conscious competition among health maintenance organizations. These large purchasing cooperatives also are addressing biased selection among the health plans they offer. Initially focused on simple demographic adjustments, risk adjustment now also entails adjustment for high-risk cases, such as acquired immunodeficiency syndrome (AIDS) and liver transplants. These purchasers also devote more detailed attention to the quality and process of care.

Themes and Variations among Seven Comprehensive Perinatal Drug and Alcohol Abuse Treatment Models

In recent years, the prevalence of perinatal chemical dependency has become widespread, .crossing all ethnic and racial lines and every socioeconomic group (Chasnoff, Landress, & Barrett, 1990). Its potential effect on the health of women, children, families, and society has prompted support at the state and federal levels for comprehensive perinatal drug and alcohol treatment models (California Legislature, 1990; Doshan & Bursch, 1982; Graham & Timney, 1990; Jessup & Green, 1987; Novick, 1990; Reed, 1987; U.S. General Accounting Office, 1990). In California, legislation was enacted that funded a novel interdepartmental partnership within the California Health and Welfare Agency. The four agencies involved in this collaborative effort, called Options for Recovery (OFR), were the departments of Alcohol and Drug Programs, Developmental Services, Health Services, and Social Services. The OFR program provided comprehensive perinatal services to more than 2,600 individual pregnant or parenting women at seven pilot sites in both urban and rural parts of the state. The primary OFR program services included case management, residential and intensive outpatient treatment, perinatal medical care, and foster care services. These services were provided in a women-focused, women-sensitive manner to an ethnically and culturally diverse client population. The OFR program also emphasized coordinated service linkages both to prevent service duplication and to ensure that potential service gaps were not left unfilled. A state interagency task force, composed of representatives from the four collaborating state agencies responsible for the OFR program, was established to develop a statewide strategy for addressing the substance abuse treatment needs of pregnant and parenting women and their children. At each of the seven pilot sites, a local lead agency, accountable to the state, was given primary responsibility for implementing the OFR program. The management teams of each pilot project, which at a minimum consisted of alcohol and drug treatment program representatives and case management staff, reported to the local lead agency. Line staff who had ongoing responsibility for providing services for clients included drug and alcohol counselors, case managers, child development specialists, child care workers, parent educators, foster parent recruiters and trainers, mental health workers, and any other service provider that was part of the pilot's OFR program. An evaluation of the OFR program was conducted from 1991 to 1993. On the basis of information obtained through interviews, surveys, and focus groups with OFR staff, clients, and foster parents at all seven pilot sites, as well as quantitative data, the author identified a number of similar treatment and service themes and variations across all seven sites. This article describes both the commonalities and the differences observed during the course of the three-year evaluation. METHODS Qualitative Staff Data In-person interviews were conducted with members of the OFR State Interagency Task Force, staff from both the California Department of Alcohol and Drug Programs and alcohol and drug treatment programs at the local pilot project level, staff from each pilot's local lead agency, managerial and program staff at all pilot sites, foster parent recruiters and trainers, and county social services agency administrators. Interview questions focused on descriptive program information, program philosophy, indicators of success, service provision, staffing, interagency coordination, and program implementation. Program personnel at all seven pilot projects were also surveyed via self-administered, semi-structured survey questionnaires. The survey questions addressed the same issues as the interview as well as professional training and time management. Focus groups were conducted at 18 randomly selected provider sites from the pool of 73 treatment providers that participated in the OFR program. …