California Residents Research Articles

An Exploration of the Relationship Between Vaccine Knowledge and Vaccine Willingness

The ongoing COVID-19 pandemic has lasted nearly three years, costing millions of lives worldwide. How-ever, increased availability of COVID-19 vaccines has provided an opportunity to increase survival rates. Willingness to receive a COVID-19 vaccine has seen fluctuations in the United States. Key pivotal shifts have been due to increasing accessibility of COVID-19 vaccines and public knowledge of how COVID-19 vaccines work, largely influenced by both the spread of information and misinformation. This study exam-ined patterns between COVID-19 vaccine knowledge and willingness to receive a COVID-19 vaccine in southern California residents over 18. Responding to an online survey, participants (n = 77) reported demographic information (including vaccine status), rated their willingness to receive the vaccine based on social pressures and perceived safety. Participants also answered questions about their individual and perceived vaccine knowledge. Data were analyzed using Pearson’s r. In support of the hypotheses, participants with higher levels of vaccine knowledge and greater perceived threat of COVID-19 were more willing to receive a vaccine. However, perception of vaccine knowledge was not significantly correlated with vaccine willingness or actual vaccine knowledge. Our findings add further understanding of factors that influence willingness to receive the COVID-19 vaccine. The results can inform researchers, policy makers, and the general public, furthering progress toward sufficiently immunizing the American population against COVID-19.

Relationship of POLST to Hospitalization and ICU Care Among Nursing Home Residents in California

BackgroundPhysician Orders for Life Sustaining Treatment (POLST) document instructions for intensity of care based upon patient care preferences. POLST forms generally reflect patients’ wishes and dictate subsequent medical care, but it is not known how POLST use and content among nursing home residents is associated with inpatient utilization across a large population.ObjectiveEvaluate the relationship between POLST use and content with hospital utilization among nursing home residents in California.DesignRetrospective cohort study using the Minimum Data Set linked to California Section S (POLST documentation), the Medicare Beneficiary Summary File, and Medicare line item claims.PatientsCalifornia nursing home residents with Medicare fee-for-service insurance, 2011–2016.Main MeasuresHospitalization, days in the hospital, and days in the intensive care unit (ICU) after adjustment for resident and nursing home characteristics.Key ResultsThe 1,112,834 residents had a completed and signed (valid) POLST containing orders for CPR with Full treatment 29.6% of resident-time (in person-years) and a DNR order with Selective treatment or Comfort care 27.1% of resident-time. Unsigned POLSTs accounted for 11.3% of resident-time. Residents experienced 14 hospitalizations and a mean of 120 hospital days and 37 ICU days per 100 person-years. Residents with a POLST indicating CPR Full treatment had utilization nearly identical to residents without a POLST. A gradient of decreased utilization was related to lower intensity of care orders. Compared to residents without a POLST, residents with a POLST indicating DNR Comfort care spent 56 fewer days in the hospital and 22 fewer days in the ICU per 100 person-years. Unsigned POLST had a weaker and less consistent relationship with hospital utilization.ConclusionsAmong California NH residents, there is a direct relationship between intensity of care preferences in POLST and hospital utilization. These findings emphasize the importance of a valid POLST capturing informed preferences for nursing home residents.

Quality of life after surgery for lower grade gliomas.

Few large studies have investigated quality of life (QOL) for adults diagnosed with lower grade glioma (LGG). QOL was assessed for 320 adults with LGG (World Health Organization grade 2/3) enrolled in the International Low Grade Glioma Registry by using the Medical Outcomes Study 36-Item Short Form health survey. Data on symptoms were also collected. QOL outcomes were examined by treatment group and also compared to those from a population-based case-control study of meningioma (the Meningioma Consortium), in which 1722 meningioma cases diagnosed among residents of Connecticut, Massachusetts, California, Texas, and North Carolina from May 1, 2006 through March 14, 2013 were enrolled and frequency matched to 1622 controls by age, sex, and geography. The LGG sample average age is 45years at the time of interview and 53.1% male. Almost 55% of patients had received radiation and chemotherapy (primarily temozolomide); 32.4% had received neither treatment. Two-thirds of participants with LGG report difficulty with speaking, memory, or thinking, and over one of three reports personality change or difficulty driving. After controlling for age and other comorbidities, individuals with LGG report levels of physical, emotional, and mental health functioning below those reported in a meningioma as well as a general healthy population. Despite being relatively young, persons with LGG report significantly reduced QOL compared to persons with nonmalignant brain tumors and to a control population, which highlights the need to better acknowledge and manage these symptoms for this group of patients diagnosed in the prime of life.

Parent perceptions of changes in eating behavior during COVID-19 of school-aged children from Supplemental Assistance Program Education (SNAP-Ed) eligible households in California

This cross-sectional study examined the associations between parent-reported, perceptions of changes in school-aged children’s (ages 5–18) school meal participation, household cooking, fast food consumption, dietary intake, and weight during the COVID-19 pandemic. Respondents with low-income and school-aged children (n = 1040) were enrolled using quota sampling to approximate the distribution of low-income households and race/ethnicity among California residents who completed an on-line questionnaire developed by the authors. Adjusted multinomial models examined associations between parent-reported changes in school meal participation and time spent cooking, with parent-reported changes in child diet and body weight during COVID-19 (from before March 2020 to January-March 2021). During the pandemic, decreased school meal participation was associated with decreased child’s fast food intake (OR[95 %CI] = 1.47[1.04–2.07]); conversely, increased school meal participation was associated with increased child’s fast food intake (OR[95 %CI] = 1.71[1.09–2.68]). Decreased cooking at home was associated with decreased fruit and vegetable intake (OR[95 %CI] = 2.71[1.62–4.53]), increased sugar-sweetened beverage intake (OR[95 %CI] = 3.83[2.16–6.81]), and increased fast food intake (OR[95 %CI] = 4.09[2.45–6.84]); while increased cooking at home was associated with increased fruit and vegetable (OR[95 %CI] = 2.26[1.59–3.20]), sugar-sweetened beverage (OR[95 %CI] = 1.88[1.20–2.94]), sweets (OR[95 %CI] = 1.46[1.02–2.10]), and salty snack food intake (OR[95 %CI] = 1.87[1.29–2.71]). These parent-reported perceived changes in meal sources during the pandemic for children from low-income California households, and the mixed results in their associations with changes in parent-reported child dietary intake, suggest the need for strengthening policies and programs to support both access to, and healthfulness of, meals from school and home during prolonged school closures.

Association between maternity care practitioner type and postpartum depression screening.

Postpartum depression (PPD) is increasingly common in the United States and poses a significant threat to maternal and neonatal health. Universal screening for postpartum depression is recommended by numerous organizations, including the American College of Obstetricians and Gynecologists, but is not achieved in practice. A cross-sectional, weighted, state-representative study of California residents who gave birth in 2016 using the Listening to Mothers in California 2018 data set. Primary exposure was type of maternity care professional providing care during pregnancy, and the primary outcome was PPD screening. The secondary exposure was self-reported depression or anxiety during pregnancy, and the secondary outcome was attending a postpartum office visit. Bivariate analyses were conducted using Rao-Scott chi-square tests, and multivariate analyses were conducted using logistic regression. Compared to participants cared for by obstetricians, participants cared for by midwives had 2.6 times the odds of reporting being screened for PPD after controlling for covariates (95% CI = 1.5, 4.4). Receiving care from any other practitioner type compared with an obstetrician was not associated with a different rate of postpartum depression screening. Reporting depression or anxiety during pregnancy was associated with 0.7 times the odds (95% CI = 0.5, 1.0) of returning for postpartum care after controlling for covariates. Being cared for by a midwife during pregnancy increases the likelihood of being screened for postpartum depression. In addition, even perfectly implemented universal screening will miss a vulnerable sector of the population that is at high risk for postpartum depression and is less likely to return for postpartum care.

Water is dying everywhere

SummaryThis flash piece asks what development means for rivers, indigenous farmers, and tourists when we redirect, move, and siphon water from one region to another. The work considers rivers as traces of time, peoples, and environments, following my chronology and physical residence(s) in California, Hunan, Guangxi, and Yunnan in China. I begin in the Bay Area, where I grew up, and move to my time spent on five rivers in Southern China: the Xiangjiang, the Li, the Jinsha, the Lancang, and the Nujiang.

How intergroup counter-empathy drives media consumption and engagement

PurposeSocial media is replete with malicious and unempathetic rhetoric yet few studies explain why these emotions are publicly dispersed. The purpose of the study is to investigate how the intergroup counter-empathic response called schadenfreude originates and how it prompts media consumption and engagement.Design/methodology/approachThe study consists of two field surveys of 635 in-group members of two professional sports teams and 300 residents of California and Texas with political party affiliations. The analysis uses SEM quantitative methods.FindingsDomain passion and group identification together determine the harmonious/obsessive tendencies of passion for an activity and explain the schadenfreude response toward the rival out-group. Group identification is a stronger driver of obsessive passion compared to harmonious passion. Schadenfreude directly influences the use of traditional media (TV, radio, domain websites), it triggers social media engagement (posting), and it accelerates harmonious passion's effects on social media posting.Research limitations/implicationsThe study is limited by the groups used to evaluate the research model, sports, and politics.Social implicationsThe more highly identified and passionate group members experience greater counter-empathy toward a rival. At extreme levels of group identification, obsessive passion increases at an increasing rate and may characterize extremism. Harboring feelings of schadenfreude toward the out-group prompts those with harmonious passion for an activity to more frequently engage on social media in unempathetic ways.Originality/valueThis study links the unempathetic, yet common emotion of schadenfreude with passion, intergroup dynamics, and media behavior.

Lessons in VCR Repair: Compliance of Android App Developers with the California Consumer Privacy Act (CCPA)

The California Consumer Privacy Act (CCPA) provides California residents with a range of enhanced privacy protections and rights. Our research investigated the extent to which Android app developers comply with the provisions of the CCPA that require them to provide consumers with accurate privacy notices and respond to "verifiable consumer requests" (VCRs) by disclosing personal information that they have collected, used, or shared about consumers for a business or commercial purpose. We compared the actual network traffic of 109 apps that we believe must comply with the CCPA to the data that apps state they collect in their privacy policies and the data contained in responses to "right to know" requests that we submitted to the app's developers. Of the 69 app developers who substantively replied to our requests, all but one provided specific pieces of personal data (as opposed to only categorical information). However, a significant percentage of apps collected information that was not disclosed, including identifiers (55 apps, 80%), geolocation data (21 apps, 30%), and sensory data (18 apps, 26%) among other categories. We discuss improvements to the CCPA that could help app developers comply with "right to know" requests and other related regulations.

Drinking and driving among Whites and Hispanics on and off the US/Mexico border in California

Objective To examine self-reported rates of driving under the influence (DUI) with and without arrest among border and non-border residents in California. Methods Data were obtained from 1,209 adults 18 to 39 years of age resident in four counties in California: Imperial on the U.S./Mexico border; and Kern, Tulare, and Madera in California’s Central Valley. Households were selected using a list assisted sample. Data were collected on the phone or online and analyzed with a heteroskedastic ordinal generalized linear model. Results Driving after drinking (11.1% vs. 6.5%; q = 0.04) and the lifetime DUI arrest rates were higher for men than women (10.7% vs. 4%; q = 0.001). In multivariable analysis driving after drinking and DUI arrests were not higher on the border, not higher among Hispanics than Whites, and among Hispanics, the rates were not higher among those located on the border. Income was positively associated with drinking and driving. Impulsivity was positively and significantly associated with both drinking and driving and lifetime DUI arrest. Conclusion The null results suggest that DUI related risk behaviors may not be higher on the border than in other areas of California. There may be health related risk behaviors of higher prevalence in the border population than in other areas, but DUI related behavior may not be one of them.

Particulate matter, traffic-related air pollutants, and circulating C-reactive protein levels: The Multiethnic Cohort Study

Inhaled particles and gases can harm health by promoting chronic inflammation in the body. Few studies have investigated the relationship between outdoor air pollution and inflammation by race and ethnicity, socioeconomic status, and lifestyle risk factors. We examined associations of particulate matter (PM) and other markers of traffic-related air pollution with circulating levels of C-reactive protein (CRP), a biomarker of systemic inflammation. CRP was measured from blood samples obtained in 1994–2016 from 7,860 California residents participating in the Multiethnic Cohort (MEC) Study. Exposure to PM (aerodynamic diameter ≤2.5 μm [PM2.5], ≤10 μm [PM10], and between 2.5 and 10 μm [PM10-2.5]), nitrogen oxides (NOx, including nitrogen dioxide [NO2]), carbon monoxide (CO), ground-level ozone (O3), and benzene averaged over one or twelve months before blood draw were estimated based on participants’ addresses. Percent change in geometric mean CRP levels and 95% confidence intervals (CI) per standard concentration increase of each pollutant were estimated using multivariable generalized linear regression. Among 4,305 females (55%) and 3,555 males (45%) (mean age 68.1 [SD 7.5] years at blood draw), CRP levels increased with 12-month exposure to PM10 (11.0%, 95% CI: 4.2%, 18.2% per 10 μg/m3), PM10-2.5 (12.4%, 95% CI: 1.4%, 24.5% per 10 μg/m3), NOx (10.4%, 95% CI: 2.2%, 19.2% per 50 ppb), and benzene (2.9%, 95% CI: 1.1%, 4.6% per 1 ppb). In subgroup analyses, these associations were observed in Latino participants, those who lived in low socioeconomic neighborhoods, overweight or obese participants, and never or former smokers. No consistent patterns were found for 1-month pollutant exposures. This investigation identified associations of primarily traffic-related air pollutants, including PM, NOx, and benzene, with CRP in a multiethnic population. The diversity of the MEC across demographic, socioeconomic, and lifestyle factors allowed us to explore the generalizability of the effects of air pollution on inflammation across subgroups.

Modular construction's capacity to reduce embodied carbon emissions in California's housing sector

Demand for new housing construction must be balanced with minimizing embodied greenhouse gas (GHG) emissions from building materials, logistical operations, and construction activities. This study examines the potential embodied GHG benefits that an innovative housing production method, factory-built modular construction, might have in meeting the multifamily housing needs, with California as a case study. A model is developed to quantify the embodied GHG emissions from materials, transportation, and construction for representative modular housing projects, contrasting results to scenarios where housing is constructed with conventional methods. Results are scaled from single building prototypes to meeting housing demand for lower income residents in California, representing 1.1 million housing units in all 58 of the state's counties. Statewide, compared to all housing units being stick-built, most modular types achieve emission reductions of 2–22%, with potential benefits depending upon structural framing material and factory location. A parametric sensitivity analysis reveals additional key modeling variables: module size and capacity of the module delivery vehicle. A Monte Carlo analysis is conducted for each county, comparing a random allocation of modular types from all factory locations to conventionally constructed housing. Counties farthest away from module factories experience GHG emission gains, while all other counties experience emission benefits of 1–14% (removing one of the modular types increases benefits to 4–20% for all counties). While the results are California-specific, the modeling framework is applicable to any location and relevant for regions assessing the embodied carbon impacts of rapid housing construction methods.

Association Between Myopia and Primary Open-Angle Glaucoma by Race and Ethnicity in Older Adults in the California Medicare Population

Racial and ethnic differences in the association between myopia and primary open-angle glaucoma (POAG) are not well understood. To investigate the association between myopia and POAG in the 2019 California Medicare population and to investigate whether there was evidence of effect measure modification of this association by race and ethnicity. This cross-sectional study used administrative claims data from 2019 California Medicare beneficiaries 65 years or older with California residence and active coverage with Medicare parts A and B. Analysis took place between October 2021 and October 2023. The primary exposure was myopia, which was defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. The outcome of interest was POAG, which was defined by ICD-10-CM code. Of 2 717 346 California Medicare beneficiaries in 2019, 1 440 769 (53.0%) were aged 65 to 74 years, 1 544 479 (56.8%) identified as female, 60 211 (2.2%) had myopia, and 171 988 (6.3%) had POAG. Overall, 346 723 individuals (12.8%) identified as Asian, 117 856 (4.3%) as Black, 430 597 (15.8%) as Hispanic, 1 705 807 (62.8%) as White, and 115 363 (4.2%) as other race and ethnicity. In adjusted logistic regression analyses, beneficiaries with myopia had higher odds of POAG compared with beneficiaries without myopia (odds ratio [OR], 2.41; 95% CI, 2.35-2.47). In multivariable models stratified by race and ethnicity, the association between myopia and POAG was stronger in Asian (OR, 2.74; 95% CI, 2.57-2.92), Black (OR, 2.60; 95% CI, 2.31-2.94), and Hispanic (OR, 3.28; 95% CI, 3.08-3.48) beneficiaries compared with non-Hispanic White beneficiaries (OR, 2.14; 95% CI, 2.08-2.21). In the 2019 California Medicare population, myopia was associated with greater adjusted odds of POAG. This association was stronger among Asian, Black, and Hispanic beneficiaries compared with non-Hispanic White beneficiaries. These findings suggest possible disparities in glaucoma risk by race and ethnicity in individuals with myopia and may indicate greater need for glaucoma screening in individuals with myopia from racial and ethnic minority backgrounds.

Real-world uptake of COVID-19 vaccination among individuals expressing vaccine hesitancy: A registry-linkage study.

Uptake of COVID-19 vaccination remains suboptimal in the United States and other settings. Though early reports indicated that a strong majority of people were interested in receiving the COVID-19 vaccine, the association between vaccine intention and uptake is not yet fully understood. Ourobjective was todescribe predictors of vaccine uptake, and estimate the sensitivity, specificity, and predictive values of self-reported COVID-19 vaccine status compared to a comprehensive statewide COVID-19 vaccine registry. A cohort of California residents that received a molecular test for SARS-CoV-2 infection during 24 February-5 December 2021 were enrolled in a telephone-administered survey. Survey participants were matched with records in a statewide immunization registry. Cox proportional hazards model were used to compare time to vaccination among those unvaccinated at survey enrollment by self-reported COVID-19 vaccination intention. Among 864 participants who were unvaccinated at the time of interview, 272 (31%) had documentation of receipt of COVID-19 vaccination at a later date; including 194/423 (45.9%) who had initially reported being willing to receive vaccination, 41/185 (22.2%) who reported being unsure about vaccination, and 37/278 (13.3%) who reported unwillingness to receive vaccination.Adjusted hazard ratios (aHRs) for registry-confirmed COVID-19 vaccination were 0.49 (95% confidence interval: 0.32-0.76) and 0.21 (0.12-0.36) for participants expressing uncertainty and unwillingness to receive vaccination, respectively, as compared with participants who reported being willing to receive vaccination. Time to vaccination was shorter among participants from higher-income households (aHR=3.30 [2.02-5.39]) and who reported co-morbidities or immunocompromising conditions (aHR=1.54 [1.01-2.36]).Sensitivity of self-reported COVID-19 vaccination status was 82% (80-85%) overall, and 98% (97-99%) among those referencing vaccination records; specificity was 87% (86-89%). Willingness to receive COVID-19 vaccination was an imperfect predictor of real-world vaccine uptake. Improved messaging about COVID-19 vaccination regardless of previous SARS-CoV-2 infection status may help improve uptake.

Waning of 2-Dose BNT162b2 and mRNA-1273 Vaccine Effectiveness Against Symptomatic SARS-CoV-2 Infection Accounting for Depletion-of-Susceptibles Bias.

Concerns about the duration of protection conferred by coronavirus disease 2019 (COVID-19) vaccines have arisen in postlicensure evaluations. "Depletion of susceptibles," a bias driven by differential accrual of infection among vaccinated and unvaccinated individuals, may obscure vaccine effectiveness (VE) estimates, hindering interpretation. We enrolled California residents who received molecular SARS-CoV-2 tests in a matched, test-negative design, case-control study to estimate VE of mRNA-based COVID-19 vaccines between February 23 and December 5, 2021. We analyzed waning protection following 2 vaccine doses using conditional logistic regression models. Additionally, we used data from a population-based serological study to adjust for "depletion-of-susceptibles" bias and estimated VE for 3 doses, by time since second dose receipt. Pooled VE of BNT162b2 and mRNA-1273 against symptomatic SARS-CoV-2 infection was 91.3% (95% confidence interval (CI): 83.8, 95.4) at 14 days after second-dose receipt and declined to 50.8% (95% CI: 19.7, 69.8) at 7 months. Adjusting for depletion-of-susceptibles bias, we estimated VE of 53.2% (95% CI: 23.6, 71.2) at 7 months after primary mRNA vaccination series. A booster dose of BN162b2 or mRNA-1273 increased VE to 95.0% (95% CI: 82.8, 98.6). These findings confirm that observed waning of protection is not attributable to epidemiologic bias and support ongoing efforts to administer additional vaccine doses to mitigate burden of COVID-19.

Abstract B057: Identifying gaps in awareness of precision medicine terms between Hispanic/Latinxs and Non-Hispanic Whites in Southern California

Abstract Background/Purpose Cancer health disparities persist between Hispanic/Latinxs (H/Ls) and non-Hispanic whites (NHWs) in the US. Structural and societal inequities including in education and access to knowledge, exacerbate disparities. We investigated differences between H/Ls and NHWs in awareness of precision medicine terms that may create a decisional disadvantage in cancer prevention, diagnostics, and treatment for H/Ls. Methods A random sample of 4,000 San Diego County, California residents and 1,000 residents with ZIP codes along the US-MX border received study mailers with Spanish/English invitations and survey booklets, and a $2-bill pre-incentive. Reminder letters were sent 8 weeks later. Respondents were asked to self-identify race and ethnicity and to indicate on a 5-point Likert scale (“not at all” to “extremely”) how familiar they were with a series of 13 medical terms [i.e., 2 precision medicine, 10 genetics, and 1 social determinants of health; Williams et al. 2018]. A total of 720 completed surveys were received (14.4% response rate), including 446 from NHWs and 154 from H/Ls. Pearson Chi-Square tests assessed associations between ethnicity and being “moderately” or “extremely” familiar with the terms. Results Of the 600 H/L and NHW residents completing surveys, 33.8% were men, 64.8% were women, 0.2% were transgender, and 1.2% did not identify. NHWs reported significantly greater familiarity than H/Ls for 10 of 13 terms. Genomics had the greatest difference with 52.3% of NHWs reporting moderate/extreme familiarity compared to 23.8% of H/Ls (p<0.01). Despite overall familiarity with more common terms, significant differences between H/Ls and NHWs were observed; although >50% of both groups reported familiarity with the terms genetic testing, gene, hereditary, DNA, and chromosome, NHWs reported greater familiarity than H/Ls by >10 percentage points (p<0.01). Greater familiarity between NHWs and H/Ls were also reported for lesser-known terms such as biological indicators (56.0% vs. 36.9%), biomarkers (45.8% vs. 26.7%), social determinants of health (29.2% vs. 15.5%), and biobank (21.3% vs. 13.6%). There were no significant differences in familiarity with the precision medicine terms or pharmacogenomics. Discussion Cancer health disparities are the result of complex, interwoven structural and societal inequities. Familiarity with medical terminology is a quantifiable example of access to knowledge. In contrast to recent literature, we report significant differences between H/Ls and NHWs using this precision medicine familiarity tool. H/L communities, and particularly H/L patients, may need additional health literacy support to fully participate in decision-making for cancer prevention and care including participation in clinical trials and tissue biorepositories. Cancer centers have an opportunity to support outreach and education efforts to bridge these gaps in the community and among the patient population through bilingual and bicultural clinical teams, translated plain-language consents, and patient navigation. Citation Format: Corinne McDaniels-Davidson, Jesse N. Nodora, Humberto Parada Jr., Sandip P. Patel, M. Elena Martinez. Identifying gaps in awareness of precision medicine terms between Hispanic/Latinxs and Non-Hispanic Whites in Southern California [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B057.

COVID-19, Climate, and Christianity in Rural Northern California: Divergent Frames for Masking

Abstract The American political and emotional response to COVID-19 during the first pandemic summer of 2020 revealed a great deal about who we are as a nation: one that is divided and diverse, as well as geographically, racially, and politically complex. Political representation of governors was a powerful indicator of the public health policies during that first year, such as mask mandates. Mask politics have been heralded as a great indicator of political division. However, unlike most of the nation that confronted masking recommendations for the first time, many residents in rural Northern California had for several years masked routinely for wildfires. We conducted a small ethnographic study of people’s perceptions and experiences around masking amidst wildfires in Redding, CA—a red district in a blue state—where many residents disagreed with the Governor’s public health policies. We conducted this research in comparison, or contrast, to concurrent research on masking perceptions and experiences among rural residents of a red district in a red state (Iowa), where many residents agreed with the Governor’s inaction around COVID-19 prevention. We found four dominant frames in the rural Iowa district (see Koon et al. 2021) that were both similar and different from those in California. The four frames were: concern, crisis, constraint, and conspiracy. The concern frame described careful masking to prevent COVID-19 transmission for the self and others; most worked in health care and related masking for COVID-19 with masking for wildfires. The crisis frame is often linked with the risk of COVID-19 with convergent political crises of inequality and climate. The constraint frame primarily highlighted how business owners felt forgotten by the government and overrun by national corporations. The conspiracy frame illuminated how older and more conservative residents perceived themselves as dislocated from state leadership. This research in Redding illustrates how perceptions of risk and norms around masking were not only influenced by politics but also social context and previous exposure to masking. This research emphasizes the need to push against oversimplified narratives of the American response because the nation exhibits cultural, social, environmental, and political differences that are not clearly divided within regions, states, districts, or communities and differ from place to place.

The role of firearm and alcohol availability in firearm suicide: A population-based weighted case-control study.

Firearm availability has been linked to firearm self-harm, but the joint relationship with alcohol availability, while supported by theory, has not been examined. This study sought to quantify the separate and joint relations of community firearm and alcohol availability with individual-level risk of (fatal and nonfatal) firearm self-harm. We conducted a case-control study of California residents, 2005-2015, using statewide mortality, hospital, firearm transfer, and alcohol license data. We estimated monthly marginal risk differences per 100,000 in the overall population and in white men aged 50+ under various hypothetical changes to firearm and alcohol availability and assessed additive interactions using case-control-weighted g-computation. In the overall population, non-pawn shop firearm dealer density was associated with firearm self-harm (RD: 0.02, 95% CI: 0.003, 0.04) but pawn shop firearm dealer and alcohol outlet densities were not. Secondary analyses revealed a relationship between firearm sales density and firearm self-harm (RD: 0.07, 95% CI: 0.04, 0.10). There were no additive interactions between measures of firearm and alcohol availability. Among older white men, generally the same exposures were related to self-harm as in the overall population, but point estimates were substantially larger. Findings suggest community-level approaches to reducing firearm sales may help mitigate suicide risk.

Assessing Perception of Wildfires and Related Impacts among Adult Residents of Southern California

Major wildfires and their smoke pose a threat to public health and are becoming more frequent in the United States, particularly in California and other populated, fire-prone states. Therefore, it is crucial to understand how California residents view wildfires and engage in risk-reducing behaviors during wildfire events. Currently, there is a knowledge gap concerning this area of inquiry. We disseminated a 40-question cross-sectional survey to explore wildfire perception and knowledge along with related risk-reducing measures and policies among 807 adult residents in the fire-prone region of Orange County, California. Results demonstrated that nearly all (>95%) participants had (or knew someone who had) previously experienced a wildfire. Female gender, knowing a wildfire victim and reporting to have a general interest/passion for environmental issues were the three factors most strongly associated with (1) wildfires (and smoke) being reported as a threat, (2) participants' willingness to evacuate if threatened by a nearby wildfire, and (3) participants' willingness to support a wildfire-related tax increase (p < 0.05). The majority (57.4%) of participants agreed that the occurrence of wildfires is influenced by climate change, with the most commonly reported risk-reducing actions (by 44% of participants) being informational actions (e.g., tracking the news) rather than self-motivated physical safety actions (e.g., using an air purifier) (29%). The results of this study can help to inform decision- and policy-making regarding future wildfire events as well as allow more targeted and effective public health messaging and intervention measures, in turn helping to reduce the risk associated with future wildfire/smoke episodes.

CARING FOR INDIVIDUALS WITH DEMENTIA AND COGNITIVE IMPAIRMENT IN LOS ANGELES: A CAREGIVER PROFILE

Abstract In 2020, the Los Angeles County Department of Public Health launched Healthy Brain LA (HBLA). HBLA is a multi-pronged project designed to promote cognitive health, reduce the risk of dementia, and help develop a dementia-focused strategic plan for Los Angeles County (LAC) that prioritizes the needs of those impacted by dementia and cognitive impairment and their caregivers. To support this effort, the HBLA team analyzed weighted data from the 2019 and 2020 California Health Interview Survey (CHIS) to better understand the profile of adult caregivers of individuals with dementia and cognitive impairment. CHIS is a publicly available, population-based, web and telephone survey that asks California residents about a wide range of health topics, yielding representative data on all 58 counties in the state. In 2019-2020, an estimated 1.6 million adults provided care to individuals aged 18 years or older in LAC. About 322,880 of those caregivers provided care for individuals with dementia and cognitive impairment, representing 2% of LAC’s adult population. Many of these caregivers were female (59%), Latino/Hispanic (44%), and between 50-64 years of age (32%). Most of them experienced challenges, such as financial stress (61%), physical/mental health problems (18%), or a change in job status (27%), due to caregiving. These data provide the first local estimate of dementia and cognitive impairment caregiving in nearly 15 years. Results offer critical information about this population that will be used by the HBLA team and its partners to guide efforts to effectively meet the needs of caregivers in LAC.

Assessing Californians’ awareness of their daily electricity use patterns

The timing of electricity consumption is increasingly important for grid operations. In response, households are being encouraged to alter their daily usage patterns through demand response and time-varying pricing, although it is unknown if they are aware of these patterns. Here we introduce an energy literacy concept, 'load shape awareness', and apply it to a sample of California residents (n = 186) who provided their household’s hourly electricity data and completed an energy use questionnaire. Choosing from four prominent load shape designations, half of respondents (51%) correctly identified their dominant load shape before COVID-19 shelter-in-place (SIP) orders while only one-third (31%) did so during SIP orders. Those aware of their load shape were more likely to have chosen evening peak, the most frequent dominant shape in the electricity data. Our work provides proof of principle for the load shape awareness concept, which could prove useful in designing energy conservation interventions and helping consumers adapt to an evolving energy system.