California Public Research Articles

Disparities in Food Insecurity and Academic Achievement Among California Public University Students: An Intersectional Approach.

Background/Objectives: Historically racialized status (HRS) and low socioeconomic position (SEP) are independent risk factors for food insecurity and poor academic achievement among college students. Despite increased enrollment of students from historically racialized groups and low SEP, little is known regarding the intersectional experience of these contemporary student characteristics with food security status or academic achievement. The purpose of this study was to examine the intersections of racialized status and SEP with food insecurity and academic achievement among undergraduate students attending a public university system in California. Methods: This cross-sectional study included 1170 undergraduates who utilized their campus food pantry between June and August 2019 at nine University of California campuses. Racialized status and SEP were used to construct four distinct intersectional positions: (1) White, not low SEP (i.e., traditional students; reference), and three contemporary student groups: (2) White, low SEP; (3) HRS, not low SEP; and (4) HRS, low SEP. Using regression analyses, these intersectional positions were examined with food insecurity and grade point average (GPA), while controlling for other student characteristics. Results: HRS, low SEP students had significantly higher odds of experiencing food insecurity (OR = 2.72; 95% CI: 1.52-4.97) and lower GPA (B = -0.14, p = 0.05) than traditional students, after adjustment. Conclusions: Contemporary students are at increased risk of food insecurity and lower academic achievement compared to traditional students.

Nourishing Farm to School Practice With Data to Inform Program Needs: An Evaluation of Participation Among California Public Districts During the 2018-2019 School Year

BackgroundThe US Department of Agriculture promotes farm to school (F2S) as an evidence-based approach to help school meals meet updated nutrition standards that promote health. California is a key agricultural state with strong support for F2S to promote local agriculture and equitable access to nutritious food for all students. ObjectiveExamine district characteristics associated with F2S participation among California public districts during the 2018-2019 school year. DesignCross-sectional evaluation of 2019 US Department of Agriculture Farm to School Census data. Participants/settingCalifornia public districts responding to the 2019 US Department of Agriculture F2S Census (N = 572). Main outcome measureReported participation in F2S activities in 2018-2019. Covariates included district size, annual per-pupil spending, urbanicity, racial/ethnic composition, and percent free and reduced-price meal (% FRPM) eligibility. Statistical analysisDescriptive statistics (unweighted frequency and weighted percent) were reported for demographic characteristics. Weighted, multiple logistic regression assessed associations between demographic characteristics and F2S participation, reported as odds ratios (95% CI). ResultsNearly 78% of California respondents reported F2S participation. Top activities were serving local food in school lunch (73%) and breakfast (65%) and local food promotion at school (45.5%). The odds of participation among districts with enrollments ≥1000 were 1.79 (95% CI 1.15 to 2.79) times higher than smaller districts and 1.57 (95% CI 1.08 to 2.28) times higher in districts with lower annual per-pupil spending (≤$13 707). No significant differences were found by racial/ethnic composition, % FRPM eligibility, or urbanicity. ConclusionsDisparities in F2S participation exist for small districts and those with high annual per-pupil spending that may lack the advantages of economies of scale. Grant incentives and support networks for these groups are recommended along with increased monitoring focused on the quality of F2S engagement. Administration of a brief annual state F2S Census could support more timely monitoring and accountability to align with state goals and improve opportunities for data sharing and community engagement.

California Gas: A Brief History and Recent Events

The author discusses recent developments and ongoing issues related to regulatory authorities, contracts and pipeline matters affecting the gas industry in California, in comparison to elsewhere in the United States and Canada. Included is a review of some of the more important decisions of the Federal Energy Regulatory Commission, the California Public Utilities Commission and the National Energy Board. This paper is solely the work of the author. The views expressed herein do not necessarily represent the views of the author's firm or any client of that firm.

"They Don't See Us": Asian Students' Perceptions of Sexual Violence and Sexual Harassment on Three California Public University Campuses.

Sexual violence and sexual harassment (SVSH) are prevalent among college and university students; however, the experiences of ethnic minority students, especially Asians, are understudied. This study aimed to reduce this gap by exploring Asian students' perceptions of SVSH on three public university campuses in Southern California. We examined their perceptions about the campus environment related to SVSH, attitudes, and behaviors toward help seeking, and utilization of on-campus resources. A total of 23 in-depth interviews were conducted with Asian students enrolled at the three University of California campuses. Thematic coding was conducted to generate main themes and subthemes. Five main themes emerged: (a) SVSH is considered a "taboo" topic in Asian culture and family systems, and Asian student survivors are often reluctant to disclose incidents or seek support services. (b) Students did not feel their campus environments were tailored to understand or meet the sociocultural realities and needs of Asian student survivors. (c) Campus SVSH services and reporting processes were seen as non-transparent. (d) Peers were the major source of support and SVSH information, as opposed to official campus-based resources and training. (e) Survivors often conduct an internal cost-benefit analysis evaluating their decision about whether to report. This study highlights the lack of conversation surrounding SVSH in Asian families, and how the cultural stigma of sex and sexual violence prevented Asian students from receiving knowledge and resources about these topics in their families. Instead of relying on formal campus resources (e.g., Title IX and confidential advocacy services, mental health services), many students turn to their peers for support. Thus, facilitating peer support groups, training university students to support each other through SVSH incidents, and tailoring campus services to the diverse cultural backgrounds of students are key considerations to foster a safe campus environment and prevent SVSH.

JUE Insight: White flight from Asian immigration: Evidence from California Public Schools

Asian Americans are the fastest-growing racial group in the US but we know little about how Asian immigration has affected cities, neighborhoods and schools. This paper studies white flight from Asian arrivals in high-socioeconomic-status suburban Californian school districts from 2000–2016 using initial settlement patterns and national immigrant flows to instrument for entry. We find that, as Asian students arrive, white student enrollment declines in these higher-income suburbs. These patterns cannot be fully explained by racial animus, housing prices, or correlations with Black/Hispanic arrivals. Parental fears of academic competition may play a role.

Association of Participation in a Value-Based Insurance Design Program With Health Care Spending and Utilization

Value-based insurance design (VBID) has mostly been used in improving medication use and adherence for certain conditions or patients, but its outcomes remain uncertain when applied to other services and to all health plan enrollees. To determine the association of participation in a California Public Employees' Retirement System (CalPERS) VBID program with its enrollees' health care spending and utilization. A retrospective cohort study with difference-in-differences propensity-weighted 2-part regression models was performed in 2021 to 2022. A VBID cohort was compared with a non-VBID cohort both before and after VBID implementation in California in 2019 with 2 years' follow-up. The study sample included CalPERS preferred provider organization continuous enrollees from 2017 through 2020. Data were analyzed from September 2021 to August 2022. The key VBID interventions include (1) if selecting and using a primary care physician (PCP) for routine care, PCP office visit copayment is $10 (otherwise, PCP office visit copayment is $35 as for specialist visit); and (2) annual deductibles reduced by a half through completion of the following 5 activities: annual biometric screening, influenza vaccine, nonsmoking certification, second opinion for elective surgical procedures, and disease management participation. The primary outcome measures included annual per member total approved payments for multiple inpatient and outpatient services. The 2 compared cohorts of 94 127 participants (48 770 were female [52%]; 47 390 were younger than 45 years old [50%]) had insignificant baseline differences after propensity-weighting adjustment. The VBID cohort had significantly lower probabilities of inpatient admissions (adjusted relative odds ratio [OR], 0.82; 95% CI, 0.71-0.95), and higher probabilities of receiving immunizations (adjusted relative OR, 1.07; 95% CI, 1.01-1.21) in 2019. Among those with positive payments, VBID was associated with higher mean total allowed amounts for PCP visits in 2019 and 2020 (adjusted relative payments ratio, 1.05; 95% CI, 1.02-1.08). There were no significant differences for inpatient and outpatient combined totals in 2019 and 2020. The CalPERS VBID program achieved desired goals for some interventions with no added total costs in its first 2 years of operation. VBID may be used to promote valued services while containing costs for all enrollees.

Disseminated Gonococcal Infections-Lessons Learned From an Ongoing California Public Health Investigation.

Disseminated Gonococcal Infections-Lessons Learned From an Ongoing California Public Health Investigation.

Construction of the Armenian Surname List (ASL) for public health research

BackgroundThere are an estimated 460,000 Armenians in the United States, and more than half live in California. Armenian-Americans are generally represented within the ‘White’ or ‘Some Other Race’ race categories in population-based research studies. While Armenians have been included in studies focused on Middle-Eastern populations, there are no studies focused exclusively on Armenians due to a lack of standardized collection of Armenian ethnicity in the United States or an Armenian surname list. To fill this research gap, we sought to construct and evaluate an Armenian Surname List (ASL) for use as an identification tool in public health and epidemiological research studies focused on Armenian populations.MethodsData sources for the ASL included the California Public Use Death Files (CPUDF) and the Middle Eastern Surname List (MESL). For evaluation of the ASL, the California Cancer Registry (CCR) database was queried for surnames with birthplace in Armenia and identified by the MESL.ResultsThere are a total of 3,428 surnames in the ASL. Nearly half (1,678) of surnames in the ASL were not identified by the MESL. The ASL captured 310 additional Armenian surnames in the CCR than the MESL.ConclusionsThe ASL is the first surname list for identifying Armenians in major databases for epidemiological research.

Employer risk‐adjustment transitions with inertial consumers: Evidence from CalPERS

AbstractRisk‐adjustment policies, which transfer money from insurers with healthy consumers to those with sick consumers, are an important tool to contend with adverse selection in health insurance markets. While the steady‐state properties of risk‐adjustment have been studied extensively, there is less evidence on the transition phase of policy implementation. We study the introduction and removal of risk‐adjustment at California Public Employees' Retirement System and show that these changes meaningfully impact premiums via plan differences in enrollee health status. Despite these premium differences, there is limited consumer resorting due to consumer inertia, though new active enrollees respond more fluidly. We show that, with inertial consumers, risk‐adjustment changes have substantial distributional consequences, leading to worse outcomes for sicker consumers when removed and vice‐versa when implemented. We estimate a model of plan choice with premium sensitivity, brand preferences, and inertia and use these estimates to study the interaction between risk‐adjustment policies and the strength of inertia.

White Flight from Asian Immigration: Evidence from California Public Schools

White Flight from Asian Immigration: Evidence from California Public Schools

Institutional investors and shareholder engagement: The Fonds Desjardins

Following in the footsteps of the celebrated California Public Employees’ Retirement System (CalPERS), more and more institutional investors are developing policies governing their proxy voting rights at annual general meetings to clearly express shareholders’ interest in environmental, social, and corporate governance issues. They are also increasingly numerous in promoting responsible investment practices through these policies. The object of this study is to examine the extent to which votes cast by the Fonds Desjardins, a major Canadian institutional investor, at the annual general meetings of firms in which it invests comply with its proxy voting rights policy and its public commitment to the social responsibility of these firms. The analyses were based on the votes recorded on the Fonds Desjardins website from July 1, 2018, to June 30, 2019. Of the 168 votes analysed, 35 did not comply with the Fonds’ policy, reflecting a non-compliance rate of 20.8%. The analyses show that votes on environmental issues are the most diverged from the institution’s policy during the period under study. Overall, the results indicate that the votes cast by the Fonds Desjardins at annual general meetings do not always correspond to the Fonds’ proxy voting rights policy. These findings raise questions about the real motivation behind such policies. Are they a genuine or a symbolic tool?

Differences in Telehealth During COVID-19 Between Commercial and Medicaid Enrollees

To compare how in-person evaluation and management (E&M) visits and telehealth use differed during the COVID-19 pandemic between commercially insured and Medicaid enrollees, and to assess how insurance plan type-fee-for-service (FFS) vs managed care (MC)-and enrollee characteristics contributed to these differences. Retrospective cohort analysis of 2019 and 2020 data from the commercially insured California Public Employees' Retirement System (CalPERS) and the California Medicaid program (Medi-Cal). We conducted unadjusted comparisons of per capita E&M visits and the share of visits conducted via telehealth by payer (CalPERS vs Medi-Cal) and plan type (FFS vs MC). We estimated linear regressions of telehealth use that adjusted for patient demographics, rurality, and internet access. Among Medi-Cal enrollees, we examined telehealth use differences based on race, language, and citizenship status. Regression-adjusted share of telehealth visits as a proportion of all E&M visits was 22.6% for CalPERS FFS patients (the reference group), 38.2% for Medi-Cal FFS patients, 46.0% for Medi-Cal MC patients, and 53.5% for CalPERS MC patients. Among Medi-Cal enrollees, telehealth use as a share of all E&M visits was higher among Spanish speakers, female enrollees, and rural enrollees. Across most demographic characteristics, Medi-Cal patients enrolled in FFS were less likely to receive telehealth compared with those enrolled in MC. During the first year of the COVID-19 pandemic, California MC enrollees had higher rates of telehealth use compared with FFS enrollees, regardless of insurer. Among FFS enrollees, those enrolled in Medicaid had higher rates of telehealth use compared with those insured by CalPERS. Telehealth policies should be aware of this heterogeneity, as well as its implications for equity of telehealth access.

Options for change: Restructuring California’s residential inclining rates for a better electricity future

Local distribution companies (LDCs) regulated by the California Public Utilities Commission use mandatory inclining rates (MIR) to bill their residential electricity customers. However, MIR hinder the California electricity industry’s provision of clean and reliable service at affordable rates. Hence, we consider the following options to restructure MIR: (1) adopting a flat energy rate and revised customer charges; (2) replacing the flat rate in (1) with time-of-use (TOU) rates; (3) replacing the TOU rates in (2) with real-time pricing; (4) replacing (3) with a Hopkinson tariff with reliability differentiation. Our assessment of these options recommends sequential implementation (1), (2) and (4), thus lessening the potentially large and adverse bill impacts on some residential end-users caused by a drastic rate design change. Our recommended implementation sequence is (2) and (4) when the potentially large bill impacts of TOU pricing on the small and poor end-users with relatively high peak kWh consumption are to be mitigated by income-based customer charges.

The Economics of Residential Solar and Battery Storage: Analyzing the California Public Utilities Commission Decision of December 2022

The Economics of Residential Solar and Battery Storage: Analyzing the California Public Utilities Commission Decision of December 2022

The Health Plan Environment In California Contributed To Differential Use Of Telehealth During The COVID-19 Pandemic.

The COVID-19 pandemic has led to substantial increases in the use of telehealth and virtual care in the US. Differential patient and provider access to technology and resources has raised concerns that existing health disparities may be extenuated by shifts to virtual care. We used data from one of the largest providers of employer-sponsored insurance, the California Public Employees' Retirement System, to examine potential disparities in the use of telehealth. We found that lower-income, non-White, and non-English-speaking people were more likely to use telehealth during the period we studied. These differences were driven by enrollment in a clinically and financially integrated care delivery system, Kaiser Permanente. Kaiser's use of telehealth was higher before and during the pandemic than that of other delivery models. Access to integrated care may be more important to the adoption of health technology than patient-level differences.

Horizontal and Vertical Racial Segregation in Higher Education: Examining Trends in California Public Colleges

ABSTRACT Conceptualizing and measuring trends in segregation in higher education is difficult as both vertical and horizontal sorting is prevalent and patterns vary across racial groups. In this paper, we measure various trends in racial segregation in California for 20 years. We find significant sorting by race both between and within sectors of higher education, though the overall levels of segregation are lower in California’s colleges than they are in California’s high schools. These trends have and remained relatively stable over time. We also find important differences between groups. We see that most Latinx-White and Black-White segregation is due to students attending different schools within the same sector, while Asian-White segregation is increasingly due to students attending schools in different sectors. We also find evidence that policy and structural changes, such as opening a new campus, can affect patterns of segregation across and within sectors.

SNAP Participation Decreases Food Insecurity among California Public University Students: A quasi-experimental Study

ABSTRACT Food insecurity is widespread among US college students. We examined the impact of participating in the Supplemental Nutrition Assistance Program (SNAP) on food security status among students at a large public university using a quasi-experimental study. Sequentially adjusted logistic regression models were used to assess the impact of SNAP participation on food insecurity. SNAP participants experienced a 63% decrease in food insecurity from baseline to six months (p < .05). Adjusted models found 89% (95% CI 0.25–0.98) lower odds of food insecurity among program participants. Strategies to increase SNAP use may decrease food insecurity and its associated consequences among college students.

How to Measure the Network Vulnerability of Cities to Wildfires: Cases in California, U.S.A.

This paper proposes a framework to evaluate the network vulnerability of cities to wildfires. Three cities are selected from the California Public Utilities Commission (CPUC), U.S., fire-threat regions: Orinda, Paradise, and Atascadero. For each city, four different network connectivity measures are calculated, and agent-based evacuation simulations are performed by the Monte Carlo method. In the simulations, the number of isolated vehicles and evacuation time estimates are measured for the following scenarios: (i) no wildfire case with original network; and (ii) wildfire cases with randomly damaged networks that are reduced by 1%, 3%, 5%, 7%, and 10% from the original network. A city-to-city comparison is conducted in relation to network connectivity measures and evacuation simulation results. It is shown that Paradise has the worst network connectivity, and the simulation results reveal that Paradise also has the most sensitive network in relation to random roadway closures caused by wildfire propagation. Thus, among the three cities, Paradise has the most vulnerable network to wildfires as determined through the two analysis results concerning the worst network measures and the simulation results. It is expected that the proposed analysis framework can be generally applied to any city located in a fire-threat region.

Extent of Follow-Up on Abnormal Cancer Screening in Multiple California Public Hospital Systems: A Retrospective Review

BackgroundInequitable follow-up of abnormal cancer screening tests may contribute to racial/ethnic disparities in colon and breast cancer outcomes. However, few multi-site studies have examined follow-up of abnormal cancer screening tests and it is unknown if racial/ethnic disparities exist.ObjectiveThis report describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems.DesignWe conducted a retrospective cohort study using data from five California public hospital systems. We used multivariable robust Poisson regression analyses to examine whether patient-level factors or site predicted receipt of follow-up test.Main MeasuresUsing data from five public hospital systems between July 2015 and June 2017, we assessed follow-up of two screening results: (1) colonoscopy after positive fecal immunochemical tests (FIT) and (2) tissue biopsy within 21 days after a BIRADS 4/5 mammogram.Key ResultsOf 4132 abnormal FITs, 1736 (42%) received a follow-up colonoscopy. Older age, Medicaid insurance, lack of insurance, English language, and site were negatively associated with follow-up colonoscopy, while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 1082 (64%) received a timely biopsy; only site was associated with timely follow-up biopsy.ConclusionDespite the vulnerabilities of public-hospital-system patients, follow-up of abnormal cancer screening tests occurs at rates similar to that of patients in other healthcare settings, with colon cancer screening test follow-up occurring at lower rates than follow-up of breast cancer screening tests. Site-level factors have larger, more consistent impact on follow-up rates than patient sociodemographic traits. Resources are needed to identify health system–level factors, such as test follow-up processes or data infrastructure, that improve abnormal cancer screening test follow-up so that effective health system–level interventions can be evaluated and disseminated.

It’s Good to Be Popular in High School: A Look at Disparities in STEM AP Offerings in Northern California Public High Schools

In 2018, in response to the proposed elimination of physics at a predominately Hispanic and socioeconomically disadvantaged (SED) high school, the Northern California/Nevada chapter of the AAPT investigated school demographics and their effect on physics offerings in public high schools in our region. As access was a key issue, the focus was on public, non-charter high schools, which are free to students and do not require winning a lottery for attendance. As reported previously, the data revealed that the percentage of Hispanic students and the percentage of SED students at a high school are highly correlated (r2=0.60). Additionally, these factors could be used as predictors of a school’s physics offerings. To determine if the disparities in course offerings extended through other Advanced Placement (AP) STEM classes, the data were further analyzed, revealing that as the popularity of an AP exam drops, so do the relative odds of it being offered, when comparing schools with different demographics. A Northern California public high school student is much more likely to get a strong selection of AP STEM classes if his/her school serves an affluent, non-Hispanic student majority rather than mostly poor, Hispanic students.