Northern California Research Articles

Provider and facility factors in relation to receipt of dose-reduced chemotherapy among patients with breast cancer.

310 Background: Little is known about how provider and facility factors relate to patients’ receipt of dose-reduced adjuvant chemotherapy. Methods: In a cohort of 8,581 stage I-IIIA women with breast cancer treated with chemotherapy at Kaiser Permanente Northern California between 2006 and 2019, we evaluated the associations between provider- and facility-level factors related to chemotherapy dosing with a primary interest in the first cycle dose reduction (FCDR). Here, FCDR is defined as a first cycle dose proportion <90% of that expected based on the intended regimen, reflecting clinician intent at the outset of chemotherapy. Provider-level factors examined included provider gender, age, race, Hispanic ethnicity, years since completion of medical school, volume of breast cancer patients treated per year, and patient-provider racial concordance; we also examined practice size and rurality. Prevalence ratios (PR) were calculated using generalized linear models of the Poisson family with a log-link function and robust standard errors, accounting for significant patient factors and clustering at the provider level. Results were further mutually-adjusted for significant provider- and facility-level factors to ensure independence of associations. Results: Patients treated by providers practicing for longer (30+ years since medical school vs <10 years) were more likely to be dose-reduced at the outset of chemotherapy (PR: 1.94; 95% CI: 1.15-3.25; p-trend: 0.02). Patients treated by providers in a larger practice (10+ vs ≤5 oncologists) were less likely to be dose reduced (PR: 0.53; 95% CI: 0.34-0.84; p-trend: 0.03) as were patients treated by providers treating a higher volume of breast cancer patients (30+ vs ≤15 patients/year: PR 0.64 (95% CI: 0.41-0.99; p-trend: 0.03). Other factors examined were not significantly associated with use of FCDR. Conclusions: These results indicate provider years of experience, as well as practice size and the volume of breast cancer patients treated per year are significantly associated with first cycle dose reductions in chemotherapy. This is a complex, multi-factorial issue, and these results indicate that provider- and provider- and facility-level factors should be considered when evaluating sources of heterogeneity in chemotherapy delivery.

Improving flu vaccination rates among adult patients with cancer at Kaiser Permanente.

326 Background: Vaccines protect cancer patients from developing severe illness, hospitalization, and death. At Kaiser Permanente (KP) South Sacramento Medical Center (KPSSC), oncology patients on active chemotherapy had an overall flu vaccination rate of 13% between September 1, 2022, and December 1, 2022. Our aim was to increase this rate to 33% during the 2023 flu season. Methods: In conjunction with the ASCO Quality Training Program, we applied quality improvement initiatives to improve flu vaccination. Our population of interest included adult cancer patients on active chemotherapy at KPSCC. We evaluated the barriers to vaccination assessment by distributing surveys to infusion nurses. We performed three Plan-Do-Study-Act (PDSA) cycles for quality improvement and monitored flu vaccination rates. Cycle 1 (9/11/2023 to 11/5/2023): We distributed the ASCO flu vaccine handout at oncology clinic. We had medical assistants and infusion nurses administer flu vaccines during clinic visits and chemotherapy sessions. Cycle 2 (11/6/2023 to 11/21/2023): We added the vaccine handout in Chinese and Spanish and updated our receptionists’ script to strongly encourage patients to receive flu vaccine. Cycle 3 (11/22/2023 to 12/6/2023): KP flu clinic set up an onsite flu vaccine cart one half day per week in the oncology clinic. Results: Barriers to vaccination assessment in the clinic included lack of time (60%), difficulty remembering to ask (10%), and non-influenza season (10%). Our interventions resulted in an increased flu vaccination rate from 13% in 2022 to 36% in 2023. During cycle 1, 298 out of 615 patients received their vaccine (48.5%). During cycle 2, 16 out of 118 patients received their vaccine (13.6%). PDSA cycle 3 resulted in 14 out of 178 patients receiving their vaccine (7.9%). Conclusions: Promoting vaccine awareness via active engagement with nurses and medical assistants early on and having onsite vaccine availability in the oncology clinic were keys to improve the overall flu vaccination rate. While most vaccines were administered at the beginning of flu season, the addition of language-tailored vaccine handouts and having an onsite vaccine cart towards the end of the season did result in late season vaccinations. Our findings do support the importance of providing timely vaccine information in the oncology clinic. Our future goal is to expand these efforts to other KP Northern California oncology centers to establish stable onsite vaccine availability in clinics and include additional vaccine types.

Associations between age at diagnosis and chemotherapy dose reductions in women treated for stage I-IIIA breast cancer.

99 Background: Several studies have shown that older women diagnosed with breast cancer and eligible for chemotherapy treatment are more likely to be dose-reduced than younger women; however, most prior studies were limited by small sample sizes and examined relative dose intensity of a single drug. We assessed the association between age at diagnosis with first cycle dose proportion (FCDP) and average relative dose intensity (ARDI) across multiple regimens in the Optimal Breast Cancer Chemotherapy Dosing (OBCD) study. Methods: This retrospective cohort study included 10,386 women ages 18+ years treated with adjuvant chemotherapy for stage I-IIIA breast cancer at Kaiser Permanente Northern California (KPNC) and Washington (KPWA) between 2004-2019. We examined associations between age at diagnosis with first cycle dose proportion (FCDP, defined as <90% of the guideline-recommended dose, reflecting clinician intent at treatment outset) and average relative dose intensity (ARDI, defined as dose proportion <90% across the course of chemotherapy). We used multivariable-adjusted generalized linear models of the Poisson family with a log link-function and robust standard errors to calculate prevalence ratios (PR) and corresponding 95% confidence intervals (CI). We adjusted for patient and tumor characteristics, with and without adjusting for pre-existing comorbidities. Results: The proportion of women with a FCDP <90% ranged from 3% among women ages 18-39 years to 19% among women ages 75+ years. Women ages 75+ years were statistically significantly more likely to have a FCDP <90% and ARDI <90% vs women ages 40-49 years regardless of adjustment for comorbidities (Table). Conclusions: Older age at diagnosis is strongly associated with chemotherapy dose reductions relative to guideline recommendations, both at the outset of chemotherapy initiation and across the course of treatment. Understanding implications of dose reductions on chemotoxicities and survival will be particularly important for improving the quality of care and long-term outcomes for older women. Age at Diagnosis (years) FCDP <90% Multivariable Adjusted*PR (95% CI) FCDP <90% Additionally Adjusted* for ComorbiditiesPR (95% CI) ARDI <90% Multivariable Adjusted*PR (95% CI) ARDI <90% Additionally Adjusted* for ComorbiditiesPR (95% CI) 18-39 0.81 (0.53-1.23) 0.84 (0.55-1.29) 0.84 (0.68-1.03) 0.85 (0.69-1.04) 40-49 REF REF REF REF 50-64 1.32 (1.08-1.61) 1.29 (1.06-1.59) 1.16 (1.04-1.29) 1.14 (1.02-1.26) 65-74 1.72 (1.36-2.17) 1.65 (1.29-2.10) 1.34 (1.18-1.52) 1.26 (1.11-1.43) 75+ 4.90 (3.61-6.65) 4.39 (3.16-6.09) 1.94 (1.61-2.35) 1.75 (1.44-2.13) p-trend <0.001 <0.001 <0.001 <0.001 *Adjusted for BMI, stage at diagnosis, year of diagnosis, study site, race/ethnicity, income, body mass index, human epidermal growth factor receptor status, grade, nodal number, estrogen and progesterone receptor status.

S1112 Trends in the Prevalence of Diagnosed Inflammatory Bowel Disease among Asian Subgroups in a Large Northern California Population

S1112 Trends in the Prevalence of Diagnosed Inflammatory Bowel Disease among Asian Subgroups in a Large Northern California Population

Beyond the pain: Decoding opioid use in advanced cancer ED visits.

298 Background: Patients with advanced cancer often turn to the emergency department (ED) for pain treatment, impacting their quality of life and escalating healthcare costs. A crucial step in reducing avoidable ED visits and maintaining patient safety is to identify the characteristics of this patient group and explore potential intervention points. This study aims to characterize the use of narcotics in the ED among patients with advanced cancer. Methods: This retrospective cross-sectional study at Kaiser Permanente Northern California involved adults aged 18 and older diagnosed with Stage IV solid cancers between 2018 to 2020, who had at least one ED visit and passed away within one year (excluding those who died within 30 days). Demographics, clinical variables, frequencies, and trends in ED visits were collected and compared based on opioid utilization. Results: The study encompassed 2,554 patients with 6,406 ED visits in their final year of life. Sixty-one percent of these patients received opioids during their ED visits, with a median of three visits per patient. Pain scores taken at triage of these visits showed 23% reported severe pain, 23% moderate pain, and 7% mild pain. In 56% of visits, patients had filled an opioid prescription within the last 30 days. Morphine (39%) and hydromorphone (29%) were the most commonly administered opioids, primarily intravenously (66%). The prevalent cancer subtypes receiving opioids during ED visits were breast, head and neck, and upper GI. Among patients who received chemo or radiation, 65% received opioids during ED visits, compared to the 55% of patients not in treatment. For treated patients, chemotherapy was associated with increased ED visits requiring opioid pain management. Median survival did not differ significantly between those who received opioids during ED visits (130 days) and those who did not (123 days). Conclusions: This study emphasizes the dynamic pain needs of patients with cancer at the end of life driving utilization of emergency care. Factors influencing these needs include cancer subtype and current treatment status, particularly chemotherapy. Further studies are essential to enable providers to better recognize cancer pain and to improve patient safety by addressing changes in patients' pain requirements outside the emergency setting.

Frequency of CKD Patient Referrals to Nephrology Clinics Using the Kidney Failure Risk Equation at Kaiser Permanente Northern California

Frequency of CKD Patient Referrals to Nephrology Clinics Using the Kidney Failure Risk Equation at Kaiser Permanente Northern California

Was receipt of any specialty alcohol treatment during the pandemic effective at reducing drinking for patients with or at risk of AUD?

IntroductionThe COVID-19 pandemic changed the way healthcare providers delivered most health services, including treatment for alcohol use disorder (AUD). Specialty alcohol treatment remained available through the pandemic, and within some systems treatment use increased likely due to telehealth availability. However, the field knows little about the relationship between the pandemic's expanded access to specialty alcohol treatment and alcohol use outcomes. MethodsThe sample included 14,712 patients from Kaiser Permanente Northern California who screened positive for unhealthy alcohol use in primary care and had an AUD diagnosis or risked developing an AUD by reporting 5 or more heavy drinking days in a 3-month period between 1/1/2019 and 2/29/2020 (pre-pandemic). The study examined the receipt of any specialty alcohol treatment (including at least one outpatient, inpatient, or telehealth specialty treatment encounter, or pharmacotherapy prescription) from 3/1/2020 (pandemic start) to either the first completed follow-up alcohol screening or 6/20/2022 (study period end). The outcomes of alcohol use included changes in heavy drinking days, drinks per week, drinking days per week, and drinks per drinking day between the pre- and post-pandemic periods. ResultsOn average patients significantly decreased alcohol use across all four alcohol use measures examined, regardless of whether they received treatment. However, those who received any treatment compared to those who did not have greater reductions in alcohol use, with an additional decrease of −3.55 heavy drinking days (95 % CI = −5.93, −1.17), −3.80 drinks per week (95 % CI = −5.18, −2.42), −0.72 drinks per drinking day (95 % CI = −1.14, −0.30), and − 1.01 drinking days per week (95 % CI = −1.30, −0.72). Treatment effects were greatest among patients who exceeded both daily and weekly limits pre-pandemic, with an additional decrease of −10.75 heavy drinking days (95 % CI = −15.28, −6.21), −12.83 drinks per week (95 % CI = −16.31, −9.35), −1.67 drinks per drinking day (95 % CI = −2.19, −1.14), and −2.02 drinking days per week (95 % CI = −2.41, −1.63). ConclusionsOn average, patients decreased alcohol use during the onset of the pandemic, however, those who had any specialty alcohol treatment had significantly greater decreases, suggesting that the hybrid in-person and telehealth treatment approach was effective during the pandemic.

Maternal Prenatal Cannabis Use and Child Autism Spectrum Disorder

Despite an increase in maternal prenatal cannabis use and associations with adverse neonatal outcomes, research on child neurodevelopmental outcomes is limited. To evaluate the association between maternal cannabis use in early pregnancy and child autism spectrum disorder (ASD). This population-based retrospective birth cohort study included children born between 2011 and 2019 to pregnant Kaiser Permanente Northern California members screened for prenatal cannabis use during pregnancy. Statistical analysis was conducted February 2023 to March 2024. Maternal prenatal cannabis use was assessed at entrance to prenatal care (approximately 8- to 10-weeks' gestation) via self-report and/or positive urine toxicology test. Use frequency was assessed. Child ASD was defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes ascertained from the electronic health record. Associations between maternal prenatal cannabis use and child ASD were modeled using Cox proportional hazards regression adjusted for maternal sociodemographic, other substance use and disorders, prenatal care initiation, comorbidities, and clustering among maternal siblings. The study cohort included 178 948 singleton pregnancies among 146 296 unique pregnant individuals, including 48 880 (27.3%) Asian or Pacific Islander, 42 799 (23.9%) Hispanic, 9742 (5.4%) non-Hispanic Black, and 70 733 (39.5%) non-Hispanic White pregnancies. The median (IQR) maternal age at pregnancy onset was 31 (6) years; 8486 (4.7%) screened positive for cannabis use, 7054 (3.9%) via urine toxicology testing and 3662 (2.0%) by self-report. In the total study population, the frequency of self-reported use was monthly or less for 2003 pregnancies (1.1%), weekly for 918 pregnancies (0.5%), daily for 741 pregnancies (0.4%), and unknown for 4824 pregnancies (2.7%). ASD was diagnosed in 3.6% of children. After adjustment for maternal characteristics, maternal prenatal cannabis use was not associated with child ASD (hazard ratio [HR], 1.05; 95% CI, 0.84-1.32). When self-reported frequency of use was assessed, no statistically significant associations were observed after confounder adjustment. No sex-specific associations were documented (males: HR, 1.01; 95% CI, 0.77-1.32; and females: HR, 1.19; 95% CI, 0.77-1.85). In this cohort study, maternal cannabis use assessed in early pregnancy was not associated with child ASD. Additional studies are needed to evaluate different patterns of use throughout pregnancy. Given the known adverse neonatal health effects of maternal prenatal cannabis use, clinicians should follow national guidelines and advise against use.

Incidence and Risk of Coronavirus Disease 2019 Hospitalization Among Unvaccinated Children.

The aim of this study is to determine the incidence and risk factors associated with COVID-19 hospitalization among unvaccinated children. Children aged 0- < 18 years, members of Kaiser Permanente Northern California (KPNC), were followed from March 1, 2020, until the earliest occurrence of: chart-confirmed COVID-19 hospitalization, disenrollment from KPNC, age 18 years, receipt of COVID-19 vaccine, death, or study end (December 31, 2022). We calculated the incidence rate of hospitalization by SARS-CoV-2 variant period and by age group. We determined risk factors for hospitalization using Poisson regression. We also conducted descriptive analyses of hospitalized cases. Among 1,107,799 children, 423 were hospitalized for COVID-19 during follow-up. The incidence of hospitalization increased with each new SARS-CoV-2 variant and was highest among children aged < 6 months. Among the < 6-month-olds, the incidence rate per 100,000 person-months was 7 during predelta, 13.3 during delta, and 22.4 during omicron. Black (RR = 2.05, 95% CI: 1.33-3.16) and Hispanic children (RR = 1.82, 95% CI: 1.34-2.46) and children with any comorbidities were at high risk of hospitalization (RR = 3.81, 95% CI: 2.94-4.95). Overall, 20.3% of hospitalized children were admitted to an intensive care unit (ICU), but ICU admission was 36.1% among 12- < 18-year-olds. The majority of ICU admits (91.8%) had no comorbidities. Children too young to be vaccinated had the highest incidence of COVID-19 hospitalization, while adolescents had the highest proportion of ICU admissions. To prevent severe disease in children and adolescents, everyone eligible should be vaccinated.

Hypertensive Blood Pressure in Adolescent Females with Polycystic Ovary Syndrome: Adolescent PCOS and hypertensive blood pressure

INTRODUCTIONPolycystic ovary syndrome (PCOS) is associated with hypertension in women, but few population studies have examined findings among adolescents. This retrospective study examines PCOS and hypertensive blood pressure (BP) in a large adolescent population receiving routine healthcare. METHODSAmong females aged 13-17 years who had a well-child visit with systolic/diastolic BP measured in a Northern California healthcare system (2013-2019), the outcome of hypertensive BP (≥130/80 mmHg) was examined. PCOS was based on clinical diagnosis (ICD-9/10 256.4/E28.2) within one year of the visit. Overweight and obesity were defined by body mass index 85th to <95th percentile and ≥95th percentile, respectively; 1.7% with underweight (<5th percentile) were excluded. Multivariable logistic regression was used to examine the association of PCOS and hypertensive BP, adjusting for age, race/ethnicity, BMI category, and estimated neighborhood deprivation index. Analyses were conducted in 2023-2024. RESULTSThe cohort included 224,418 females (mean age 14.9±1.4 years; 34.3% non-Hispanic White, 30.1% Hispanic, 19.5% Asian/Pacific Islander, and 9.7% Black. Overall, 18.7% had overweight and 15.8% had obesity. The prevalence of hypertensive BP was 7.2%, much higher for those with PCOS (18.2%) versus no PCOS (7.1%, p<0.001). In adjusted analyses, PCOS was associated with 1.25-fold greater odds of hypertensive BP [95% confidence interval 1.10-1.42]). Similar findings were seen among the subset with obesity (odds ratio 1.23 [1.06-1.42]). CONCLUSIONSNearly 1 in 5 adolescents with PCOS had hypertensive BP. PCOS was associated with 25% increased adjusted odds of hypertensive BP, emphasizing the importance of BP surveillance in this population with higher cardiometabolic risk.

The impact of COVID-19 on time toxicity in patients with advanced cancer.

267 Background: The COVID-19 pandemic necessitated the rapid adoption of telemedicine but little is known about whether the changes in care delivery has led to differences in time toxicity for patients with advanced cancer. This study examines the impact of the pandemic on time toxicity, defined as the time burden of interacting with the healthcare system, by comparing healthcare contact days between pre-COVID and post-COVID periods. Methods: A retrospective cohort study was performed on patients with advanced (stage 4) cancer who died within one year of diagnosis at Kaiser Permanente Northern California between January 1, 2015 and June 30, 2023. Time toxicity was defined as the percentage of healthcare contact days over the course of survival period between cancer diagnosis and death (contact days/survival days). We included outpatient days (imaging, labs, treatment, provider visits), inpatient stays (emergency department, acute inpatient, non-acute institutional stays), and in-home days (in-home care, virtual care, home hospice). Differences between pre-COVID (diagnosed and died before March 1, 2020) and post-COVID (diagnosed after March 1, 2020) periods were analyzed using Wilcoxon tests. Results: The cohort included 9643 patients, with 6558 pre-COVID and 3085 post-COVID. Median age at diagnosis was 74 years, and the cohort was 46.9% female, largely white (64.5%), with a high comorbidity score (median Elixhauser score: 4). Post-COVID, there was an increase in institutional stay (8.7% vs. 9.3%) and outpatient service (imaging and labs) (4.4% vs. 3.1%), while in-person outpatient visits decreased (5.9% vs. 8.7%, p&lt;0.0001). Additionally, in-home days increased (25.0% vs. 20.8%), with a significant rise in in-home virtual care (3.9% vs. 1.8%, all p&lt;0.01). Conclusions: The COVID-19 pandemic led to notable shifts in healthcare utilization for patients with advanced cancer in the last year of life. The increase in telehealth and in-home services in the post-COVID era was accompanied by a slight increase in emergency and ancillary services. Further understanding patient experiences around these shifts is crucial for optimizing care and managing time toxicity in the evolving healthcare landscape. Description of outcomes pre and post-COVID-19 pandemic. Total Pre-COVID Post-COVID P-value Survival Days, median 86.0 84.0 89.0 0.02 Percentage of Contact, median (interquartile range) Comprehensive Contact 63.3 (41.0-92.0) 62.5 (40.7-91.0) 65.2 (41.7-94.1) 0.01 Institutional stay 9.0 (2.7-26.2) 8.7 (2.7-25.9) 9.3 (2.9-26.8) 0.11 Outpatient 12.4 (5.3-19.8) 12.9 (5.6-20.6) 11.2 (4.8-18.1) &lt;.001 Outpatient visit 7.7 (2.8-13.4) 8.7 (3.5-14.6) 5.9 (1.6-10.7) &lt;.0001 Outpatient service 3.5 (0.8-6.3) 3.1 (0.4-5.8) 4.4 (1.5-7.1) &lt;.0001 In-home 22.2 (7.4-50.0) 20.8 (6.0-48.4) 25.0 (10.4-51.7) &lt;.001 In-home care 18.1 (1.7-46.6) 17.4 (1.2-46.2) 19.2 (2.4-47.2) 0.03 In-home virtual care 2.2 (0.0-4.8) 1.8 (0.0-3.8) 3.9 (0.7-7.0) &lt;.0001

Time toxicity faced by patients with advanced cancer across primary cancer sites.

268 Background: Time toxicity, defined as the burden of time for patients interacting with the health care systems, is particularly important for patients with limited life expectancy. Little is known about the relative impact of time toxicity among different cancer types at the end of life. This study examines median contact days for inpatient, outpatient, and home health services among different primary cancer types for patients with advanced cancer with limited prognosis. Methods: A retrospective cohort analysis was performed on patients with advanced (stage 4) cancer who died within one year of diagnosis at Kaiser Permanente Northern California between January 1, 2015, and June 30, 2023. Time toxicity was defined as comprehensive contact days with healthcare system over the course of patients’ survival period between cancer diagnosis and death (i.e., contact days divided by survival or contact %). Types of contact included institutional stay (emergency department visit, hospitalization, skilled nursing facility, rehabilitation); outpatient visits (ambulatory care, labs, imaging); and in-home care (home-health, home hospice, telephone and virtual visit). The study quantified overall median contact % and contact % by specific care settings, stratified by cancer primary site. Results: The study included 10102 patients. The median age at diagnosis was 74 years with 47% female. Patients were predominantly white (65%), followed by Asian (12%), Hispanic (12%), and black (8%). The median Elixhauser comorbidity score was 4. With the exception of head and neck cancers, most cancers had higher contact % near diagnosis and at end of life (U-shaped curve). Head and neck cancers had the highest percent of patients undergoing surgery (36%) and radiation (52%), which may explain its sinuosity-like curve with a rapid increase of weekly contact % after diagnosis (a small peak), followed by rapid decrease and another increase by the end of their life. Survival days were comparatively long for head and neck cancers (158 days, IQR: 84-265) and short for thoracic (80 days, IQR: 35-166) and upper gastrointestinal cancers (80 days, IQR: 38-173). Malignant hematology patients had notably higher comprehensive contact % (74%, IQR: 47-100) which was driven primarily by emergency room department visits and hospital stays (p&lt;0.001 for all contact types). Conclusions: The study highlights the high burden of time toxicity in patients with advanced cancer with limited prognosis. The significant variations in time toxicity among different cancer types, especially in malignant hematology and head and neck patients, emphasize the need to tailor goals of care discussions for patients with cancer at the end of life. By focusing on reducing unwanted time toxicity, healthcare providers can enhance the quality of life for patients with cancer, ensuring more efficient and patient-centered care delivery.

New simple sequence repeat markers reveal undetected diversity in Spanish and Californian Diplodia sapinea populations

Diplodia sapinea is the causal agent of Diplodia shoot blight, an emerging disease affecting pine forests worldwide. The range expansion of this pathogen in northern Europe has been suggested to be partially facilitated by recent warmer conditions. Although D. sapinea has been studied extensively, critical aspects of its infection biology and population structure remain unexplored. In this study, we developed nine simple sequence repeat (SSR) markers mined from D. sapinea genomes to assess the genetic diversity at higher resolution. Isolates from northern Spain, an area formerly regarded as having low genetic diversity and samples from a Californian population that was formerly regarded as clonal, were analysed in the study. In Spain, the nine SSR markers identified 56 genotypes in 285 samples. Isolates from symptomatic shoots, cones and asymptomatic tissues collected from different stands, suggested admixture between local populations. The same genotype tended to dominate within a single cone, and the same genotypes were usually found in both symptomatic and asymptomatic shoot tissues. The nine new SSR markers developed in this study revealed a high level of genetic diversity in both the northern Spanish and northern Californian populations than previous anticipated. Analyses using these nine SSR markers should contribute to a better understanding of the epidemiology, evolution and origin of D. sapinea, a pathogen that is gaining prominence in many parts of the world.

Dissonance between posts of health agencies and public comments regarding COVID-19 and vaccination on Facebook in Northern California.

Public health crises, such as the COVID-19 pandemic, have prompted a need for health agencies to improve their disease preparedness strategies, informing their communities of new information and promoting preventive behaviors to help curb the spread of the virus. We ran unsupervised machine learning and emotion analysis, validated with manual coding, on posts of health agencies (N = 1588) and their associated public comments (N = 7813) during a crucial initial period of the COVID-19 pandemic (January 2020 to February 2021) among nine different counties with a higher proportion of vaccine-hesitant communities in Northern California. In addition, we explored differences in concerns and expressed emotions by two key group-level factors, county-level COVID-19 death rate and political party affiliation. We consistently find that while health agencies primarily disseminated information about COVID-19 and the vaccine, they failed to address the concerns of their communities as expressed in public comment sections. Topics among public audiences focused on concerns with the COVID-19 vaccine safety and rollout, state mandates, flu vaccination, and frustration with politicians, and they expressed more positive and more negative emotions than health agencies. Further, there were several differences in primary topics and emotions expressed among public audiences by county-level COVID-19 death rate and political party affiliation. While this research serves as a case study, findings indicate how local health agencies, and their audiences, discuss their perceptions and concerns regarding the COVID-19 pandemic and may inform health communication researchers and practitioners on how to prepare and manage for emerging health crises.

Toddlers' visual exploration during decisions predicts uncertainty monitoring 1 year later.

The longitudinal relation between toddlers' behaviors in uncertain situations (e.g., information seeking, hesitation) and preschoolers' uncertainty monitoring was investigated (between 2014 and 2019 in Northern California; Time 1: N = 183, M = 28.99 months, 53% female, 67.8% White; Time 2: N = 159, M = 41.64 months, 52.2% female). Eye movements and response latencies were recorded as children identified a target from two partially occluded (Time 1) or degraded (Time 2) images. Confidence ratings for identifications were collected at Time 2. At Time 1, gaze transitions between response options, but not response latencies and mental state language, predicted Time 2 uncertainty monitoring. Overall, these findings provide the first direct evidence of connections between toddlers' uncertainty behaviors and preschoolers' uncertainty monitoring.

Life cycle impact and cost analysis of quarry materials for land-based enhanced weathering in Northern California

Enhanced weathering (EW) is a CO2 removal (CDR) and sequestration strategy that accelerates the natural reactions of minerals that can store carbon from the atmosphere and biotic reactions. One method of EW is to apply finely ground silicate rocks to agricultural lands. EW has been demonstrated in laboratory and field tests, but great uncertainty remains regarding the life-cycle of using locally available rocks on candidate soils. We evaluate the life-cycle impacts, job creation, and cost of scenarios where fines and rocks mined from quarries in Oregon and Northern California are transported by truck and tilled into agricultural soils. Candidate quarry dust samples were classified as dacite, andesite, and olivine-bearing rocks, with EW potentials ranging from 125 to 760 kg CO2/metric tonne rock. We determined the olivine-bearing rock from Southern Oregon could achieve a levelized cost of CDR under the DOE Earthshot target of $100/t CO2, as long as application rates are 25 t/ha or more. Even andesite and dacite materials reach lower costs than commercial direct air capture technologies, with reduction in fines purchase and transport costs critical for achieving the Earthshot target. The results suggest that low-cost EW can be achieved using natural quarry materials, with average removal up to 2.2 t CO2e per hectare per year.

Cigarette smoking status and COVID-19 hospitalization in the context of cannabis use: An electronic health record cohort study in northern California

BackgroundResearch investigating the association between cigarette smoking and COVID-19 outcomes has yielded mixed results, often overlooking cannabis use. This study examined the association between cigarette smoking and COVID-19 hospitalization with consideration of cannabis use. MethodsWe used electronic health record data from adult patients with COVID-19 (2/1/2020 to 2/3/2022) at a northern California academic medical center. The outcome was COVID-19 hospitalization. We conducted three multivariable logistic models to examine the relationship between cigarette smoking and hospitalization. Model 1 included cigarette smoking status and other covariates; Model 2 added cannabis use status to Model 1; Model 3 added interaction term of cigarette and cannabis use to Model 2, followed by a post-hoc analysis. ResultsOf the 14,440 patients, 8.5 % had COVID-19 hospitalization, 4.9 % and 24.1 % currently and formerly smoked cigarettes, respectively; 7.2 % currently used cannabis, 62.8 % had unknown cannabis use status. Both current and former cigarettes smoking were associated with hospitalization (Models 1–2). In Model 3, the cigarette-cannabis interaction was significant. Former cigarette smoking had higher odds for hospitalization (adjusted odds ratio [AOR] = 1.36; 95 % confidence interval [CI] 1.09–1.70) only among people who did not currently use cannabis. Current cigarette smoking yielded higher odds of hospitalization (AOR = 1.47; 95 % CI 1.02–2.12) among people whose cannabis use was unknown. Cigarette smoking status was not associated with hospitalization among people who currently used cannabis. ConclusionsCigarette smoking’s associations with COVID-19 hospitalization varied by cannabis use. Future research should include both cigarette and cannabis use in understanding risk factors for COVID-19 outcomes.

Transgenerational impact of maternal adverse childhood experiences on children's mental health among families experiencing homelessness

BackgroundAdverse childhood experiences (ACEs) threaten the livelihood of individuals and their families. This may be particularly detrimental for mothers facing homelessness and their children's behavioral adjustment. ObjectiveThis study compared two models to examine the impact of maternal ACEs on children's internalizing and externalizing symptoms. Rather than using the cumulative approach to conceptualize ACEs, we analyzed a model that assessed the effect of each maternal ACE individually (i.e., specificity model) and another model that categorized them into two subtypes of maltreatment and household dysfunction (i.e., dimensional model). Participants and settingWe evaluated a sample of 164 children and their mothers in a residential vocational training program in Northern California. MethodsACEs for both mother and children and children's behavioral outcomes were collected via questionnaires completed by the mothers with the assistance of trained researchers. Additional demographic data was collected via trained case managers at the residential facility. Two models (i.e., specificity model; dimensional model) were utilized to better understand how to best assess adversity in settings with limited resources. ResultsResults of the specificity ACE model identified maternal childhood physical abuse and parental incarceration as predictors of internalizing problems and parental substance problems as a predictor of externalizing behaviors. The dimensional ACE model indicated that only the broad category of maltreatment predicted internalizing behavioral difficulties. The individual ACE model demonstrated a better fit for the data and highlighted specific events relevant to children's outcomes. ConclusionsThese results suggest that programs focusing on ending generational trauma may benefit from screening participants for individual ACE and tailoring services for mothers and children accordingly.

Abalone recruitment patterns before and after sea urchin barrens formation in northern California: incorporating climate change

ABSTRACT Understanding the recruitment dynamics of invertebrates in kelp forests is critical to informing climate-ready restoration. Here we examine abalone and sea urchin recruitment (3–20 mm in size) patterns in northern California across a period of drastic change. Annual surveys were conducted before, during and after the MHW (2014–2016), the loss of a major predatory sea star (2012–2016) and the collapse of a bull kelp forest in 2014. Divers surveyed artificial reef recruitment modules (n = 12) over 20 years in an area that once supported dense bull kelp, Nereocystis leutkeana, forests and the world's largest recreational abalone fishery. From 2016 to 2022, we tracked the decline of red abalone, Haliotis rufescens, recruitment and the rise of purple sea urchin, Strongylocentrotus purpuratus, recruitment. Adult densities of purple sea urchins increased as did newly settled sea urchins (<3 mm), while adult and newly settled red abalone declined. Eight years after the kelp forest collapse, red abalone recruitment remained low and sea urchin recruitment continued to increase. Recruitment patterns can inform both abalone restoration targets and sea urchin dynamics as part of a more holistic kelp forest recovery plan that is responsive to climate change drivers.

Altimeter-derived poleward Lagrangian pathways in the California Current System: Part 1

We use altimeter-derived geostrophic velocities, with and without the addition of surface Ekman transports, to create trajectories for virtual parcels in the California Current System (CCS). The goal is to investigate the poleward transport of passive water parcels in the surface 50–100 m of the nominally equatorward system. Motivation for the study is provided by observations of anomalous biomass of copepods with warm water affinities along the Newport Hydrographic Line off central Oregon (44.7°N) during El Niño years, as well as during and following the 2014–2016 marine heat wave. By backward tracking virtual parcels from 44.7°N, we find that the most distant source of passive water parcels in the upper ocean during a one-year period of travel is from within the Southern California Bight (SCB), north of 30°N. To make that journey, parcels use the Inshore Countercurrent off southern and central California during summer–winter and the Davidson Current off northern California and Oregon during autumn–winter. The inclusion of small-scale eddy diffusion usually increases the number of parcels that reach more northern latitudes, while the inclusion of Ekman velocities more often reduces those numbers. Even so, parcels can travel from the SCB to central Oregon in either the Ekman layer or beneath it in the geostrophic flow. Using backward tracking, we find that parcels arrive at 44.7°N most often in winter–spring, least often in autumn. They arrive from within the large-cape region off northern California (41°–42°N) during all years and all months, from just south of the large-cape region (38°–39°N) during most years but seldom in autumn, from south of Monterey Bay along central California (36°N) and within the SCB (34.5°N) during a third (or less) of the years and only in winter-spring. The shortest average transit times are found in winter: for parcels reaching 44.7°N in February, the average transit time is 2 months for parcels coming from 41°–42°N, 4 months for parcels coming from 38°–39°N, and 5–6 months or more for parcels coming from south of 36°N. Transit times increase as the arrival time progresses from winter to autumn. The longest average transit times are for parcels reaching central Oregon in autumn (9–12 months in October for parcels coming from south of 39°N). This makes the journey a multi-generational task for the copepods. Interannual variability in the observed southern copepod species biomass off central Oregon correlates highly with years when more virtual parcels from the south reach central and northern Oregon, providing increased confidence in the results found with the altimeter-derived parcel trajectories.