California Residents Research Articles

Adoption of low-carbon fuels reduces race/ethnicity disparities in air pollution exposure in California

An environmental justice (EJ) analysis shows that adoption of low-carbon energy sources in the year 2050 reduces the race/ethnicity disparity in air pollution exposure in California by as much as 20% for PM2.5 mass and by as much as 40% for PM0.1 mass. An ensemble of six different energy scenarios constructed using the energy-economic optimization model CA-TIMES were evaluated in future years. Criteria pollutant emissions were developed for each energy scenario using the CA-REMARQUE model using 4 km spatial resolution over four major geographic areas in California: the greater San Francisco Bay Area including Sacramento (SFBA&SAC), the San Joaquin Valley (SJV), Los Angeles (LA), and San Diego (SD). The Weather Research & Forecasting (WRF) model was used to predict future meteorology fields by downscaling two different climate scenario (RCP4.5 and RCP8.5) generated by two different GCMs (the Community Climate System Model and the Canadian Earth Systems Model). Simulations were performed over 32 weeks randomly selected during the 10 year window from the year 2046 to 2055 to build up a long-term average in the presence of ENSO variability. The trends associated with low-carbon energy adoption were relatively stable across the ensemble of locations and scenarios. Deeper reductions in the carbon intensity of energy sources progressively reduced exposure to PM2.5 mass and PM0.1 mass for all California residents. The greater adoption of low-carbon fuels also reduced the racial disparity in the PM exposure. The three energy scenarios that achieved an ~80% reduction in GHG emissions relative to 1990 levels simultaneously produced the greatest reduction in PM exposure for all California residents and the greatest reduction in the racial disparity of that exposure. These findings suggest that the adoption of low-carbon energy can improve public health and reduce racial disparities through an improvement in air quality.

Homicide Deaths Among Adult Cohabitants of Handgun Owners in California, 2004 to 2016 : A Cohort Study.

Although personal protection is a major motivation for purchasing firearms, existing studies suggest that people living in homes with firearms have higher risks for dying by homicide. Distribution of those risks among household members is poorly understood. To estimate the association between living with a lawful handgun owner and risk for homicide victimization. This retrospective cohort study followed 17.6 million adult residents of California for up to 12 years 2 months (18 October 2004 through 31 December 2016). Cohort members did not own handguns, but some started residing with lawful handgun owners during follow-up. California. 17569096 voter registrants aged 21 years or older. Homicide (overall, by firearm, and by other methods) and homicide occurring in the victim's home. Of 595448 cohort members who commenced residing with handgun owners, two thirds were women. A total of 737012 cohort members died; 2293 died by homicide. Overall rates of homicide were more than twice as high among cohabitants of handgun owners than among cohabitants of nonowners (adjusted hazard ratio, 2.33 [95% CI, 1.78 to 3.05]). These elevated rates were driven largely by higher rates of homicide by firearm (adjusted hazard ratio, 2.83 [CI, 2.05 to 3.91]). Among homicides occurring at home, cohabitants of owners had sevenfold higher rates of being fatally shot by a spouse or intimate partner (adjusted hazard ratio, 7.16 [CI, 4.04 to 12.69]); 84% of these victims were female. Some cohort members classified as unexposed may have lived in homes with handguns. Residents of homes with and without handguns may have differed on unobserved traits associated with homicide risk. Living with a handgun owner is associated with substantially elevated risk for dying by homicide. Women are disproportionately affected. The National Collaborative on Gun Violence Research, the Fund for a Safer Future, the Joyce Foundation, Stanford Law School, and the Stanford University School of Medicine.

Changes and Disparities in Nature Access During the COVID-19 Pandemic

Time in nature is associated with a range of physical and psychological benefits. These benefits tend to be unevenly distributed, with non-white and low-income communities often having lower access to nature than richer, more white neighborhoods. When the COVID-19 pandemic hit the United States in Spring 2020, changes in daily routines, restrictions on public nature access, and risk perceptions may have affected whether and how much people spent time in nature. We explore how nature access changed during the COVID-19 pandemic and how those changes were experienced by different demographic groups. We surveyed representative samples of California and New York residents (n = 2,036) in May and June of 2020 and examined differences in nature access and nature-related COVID restrictions and risks by gender, income and race. We find that, on average, the pandemic was associated with reductions in frequency of nature access and less time in nature for all respondents. However, these trends were greatest for women, people of color and people who are low-income. Moreover, the pandemic seems to have widened prior inequalities: low-income and non-white people accessed nature even less frequently and had fewer nature access options than they did prior to the pandemic. Given the disparities in broader pandemic impacts by gender, income, and race, these results further demonstrate the inequalities laid bare by COVID-19.

English

Research suggests that inappropriate approaches to information dissemination can negatively affect containment of an outbreak, including Ebola, norovirus, SARS, influenza, and now Coronavirus. The objective of this study was to examine how COVID-19 information disseminated to the public was perceived by Californians during the beginning of the COVID-19 outbreak. A cross sectional study of 207 California residents was conducted to determine perceptions regarding the dissemination of COVID-19 information. A Kruskal Wallis test was conducted using SPSS 27 to examine potential differences in groups regarding access to information. Also, Chi-square analysis was conducted to determine Californian’s perceived reliability of the information presented to them early in the outbreak. A difference was found between the use of social media and online sources, the news, and word of mouth in relation to accuracy of information (p=0.05) and trustworthiness of information (p=0.05). There is also a statistical significance for sufficiency of information, timeliness of information, and trustworthiness of information compared to reliability of information (p<0.001). Of the 66% of participants who said COVID-19 related information provided during the start of the outbreak was unreliable, 75% of them reported that the information was also insufficient, 84% said it was untimely and untrustworthy. The majority of Californians were dissatisfied with how information was presented during the beginning of the COVID-19 pandemic. Not providing accurate, timely, trustworthy, and sufficient information during an outbreak result in knowledge gaps, riskier behaviors, and in the case of California, may have potentially increased cases of COVID-19. Key words: COVID-19, health information, California, trend study, epidemiology.

Care preferences in physician orders for life sustaining treatment in California nursing homes.

Physician Orders for Life-Sustaining Treatment (POLST) facilitates documentation and transition of patients' life-sustaining treatment orders across care settings. Little is known about patient and facility factors related to care preferences within POLST across a large, diverse nursing home population. We describe the orders within POLST among all nursing home (NH) residents in California from 2011 to 2016. California requires NHs to document in the Minimum Data Set whether residents complete a POLST and orders within POLST. Using a serial cross-sectional design for each year, we describe POLST completion and orders for all California NH residents from 2011 to 2016 (N= 1,112,668). We used logistic mixed-effects regression models to estimate POLST completion and resuscitation orders to understand the relationship with resident and facility characteristics, including Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare overall five-star quality rating. POLST completion significantly increased from 2011 to 2016 with most residents having a POLST in 2016 (short-stay:68%; long-stay:81%). Among those with a POLST in 2016, 54% of long-stay and 41% of short-stay residents had a DNR order. Among residents with DNR, >90% had orders for limited medical interventions or comfort measures. Few residents (<6%) had a POLST with contradictory orders. In regression analyses, POLST completion was greater among residents with more functional dependence, but was lower among those with more cognitive impairment. Greater functional and cognitive impairment were associated with DNR orders. Racial and ethnic minorities indicated more aggressive care preferences. Higher CMS five-star facility quality rating was associated with greater POLST completion. Six years after a state mandate to document POLST completion in NHs, most California NH residents have a POLST, and about half of long-stay residents have orders to limit life-sustaining treatment. Future work should focus on determining the quality of care preference decisions documented in POLST.

California Residents' Perceptions of Gene Drive Systems to Control Mosquito-Borne Disease.

Scientists developing gene drive mosquitoes for vector control must understand how residents of affected areas regard both the problem of mosquito-borne disease and the potential solutions offered by gene drive. This study represents an experiment in public engagement at an early stage of technology development, intended to inform lab scientists about public attitudes toward their research and inspire consideration and conversation about the social ramifications of creating mosquitoes with gene drive. Online focus groups with California residents explored views on mosquito-borne disease risk, current mosquito control methods, and the proposed development and use of different classes of gene drives to control Ae. aegypti. Rather than a dogmatic rejection of genetic engineering or gene drive, many participants expressed pragmatic concerns with cost, control, the ability to narrowly target specific species, and the challenges of mistrust and institutional cooperation. Work like this can inform the alignment of community priorities and the professional priorities of scientists and vector control specialists.

The Last Will and Testament of Silverdene Emblem O'Neill

“The Last Will and Testament of Silverdene Emblem O'Neill,” performed by Alex Roe, is among the recent offerings from the Metropolitan (Virtual) Playhouse to feature lesser-known works by Eugene O'Neill and the Provincetown Players. This solo performance of a short prose piece embodies the imagined final thoughts and wishes of O'Neill's beloved dog, affectionately called “Blemie,” who passed of old age in 1940.Although O'Neill endows Blemie with the considerate and loving impulses of a canine family member, he crafts a character whose voice and preoccupations are unmistakably O'Neill's. Early in the performance, Blemie notes that he is burying his missive in his master's brain, although “he will not know it is there until after I am dead.” Blemie clearly knows his master well, and he predicts O'Neill's and his wife Carlotta's deep well of loneliness once he passes, even as he works to assuage that loss. The piece is both a mourner's rationalization of loss and a gift to those who love and mourn him. As in his great plays, O'Neill here contemplates the fact that humans live lives of gathering property and possessions, only to find that the most important things we can pass on are the things that dogs leave behind: love and faith.The parallel enactment of Blemie's “last will and testament” and O'Neill's exorcism of his sorrow is detailed, charming, and understated. Roe highlights this parallelism through visual cues, including a Beckettian close-up on his penetrating stare and a black-and-white aesthetic that focuses the viewer's gaze on the actor's face. His evocative vocal and physical choices include a deep sigh that emerges from his nose before he begins to speak and a pronounced clacking of his tongue—a sound no human normally makes but one typical of a dog. This work continues subtly throughout, with Roe's “paw” adjusting an errant ear and his darting sideward glance indicating that something has caught his eye.Blemie's tone is formal; he is well mannered, well bred, and had been distinguished and handsome in his prime. Roe's deep and resonant voice conjures all of these features and smoothly supports O'Neill as he utilizes Blemie's generosity of spirit to plead with Carlotta to adopt another dog. Blemie notes, “Dalmatians, naturally, as everyone knows, are best,” before bequeathing his made-to-order Hermès coat to his imagined successor.Finally, Roe's performance of Blemie evokes another of O'Neill's favorite themes: the contemplation of what lies beyond death. For Blemie, the vision of paradise involves a life of full bladders, with each blissful hour a mealtime. For O'Neill during his years with Blemie, however, this question was a constant source of inspiration. Blemie references his life “on the ranch,” indicating the O'Neills' beautiful Northern California property and residence, Tao House, now the home of the Eugene O'Neill Foundation and a National Historic Site. O'Neill wrote his final and most memorable plays at Tao House, where Blemie is buried. Visitors pause at the memorial and grave to appreciate O'Neill's deep love for his pet, which is beautifully expressed in the rare vision of hope and open adoration in the final lines of the “Last Will and Testament.” Blemie instructs O'Neill and Carlotta to think this as they look at his grave: “Here lies one who loved us, and whom we loved. No matter how deep my sleep, I shall hear you. And not all the power of death can keep my spirit from wagging a grateful tail.”

Development of a Survey of Sunscreen Use and Attitudes among Adults in Two Coastal States, 2019

Skin cancer is the most common form of cancer in the United States, and regular use of broad-spectrum sunscreens can prevent skin cancer. However, a new law in Hawaii that limits sunscreen choices due to the belief that some UV (ultraviolet) filters may damage coral reefs may reduce sunscreen use and increase skin-cancer risk. Because of this, there is a need for measurement tools to help understand consumer behavior and determinants of sunscreen purchase and use. The objectives of this study were (1) to test new questionnaire measures relevant to the Hawaii Sunscreen Ban; and (2) to assess adults’ knowledge, attitudes, and habits related to sunscreen in two other coastal states. This survey of adult residents of California and Florida was conducted in the summer of 2019. Newly developed scales addressed beliefs about effects of sunscreens on aquatic/marine environments and awareness of the Hawaii sunscreen ban. Respondents completed the survey twice to evaluate the test–retest reliability. Respondents (n = 162) were mainly female, White, and college-educated. New scales had moderate-to-high internal consistency and high test–retest reliability. Sunscreen use was high, sunburn was common, and knowledge and attitudes about sunscreen were modest. Most respondents did not know the specifics of the Hawaii Sunscreen Ban. In multivariate models, significant predictors of sunscreen use were being older, female, and having higher sunscreen knowledge. Sunscreen beliefs were not significantly associated with sunscreen use or sunburn. The findings support the use of the newly developed survey and suggest that more education about sunscreen and sunscreen ingredients is needed.

Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection - California, February-December 2021.

The use of face masks or respirators (N95/KN95) is recommended to reduce transmission of SARS-CoV-2, the virus that causes COVID-19 (1). Well-fitting face masks and respirators effectively filter virus-sized particles in laboratory conditions (2,3), though few studies have assessed their real-world effectiveness in preventing acquisition of SARS-CoV-2 infection (4). A test-negative design case-control study enrolled randomly selected California residents who had received a test result for SARS-CoV-2 during February 18-December 1, 2021. Face mask or respirator use was assessed among 652 case-participants (residents who had received positive test results for SARS-CoV-2) and 1,176 matched control-participants (residents who had received negative test results for SARS-CoV-2) who self-reported being in indoor public settings during the 2 weeks preceding testing and who reported no known contact with anyone with confirmed or suspected SARS-CoV-2 infection during this time. Always using a face mask or respirator in indoor public settings was associated with lower adjusted odds of a positive test result compared with never wearing a face mask or respirator in these settings (adjusted odds ratio [aOR]=0.44; 95% CI = 0.24-0.82). Among 534 participants who specified the type of face covering they typically used, wearing N95/KN95 respirators (aOR=0.17; 95% CI = 0.05-0.64) or surgical masks (aOR=0.34; 95% CI = 0.13-0.90) was associated with significantly lower adjusted odds of a positive test result compared with not wearing any face mask or respirator. These findings reinforce that in addition to being up to date with recommended COVID-19 vaccinations, consistently wearing a face mask or respirator in indoor public settings reduces the risk of acquiring SARS-CoV-2 infection. Using a respirator offers the highest level of personal protection against acquiring infection, although it is most important to wear a mask or respirator that is comfortable and can be used consistently.

Ready to Stay: A Comprehensive Analysis of the US Foreign-Born Populations Eligible for Special Legal Status Programs and for Legalization Under Pending Bills

Ready to Stay: A Comprehensive Analysis of the US Foreign-Born Populations Eligible for Special Legal Status Programs and for Legalization Under Pending Bills

Review: Fire in Paradise: An American Tragedy, by Alastair Gee and Dani Anguiano

Review: Fire in Paradise: An American Tragedy, by Alastair Gee and Dani Anguiano

Sexual Violence Associated With Sexual Identity and Gender Among California Adults Reporting Their Experiences as Adolescents and Young Adults

Disproportionate levels of violence exist in lesbian, gay, bisexual, queer, asexual, and other sexual identity (LGBQA+) communities, often starting in adolescence and young adulthood, but little research exists on the range of sexual violence (SV) experiences. To assess risk of experiences of sexual violence among California LGBQA+ adults during adolescence and young adulthood. This survey study analyzed data from Cal-VEX 2020, a state-representative survey of California residents aged 18 years and older, to assess associations between LGBQA+ identification and types of SV experienced in adolescence (ages 13-17 years) and young adulthood (ages 18-24 years) using gender-stratified adjusted logistic regression. Forms of SV included verbal, cyber, and coercion or physically aggressive sexual harassment; homophobic or transphobic slurs; and forced sex. Sexual identity. The outcome of interest was experiences with any 5 forms of sexual violence (verbal sexual harassment, homophobic or transphobic slurs, cyber sexual harassment, sexual coercion or physically aggressive sexual harassment, and forced sex) during adolescence or young adulthood. A total of 2102 contacted individuals (response rate, 26.2%) completed the Cal-VEX survey and were included in these analyses. Among these, the mean (SD) age was 46.6 (17.7) years, 1149 identified as female, 953 identified as male, and 214 respondents (9.6%) identified as LGBQA+. Compared with heterosexual individuals, LGBQA+ individuals had significantly higher odds of having experienced homophobic or transphobic slurs (women: AOR, 14.65; 95% CI, 5.14-41.77; men: AOR, 14.17; 95% CI, 6.96-28.86) and forced sex (women: AOR, 5.35; 95% CI, 2.74-10.43; men: AOR, 2.68; 95% CI, 1.01-7.10) in adolescence. LGBQA+ women also had higher odds of having experienced verbal and coercion or physically aggressive sexual harassment in adolescence (AOR, 2.33; 95% CI, 1.30-4.19). In young adulthood, LGBQA+ individuals also had higher odds of having experienced homophobic or transphobic slurs (women: AOR, 18.58; 95% CI, 7.12-48.49; men: AOR, 16.73; 95% CI, 8.26-33.92) in young adulthood. LGBQA+ men also had higher odds of having experienced homophobic or transphobic slurs (AOR, 16.73; 95% CI, 8.26-33.92); verbal (AOR, 3.29; 95% CI, 1.44-7.53), cyber (AOR, 6.32; 95% CI, 1.50-26.52), and coercion or physically aggressive (AOR, 5.54; 95% CI, 2.08-14) sexual harassment; and forced sex (AOR, 21.26; 95% CI, 5.63-80.35) in young adulthood. This survey study found that adult LGBQA+ individuals were at increased risk for having experienced SV across the continuum during adolescence and young adulthood, consistent with prior research. Multifold solutions are needed to support LGBQA+ youth, including altering social norms accepting SV and homophobia, creating safer schools and other institutional environments, and supporting healthy sexual and romantic partnerships.

Conserving for the common good: Preferences for water conservation policies during a severe drought in Northern California

During the 2011–2017 drought in California, water providers used a variety of demand-side management (DSM) policies to successfully reduce water consumption by over 20%. Unfortunately, because utilities used numerous conservation policies simultaneously, little is known about support for specific policies—specifically, an untested water-budgeting policy wherein utilities gave households an allotment of water and charged higher prices for water used in excess of the budget. California recently legislated mandatory long-term reductions in water usage. It is therefore critical to obtain a better understanding of which policies, including water budgeting, have strongest public support, and to understand how the drought experience changed residents' water use behaviors, attitudes, beliefs, habits, and personal capabilities surrounding conservation. This work surveyed individuals residing in northern California, the “North State,” during a period of severe drought. We used best-worst scaling to determine households’ preferences for DSM policies; asked households how their water use behaviors changed; and evaluated psychological attitudes toward drought and water conservation. Results show the vast majority of households changed their water use behaviors during the drought. Over two-thirds of respondents never exceeded their water budgets and said they would continue to conserve after the state lifted conservation requirements. Respondents preferred water budgets relative to more familiar DSM policies, a result with implications for forecasting future water demand. Last, our survey finds only minor differences in policy preferences for respondents with different demographics and attitudes toward water use, even for variables (e.g., income) that previous literature has found to have disparate welfare effects across users. • A majority of Californians changed their water-use behaviors during severe drought. • Northern California residents support using novel water budgets over voluntary conservation or watering restrictions. • Sociodemographic/psychological differences had little effect on conservation support.

Setting the agenda in environmental crisis: Relationships between tweets, Google search trends, and newspaper coverage during the California drought.

Nuanced public responses to droughts and other chronic environmental crises reflect today’s increasingly complex communication ecosystem. At once global and infinitely customizable, this vast array of media and information channels requires existing theory to address the implications of interactions among social media, “traditional” mass media outlets, and information-seeking tools such as search engines. How do these channels intervene in public conversation? What might the agenda-setting perspective have to say? Data collected during peak years of the California drought, 2013–2015, indicate that California residents responded to worsening drought conditions Twitter first, which was the only media behavior directly stimulated by environmental stressors. Google searches stimulated newspaper coverage and Twitter activity, revealing the centrality of search behaviors in this environmental crisis. The findings suggest significant changes to the communication landscape as individual and collective users become increasingly dependent on non-mainstream media channels for information in chronic crisis situations.

Sociodemographic Characteristics, Comorbidities, and Mortality Among Persons Diagnosed With Tuberculosis and COVID-19 in Close Succession in California, 2020

Tuberculosis (TB) and COVID-19 are respiratory diseases that disproportionately occur among medically underserved populations; little is known about their epidemiologic intersection. To characterize persons diagnosed with TB and COVID-19 in California. This cross-sectional analysis of population-based public health surveillance data assessed the sociodemographic, clinical, and epidemiologic characteristics of California residents who were diagnosed with TB (including cases diagnosed and reported between September 3, 2019, and December 31, 2020) and COVID-19 (including confirmed cases based on positive results on polymerase chain reaction tests and probable cases based on positive results on antigen assays reported through February 2, 2021) in close succession compared with those who were diagnosed with TB before the COVID-19 pandemic (between January 1, 2017, and December 31, 2019) or diagnosed with COVID-19 alone (through February 2, 2021). This analysis included 3 402 713 California residents with COVID-19 alone, 6280 with TB before the pandemic, and 91 with confirmed or probable COVID-19 diagnosed within 120 days of a TB diagnosis (ie, TB/COVID-19). Sociodemographic characteristics, medical risk factors, factors associated with TB severity, and health equity index. Frequency of reported successive TB and COVID-19 (TB/COVID-19) diagnoses within 120 days, frequency of deaths, and age-adjusted mortality rates. Among the 91 persons with TB/COVID-19, the median age was 58.0 years (range, 3.0-95.0 years; IQR, 41.0-73.0 years); 52 persons (57.1%) were male; 81 (89.0%) were born outside the US; and 28 (30.8%) were Asian or Pacific Islander, 4 (4.4%) were Black, 55 (60.4%) were Hispanic or Latino, 4 (4.4%) were White. The frequency of reported COVID-19 among those who received a TB diagnosis between September 3, 2019, and December 31, 2020, was 225 of 2210 persons (10.2%), which was similar to that of the general population (3 402 804 of 39 538 223 persons [8.6%]). Compared with persons with TB before the pandemic, those with TB/COVID-19 were more likely to be Hispanic or Latino (2285 of 6279 persons [36.4%; 95% CI, 35.2%-37.6%] vs 55 of 91 persons [60.4%; 95% CI, 49.6%-70.5%], respectively; P < .001), reside in low health equity census tracts (1984 of 6027 persons [32.9%; 95% CI, 31.7%-34.1%] vs 40 of 89 persons [44.9%; 95% CI, 34.4%-55.9%]; P = .003), live in the US longer before receiving a TB diagnosis (median, 19.7 years [IQR, 7.2-32.3 years] vs 23.1 years [IQR, 15.2-31.5 years]; P = .03), and have diabetes (1734 of 6280 persons [27.6%; 95% CI, 26.5%-28.7%] vs 42 of 91 persons [46.2%; 95% CI, 35.6%-56.9%]; P < .001). The frequency of deaths among those with TB/COVID-19 successively diagnosed within 30 days (8 of 34 persons [23.5%; 95% CI, 10.8%-41.2%]) was more than twice that of persons with TB before the pandemic (631 of 5545 persons [11.4%; 95% CI, 10.6%-12.2%]; P = .05) and 20 times that of persons with COVID-19 alone (42 171 of 3 402 713 persons [1.2%; 95% CI, 1.2%-1.3%]; P < .001). Persons with TB/COVID-19 who died were older (median, 81.0 years; IQR, 75.0-85.0 years) than those who survived (median, 54.0 years; IQR, 37.5-68.5 years; P < .001). The age-adjusted mortality rate remained higher among persons with TB/COVID-19 (74.2 deaths per 1000 persons; 95% CI, 26.2-122.1 deaths per 1000 persons) compared with either disease alone (TB before the pandemic: 56.3 deaths per 1000 persons [95% CI, 51.2-61.4 deaths per 1000 persons]; COVID-19 only: 17.1 deaths per 1000 persons [95% CI, 16.9-17.2 deaths per 1000 persons]). In this cross-sectional analysis, TB/COVID-19 was disproportionately diagnosed among California residents who were Hispanic or Latino, had diabetes, or were living in low health equity census tracts. These results suggest that tuberculosis and COVID-19 occurring together may be associated with increases in mortality compared with either disease alone, especially among older adults. Addressing health inequities and integrating prevention efforts could avert the occurrence of concurrent COVID-19 and TB and potentially reduce deaths.

Stated Preference Analysis of Automated Vehicles among California Residents Using Probabilistic Inferences

As technology advances, improvements in the way people travel also occur. In 2017, the National Renewable Energy Laboratory (NREL) conducted a travel survey in California to understand residents’ perception of several aspects of mobility. This study used the data collected by NREL to understand various factors associated with safety perceptions and acquisition of automated vehicles among California residents. Bayesian networks (BNs) were used to learn the probabilistic interrelationships between aspects of automated vehicles. The predicted probabilities for safety concerns about vehicles with full driving automation (FAVs), purchase of vehicles with auto-drive assistance, and purchase of FAVs were determined after learning the BN structure and parameters from the data. The study found a strong relationship between the acquisition of automated vehicles and vehicles with auto-drive assistance. The BN model predicted that residents who are interested in purchasing vehicles with auto-drive assistance also have about 95% likelihood of purchasing FAVs. Moreover, ridesharing, number of vehicles in the household, housing type, and plug-in electric vehicle (PEV) ownership are among other factors playing a great role in the acquisition and safety perception of automated vehicles. Residents who are currently participating in ridesharing and living in apartments are more likely to purchase vehicles with auto-drive assistance. Residents who either own a PEV or have three or more vehicles are more likely to have safety concerns about FAVs. Additionally, residents who do not have safety concerns about FAVs have about a 45% likelihood of purchasing them. These results could provide valuable user opinion information for vehicle developers and other stakeholders.

Risk factors for hyperthermia mortality among emergency department patients

PurposeThis study examines risk factors for heat-related mortality due to hyperthermia in emergency department patients, a vulnerable population. MethodsThis matched case-control study used statewide, longitudinally linked emergency department (ED) data and death records from California. Cases comprised California residents (≥18 years) who presented to a state-licensed ED and died of hyperthermia during the study period (2009–2012). For each case, up to five ED patients were randomly selected as live controls and matched on sex and age. Patients’ demographic characteristics and history of ED utilization for alcohol use, drug use, psychiatric disorders, heart-related conditions, chronic respiratory disease, neurodegenerative disorders, and cerebrovascular disease were assessed in relationship to hyperthermia mortality. ResultsUsing multivariate conditional logistic regression models, hyperthermia mortality cases had higher odds of prior ED utilization for alcohol use (OR = 11.16, 95% CI = 3.87, 32.17) compared to controls. Cases were also more likely than controls to have Medicare insurance (OR = 5.80, 95% CI = 1.70, 15.15) or self-pay (OR = 5.39, 95% CI = 1.73, 16.79), at their most recent ED visit. ConclusionsED patients presenting with alcohol problems may face increased risk of hyperthermia mortality. To help reduce heat-related mortality, EDs should consider interventions that target patients vulnerable to heat exposure.

Rooftop solar in the United States: Exploring trust, utility perceptions, and adoption among California homeowners

The transition to a more sustainable grid is likely to involve residential customers who make decisions about whether or not to install solar panels on their property. It will require that utilities engage customers in order to effectively manage the demand and supply of electricity. This means that relationships between customers and utilities are key to the future electric grid. Although industry consultants are increasingly drawing attention to the importance of customer trust in their utility, little research examines the issue. Using an exploratory sequential mixed methods design, we draw on semi-structured interviews conducted with 61 California residents and analyzed with line-by-line coding to identify the main themes related to people’s perceptions of their utility company and their interest in solar energy. The interview results helped to inform the development of a survey conducted with California homeowners (N = 3402) and analyzed using a series of logistic regressions to quantitively assess the role of distrust. The findings from the two sets of data are complementary. Together they show that people who distrust their utility are more likely to be interested in and to have rooftop solar panels. Our findings have implications for the successful transition to a more sustainable grid.

PD47-04 NATIVITY AND BLADDER CANCER OUTCOMES IN MULTI-ETHNIC POPULATIONS: A CALIFORNIA CANCER REGISTRY ANALYSIS

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II (PD47)1 Sep 2021PD47-04 NATIVITY AND BLADDER CANCER OUTCOMES IN MULTI-ETHNIC POPULATIONS: A CALIFORNIA CANCER REGISTRY ANALYSIS Sumeet Bhanvadia, Unwanaobong Nseyo, Sidney Roberts, Ziwei Song, Lihua Liu, Inderbir Gill, Siamak Daneshmand, and Mariana C. Stern Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Sidney RobertsSidney Roberts More articles by this author , Ziwei SongZiwei Song More articles by this author , Lihua LiuLihua Liu More articles by this author , Inderbir GillInderbir Gill More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , and Mariana C. SternMariana C. Stern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002069.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While racial disparities in bladder cancer (BC) outcomes have been described, it is unclear to what degree foreign-born status contributes to disparities among racial/ethnic minorities. We investigated clinical characteristics and survival patterns for bladder cancer (BC) among various racial/ethnic groups, factoring in nativity as compared to non-Latino Whites (NLW). METHODS: We used data from the California Cancer Registry (1995-2017) to identify BC cases among California residents diagnosed between January 1, 1977 and December 31, 2017. Latino status and country of origin were identified by the NAACCR Hispanic Identification Algorithm (NHIA) and birthplace variable. Nativity (US-born versus foreign-born) was defined based on birthplace information. Cox regression modeling was performed to determine overall cancer-specific mortality (CSM) adjusting for sex, age, stage, treatment, SES, nativity and insurance type, using non-Latino white (NLW) as the reference. RESULTS: We identified a total of 141,083 cases of all stages/grades of BC: 113461 NLW (80.4%), 13,310 Latinos (9.4%), 8529 Asians (6.0%), and 5783 non-Latino Blacks (NLB) (4.1%). Foreign-born (FB) Asians and Latinos represented 81.1% and 52.6% of their total populations, respectively. Relative to NLW, Latinos and Asians had worse clinical characteristics in terms of higher stage at presentation, tumor size, and longer time interval before treatment. FB members of both racial/’ethnic groups were more likely to be of low SES, uninsured, married, and older at diagnosis. FB Asians had higher rates of nodal and metastatic disease at presentation compared to US-born Asians. While FB Latinos (10.3%) presented at a higher stage relative to US Latinos (9.1%), there was a greater frequency of FB Latinos receiving no treatment. On adjusted regression analysis, US Latinos had the highest risk of dying of BC and FB individuals fared better than their US-born counterparts. CONCLUSIONS: Differences in BC incidence, treatment patterns and surgical outcomes were observed between FB and US-born populations among Latinos and Asians. Despite higher prevalence of adverse characteristics among FB Latinos, US-born Latinos had the worst survival outcomes. This study highlights the need for more in-depth study of outcomes within racial/ethnic subgroups. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e833-e834 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumeet Bhanvadia More articles by this author Unwanaobong Nseyo More articles by this author Sidney Roberts More articles by this author Ziwei Song More articles by this author Lihua Liu More articles by this author Inderbir Gill More articles by this author Siamak Daneshmand More articles by this author Mariana C. Stern More articles by this author Expand All Advertisement Loading ...

Towards epigenomic and metabolomic profiles of chronic organophosphate exposure in residents of California’ Central Valley

BACKGROUND AND AIM: Organophosphates (OP) are widely used in the agricultural Central Valley region of California. This study aimed to elucidate metabolomic and epigenetic changes induced by chronic ambient OP exposure, as well as possible interactions between different molecular layers. METHODS: We conducted high-resolution metabolomic profiling (liquid chromatography with high-resolution mass spectrometry) and genome-wide DNA methylation profiling (Illumina 450 k) of blood samples from 176 older adults living in the California Central Valley. Cumulative OP exposure from ambient sources at homes and workplaces over a ten-year period was estimated using a geographic information system (GIS)-based model. Biweighted midcorrelation (bicor) and partial least squares regression were used to identify metabolomic features and CpGs associated with OPs. Potential confounders, including age, sex, race/ethnicity, education, and cell compositions, were adjusted a prior. Functional annotation and pathway enrichment analyses were conducted for biological interpretation. We also integrated the methylome and metabolome by investigating the correlation structures existing between OP-related CpGs and metabolites and all other features via bicor. RESULTS:The single-omic analyses showed both epigenomic and metabolomic signatures of OP as being enriched in the glycosphingolipid (GSL) biosynthesis pathway. Besides this common pathway, the metabolome and epigenome also exhibited distinct responses to OPs, with differently methylated CpGs being involved in intracellular membrane transport, cell adhesion, and carcinogenesis; and OP-related metabolites being involved in aromatic amino acids metabolism, neurotransmitter precursors, oxidative stress, and mitochondria function. Moreover, we illustrate possible interactions between these two molecular layers through metabolic processes and nutrient-sensing pathways when integrating the epigenomic and metabolomic signals. CONCLUSIONS:In summary, we linked GIS-modeled chronic low-level OP pesticide data with blood metabolomic and epigenomic data in an older adult population. Our findings suggest that it seems feasible to use multi-omics integration in studies of chronic environmental exposures in humans to better understand the pathophysiology involved in pesticide-related chronic health outcomes. KEYWORDS: Organophosphates, multi-omics, metabolomics, epigenomics, glycosphingolipid