California Survey Research Articles

Clinician care priorities and practices in the fourth trimester: perspective from a California survey

BackgroundProfessional societies such as the American College of Obstetricians and Gynecologists (ACOG) promote the idea that postpartum care is an ongoing process where there is adequate opportunity to provide services and support. Nonetheless, in practice, the guidelines ask clinicians to perform more clinical responsibilities than they might be able to do with limited time and resources.MethodsWe conducted an online survey among practicing obstetric clinicians (obstetrician/gynecologists (OB/GYNs), midwives, and family medicine doctors) in California about their priorities and care practices for the first postpartum visit and explored how they prioritize multiple clinical responsibilities within existing time and resources. Between September 2023 and February 2024, 174 out of 229 eligible participants completed the survey, a 76% response rate. From a list of care components, we used descriptive statistics to identify those that were highly prioritized by most clinicians and those that were considered a priority by very few and examined the alignment between prioritized components and recommended care practices.ResultsClinicians were highly invested in the care components that they rated as most important, indicating that they always check these components or assess them when they perceive patient need. Depression and anxiety, breast health/breast feeding issues, vaginal birth complications and family planning counseling were highly ranked components by all clinicians. In contrast, clinicians more often did not assess those care components that infrequently ranked highly among the priority listing, consisting mainly of social drivers of health such as screening and counseling for intimate partner violence, working conditions and food/housing insecurity. In both instances, we found little discordance between priorities and care practices. However, OB/GYNs and midwives differed in some care components that they prioritized highly.ConclusionsWhile there is growing understanding of how important professional society recommendations are for maternal-infant health, clinicians face barriers completing all recommendations, especially those components related to social drivers of health. However, what the clinicians do prioritize highly, they are likely to perform. Now that Medi-Cal (Medicaid) insurance is available in California for up to 12 months postpartum, there is a need to understand what care clinicians provide and what gaps remain.

Predicting COVID-19 Cases in Nursing Homes of California and Ohio: Does the Work Environment Matter?

The cross-sectional study evaluates if the pre-pandemic work environments in nursing homes predict COVID-19 cases among residents and staff, accounting for other factors. Leveraging data from a survey of California and Ohio nursing homes (n = 340), we examined if Workplace Integrated Safety and Health domains - Leadership, Participation, and Comprehensive and Collaborative strategies predicted cumulative COVID-19 cases among nursing home residents and staff. In Ohio, a 1-unit increase in Leadership score was associated with 2 fewer staff cases and 4 fewer resident cases. A 1-unit increase in Comprehensive and Collaborative Strategies score in California showed an average marginal effect of approximately 1 less staff case and 2 fewer resident cases. These findings suggest that leadership commitment and inter-department collaboration to prioritize worker safety, may have protected against COVID-19 cases in nursing homes.

Role of Obstetric Violence and Patient Choice: Factors Associated With Episiotomy.

In the United States, 1 in 6 women reports obstetric violence in the form of physical and verbal abuse, coercion, and lack of informed consent. Despite recommendations against routine episiotomy, its use in the United States remains notable and varies considerably. This study aimed to analyze the various forms of obstetric violence associated with undergoing an episiotomy and having a choice in undergoing an episiotomy. Data from the cross-sectional Listening to Mothers in California survey were analyzed using weighted sample. Logistic regression models were conducted to compute adjusted odds ratios (aORs) and 95% CIs for undergoing episiotomy and having a choice in it. Overall, 21% of the respondents reported undergoing an episiotomy, and 75% of them reported not having a choice in undergoing this procedure. After adjusting for covariates, feeling pressured to induce labor (aOR, 1.31; 95% CI, 1.28-1.35) and to use an epidural analgesia (aOR, 1.82; 95% CI, 1.77-1.88) increased the odds of undergoing an episiotomy. Having a midwife during childbirth significantly reduced the odds of an episiotomy. Respondents who indicated being handled roughly by health care providers were 95% less likely to have a choice in receiving an episiotomy (aOR, 0.05; 95% CI, 0.04-0.06). This is the first study to examine other forms of obstetric violence as correlates of episiotomy and having a choice in it. Standardized institutional measures against obstetric violence, patients' ability to make autonomous decisions through informed consent, and engaging midwives could decrease medically unnecessary labor procedures and associated complications.

Persistent effects of legal status on healthcare access and outcomes: findings from a state-wide representative cross-sectional survey in California

BackgroundTo examine how legal status and past undocumented status are associated with healthcare access and health outcomes.MethodsData were collected between 2018 and 2020 as a follow-on, cross-sectional survey to the...

Continuity of Clinician Type and Intrapartum Experiences During the Perinatal Period in California.

Continuity of care with an individual clinician is associated with increased satisfaction and better outcomes. Continuity of clinician type (ie, obstetrician-gynecologist or midwife) may also impact care experiences; however, it is unknown how common it is to experience discontinuity of clinician type and what its implications are for the birth experience. We aimed to identify characteristics associated with having a different clinician type for prenatal care than for birth and to compare intrapartum experiences by continuity of clinician type. For this cross-sectional study, data were from the 2017 Listening to Mothers in California survey. The analytic sample was limited to individuals with vaginal births who had midwifery or obstetrician-gynecologist prenatal care (N = 1384). Bivariate and multivariate analysis examined characteristics of individuals by continuity of clinician type. We then examined associations of clinician type continuity with intrapartum care experiences. Overall, 74.4% of individuals had the same type of clinician for prenatal care and birth. Of individuals with midwifery prenatal care, 45.1% had a different birth clinician type, whereas 23.5% of individuals who had obstetrician-gynecologist prenatal care had a different birth clinician type. Continuity of clinician type was positively associated with having had a choice of perinatal care clinician. There were no statistically significant associations between clinician type continuity and intrapartum care experiences. Findings suggest individuals with midwifery prenatal care frequently have a different type of clinician attend their birth, even among those with vaginal births. Further research should examine the impact of multiple dimensions of continuity of care on perinatal care quality.

Two Steps Forward, One Step Back: The Legal Response to Sex Trafficking

ABSTRACT In 2012, voters in California overwhelmingly supported the Californians Against Sexual Exploitation Act (CASE Act) which was designed to both fight human trafficking and protect the victims. Part of the protection for victims included the adoption of a safe harbor provision which prohibits evidence that victims committed a crime while being trafficked from being used against them in court. This study conducted a systematic survey of California appellate court decisions discussing the safe harbor provision. Relevant themes were identified and analyzed, including issues that victims face when seeking safe harbor protection and legal challenges raised by traffickers facing prosecution. Based on the results of this survey, safe harbor provisions continue to be a promising approach for protecting victims of sex trafficking that policymakers should continue to explore. Safe harbor provisions, however, have noteworthy limitations and highlight the importance of not relying so heavily on criminal prosecution to combat sex trafficking. Instead, jurisdictions are recommended to adopt comprehensive strategies that place more emphasis on prevention and protection.

Structural Factors in Health Care Associated With the Mental Health Needs of Black Women in California During the Perinatal Period

ObjectiveTo identify structural factors associated with the receipt of mental health care treatment among Black women in California during pregnancy and after childbirth. DesignSecondary analysis of data from the population-based Listening to Mothers in California survey. ParticipantsThe sample included 194 non-Latina Black women in the postpartum period. MethodsWe used descriptive statistics, including differences between means and logistic regression, to conduct a series of bivariate analyses. ResultsMost respondents (84.4%, n = 163) reported symptoms of perinatal mood and anxiety disorders prenatally, and half (50% n = 97) reported symptoms of perinatal mood and anxiety disorders in the postpartum period. Only 12.3% to 14.6% of those who reported symptoms received mental health care treatment. Furthermore, 21.2% (n = 38) of respondents were not screened for postpartum depression. Respondents with private insurance coverage were more likely to report receipt of mental health care after childbirth (OR = 4.6; 95% confidence interval [1.5, 13.5]) compared to respondents with public insurance coverage. ConclusionOur results suggest a high prevalence of unmet mental health needs among non-Latina Black women who lived in California during the perinatal period. Practitioners in clinical settings may be more likely to make referrals to mental health care for women with private insurance coverage in the postpartum period.

Discrimination during childbirth and postpartum care utilization among Black birthing people in California, United States.

The purpose of this study was to investigate the relationship between discrimination during childbirth hospitalization and postpartum care utilization among Black birthing people in California, United States. This was a secondary analysis of data from the Listening to Mothers in California survey, a population-based survey of individuals with a singleton hospital-based birth in California in 2016. The primary outcome was number of postpartum care visits. The primary exposures were racial, language, and insurance discrimination. A multiple linear regression model was used to estimate associations between discrimination and postpartum care use, adjusting for sociodemographic covariates. Black birthing people in the sample had an average of two postpartum visits. Almost 15% of the sample reported one or more forms of discrimination during hospital-based childbirth. In adjusted models, racial discrimination (β = 0.09, 95% CI = 0.04-0.14, p < 0.01) and language discrimination (β = 1.03, 95% CI = 0.98-1.07, p < 0.01) were associated with increased postpartum visits, while insurance discrimination was linked to decreased postpartum visits (β = -0.96, 95% CI = -1.04 to -0.89, p < 0.01). Among Black birthing people in California, the drivers of postpartum care utilization after childbirth are complex. There are multiple negative drivers (e.g., experiencing racial and language discrimination and unmet needs), barriers (e.g., insurance discrimination), and positive drivers (e.g., clinician type and education) that affect postpartum care utilization among Black birthing people.

Association between primary Spanish language and quality of intrapartum care among Latina women: a secondary analysis of the Listening to Mothers in California survey

BackgroundLanguage barriers play significant roles in quality of healthcare. Limited studies have examined the relationships between Spanish language and quality of intrapartum care. The objective was to determine the association between primary Spanish language and quality of intrapartum care so as to further inform best practices for non-English speaking patients in the labor and delivery setting.MethodsWe used the 2016 Listening to Mothers in California survey data, which included a statewide representative sample of women who gave birth in hospitals. Our analytical sample included 1202 Latina women. Multivariable logistic regression was used to examine the association between primary language (monolingual English vs. monolingual Spanish vs. bilingual Spanish/English) and perceived discrimination due to language, perceived pressure for medical interventions, and mistreatment during labor, adjusting for maternal sociodemographics and other maternal and neonatal factors.ResultsOver one-third of the study population spoke English (35.6%), less than one-third spoke Spanish (29.1%), and greater than one-third spoke bilingual Spanish/English (35.3%). Overall, 5.4% of Latina women perceived discrimination due to language spoken, 23.1% perceived pressure for any medical intervention, and 10.1% experienced either form of mistreatment. Compared to English-speakers, Spanish-speakers were significantly more likely to report discrimination due to language (aOR 4.36; 95% CI 1.15–16.59), but were significantly less likely to experience pressure for certain medical interventions (labor induction or cesarean delivery) during labor (aOR 0.34; 95% CI 0.15–0.79 for induction; aOR 0.44; 95% CI 0.18–0.97 for cesarean delivery). Bilingual Spanish/English-speakers also significantly reported discrimination due to language to a lesser extent than monolingual Spanish-speakers (aOR 3.37; 95% CI 1.12–10.13). Any form of Spanish language (monolingual or bilingual) was not significantly associated with mistreatment.ConclusionsSpanish language may contribute to experiences of discrimination during intrapartum care among Latina women. Future research is needed to explore perceptions of pressure, discrimination and mistreatment, among patients with limited English proficiency.

Factors Influencing the Types of Merchandise Purchased Online: Evidence From the 2018 California Survey of Emerging Transportation Trends

Understanding consumer preferences has become increasingly important with the growth of e-commerce. This study leverages the 2018 California Panel Study of Emerging Transportation Trends to analyze the factors that influence consumer decisions to purchase different merchandise online. Diffusion of innovations theory and efficient market hypothesis guide the execution of our research. According to our findings, two hypotheses can explain the links between neighborhood characteristics and online shopping frequency for different types of merchandise: 1) Physical books and DVDs, 2) E-books, digital movies, TV shows, 3) Clothing, shoes, 4) Groceries, fresh produce, flowers, and 5) Electronics. People's online purchasing behaviors are significantly influenced by sociodemographic traits. Online shopping is less popular among people who drive more frequently. The research results can provide valuable insights and help assess the impacts of e-shopping behaviors.

Importance of Accounting for Regional Differences in Modifiable Risk Factors for Alzheimer's Disease and Related Dementias: The Case for Tailored Interventions.

Background:We recently estimated that 36.9% of Alzheimer’s disease and related dementias (ADRD) cases in the US may be attributable to modifiable risk factors, but it is not known whether national estimates generalize to specific states or regions.Objective:To compare national estimates of modifiable risk factors of ADRD to California, overall and by sex and race/ethnicity, and to estimate number of cases potentially preventable by reducing the prevalence of key risk factors by 25%.Methods:Adults ≥18 years who participated in the Behavioral Risk Factor Surveillance Survey in California (n = 9,836) and the US (n = 378,615). We calculated population attributable risks (PARs) for eight risk factors (physical inactivity, current smoking, depression, low education, diabetes mellitus, midlife obesity, midlife hypertension, and hearing loss) and compared estimates in California and the U.S.Results:In California, overall, 28.9% of ADRD cases were potentially attributable to the combination of risk factors, compared to 36.9% in the U.S. The top three risk factors were the same in California and the U.S., although their relative importance differed (low education [CA:14.9%; U.S.:11.7% ], midlife obesity [CA:14.9%; U.S.:17.7% ], and physical inactivity [CA:10.3%; U.S.:11.8% ]). The number of ADRD cases attributable to the combined risk factors was 199,246 in California and 2,287,683 in the U.S. If the combined risk factors were reduced by 25%, we could potentially prevent more than 40,000 cases in California and 445,000 cases in the U.S.Conclusion:Our findings highlight the importance of examining risk factors of ADRD regionally, and within sex and race/ethnic groups to tailor dementia risk reduction strategies.

The role of doulas in respectful care for communities of color and Medicaid recipients.

Despite the tenets of rights-based, person-centered maternity care, racialized groups, low-income people, and people who receive Medicaid insurance in the United States experience mistreatment, discrimination, and disrespectful care more often than people with higher income or who identify as white. This study aimed to explore the relationship between the presence of a doula (a person who provides continuous support during childbirth) and respectful care during birth, especially for groups made vulnerable by systemic inequality. We used data from 1977 women interviewed in the Listening to Mothers in California survey (2018). Respondents who reported high levels of decision making, support, and communication during childbirth were classified as having "high" respectful care. To examine associations between respectful care and self-reported doula support, we conducted multivariable logistic regressions. Interactions by race/ethnicity and private or Medi-Cal (Medicaid) insurance status were assessed. Overall, we found higher odds of respectful care among women supported by a doula than those without such support (odds ratios [OR]: 1.4, 95% CI: 1.0-1.8). By race/ethnicity, the association was largest for non-Hispanic Black women (2.7 [1.1-6.7]) and Asian/Pacific Islander women (2.3 [0.9-5.6]). Doula support predicts higher odds of respectful care among women with Medi-Cal (1.8 [1.3-2.5]), but not private insurance. Doula support was associated with high respectful care, particularly for low-income and certain racial/ethnic groups in California. Policies supporting the expansion of doulas for low-income and marginalized groups are consistent with the right to respectful care and may address disparities in maternal experiences.

Spatiotemporal analysis of activity-travel fragmentation based on spatial clustering and sequence analysis

In this study using data from the 2017 National Household Travel Survey in California from 26,078 survey participants, sequence analysis is used to estimate a fragmentation indicator of people's daily schedules. Then, spatial clustering is used to find groups of observations with similarly high or low fragmentation using the longitude and latitude of their residential locations. This is followed by a hierarchical sequence clustering within each spatial cluster to identify distinct patterns of time allocation. Using the Local Indicator of Spatial Association (LISA) we find a large portion (approximately 30%) of the sample with significant spatial clustering of fragmentation. We also find systematic and significant differences in membership to these clusters based on land use, county of residence, household and personal characteristics, and travel modes used. Sequence analysis pattern recognition within LISA spatial clusters shows systematically repeating time allocation patterns that include typical work and school schedules as well as staying at home patterns. However, each spatial LISA cluster is composed of different time allocation clusters. All this analysis taken together points out substantial and measurable heterogeneity in spatial clustering of fragmentation and the need for customized policy actions in different geographies.

The Relationship between Social Support and Postnatal Anxiety and Depression: Results from the Listening to Mothers in California Survey.

Perinatal mood and anxiety disorders (PMADs) impact multiple domains of maternal and child well-being. Estimates of postpartum depressive symptoms range from 6.5% to 12.9% and from 8.6% to 9.9% for postpartum anxiety. We sought to identify the role social support could play in mitigating PMADs. The data are drawn from the Listening to Mothers in California survey; results are representative of women who gave birth in 2016 in a California hospital. The Patient Health Questionnaire-4 was used to assess total symptoms of PMADs and anxiety and depressive symptoms individually. Two questions adapted from the Medical Outcomes Study Social Support Survey were used to assess emotional, practical, and functional (combined) social support. After exclusions for missing data related to PMADs or social support, we analyzed data from 2,372 women. At the time of survey administration (mean 5.7months after birth), 7.0% of respondents reported elevated PMAD symptoms and 45.9% reported that they always received functional social support. In multivariable analysis, controlling for demographic and pregnancy-related factors and prenatal anxiety and depressive symptoms, women who reported consistent support had a prevalence of elevated PMAD symptoms one-half that of those who did not (adjusted odds ratio, 0.50; 95% confidence interval, 0.34-0.74). This study suggests that consistent social support serves as a robust protective factor against postpartum symptoms of PMADs. Because many predictors of PMADs are not modifiable, social support stands out as an important target for programmatic intervention, particularly in light of increased isolation related to the COVID-19 pandemic.

Mental Health and Postpartum Care in California: Implications from California's Provisional Postpartum Care Extension.

California's Provisional Postpartum Care Extension (PPCE) extended Medicaid eligibility through 1year postpartum for women enrolled in Medi-Cal with annual household incomes of 138%-322% of the federal poverty level and maternal mental health diagnoses. For this cross-sectional descriptive study, we used the 2017 Listening to Mothers in California survey of postpartum women to identify those potentially eligible for PPCE. We then sought to describe their demographic characteristics, self-reported mental health, and utilization of postpartum care and mental health services compared with those with Medi-Cal during pregnancy who did not meet PPCE eligibility criteria. Overall, potentially PPCE-eligible women comprised 6.8% of respondents. Among those who did not qualify for PPCE, the primary reason was the absence of self-reported maternal mental health symptoms. Potentially PPCE-eligible women were approximately two-thirds Hispanic/Latina and more than one-third were ages 25 to 29. The most common self-reported mental health symptom was anxiety during pregnancy (78.9%). Among potentially PPCE-eligible women, 8.4% were taking medicine for anxiety/depression postpartum and 16.0% were receiving postpartum counseling/treatment for emotional or mental well-being. Our analyses suggest that PPCE could have extended postpartum coverage eligibility for approximately 30,360 women statewide. However, our findings demonstrate how narrowly defined PPCE eligibility criteria likely excluded many postpartum women in Medi-Cal who would have been left with limited benefits or more cost-sharing under alternative coverage options. This research could inform state and federal policymakers considering other proposals to extend postpartum Medicaid eligibility.

Seismic fragility of approach backfill differential settlement for statewide bridges in California

This study develops the first-of-its-kind seismic fragility models for estimation of approach backfill differential settlement for statewide bridges in California. Seismic compression analysis is carried out through a multi-step framework that estimates seismic-induced shear strain profiles for backfills, converts them to volumetric strains, and computes soil settlement through depth integration. As a crucial step, three independent methods are advanced on a uniform basis to estimate soil shear strains under earthquake loading: a simplified one-dimensional (1D) Static approach, a 1D Dynamic method from site response analysis, and a two-dimensional (2D) Dynamic method that accounts for the trapezoidal shape of the bridge embankment. Subsequently, seismic fragility models are derived using the multiple-stripe analysis (MSA) approach that convolves the seismic demands of backfill settlement with capacity models for several broad groupings of approach-slab designs having different abutment and abutment-foundation types, and abutment-connection details. A survey of California's bridge inventory provides stochastic data inputs that quantify various sources of uncertainties in backfill profile, embankment geometry, and both approach slab and abutment designs. Finally, a combined fragility model is developed by considering an equal methodological contribution from each mentioned approach. The final fragility models suggest that the lowest differential-settlement fragility is achieved by combining regular abutments on spread footings with long-length approach slabs connected to the bridge abutment, while the worst case occurs where bridge abutments on deep foundations are not connected with abutting pavements. The proposed seismic fragility models offer a sound basis for first-order estimation of approach-fill differential settlement which may lead to reduced ride quality, traffic speed reductions, and in extreme cases, temporary roadway closure. These represent one of many seismic fragility models for the full range of bridge components needed for prioritizing seismic retrofit measures, facilitating post-hazard inspections and repair actions, as well as assessing the network mobility for resilience quantification.

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.

Racial inequities in the course of treating perinatal mental health challenges: Results from listening to mothers in California.

BackgroundConcern with depression during the perinatal period has resulted in multiple states enacting legislation to require universal screening of mothers for postpartum depression. Despite this concern, rates of women receiving mental health counseling during pregnancy and postpartum remain low. This study examines factors, especially inequities in race/ethnicity, associated with receiving perinatal mental health counseling.MethodsThis study draws on data from the Listening to Mothers in California survey of 2539 women, based on a representative sample of birth certificate files of women who gave birth in 2016. The survey included a series of mental health questions, based on the 4‐item Patient Health Questionnaire (PHQ‐4), and questions on the receipt of counseling, whether a practitioner asked respondents about their mental health, and whether the respondent was taking medications for anxiety or depression.ResultsWe found non‐Latina Black women to experience both higher rates of prenatal depressive symptoms and significantly lower use of postpartum counseling services and medications than non‐Latina White women. Among women with depressive symptoms, those asked by a practitioner about their mental health status reported a 46% rate of counseling compared with 20% who were not asked, and in a multivariable analysis, those asked were almost six times more likely (aOR 5.96; 95% CI 1.6‐21.7) to report counseling.DiscussionThese findings lend evidence to those advocating for state laws requiring universal screening for depressive symptoms to reduce inequities and help address the underuse of counseling services among all women with depressive symptoms, particularly women of color.

2018 Survey of antimicrobial drug use and stewardship practices in adult cows on California dairies: post-Senate Bill 27.

BackgroundA survey of California (CA) dairies was performed in spring 2018 to characterize antimicrobial stewardship practices, antimicrobial drug (AMD) use, and health management of adult cows on CA dairies since the implementation of the Veterinary Feed Directive (VFD) and the CA Senate Bill 27 (SB 27). Effective January 1, 2017, the U.S. Food and Drug Administration (FDA) implemented regulatory changes requiring veterinary oversight for therapeutic uses of medically-important antimicrobial drugs (MIADs) administered in feed (VFD) and water (veterinary prescription). Similarly, effective January 1, 2018, the CA legislature enacted California Food and Agricultural Code (FAC) 14400–14408, formerly known as Senate Bill 27 (SB 27) requiring veterinary prescriptions for all other dosage forms of MIADs.MethodsThe questionnaire consisted of 43 questions partitioned into three sections to assess herd information, management practices, and AMD use and perspectives. The questionnaire was mailed to 1,282 grade A licensed dairies in CA and 149 responses (11.6%) were collected from 19 counties across the three defined regions of CA: Northern CA (NCA), Northern San Joaquin Valley (NSJV), and Greater Southern CA (GSCA).ResultsMost dairies reported treating all dry cows with intramammary AMD and/or teat sealant at the end of a lactation (87.2%). In 92.3% of dairies, producers relied on the veterinarian for information about AMD used to treat cows. Treatment duration for cows treated with AMD was based on the drug manufacturer’s label and veterinarian’s instructions in most dairies (98.6%). Most respondents to the survey confirmed having a valid veterinarian-client-patient-relationship (VCPR) for their dairies (91.7%), participated in animal welfare audit programs (81.8%) and dairy quality assurance programs (52.9%). Approximately 98.6% respondents were aware that all uses of MIADs in livestock required a veterinary feed directive (VFD) or prescription and are no longer sold over-the-counter (OTC) in CA since January 1, 2018. Multiple factor analysis (MFA) was performed and identified seven components composed of 21 variables (questions) that explained 99.7% of the total variance in the data. Hierarchical cluster analysis on the principal coordinates of the MFA based on conventional dairy survey responses identified two clusters characterized as large conventional dairies (median herd size: 1,265 cows) and mid-sized conventional dairies (median herd size: 715 cows) mostly in GSCA and NSJV. The organic dairies grouped into a single cluster of median herd size of 325 cows mostly in NCA.ConclusionsThe survey results contribute to the knowledge of AMD use and antimicrobial stewardship practices on CA dairies since the implementation of the SB 27 and VFD laws and provide useful information for future evaluation of resistance-related risk in adult cows.

Toward a Nuanced and Contextualized Understanding of Undocumented College Students: Lessons from a California Survey

ABSTRACT Prior research has established that undocumented immigrant experiences are dynamic, reflecting the complex web of immigration-related policies that create legal vulnerability. As such, undocumented college students’ experiences must be situated in their current policy context. Drawing on descriptive analyses of a survey of 1,277 undocumented 4-year college students in California, we examine how undocumented students are faring in a relatively inclusive policy context. Results demonstrate the heterogeneity of undocumented student experiences and unpack the challenges they confront while also demonstrating the ways they thrive. We document how respondents are performing across a variety of academic, well-being, and civic and political engagement outcomes. We also show that undocumented students’ perceptions of legal vulnerability are complex and varied, taking into account family-level legal vulnerability and individual protections. Further, students perceive campuses as fairly welcoming spaces, with some differences arising across the two university systems. Ultimately, we argue that undocumented college students’ experiences merit more nuanced and contextualized analysis.