Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CALIFORNIA”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed2006

Estimation of future outflows and infrastructure needed to recycle personal computer systems in California.

The objectives of the present study are to estimate future quantities of electronic waste (e-waste) for which appropriate infrastructure needs to be established, and to the estimate the total cost for e-waste recycling in California. Estimation of the future amounts of e-waste as a function of time is critical to effective e-waste management. To generate estimates, we use a time-series materials flow analysis model (MFAM). The model estimates future e-waste quantities by modeling the stages of production, usage, and disposal. We consider four scenarios for the estimation of future e-waste generation in order to consider the effects of exportation outside the State of California and of user preferences to store or to recycle the e-waste. These efforts were further investigated through the use of sensitivity analysis. The results of the present research indicate that the outflow (recycling) amount of central processing units (CPUs) will increase and will reach approximately 8.5 million units per year in 2013, but the outflow (recycling) of cathode ray tube (CRT) monitors will decrease from 2004 in California because of the replacement of CRT monitors by liquid crystal display (LCD) monitors. In 2013, the cost for CPU recycling will be 1.7 times higher than that in 2005. But for CRT monitors, the cost for recycling in 2013 will be negligible. After the State of California enacted the ban on landfill disposal of e-waste, recycling became the most common end-of-life (EOL) option in California. Also, after 2005, the State of California will need more than 60 average-capacity materials recovery facilities (MRFs), to recycle the number of personal computer systems generated, which represents an investment in capital of over 16 million dollars.

California↗
PubMed2006

Trends in the in-hospital stroke rate following carotid endarterectomy in California and Maryland.

OBJECTIVE: We examined the outcome of carotid endarterectomy (CEA) in the state of Maryland during the last decade to identify any trends in the incidence of in-hospital stroke and mortality and compared these results with the outcome of the operation throughout the state of California as a control population. METHOD: We performed a retrospective analysis of 10 years (1994 to 2003) of the Maryland and 5 years (1999 to 2003) of the California hospital discharge databases. The following patients were included in the analysis: (1) International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code 38.12 (endarterectomy of the vessels of the head and neck other than intracranial vessels) in the primary coding position but not in any secondary position, or (2) the diagnosis code 433.00 to 433.91 (occlusion/stenosis, precerebral artery), or (3) the diagnosis-related group (DRG) 5 (extracranial vascular procedure). Symptomatic patients were identified by history of previous stroke (ICD-9 codes 342 or 438), transient ischemic attack (435 or 781.4), or amaurosis fugax (362.34 or 368.12). In-hospital strokes were identified by ICD-9 codes 997.0, 997.00, 997.01, and 997.09. Low-, moderate-, and high-volume surgeons were defined as performing <15, 15 to 74 and >or=75 CEAs annually. Hospital volumes were similarly classified as low for those performing 100 annually. RESULTS: In the Maryland data, 23,237 CEA cases were identified with 169 in-hospital strokes over 10 years (0.73%), whereas the 51,331 California CEAs had 232 in-hospital strokes over 5 years (0.45%). The stroke rate in Maryland was 2.12% in 1994, 1.47% in 1995, and 0.29% to 0.65% from 1996 to 2003. The decrease in strokes was more pronounced among symptomatic patients, where the rate was 3.82% in 1994, 4.44% in 1995, and 0.90% to 2.29% from 1996 to 2003. A similar decrease was identified in the asymptomatic patient population but was less pronounced: 1.64% in 1994, 0.81% in 1995, and 0.15% to 0.44% from 1996 to 2003. The low recent stroke rates were confirmed by the California data (0.44% to 0.48% from 1999 to 2003). Changes in the death rate for CEA during this time frame have not been as pronounced, from 0.33% to 0.58% for Maryland and 0.78% to 0.91% for California. CONCLUSIONS: A dramatic decrease in the in-hospital stroke rates in Maryland occurred around 1995. The stroke rates in Maryland in the past 5 years are similar to those in California during the same period. An analysis of data from the two states shows that the in-hospital stroke rate now for carotid endarterectomy is approximately 0.54%.

Adult↗
PubMed2001

Adoption of the AHCPR Clinical Practice Guideline for Smoking Cessation: a survey of California's HMOs.

OBJECTIVE: Our objective was to assess the degree to which health maintenance organizations (HMOs) and Medicaid managed care (MMC) plans in California have adopted the 1996 AHCPR Clinical Practice Guideline for Smoking Cessation. (AHCPR [U.S. Agency for Health Care Policy and Research] was renamed AHRQ [Agency for Healthcare Research and Quality] in 1999.) METHODS: A fax survey of 13 licensed HMOs and 21 MMC plans operating in California in 1999 with up to 10 follow-up contacts by telephone, mail, fax, and/or electronic mail. RESULTS: Awareness of the AHCPR guideline is widespread, and all HMOs in California in 1999 offered coverage for at least one treatment for smoking cessation. We found that 77% of the HMOs in California were aware of the AHCPR guideline, but less than half had used it to design benefits or distribute treatment guidelines to medical care providers in their networks. While only 23% of California HMOs covered the nicotine patch or gum, 69% covered at least one form of the pharmacotherapy and one type of counseling to treat tobacco dependence. In addition, a majority of the HMOs and MMC plans inform their members about coverage for smoking cessation treatments and inform providers about their role in helping smokers to quit. CONCLUSION: Considerable progress has been made in increasing access to effective smoking cessation treatments in California's managed care organizations over the last 10 years. Future efforts and research must concentrate on: (1) adopting the 2000 Public Health Service Clinical Practice Guideline on Treating Tobacco Use and Dependence, (2) increasing purchaser demand for coverage of tobacco dependence treatments, (3) increasing health plan documentation and monitoring of member smoking status, and (4) increasing provider provision of effective tobacco dependence treatments.

California↗
PubMedDate not supplied

Education and practice partnerships in California.

As the most populous state in the United States, California often serves as a bellwether of events to come. The following describes nursing work force issues in California, examples of how nurse educators are responding to health care system changes, and how practice colleagues are joining educators to prepare nurses for meeting the health needs of the people of California. The discussion begins with historical perspectives from the late 1980s to the present, the founding of the California Strategic Planning Committee for Nursing and its work, the Robert Wood Johnson Colleagues in Caring project for developing a master plan for nursing in California, and examples of existing programs in California that serve as models for preparing the best care providers to meet the health care needs of the population.

California↗
PubMed2003

Improvements in prenatal insurance coverage and utilization of care in California: an unsung public health victory.

OBJECTIVE: To examine trends in prenatal insurance coverage and utilization of care in California over two decades in the context of expansions in Medi-Cal (California's Medicaid) and other public efforts to increase prenatal care utilization. METHODS: Retrospective univariate and bivariate analysis of prenatal care coverage and utilization data from 10,192,165 California birth certificates, 1980-99; descriptive analysis of California poverty and unemployment data from the U.S. Census Bureau Current Population Survey; review of public health and social policy literature. RESULTS: The proportion of mothers with Medi-Cal coverage for prenatal care increased from 28.2 to 47.5% between 1989 and 1994, and the proportion uninsured throughout pregnancy decreased from 13.2 to 3.2%. Since the mid-1990s, fewer than 3% of women have had no insurance coverage for prenatal care. Between 1989 and 1999, the proportion of women with first trimester initiation of prenatal care increased from 72.6 to 83.6%, reversing the previous decade's trend, and the proportion of women with adequate numbers of visits rose from 70.7 to 83.1%. Improvements in utilization measures were greater among disadvantaged social groups. Improvements in California during the 1990s coincided with a multifaceted public health effort to increase both prenatal care coverage and utilization, and do not appear to be explained by changes in the economy, maternal characteristics, the overall organization/delivery of health care, or other social policies. CONCLUSIONS: While this ecologic study cannot produce definitive conclusions regarding causality, these results suggest an important victory for public health in California.

Adolescent↗
PubMedDate not supplied

Correlation analysis of pesticide use data and cancer incidence rates in California counties.

California, the leading agricultural state in the United States, has maintained a population-based cancer registry since 1988, and it also maintains a comprehensive, state-wide pesticide reporting system. Data on cancer incidence and pesticide use reporting are available, by county, for all 58 counties in California. Average annual age-adjusted cancer incidence rates (1988-1992), on a county-, sex-, and race/ethnicity-specific basis, were obtained from the California Cancer Registry (CCR), which maintains the population-based cancer registry throughout California. Pesticide use data (i.e., pounds of active ingredient applied annually in each county) were obtained from the California Department of Pesticide Regulation for 1993. Investigators used Pearson product-moment correlation coefficients (r) to correlate age-adjusted incidence rates for selected cancers with the use data for selected pesticides. For most sex- and race/ethnicity-specific groups, the correlation coefficients were very close to zero or negative in sign, indicating no correlation between pesticide use and cancer incidence. There were, however, several exceptions, particularly in Hispanic males for whom the following correlations were observed: leukemia and atrazine (r=.40), leukemia and 2,4-dichlorophenoxyacetic acid (r=.41), leukemia and captan (r=.46), atrazine and brain cancer (r=.54), and atrazine and testicular cancer (r=.41). For black males, we observed the following: atrazine and prostate cancer (r=.67) and Captan and prostate cancer (r=.49). In females, only a few of the correlations were elevated. Although most of the correlations examined in this analysis were not elevated, several of those in the Hispanic and black male populations were. These segments of the population have traditionally been employed as farm workers in California and have had the greatest potential for exposure to pesticides. This was an ecological study for which no data about exposure to pesticides at the individual level were available for analysis. In addition, no latency period was allowed between potential exposure and diagnosis with cancer. However, the results obtained in two minority groups who represented the majority of farm workers in the fields suggested that additional research studies, in which more rigorous study designs are used, should be conducted in those groups.

Age Distribution↗
PubMed1997

An analysis of Michigan and California CO remote sensing measurements.

Remote sensing measurements of CO emissions from onroad vehicles were made in California in 1991 and in Michigan in 1992. It was determined that both fleets had a small linear increase in the high emitter frequency (vehicles emitting more than 4% CO) as a function of vehicle age for 1986 and newer model vehicles. Although high emitting vehicles were only a small minority of the fleet, they had a dominant impact on the mean CO and total CO emitted by the fleet. In Michigan, the highest emitting 5% of passenger cars generated 45% of the CO from cars. In California, the highest emitting 5% of passenger cars generated 38% of the CO from cars. There was a high correlation between the mean CO emitted by each model year of vehicle and the frequency of high emitting vehicles within the model year for both the Michigan and California fleets. The frequency of high emitters within any model year had no obvious relation to that model year's certification standards. The high emitter frequencies for vehicles less than nine years old were very similar for the California and Michigan fleets. An increase in the high emitter frequency in the ten-year-old and older Michigan passenger car fleet (relative to the California passenger car fleet), suggests, but does not conclusively demonstrate, that the rate of high emitters in Michigan and California is reduced by the inspection and maintenance (I/M) programs.

Automobiles↗
PubMed2003

Particulate matter in California: part 1--Intercomparison of several PM2.5, PM10-2.5, and PM10 monitoring networks.

It will be many years before the recently deployed network of fine particulate matter with an aerodynamic diameter less than 2.5 microm (PM2.5) Federal Reference Method (FRM) samplers produces information on nonattainment areas, trends, and source impacts. However, data on PM2.5 and its major constituents have been routinely collected in California for the past 20 years. The California Air Resources Board operated as many as 20 dichotomous (dichot) samplers for PM2.5 and coarse PM (PM10-2.5). The California Acid Deposition Monitoring Program (CADMP) collected 12-h-average PM2.5 and PM10 from 1988 to 1995 at ten urban and rural sites and 24-h-average PM2.5 at five urban sites since 1995. Beginning in 1994, the Children's Health Study collected 2-week averages of PM2.5 in 12 communities in southern California using the Two-Week Sampler (TWS). Comparisons of collocated samples establish relationships between the dichot, CADMP, and TWS samplers and the 82-site network of PM2.5 FRM samplers deployed since 1999 in California. PM mass data from the different monitoring programs have modest to high correlation to FRM mass data, fairly small systematic biases and negative proportional biases ranging from 7 to 22%. If the biases are taken into account, all of the programs should be considered comparable with the FRM program. Thus, historical data can be used to develop long-term PM trends in California.

Air Pollutants↗
PubMed1999

Temporal and spatial genetic variation within and among populations of the mosquito Culex tarsalis (Diptera: Culicidae) from California.

The genetic structure of 11 populations of Culex tarsalis Coquillett from California and 1 population from Nevada was examined at 18 loci using polyacrylamide gel electrophoresis. Six populations from northern and southern California were sampled repeatedly to determine if the genetic structure of Cx. tarsalis changes seasonally. Significant differences in allele frequencies at 13 different loci were seen in 3 populations over time as determined by contingency chi-square tests. Nei's genetic distance coefficients among different sampling dates was consistently < 0.025. The number of alleles per locus in these populations ranged from 1.6 to 2.7, whereas the average heterozygosity ranged from 0.086 to 0.228. No single locus was found to vary in a consistent pattern within all populations that were sampled repeatedly. These results indicate that Cx. tarsalis populations are genetically stable over time and that temporal variation is due to fluctuations in population size or immigration of genetically distinct individuals. In contrast, Cx. tarsalis did exhibit some differences in genetic structure that were related to geographical features including the Sierra Nevada and the Tehachapi Mountains of southern California. Genetically differentiated populations occurred in Nevada, southern and northeastern California, and the Central Valley of California. Little differentiation was observed among populations located in the Central Valley of California and those located at high elevations in the Sierra Nevada. Thus, in the populations examined, mountain ranges or arid conditions that limit the number of larval development sites appeared to be important barriers to the dispersal of Cx. tarsalis.

Animals↗
PubMed1975

Hydatid disease transmission in California. A study of the Basque connection.

A descriptive epidemiologic and anthropologic study was designed to determine by field observation and interview the extent of Basque involvement in the sheep industry of California, the nature of the sheep and dog husbandry practices of California Basques as they might influence Echinococus granulosus transmission, and the "folk knowledge" of hydatid disease possessed by California Basques, particularly as it might indicate the early presence of this infection in California and provide evidence for or against possible intensification or spread of transmission in the recent past. Basques were found to dominate the sheep industry of California's Central Valley from Sacramento south, but to be virtually absent from other sheep-raising areas of the state. In contrast to most other California sheep ranchers, Basques practice a transhumant form of husbandry in which bands of sheep are moved from location to location under the control of contract Basque shepherds from Spain and France and a number of sheep dogs.

Adult↗
PubMed2001

Phylogeography of the tidewater goby, Eucyclogobius newberryi (Teleostei, Gobiidae), in coastal California.

The tidewater goby, Eucyclogobius newberryi, inhabits discrete, seasonally closed estuaries and lagoons along approximately 1500 km of California coastline. This species is euryhaline but has no explicit marine stage, yet population extirpation and recolonization data suggest tidewater gobies disperse intermittently via the sea. Analyses of mitochondrial control region and cytochrome b sequences demonstrate a deep evolutionary bifurcation in the vicinity of Los Angeles that separates southern California populations from all more northerly populations. Shallower phylogeographic breaks, in the vicinities of Seacliff, Point Buchon, Big Sur, and Point Arena segregate the northerly populations into five groups in three geographic clusters: the Point Conception and Ventura groups between Los Angeles and Point Buchon, a lone Estero Bay group from central California, and San Francisco and Cape Mendocino groups from northern California. The phylogenetic relationships between and patterns of molecular diversity within the six groups are consistent with repeated, and sometimes rapid, northward and southward range expansions out of central California caused by Quaternary climate change. Plio-Pleistocene tectonism, Quaternary coastal geography and hydrography, and historical human activities probably also influenced the modern geographic and genetic structure of E. newberryi. The phylogeography of E. newberryi is concordant with phylogeographic patterns in several other coastal California taxa, suggesting common extrinsic factors have had similar effects on different species. However, there is no evidence of a phylogeographic break coincident with a biogeographic boundary at Point Conception.

Animals↗
PubMed2006

MHC gene configuration variation in geographically disparate populations of California sea lions (Zalophus californianus).

Major histocompatibility complex (MHC) class II DRB genotypes were examined in two geographically isolated populations of California sea lions (Zalophus californianus) (Gulf of California and California coastal Pacific Ocean). Genomic DNA from 227 California sea lions was examined using eight sequence-specific primer (SSP) pairs flanking the putative peptide-binding site. A total of 40 different Zaca-DRB genotype configurations were identified among the 227 individuals. Using SSP-PCR, significant differences were found between coastal California and Gulf of California Zalophus populations in numbers of DRB sequences per individual and configuration of sequences within individuals. Additionally, unique local patterns of MHC diversity were identified among the Midriff Island animals. These population differences are consistent with either ecologically distinct patterns of selection pressures and/or geographical isolation. The consequences of these partitioned MHC configurations at the population level are as yet unknown; however, the worldwide increase in emerging marine diseases lends urgency to their examination.

California↗
PubMed2001

Collapse of the California Current during glacial maxima linked to climate change on land.

Time series of alkenone unsaturation indices gathered along the California margin reveal large (4 degrees to 8 degrees C) glacial-interglacial changes in sea surface temperature (SST) over the past 550,000 years. Interglacial times with SSTs equal to or exceeding that of the Holocene contain peak abundances in the pollen of redwood, the distinctive component of the temperate rainforest of the northwest coast of California. In the region now dominated by the California Current, SSTs warmed 10,000 to 15,000 years in advance of deglaciation at each of the past five glacial maxima. SSTs did not rise in advance of deglaciation south of the modern California Current front. Glacial warming along the California margin therefore is a regional signal of the weakening of the California Current during times when large ice sheets reorganized wind systems over the North Pacific. Both the timing and magnitude of the SST estimates suggest that the Devils Hole (Nevada) calcite record represents regional but not global paleotemperatures, and hence does not pose a fundamental challenge to the orbital ("Milankovitch") theory of the Ice Ages.

Calcium Carbonate↗
PubMed2002

Was there significant tax evasion after the 1999 50 cent per pack cigarette tax increase in California?

OBJECTIVES: Several states, including California, have implemented large cigarette excise tax increases, which may encourage smokers to purchase their cigarettes in other lower taxed states, or from other lower or non-taxed sources. Such tax evasion thwarts tobacco control objectives and may cost the state substantial tax revenues. Thus, this study investigates the extent of tax evasion in the 6-12 months after the implementation of California's 0.50 dollars/pack excise tax increase. DESIGN AND SETTING: Retrospective data analysis from the 1999 California Tobacco Surveys (CTS), a random digit dialled telephone survey of California households. MAIN OUTCOME MEASURES: Sources of cigarettes, average daily cigarette consumption, and reported price paid. RESULTS: Very few (5.1 (0.7)% (+/-95% confidence limits)) of California smokers avoided the excise tax by usually purchasing cigarettes from non- or lower taxed sources, such as out-of-state outlets, military commissaries, or the internet. The vast majority of smokers purchased their cigarettes from the most convenient and expensive sources: convenience stores/gas (petrol) stations (45.0 (1.9)%), liquor/drug stores (16.4 (1.6)%), and supermarkets (8.8 (1.2)%). CONCLUSIONS: Despite the potential savings, tax evasion by individual smokers does not appear to pose a serious threat to California's excise tax revenues or its tobacco control objectives.

Adolescent↗
PubMedDate not supplied

Hepatitis A: the burden among Latino children in California.

OBJECTIVE: To determine the prevalence of Hepatitis A within subpopulations of southern California counties. MATERIAL AND METHODS: Age and race/ethnic-specific hepatitis A rates were derived from the California Department of Health Services Surveillance and Statistics Section for 1996-2001 and from demographic data of the California Department of Finance. RESULTS: 2.3 million Latino children (aged 0-14 years) in five southern California counties had a rate of 31.1 cases per 100,000, five times higher than the non-Hispanic white rate. CONCLUSION: The CDC Advisory Committee on Immunization Practices recommends routine vaccination for children with "very high" rates of hepatitis A. The annual prevalence of hepatitis A in California, especially in southern California, met the CDC's "very high" definition, therefore Latino children in these counties should be considered for routine childhood hepatitis A vaccination. As health has no borders, this issue should be addressed by the public health services of both, the United States' and Mexico's public health services.

Adolescent↗
PubMed2003

Reconstructing the spread of Dirofilaria immitis in California coyotes.

Dirofilaria immitis is a filarial nematode parasite that is currently widely enzootic in dog and coyote (Canis latrans) populations of California. Weak historical evidence suggests that the initial focus of D. immitis in California occurred 3 decades ago in the Sierra Nevada foothills (SNF) and spread to other parts of California thereafter. However, this hypothesis is difficult to evaluate because of the lack of epidemiological studies on heartworm in California before 1970. We investigated this hypothesis by comparing D. immitis prevalence in coyotes between initial (1975-1985) and current (2000-2002) surveys in the SNF and 2 coastal regions. In the SNF, prevalence of heartworm was not significantly different between initial (35%, n = 169) and current (42%, n = 60) surveys (P = 0.17), suggesting the existence of a stable enzootic focus in the initial survey period. In contrast, current prevalence was 4 times higher than initial prevalence in the northern Coast Range foothills (44 vs. 10%; n = 119, 107; P < 0.001) and in the south San Francisco Bay foothills (32 vs. 8%; n = 31, 59; P = 0.005), suggesting that initial surveys were made during the early stages of colonization. Dirofilaria immitis prevalence, intensity, and abundance was similar in a coastal location in Mendocino County between 1994-1996 and 1999-2002, suggesting some degree of stability in this enzootic focus. Collectively, these findings support the hypothesis that D. immitis established itself initially in California coyotes living in the SNF and subsequently expanded its range of enzootic foci in central California.

Animals↗
PubMed2006

Carbon sequestration in California agriculture, 1980-2000.

To better understand agricultural carbon fluxes in California, USA, we estimated changes in soil carbon and woody material between 1980 and 2000 on 3.6 x 10(6) ha of farmland in California. Combining the CASA (Carnegie-Ames-Stanford Approach) model with data on harvest indices and yields, we calculated net primary production, woody production in orchard and vineyard crops, and soil carbon. Over the 21-yr period, two trends resulted in carbon sequestration. Yields increased an average of 20%, corresponding to greater plant biomass and more carbon returned to the soils. Also, orchards and vineyards increased in area from 0.7 x 10(6) ha to 1.0 x 10(6) ha, displacing field crops and sequestering woody carbon. Our model estimates that California's agriculture sequestered an average of 19 g C x m(-2) x yr(-1). Sequestration was lowest in non-rice annual cropland, which sequestered 9 g C x m(-2) x yr(-1) of soil carbon, and highest on land that switched from annual cropland to perennial cropland. Land that switched from annual crops to vineyards sequestered 68 g C x m(-2) x yr(-1), and land that switched from annual crops to orchards sequestered 85 g C x m(-2) x yr(-1). Rice fields, because of a reduction in field burning, sequestered 55 g C x m(-2) x yr(-1) in the 1990s. Over the 21 years, California's 3.6 x 10(6) ha of agricultural land sequestered 11.0 Tg C within soils and 3.5 Tg C in woody biomass, for a total of 14.5 Tg C statewide. This is equal to 0.7% of the state's total fossil fuel emissions over the same time period. If California's agriculture adopted conservation tillage, changed management of almond and walnut prunings, and used all of its orchard and vineyard waste wood in the biomass power plants in the state, California's agriculture could offset up to 1.6% of the fossil fuel emissions in the state.

Agriculture↗
PubMed1993

The tobacco industry, state politics, and tobacco education in California.

OBJECTIVES: Proposition 99 added 25 cents to the California state cigarette tax and mandated that 20% of the new revenues be spent on tobacco education and prevention programs. This paper examines the implementation of these programs and the tobacco industry's response to Proposition 99. METHODS: Political expenditure data for twelve tobacco firms and associations were gathered from California's Fair Political Practices Commission and secretary of state's Political Reform Division. Tobacco education expenditure data were collected from Governor's Budgets and the Department of Finance. RESULTS: Since Proposition 99 passed, tobacco industry political expenditures in California have risen 10-fold, from $790,050 in the 1985-1986 election to $7,615,091 in the 1991-1992 election. The tobacco industry is contributing more heavily to the California legislature than to Congress. A statistical analysis of data on campaign contributions indicates that California legislators' policy-making is influenced by campaign contributions from the tobacco industry. Since fiscal year 1989-1990, the state has ignored the voters' mandate and spent only 14.7% of the new revenues to tobacco education. Medical care programs received more money than permitted by the voters. CONCLUSIONS: The tobacco industry has become politically active in California following the passage of Proposition 99. One result may be that the state has underfunded tobacco education by $174.7 million through the 1993-1994 fiscal year. The estimated redirection of funds to medical care would essentially eliminate the tobacco education campaign by the year 2000.

California↗