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PubMed2000

Cancer of the colon and rectum in California: trends in incidence by race/ethnicity, stage, and subsite.

BACKGROUND: Incidence and mortality from cancer of the colon and rectum have declined in recent years in the United States and California, but reasons for the decline are unknown. METHODS: Age-adjusted site-specific and stage-specific incidence rates were calculated for approximately 9,000 cases of in situ cancer and 120,000 cases of invasive cancer of the colon and rectum diagnosed between 1988 and 1996 among California residents and reported to the California Cancer Registry. Trends in incidence over time were measured using the estimated annual percent change. RESULTS: Among non-Hispanic whites there was a decline in all sites and stages, but the decrease was most pronounced for rates of in situ and regional/distant tumors in the rectum and sigmoid which declined by about 4 to 7% a year. For tumors in the proximal colon, the decrease was statistically significant only for regional/distant tumors which declined about 2% a year. Among blacks, there was an approximately 7% annual decline in the incidence of regional/distant tumors of the rectum in women and a nearly 3% a year decrease in regional/distant tumors of the proximal colon in men. The decline in rates for Hispanics and Asian/Pacific Islanders was smaller and less consistent than for non-Hispanic whites. CONCLUSIONS: The results confirm a overall decline in all stages of cancer of the colon and rectum in California, particularly among non-Hispanic white men and women. The decrease was most pronounced for tumors in the rectum and sigmoid colon and may be attributable to screening.

California↗
PubMed1994

Evolution of the L2 gene of strains of bluetongue virus serotype 10 isolated in California.

The genetic characteristics and phylogenetic relationships between the U.S. prototype strain of bluetongue virus serotype 10 (BTV 10), the modified live virus vaccine currently used in California, and three field isolates of BTV 10 obtained in 1980 and three in 1990 in California were determined by comparison of their L2 gene sequences. The L2 genes of the 1980 field isolates were very closely related to the L2 genes of the prototype strain and the vaccine strain, differing by only 0.1 to 0.5%. The 1990 field isolates diverged from all the other viruses by an average of 4.8%. They showed a high degree of genetic similarity that ranged from 98.2 to 99.7% and formed a separate group. All BTV 10 viruses derived from a common ancestor (bootstrap value 100%) from which two different lineages have diverged giving rise to two monophyletic groups, one including all the 1990 viruses and the other the prototype, the vaccine, and all 1980 field strains. The bootstrap analyses placed a 100% confidence value at each of these two nodes. These results indicate that two different lineages of BTV 10 circulated in California between 1953 and 1990. The effect of the vaccine on the evolutionary pathways of the BTV 10 population present in California in 1980 was not clearly established, but it did not influence the evolution of the BTV 10 field isolates obtained in 1990.

Base Sequence↗
PubMed1990

Illness, injuries, and deaths from pesticide exposures in California 1949-1988.

Data on human acute illness/injury and death associated with pesticide exposure in California for the 40-yr period, beginning with 1949, were reviewed. Even though California has better data of this type than most government jurisdictions in the world, there are some shortcomings. In the early part of this period, nonoccupational data were scant because poison information centers were just being developed. Also in the early period, many occupational exposures were not recorded in state statistics although a good system to allow for such reporting was in place. California data currently available still do not take into account (i) persons who are exposed and become ill, but do not visit a physician or call a poison center, and (ii) most occupational exposures of the self-employed, U.S. military employees, U.S. government employees, maritime workers, and interstate railroad workers. In 1987, 268,092,595 kg of pesticides were sold and estimated as used in the state. Although the amount of pesticides used annually in California is estimated to have increased 4-fold in this 40-yr period, it is believed that the actual number of pesticide-related occupational illnesses/yr increased very little. Cholinesterase inhibitors and methyl bromide were most often involved in the more serious occupational systemic poisonings throughout the time period. Well-educated and trained farmers and other pesticide handlers as well as a strict regulatory system have contributed to keeping the number and the extent of pesticide exposure in check, considering the widespread use of pesticides, some of which are quite toxic and potentially hazardous if misused. In 1987, there were 1,507 cases of occupational illness identified, with 744 of these demonstrating systemic toxic symptoms. In 1987, approximately 17,000 human pesticide exposure incidents, almost all of which were nonoccupational, were handled by poison control centers. It is estimated that about 30 to 60% developed signs or symptoms. Occupational deaths for the past 10 yr have averaged about 1/yr. Suicides by use of pesticides are estimated at 15/yr, and nonsuicides, nonoccupational deaths are estimated at 5/yr. This paper does not address chronic effects such as cancer induction, developmental effects, or reproductive effects that may be suspected as being the result of pesticide exposure. Data presented in this report may be useful in estimating the number of poisonings that may occur in other geographic settings. Numerous variables that must be considered in making such estimates are discussed.

Agricultural Workers' Diseases↗
PubMed1990

AIDS-phobia and political reaction in California: student versus public responses to reactive political initiatives.

A "social reactivist" study was conducted of the responses of 563 students enrolled in a Southern California university compared with those of a random sample of 1002 Californians telephone-polled by the California Poll. The study focused on AIDS-phobia, the fear of getting AIDS or the AIDS virus, HIV, from casual contact. In both samples, AIDS-phobia correlated well with reactive political sentiment. Students who were AIDS-phobic were expected to vote in favor of proquarantine initiatives (Proposition 64 in 1986 and Proposition 69 in June 1988). California Poll respondents who were AIDS-phobic, likewise, were expected to vote in favor of Proposition 102 (November 1988) which required reporting HIV-positive patients to local health officers. In the student samples, however, AIDS-phobia was found by factor analysis to have two subsets: AIDS-phobia-Wet and AIDS-phobia-Dry. These did not appear in the California Poll results. In the 1988 student sample, AIDS-phobia-Wet was significant in explaining proquarantine sentiment, while AIDS-phobia-Dry proved significant in explaining sexual activity. The converse was not true. AIDS-phobia is a major characteristic of the social audience to AIDS as a disease and may prove decisive in the evolution of the disease. Support for the victim (or lack of it) may influence the course of the disease and even public funding to fight the disease. AIDS-phobia may also blind heterosexuals to their own vulnerability, thus making them vulnerable to the disease.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Utilization of pay-in antenatal leave among working women in Southern California.

OBJECTIVES: Examine antenatal leave arrangements among pregnant workers in California, and the occupational, demographic and well-being characteristics associated with leave taking. Unlike most states, California provides paid pregnancy leave up to 4 weeks antenatally and 6-8 weeks postnatally. METHODS: Weighted data from postpartum telephone interviews conducted between July 2002 and November 2003 were analyzed for 1214 women participating in a case-control study of birth outcomes in Southern California. Eligible women worked at least 20 h/week during the first two trimesters of pregnancy or through the date of prenatal screening. The overall response rate was 73%. RESULTS: Fifty-two percent of women took no leave, 32% took antenatal leave expecting to return to their job or employer sometime after giving birth, and 9% quit their jobs during pregnancy. For leave-takers with paid leave (69%), the state was the main source of pay (74%). Medical problems (52%) rather than maternity leave benefits (25%) were the most common stated reasons for taking leave. The strongest predictors of leave taking versus working through pregnancy were feeling stressed and tired (adjusted OR = 4.3, 95% CI [2.2-8.2]) and having young children (adjusted OR = 2.1, 95% CI [1.2-3.7]), followed by occupational factors (night shift, unfulfilling and inflexible work, short work tenure). Lack of employer-offered maternity leave benefits was associated with increased quitting relative to both leave taking and working through pregnancy. CONCLUSIONS: Maternity benefits influence quitting, but alone do not determine antenatal leave taking. Working pregnant women in California utilize leave cautiously and predominantly to cope with health problems, work dissatisfaction and fatigue.

Adult↗
PubMed1993

Trends in cesarean section use in California, 1983 to 1990.

OBJECTIVE: Our aim was to assess recent trends in cesarean section use in California. STUDY DESIGN: California discharge abstract data on hospital deliveries in 1983 through 1990 (379,759 to 587,508 annual deliveries) were used to analyze time trends by indication, age, race, and payment source. RESULTS: California cesarean section rates increased annually from 21.8% in 1983 to 25.0% in 1987 and then decreased to 22.7% by 1990. Similar patterns were noted for all age and race or ethnicity groups. Primary cesarean section rates increased from 15.2% in 1983 to 17.9% in 1987, then decreased to 16.2% by 1990. Declines in repeat cesarean section rates continued throughout 1983 through 1990, accelerating after 1987. For both primary and repeat cesarean section rates, time trends after mid-1987 were significantly different than those for 1983 to 1987. CONCLUSION: After increasing from 1983 to 1987, California cesarean section rates declined from 1988 to 1990. Existing payment source differences in cesarean section use increased in magnitude from 1983 to 1990, with privately insured women consistently having the highest cesarean section rates.

California↗
PubMed1984

Introduction of the scorpion Centruroides exilicauda into California and its public health significance.

The bark scorpion, Centruroides exilicauda, formerly C. sculpturatus, is a native of Arizona and adjacent parts of New Mexico in the United States, and Baja California and Sonora in Mexico. A few specimens have been captured on the California side of the Colorado River. The general biology of this scorpion is discussed and the introduction of the arthropod into three California counties, probably in trailer paraphernalia and dune buggies, is described. Four probable stings by C. exilicauda in California and their public health significance are presented.

Adult↗
PubMed2006

Trends in smoking among Hispanic women in California: Relationship to English language use.

BACKGROUND: Research has shown that Hispanic women who speak mostly English have higher smoking rates than those who speak mostly another language. It is unknown how differences in smoking by English language use among adult Hispanic women in California have changed in recent years. METHODS: We compared current daily (100 or more cigarettes in lifetime, now smokes daily) and current nondaily (100 or more cigarettes in lifetime, now smokes some days) smoking prevalence for adult Hispanic women by English language use at home from population-based, random-digit-dialed California Tobacco Surveys in 1996 (n = 1406, 74% response rate [RR]); 1999 (n = 1379, 69% RR), and 2002 (n = 2912, 64% RR). RESULTS: Current smoking prevalence was at least twice as high among those who speak mostly English compared to those who speak mostly another language in every survey year (1996: 14.7% vs 6.1%; 1999: 14.6% vs 6.1%; 2002: 11.7% vs 4.9%) with the ratio staying constant (2.4:1). There was a decline in current nondaily smoking among those who speak mostly English by 2002 (1996 and 1999 prevalence: approximately 6%, 2002: approximately 4%), but no declines in current daily smoking for either language-use group. CONCLUSIONS: There has been no reduction in the English-language-use gap in smoking among Hispanic women in California. There has been a significant decline in current nondaily smoking prevalence among women who speak mostly English, but no significant reduction in current daily smoking for either language-use group. It appears that not much progress has been made in California in reducing daily smoking prevalence among Hispanic women at the population level. Smoking prevention and cessation efforts among Hispanic women remain a priority.

Acculturation↗
PubMed2006

Patterns of ecstasy-associated hyponatremia in California.

STUDY OBJECTIVE: We describe the clinical characteristics of patients with ecstasy- (3,4-methylenedioxymethamphetamine [MDMA]) associated hyponatremia (serum sodium level <130 mmol/L) reported to the California Poison Control System during a 5-year period and determine whether a sex difference exists among patients with ecstasy-associated hyponatremia and hyponatremia-associated adverse outcomes. METHODS: We performed a retrospective review of cases involving ecstasy intoxication reported to the California Poison Control System and recorded in its computerized database from January 1, 2000, through October 9, 2005. We excluded cases that did not involve MDMA exposure or in which there were no symptoms or were minimal effects only. Confirmation of exposure to MDMA was based on history of use and, when available, urine toxicology testing results positive for MDMA or amphetamine derivatives. Hyponatremia was defined as a measured serum sodium level less than 130 mmol/L. RESULTS: A total of 1,436 cases potentially involving ecstasy were reported to the California Poison Control System during the 5-year study period, of which 891 were excluded according to the criteria described above. Of the 545 cases that met inclusion criteria, 296 (54.3%) were women and 249 (45.7%) were men. There were 188 cases (34.5%) with a documented serum sodium level, of which 73 (38.8%) reported hyponatremia (Na <130 mmol/L). Of the 73 subjects with hyponatremia, 55 (75.3%) were women and 18 (24.7%) men; of the 115 nonhyponatremic subjects, 50 (43.5%) were women and 65 (56.5%) were men. Among patients with a documented serum sodium level, female sex was associated with increased odds of hyponatremia (odds ratio [OR] 4.0; 95% confidence interval [CI] 2.1 to 7.6). Among women, those with hyponatremia demonstrated increased odds of coma (OR 3.9; 95% CI 1.2 to 12.9), whereas among men, no increased odds of hyponatremia-associated coma were observed (OR 0.8; 95% CI 0.15 to 4.0). CONCLUSION: Female sex was associated with increased odds of hyponatremia and increased odds of hyponatremia-associated coma among persons with ecstasy intoxication and a documented serum sodium level reported to the California Poison Control System from 2000 to 2005. Multiple potential confounders, including spectrum bias, incomplete laboratory data, and individual differences in study subject characteristics, prevent determination of causality about sex differences in the incidence of ecstasy-associated hyponatremia and its complications.

Adult↗
PubMed2004

Organochlorine pesticides and polychlorinated biphenyls in California sea lions.

Concentrations of polychlorinated biphenyls (PCBs), DDTs, chlordanes, HCHs, hexachlorobenzene (HCB), dieldrin, heptachlor epoxide, tris(4-chlorophenyl)methane (TCPMe), and tris(4-chlorophenyl)methanol (TCPMOH) were measured in the blubber of California sea lions (Zalophus californianus) collected in 2000. DDTs were the most predominant contaminants, followed by PCBs, chlordanes, TCPMe, HCHs, TCPMOH, dieldrin, and heptachlor epoxide. Concentrations of PCBs and DDTs varied from a few microg/g to several hundreds of microg/g on a lipid weight basis. Concentrations of DDTs have declined by an order of magnitude over the last three decades in California sea lions; nevertheless, the measured concentrations of PCBs and DDTs in California sea lions are still some of the highest values reported for marine mammals in recent years. Concentrations of organochlorines were highly correlated with one another. Concentrations of PCBs and DDTs in the blubber of gray whale, humpback whale, northern elephant seal, and harbor seal, and in the adipose fat of sea otter, were lower than the levels found in California sea lions, and were in the range of a few to several microg/g on a lipid weight basis.

Adipose Tissue↗
PubMed2005

PCBs and DDT in the serum of juvenile California sea lions: associations with vitamins A and E and thyroid hormones.

Top-trophic predators like California sea lions bioaccumulate high levels of persistent fat-soluble pollutants that may provoke physiological impairments such as endocrine or vitamins A and E disruption. We measured circulating levels of polychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethane (DDT) in 12 healthy juvenile California sea lions captured on Año Nuevo Island, California, in 2002. We investigated the relationship between the contamination by PCBs and DDT and the circulating levels of vitamins A and E and thyroid hormones (thyroxine, T4 and triiodothyronine, T3). Serum concentrations of total PCBs (sigmaPCBs) and total DDT were 14 +/- 9 mg/kg and 28 +/- 19 mg/kg lipid weight, respectively. PCB toxic equivalents (sigmaPCB TEQs) were 320 +/- 170 ng/kg lipid weight. Concentrations of sigmaPCBs and sigmaPCB TEQs in serum lipids were negatively correlated (p < 0.05) with serum vitamin A and T3, potentially reflecting PCB-related toxicity. A slight but not significant negative correlation (p < 0.1) was observed between serum T4 and the levels of sigmaPCBs and sigmaPCB TEQs. Conversely, no relationship was evident between the contaminant concentrations and vitamin E (p > 0.1). As juvenile California sea lions are useful sentinels of coastal contamination, the high levels encountered in their serum is cause for concern about the ecosystem health of the area.

Animals↗
PubMed2005

The link between obesity and the built environment. Evidence from an ecological analysis of obesity and vehicle miles of travel in California.

AIMS: Obesity and physical inactivity are known to be risk factors for many chronic diseases including hypertension, coronary artery disease, diabetes, and cancer. We sought to explore the association between an indicator of transportation data (Vehicle Miles of Travel, VMT) at the county level as it relates to obesity and physical inactivity in California. METHODS: Data from the California Health Interview Survey 2001 (CHIS 2001), the US 2000 Census, and the California Department of Transportation were merged to examine ecological correlations between vehicle miles of travel, population density, commute time, and county indicators of obesity and physical inactivity. Obesity was measured by body mass index (BMI). Physical inactivity was based on self-reported behaviors including walking, bicycling, and moderate to vigorous activity. The unit of analysis was the county. Thirty-three counties in California with population size greater than 100,000 persons per county were retained in the analyses. RESULTS: CHIS 2001 statewide obesity prevalence ranged from 11.2% to 28.5% by county. Physical inactivity ranged from 13.4% to 35.7%. Daily vehicle miles of travel ranged from 3.3 million to 183.8 million per county. By rank bivariate correlation, obesity and physical inactivity were significantly associated (p<0.01). Furthermore, by rank analysis of variance, the highest mean rank obesity was associated with the highest rank of VMT (p<0.01). Similar rank patterns were observed between obesity and physical inactivity and commute time. Associations between VMT and physical inactivity were examined but failed to reach statistical significance. CONCLUSION: This analysis adds to the growing evidence supporting the association between VMT (a measure of automobile transportation) and obesity. An urban design characterized by over dependence on motorized transportation may be related to adverse health effects.

Adolescent↗
PubMed2006

A survey of labor patient-controlled epidural anesthesia practice in California hospitals.

BACKGROUND: Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for labor analgesia including fewer physician interventions, improved analgesia and satisfaction, and reduced local anesthetic doses. However, anesthesiologists have been slow to adopt this technique, first described in 1988. No previous studies have evaluated specific labor patient-controlled epidural analgesia practices in the United States. The aim of this study was to determine labor epidural and patient-controlled epidural analgesia practices among California hospitals. METHODS: Following institutional review board exemption approval, an online survey was created using freeonlinesurveys.com. An anonymous survey was sent via e-mail to 230 California Society of Anesthesiologists' members chosen at random to represent their hospitals' labor analgesia practices. RESULTS: We received 133 replies from the 230 survey requests sent, a 58% response rate. The median labor epidural rate among the hospitals involved was 65% (range 0-95%). Overall, only 25% of California hospitals use patient-controlled epidural analgesia for analgesia in labor, with greater use among hospitals with dedicated obstetric anesthesia coverage and larger numbers of deliveries. Reasons given for not using patient-controlled epidural analgesia include cost, clinician preference, safety concerns and the inconvenience of change. CONCLUSIONS: Despite the potential advantages of patient-controlled epidural analgesia over continuous epidural infusions for labor analgesia, patient-controlled epidural analgesia has not been widely adopted in California hospitals. Education regarding this technique is needed to encourage its increased use.

Analgesia, Epidural↗
PubMed2006

Hospitalization for respiratory syncytial virus among California infants: disparities related to race, insurance, and geography.

OBJECTIVES: To evaluate population-based rates of Respiratory Syncytial Virus (RSV)-associated infant hospitalizations related to race/ethnicity, payer source, and geography in California. STUDY DESIGN: Retrospective analysis of RSV-coded infant hospitalizations were performed using the California patient discharge data for 1999 to 2003. All discharge records for infants younger than 1 year of age with an ICD-9-CM code for any RSV-related illness (466.11, 480.1, or 079.6) among any of the diagnosis fields were selected for analysis (n = 45,330). Rates were expressed as the number of RSV-associated hospitalizations per 1000 live births in the same calendar year. RESULTS: Infants enrolled in MediCal (California's version of the United States' national Medicaid program) had a relative risk of 2.03 (95% CI, 1.99 to 2.06) compared with non-MediCal payers (24.3 vs 12.0/1000 live births, respectively). The 1999 to 2003 rates per 1000 live births of RSV-associated hospitalizations for MediCal payers by race/ethnicity were: non-Hispanic white (34.9), African-American (27.9), Hispanic (21.8), Asian/Pacific Islander (12.5), and American Indian/Alaska Native (12.2). CONCLUSIONS: RSV was the leading cause of infant hospitalizations in California between 1999 and 2003. RSV hospitalization rates were highest among non-Hispanic white MediCal insured infants.

California↗
PubMed2006

Potential diversity in vegetative compatibility groupings in the California population of Gibberella circinata.

Pitch canker, caused by Gibberella circinata, is a disease affecting pines throughout the world. Although the pathogen is capable of sexual reproduction, natural populations are often comprised of very few vegetative compatibility groups (VCGs), which implies a predominance of asexual reproduction. However, even where outcrossing occurs, a population could have limited VCG diversity due to a low level of polymorphism at the loci governing vegetative compatibility (=vic loci). To determine whether this was the case for the California population of G. circinata, inter-fertile strains were crossed under laboratory conditions. Progeny of this cross included a minimum of 29 VCGs, which was consistent with segregation of vic alleles at five loci. Only two of these VCGs were known to occur naturally in California. Three VCGs accounted for 32.4% of the progeny but 0% of the California population. Overall, the results support the conclusion that outcrossing has been rare or absent in the California population of G. circinata.

California↗
PubMed2004

Acoustic neuroma surgical cost and outcome by hospital volume in California.

CONTEXT: Successful outcome of complex surgical techniques depend on the surgical team's level of experience. However, unless benefit is demonstrated in the presence of cost savings, insurance companies are reluctant to approve care from highly experienced hospitals and surgical teams. OBJECTIVE: To determine the relationship between the number of acoustic neuroma surgeries performed at California hospitals with surgical outcome and hospital stay cost. DESIGN: Acoustic neuroma surgery information was extracted from the California hospital discharge database and was grouped according to the number of surgeries performed at each hospital. SETTING: A database review of California hospitals. PATIENTS: Persons (n=1,213) undergoing acoustic neuroma surgery at a California hospital between 1996 and 1998. Main outcome measures Outcome measures included discharge status (routine vs. not routine), medical procedures indicating surgical complications, total cost of hospitalization, and average cost per hospitalization day. Odds ratios were used to compare the hospital volume groups on likelihood of a routine surgical outcome. RESULTS: The frequency of routine surgical outcome increased as hospital acoustic neuroma surgical volume increased, ranging from 68% among patients in the lowest volume group to 97% in the highest hospital volume group. Patients in the highest hospital volume group were 15 times more likely to have a routine surgical outcome than patients in the lowest hospital volume group. Patients in the second highest volume group were 5 times more likely to have a routine surgical outcome than in the lowest volume group. The two highest volume hospital groups had lower total charges and average charges per day than the two lower volume hospital groups. CONCLUSIONS: Acoustic neuroma surgeries at higher volume hospitals had higher frequency of routine discharge, lower frequency of apparent complications, and lower average cost of hospitalization.

California↗
PubMed2006

A review of the small canine piroplasms from California: Babesia conradae in the literature.

Small piroplasms as a cause of canine babesiosis in southern California were first documented in 1990. Initially these piroplasms were considered to be Babesia gibsoni, the only small Babesia parasite known to infect dogs at that time. In the following decade, the use of molecular analysis made it clear that small canine Babesia in fact are comprised of at least three distinct species, and the isolates from dogs in southern California were not B. gibsoni. Molecular, antigenic, and morphological characteristics of the southern California species of canine piroplasm supported naming it as a distinct species, Babesia conradae. The renaming of this species prompted this literature review of small canine piroplasms in California in order to clarify clinical, diagnostic, epidemiological, and molecular characteristics of B. conradae in comparison to other small canine piroplasms. Clinical symptoms of B. conradae are similar to those of B. gibsoni; however, B. conradae infections may be more pathogenic, resulting in higher parasitaemia and more pronounced anaemia when compared with B. gibsoni-infected dogs. The immunofluorescent antibody test is the most commonly used test to diagnose B. conradae. It is important to specify which small Babesia species to test for since there is little serological cross reactivity between the small canine Babesia antigens or cross-detection in the newer molecular tests. Molecular characterization of B. conradae, based principally on the 18S small subunit rRNA gene, and recently the second internal transcribed spacer region, demonstrate that B. conradae is most closely related to piroplasms recovered from humans and animals in the western United States.

Animals↗
PubMedDate not supplied

Accessibility of emergency contraception in California's Catholic hospitals.

BACKGROUND: Access to emergency contraception (EC) is an important option for women wanting to prevent an unintended pregnancy. In California, emergency rooms (ERs) are required to provide survivors of sexual assault with information about and access to EC. This study assessed the likelihood that a woman calling a Catholic hospital in California to inquire about EC could access the medication. METHODS: During September 2003, we contacted an ER staff member in each of California's Catholic hospitals (n = 45) using a mystery caller approach. Following a written script, trained female researchers asked ER staff whether they dispense EC at their facility and under what circumstances. If respondents initially stated that their facility would not dispense EC, the caller asked whether EC was available to women who had been raped. If staff confirmed that their facility would not provide EC under any circumstances including rape, callers requested a referral to another facility that would provide the medication. RESULTS: Sixty-six percent of staff contacted stated that their hospital would not provide EC under any circumstances, including rape. Of those that would not dispense EC, fewer than half of respondents (48%) provided a referral. Of the 14 referrals given, only about one third (n = 5) led to a facility that provides EC. CONCLUSIONS: Our findings suggest that access to EC in California's Catholic hospitals is minimal, even for victims of sexual assault. As many as two-thirds of these hospitals may be violating state legislation requiring hospitals to provide EC to sexual assault survivors upon request.

California↗