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Characteristics of hazardous material spills from reporting systems in California.

Data on hazardous material releases that occurred between January 1, 1982 and September 30, 1983 in California were obtained from the California Highway Patrol (CHP) and the US Department of Transportation (DOT). The majority of incidents involved highway transport of hazardous materials, although some information was available on air, rail, and stationary facility releases. Vehicle accidents and failure of or damage to the container were the most frequent causes of releases. Proportionately more hazardous materials incidents occurred in early summer than at other times of the year, during weekdays, and daytime hours. The largest proportions of incidents involved the chemical categories of corrosives and fuels. Reported exposures and injuries to response personnel and other people at the scene were relatively few; no fatalities were reported. Few incidents were reported in both data sources, suggesting that the examination of only one data source would yield a gross underestimate of the total number of hazardous materials incidents in California. The lack of available denominator data limits the interpretation of the findings.

Accidents↗

Elevated blood lead in California adults, 1987: results of a statewide surveillance program based on laboratory reports.

California medical laboratories that test for blood lead are required to report results exceeding 1.21 mumols/L (25 micrograms/dl). Between April and December 1987, the California Department of Health Services received 3,077 blood lead reports from 34 laboratories for 1,293 civilian, non-institutionalized adults. Approximately 1 percent of all reports exceeded 3.87 mumols/L (80 micrograms/dl), 7 percent exceeded 2.42 mumols/L (50 micrograms/dl), and 21 percent exceeded 1.93 mumols/L (40 micrograms/dl). Individuals tested were overwhelmingly male (94 percent), disproportionately Hispanic surnamed (44 percent), and most often residents of Los Angeles County (81 percent). Workers in lead smelting, battery manufacturing, and brass foundries accounted for nearly 80 percent of reports. Construction, radiator repair, pottery and ceramics manufacturing, and gun firing ranges accounted for the remainder. All adults with reports of greater than or equal to 2.90 mumols/L who were contacted reported on occupational exposure. Approximately half were not in routine medical monitoring programs. Despite OSHA standards, elevated blood lead with the potential for serious acute and chronic lead poisoning in California adults remains a significant public health and major occupational health concern.

Adolescent↗

Distribution of HIV type 1 infection in childbearing women in California.

The incidence of acquired immunodeficiency syndrome (AIDS) is increasing among California heterosexuals and children. To assess human immunodeficiency virus (HIV)-1 infection in childbearing women, we conducted a blinded serosurvey of newborns. Dried blood specimens taken from 99% of California births during the third quarter of 1988 (n = 135,808) and linked only to maternal demographic categories were tested for HIV-1 antibody by enzyme immunoassay and confirmed by Western blot. Period prevalence of HIV-1 infection was 7.4 per 10,000 childbearing women. Prevalence was highest for Black women and was also elevated for Hispanic and San Francisco Bay Area women. Findings suggest that California Hispanic women will make up an increasing proportion of new AIDS cases.

Adult↗

Seroprevalence of HIV-type 1 in a northern California health plan population: an unlinked survey.

We conducted an unlinked seroprevalence survey for human immunodeficiency virus-type 1 (HIV-1) of 9821 persons who had a routine personal health appraisal examination in 1989 while members of the Kaiser Permanente Medical Care Program in northern California. An outside laboratory performed enzyme immunoassay (EIA) analyses, and the California Viral and Rickettsial Diseases Laboratory confirmed EIA-reactive samples by immunofluorescent assay and Western blot assay. Only 20 specimens (0.2%) were confirmed as positive, and 18 were from men. These data suggest that, at the time of this survey, HIV-1 infection was not widespread in the northern California population represented by this health plan membership.

Adolescent↗

California adults with elevated blood lead levels, 1987 through 1990.

OBJECTIVES: Follow-up of California blood lead registry reports, 95% of which are of occupationally exposed adults, can guide interventions at specific high-risk work sites and measure the impact of targeted, industry-specific interventions. METHODS: A protocol was implemented to follow up the most severe case reports (> or = 2.90 mumol/L) and establish a statistical database for descriptive analysis. RESULTS: From 1987 through 1990, the California Department of Health Services received 17,951 reports for 4069 civilian, noninstitutionalized adults employed by at least 328 companies. Of 232 incident case subjects with severe lead toxicity (> or = 2.90 mumol/L), 182 were successfully traced and interviewed. Index case subjects were mostly male (95%) and disproportionately Hispanic (46%); 35% lived with children aged 7 or younger, and 10% had been hospitalized. Ninety-four percent involved overexposures at work sites that lacked medical removal (50%), ventilation (36%), appropriate respirators (62%), training (64%), clothing changes (45%), or showering (60%). CONCLUSIONS: Well-known risk factors for occupational lead poisoning clustered at the work sites of index case subjects. Despite standards of the Occupational Safety and Health Administration, lead overexposure in California adults remains a significant public and occupational health concern.

Adult↗

Public health on the railroad: William Freeman Snow and the California Sanitation Exhibit.

This paper describes the California Sanitation Exhibit, a railroad car outfitted for instruction in public health that toured California in 1909 and 1910. The sanitation exhibit used display models, photographs, and lectures to educate the public about tuberculosis and other infectious diseases, waste contamination, and the dangers of bad milk. The success of the exhibit, which reached 5% of the state's population, resulted in the appointment of its creator, William Freeman Snow, as secretary of the California State Board of Health.

California↗

Mandatory reporting of intimate partner violence to police: views of physicians in California.

OBJECTIVES: This study examined physicians' perspectives on mandatory reporting of intimate partner violence to police. METHODS: We surveyed a stratified random sample of California physicians practicing emergency, family, and internal medicine and obstetrics/gynecology. RESULTS: An estimated 59% of California primary care and emergency physicians (n = 508, 71% response rate) reported that they might not comply with the reporting law if a patient objects. Primary care physicians reported lower compliance. Most physicians agreed that the legislation has potential risks, raises ethical concerns, and may provide benefits. CONCLUSIONS: Physicians' stated noncompliance and perceived negative consequences raise the possibility that California's mandatory reporting law is problematic and ineffective.

Adult↗

Welfare reform and the perinatal health and health care use of Latino women in California, New York City, and Texas.

OBJECTIVES: This study analyzed changes in the financing of prenatal care and delivery, the use of prenatal care, and birth outcomes among foreign-born vs US-born Latino women following enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in August 1996. METHODS: We used a pre-post design with a comparison group. The sample consisted of resident Latinas in California, New York City, and Texas who delivered a live infant in 1995 or 1998. RESULTS: The proportion of births to Latinas that initiated prenatal care in the first 4 months of pregnancy increased for all foreign-born Latinas in California, New York City, and Texas between 1995 and 1998 (P <.05). Except for non-Dominicans in New York City, there was no increase in the proportion of low- or very-low-birthweight births among foreign-born vs US-born Latinas in the 3 localities between 1995 and 1996. CONCLUSIONS: There is little evidence from vital statistics in California, New York City, and Texas that PRWORA had any substantive impact on the perinatal health and health care utilization of foreign-born relative to US-born Latinas.

California↗

Independent evaluation of the California Tobacco Control Program: relationships between program exposure and outcomes, 1996-1998.

OBJECTIVES: This study sought to determine the effects of the California Tobacco Control Program on tobacco-related attitudes and behaviors. METHODS: In 1996 and 1998, a telephone survey was conducted among adults in randomly selected households in 18 California counties. Tenth-grade youths in 84 randomly selected high schools completed a written survey. In analyses conducted at the county level, differences in outcomes were regressed on an index of program exposure. RESULTS: Among adults, program exposure was associated with decreased smoking prevalence rates, increased no-smoking policies in homes, and decreased violations of workplace no-smoking policies. Among youths, there was no effect of program exposure on outcomes. CONCLUSIONS: These results suggest that the California Tobacco Control Program may have reduced adult smoking prevalence rates and exposure to environmental tobacco smoke.

Adolescent↗

Summary of well water sampling in California to detect pesticide residues resulting from nonpoint-source applications.

This report summarizes well sampling protocols, data collection procedures, and analytical results for the presence of pesticides in ground water developed by the California Department of Pesticide Regulation (DPR). Specific well sampling protocols were developed to meet regulatory mandates of the Pesticide Contamination Prevention Act (PCPA) of 1986 and to provide further understanding of the agronomic, chemical, and geographic factors that contribute to movement of residues to ground water. The well sampling data have formed the basis for the DPR's regulatory decisions. For example, a sampling protocol, the Four-Section Survey, was developed to determine if reported detections were caused by nonpoint-source agricultural applications, a determination that can initiate formal review and subsequent regulation of a pesticide. Selection of sampling sites, which are primarily rural domestic wells, was initially based on pesticide use and cropping patterns. Recently, soil and depth-to-ground water data have been added to identify areas where a higher frequency of detection is expected. In accordance with the PCPA, the DPR maintains a database for all pesticide well sampling in California with submission required by all state agencies and with invitations for submission extended to all local and federal agencies or other entities. To date, residues for 16 active ingredients and breakdown products have been detected in California ground water as a result of legal agricultural use. Regulations have been adopted for all detected parent active ingredients, and they have been developed regardless of the level of detection.

Agriculture↗

Tracking sources of bacterial contamination in stormwater discharges to Mission Bay, California.

Sources of the indicator bacteria total coliform, fecal coliform, and enterococcus were investigated in stormwater flows discharging to Mission Bay, a heavily used aquatic park in San Diego, California. Stormwater flows were targeted because long-term receiving water monitoring of the bay indicated that wet weather discharges were the predominant source of bacterial contamination. Exceedences in water quality objectives for body contact recreation established by the State of California most often occurred in the east bay, where the least amount of circulation and largest quantities of stormwater discharges occur. Unlike the wet weather results, almost all of the 89 storm drains that discharge to the bay either did not have flowing fresh water or did not contain exceedingly high bacteria densities during dry weather. Upstream tracking during multiple storm events on two of the largest watersheds draining to the bay showed that sources of indicator bacteria were diffuse and widespread. Densities were as high at the head of each watershed as they were at the mouth, where both discharged to the bay. Every reach in each creek exceeded State of California water quality objectives and had densities similar to surface flows measured before they entered the separate municipal storm sewer system from urban land uses, such as residential, commercial, and industrial, as well as open lands.

California↗

Spatial distribution of seropositivity to the causative agent of granulocytic ehrlichiosis in dogs in California.

OBJECTIVE: To assess spatial and temporal patterns of seroprevalence among dogs in California to the causative agent of granulocytic ehrlichiosis (GE). SAMPLE POPULATION: Sera of 1,082 clinically normal dogs from 54 of 59 counties in California in 1997 to 1998. PROCEDURES: Serum-specific IgG reactivity to Ehrlichia equi was assessed by use of an immunofluorescent antibody assay, using E. equi-infected horse neutrophils as substrate. Data were analyzed, using a geographic information system. Spatial analysis of seroprevalence included first order Bayesian analysis of seroprevalence and second order analysis of clustering by K-function and Cuzick-Edwards tests. Monthly seroprevalence among dogs was examined by use of regression on monthly densities of Ixodes pacificus adults and nymphs. RESULTS: Seroprevalence among dogs to E. equi was 8.68%. Data were seasonally bimodal with highest prevalence in winter (when adult ticks were abundant) and a secondary peak in late spring (corresponding to nymphal ticks). Humboldt County had the highest seroprevalence (47.3%), and other northern coast range counties had seroprevalence from 15 to 30%. CONCLUSIONS AND CLINICAL RELEVANCE: The patchy distribution of exposure to Ehrlichia organisms is a subset of the distribution of the tick vector. This may reflect enzootic cycles or climatic or historical factors that limited the range of the disease. Dogs, horses, and humans from north coast range counties in California are at increased risk of GE. These data provide a background for assessing risk of infection in horses and dogs, depending on geographic location. Dogs may be sentinels for assessing risk of GE in humans.

Animals↗

Asthma mortality rates among California youths.

Asthma mortality rates for California youths (ages 5-17 years) were examined over the period 1981-1995. Data were analyzed by Poisson regression from the California Departments of Vital Statistics, Finance, and the U.S. Census Bureau. Aggregate statewide mortality demonstrated a 2.01%, statistically insignificant, upward trend without geographic clustering. Stratified race/ ethnicity rates differed significantly, with African-American mortality twice that of the Caucasian population. In addition, an increased number of deaths occurred in households of African-Americans, Caucasians (including Hispanics), and Hispanics with incomes below statewide medians. This study on California youths differs from reports on larger populations with its minimal aggregate increase in asthma mortality, yet mirrors national trends of disproportionate impact on African-Americans and the economically disadvantaged.

Adolescent↗

Access to Spanish-speaking physicians in California: supply, insurance, or both.

BACKGROUND: National studies report patients with limited English proficiency (LEP) have difficulty finding bilingual physicians; however, it is unclear whether this situation is primarily a result of an inadequate supply of bilingual physicians or a lack of the insurance coverage necessary to gain access to bilingual physicians. In California, 12% of urban residents are Spanish-speaking with some limited proficiency in English. The majority of these residents (67%) are uninsured or on Medicaid. METHODS: In 2001, we performed a mailed survey of a probability sample of primary care and specialist physicians practicing in California. We received 1364 completed questionnaires from 2240 eligible physicians (61%). Physicians were asked about their demographics, practice characteristics, whether they were fluent in Spanish, and whether they had Medicaid or uninsured patients in their practice. RESULTS: Twenty-six percent of primary care and 22% of specialist physicians in the 13 urban study counties reported that they were fluent in Spanish. This represented 146 primary care and 66 specialist physicians who spoke Spanish for every 100,000 Spanish-speaking LEP residents. In contrast to the general population, there were only 48 Spanish-speaking primary care and 29 specialist physician equivalents available for every 100,000 Spanish-speaking LEP patients on Medicaid and even fewer (34 primary care and 4 specialist) Spanish-speaking physician equivalents for every 100,000 Spanish-speaking physician equivalents for uninsured Spanish-speaking LEP patients. CONCLUSION: Although the supply of Spanish-speaking physicians in California is relatively high, the insurance status of LEP Spanish-speaking patients limits their access to the physicians. Addressing health insurance-related barriers to care for those on Medicaid and the uninsured is critical to improving health care for Spanish-speaking LEP patients.

California↗

Quantity and economic importance of nine selected by-products used in California dairy rations.

Food processing representatives, brokers, nutritionists, livestock producers, and trade associations were surveyed to quantify 9 by-products used for feeding livestock during 1992 in California. The commodities were almond hulls, dried beet pulp, wet brewers grains, wet citrus pulp, pressed citrus pulp, wet corn gluten feed, corn gluten meal, whole cottonseed, and rice bran. The 9 by-products contributed over 2.5 million tonnes and about 27% of the total feed concentrate moved within California during 1992. Market value of these 9 by-products was almost .25 billion dollars. Whole cottonseed accounted for about 31% of the total tonnage of these 9 by-products and provided about 66% of the total CP and 53% of the total NEL of these 9 by-products. The by-products were more valuable as energy sources than CP sources compared with NEL from corn and CP from soybean meal, respectively. Calculations of milk production, based on the CP content or NEL content of the by-products, showed that these 9 by-products could have contributed sufficient CP or NEL for over 31% of the milk produced in California during 1992. Ration formulations demonstrated that the economic value of by-products changed with feedstuffs available and, in general, would be used in rations over a range of market prices.

Animal Feed↗

Vector competence of California mosquitoes for West Nile virus.

To identify the mosquito species competent for West Nile virus (WNV) transmission, we evaluated 10 California species that are known vectors of other arboviruses or major pests: Culex tarsalis, Cx. pipiens pipiens, Cx. p. quinquefasciatus, Cx. stigmatosoma, Cx. erythrothorax, Ochlerotatus dorsalis, Oc. melanimon, Oc. sierrensis, Aedes vexans, and Culiseta inornata. All 10 became infected and were able to transmit WNV at some level. Ochlerotatus, Culiseta, and Aedes were low to moderately efficient vectors. They feed primarily on mammals and could play a secondary role in transmission. Oc. sierrensis, a major pest species, and Cx. p. quinquefasciatus from southern California were the least efficient laboratory vectors. Cx. tarsalis, Cx. stigmatosoma, Cx. erythrothorax, and other populations of Cx. pipiens complex were the most efficient laboratory vectors. Culex species are likely to play the primary role in the enzootic maintenance and transmission of WNV in California.

Animals↗

Cysticercosis-related deaths, California.

Cysticercosis is an increasingly important disease in the United States, but information on the occurrence of related deaths is limited. We examined data from California death certificates for the 12-year period 1989-2000. A total of 124 cysticercosis deaths were identified, representing a crude 12-year death rate of 3.9 per million population (95% confidence interval [CI] 3.2 to 4.6). Eighty-two (66%) of the case-patients were male; 42 (34%) were female. The median age at death was 34.5 years (range 7-81 years). Most patients (107, 86.3%) were foreign-born, and 90 (72.6%) had emigrated from Mexico. Seventeen (13.7%) deaths occurred in U.S.-born residents. Cysticercosis death rates were higher in Latino residents of California (13.0/106) than in other racial/ethnic groups (0.4/106), in males (5.2/106) than in females (2.7/106), and in persons >14 years of age (5.0/106). Cysticercosis is a preventable cause of premature death, particularly among young Latino persons in California and may be a more common cause of death in the United States than previously recognized.

Adolescent↗

Acute encephalitis hospitalizations, California, 1990-1999: unrecognized arboviral encephalitis?

Historically, Western equine encephalomyelitis and St. Louis encephalitis caused substantial human and equine illness and death in California. This study describes the epidemiology of encephalitis with data from 13,807 patients hospitalized in California with acute encephalitis from 1990 through 1999. The incidence of encephalitis hospitalizations decreased over this period. The greatest proportion of case-patients was hospitalized in the winter. Encephalitis of unspecified origin was the most common diagnosis, and arboviral encephalitis was the least common. Some California counties had concurrent increases in encephalitis rates and in detected arboviral activity in sentinel chickens and mosquito vectors. However, a diagnosis of arboviral encephalitis was made for few hospitalized patients in these counties during these periods. Although some arboviral encephalitis cases may have been undiagnosed, such cases probably did not occur frequently. Active hospital-based surveillance during periods of heightened sylvatic arboviral activity could increase detection of arboviral encephalitis.

Acute Disease↗