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PubMed1981

The California registration system for habitues to schedule II drugs.

In order to help control abuse and prevent over-prescribing, California has developed triplicate prescriptions for Schedule II narcotics as well as a system for physicians to publicly register patients who are habitues to Schedule II Controlled Substances. A preliminary evaluation indicates that there is under-reporting and confusion among physicians about the system, but it has probably helped control Schedule II narcotic abuse in California while not depriving patients of needed treatment. Physicians appear to prescribe Schedule II narcotics for serious medical conditions but may underprescribe narcotics for some chronic pain patients and subject others to potential complications of high, chronic doses or oral narcotics which are combined with salicylate, acetaminophen, or phenacetin. Despite some defects, California's system of triplicate prescriptions and public registration of habitues appears a viable alternative to the removal of abusable, Schedule II drugs from the commercial market.

Barbiturates↗
PubMed1995

Blood lead levels among children in a managed-care organization--California, October 1992-March 1993.

Despite substantial progress in reducing exposures to lead among children, as recently as 1991, 9% of children in the United States had blood lead levels (BLLs) of > or = 10 micrograms/dL (1)--levels that can adversely affect intelligence and behavior. In 1991, CDC recommended screening all children for lead exposure except those residing in communities in which large numbers or percentages previously had been screened and determined not to have lead poisoning (2). Subsequently, the California Department of Health Services (CDHS) issued a directive to all California health-care providers participating in the Child Health and Disability Prevention Program to routinely screen children for lead poisoning in accordance with the 1991 CDC guidelines (3). This report presents finding of BLL testing during 1992-1993 from a managed-care organization that provides primary-care services to Medicaid beneficiaries in several locations in California (i.e., Los Angeles County, Orange County, San Bernardino County, Riverside County, Sacramento, and Placerville).

California↗
PubMed1994

Firearm violence in California. Information and ideas for creating change.

Homicides have been on the rise in California in recent years, almost entirely as a result of increased firearm activity, resulting in one of the highest homicide rates in the country. With increasing morbidity and mortality from guns, health care professionals have called the situation an epidemic. In the past decade, attention from the health care profession has resulted in a new focus on the public health issues surrounding firearms. There is considerable confusion among policy makers regarding what should be done to stem firearm violence. I discuss morbidity and mortality trends, academic research, and legal issues surrounding firearm violence, affording insight into the seriousness and complexity of this rapidly growing problem and providing policy ideas for addressing the role of firearms. Such policy ideas include removal of the California Legislature's preemptive authority on firearms licensing and registration; the formation of an information and advisory body within the California Department of Health; increased liability for manufacturers, distributors, dealers, and owners; and a statewide registration system.

California↗
PubMedDate not supplied

Malathion and malaoxon environmental levels used for exposure assessment and risk characterization of aerial applications to residential areas of southern California, 1989-1990.

Between August 1989 and July 1990, California conducted a Mediterranean fruit fly eradication project in southern California which included repeated aerial applications of malathion bait to urban areas where approximately 1.6 million people resided. Concern about the safety of these applications prompted the California Department of Health Services to prepare a risk assessment. The current work presents the estimates of environmental levels of malathion and malaoxon, derived from mass deposition rates during application and monitoring of air. We estimated short and long-term malathion and malaoxon levels on outdoor surfaces, plants, and soils (0.1 and 1.0 cm mixing depth), using a simple first-order exponential decay model and literature half-life values ranging from three to nine days. Direct monitoring data were used to characterize short-term air levels. Average and upper-bound malathion levels immediately following an application were 0.091 microgram/m3 and 0.207 microgram/m3 in air; 22 and 52 mg/m2 on outdoor surfaces; 3.8 and 9.6 micrograms/g in plants; and 1.5 and 3.5 micrograms/g in soil (1 cm mixing depth). Malaoxon levels were 0.039 microgram/m3 and 0.110 microgram/m3 in air; 0.15 and 0.46 mg/m2, 0.03 and 0.09 microgram/g, and 0.01 and 0.03 microgram/g, respectively. Estimates of average and upper-bound levels over the duration of the eradication program were roughly one-third the immediate levels in all media. No field measurements were available for co-products other than malaoxon, for environmental persistence, or for concentrations on surfaces, soil, or plants after repeated applications. Because of limited monitoring data, and the likelihood that similar pest-eradication programs will be conducted, additional studies are warranted to more accurately characterize the environmental fate of malathion and human exposures after aerial application to residential communities.

Animals↗
PubMedDate not supplied

Assessment of exposure to malathion and malaoxon due to aerial application over urban areas of southern California.

The state of California conducted aerial applications of malathion (MA) bait over urban areas in the southern California air basin in order to eradicate the Mediterranean Fruit Fly (Ceratitis capitata). Concern about the potential human health effects of this activity prompted a risk assessment conducted by the California Department of Health Services. Estimates of potential human exposures to MA and its primary breakdown product, malaoxon, (MO) are based on assumptions of daily human activities which influence the rate of contact with MA and MO. Several exposure scenarios, representing a range of activity levels from sedentary to very active, are used as surrogates for a variety of human activities. For each exposure scenario, acute dose rates are calculated using both the mean and the mean plus 2 standard deviations (SD) (98% upper confidence limit (UCL)) of measured environmental values. Chronic dose rates are calculated using long-term averages incorporating degradation and multiple applications at 14 day intervals, and the estimated 98% UCL for these averages. Based on this model, estimated adult dermal doses (1-246 micrograms/kg-d) are up to about 2000-fold higher than the estimated inhalation doses (0.01-0.1 microgram/kg-d) but are comparable to the doses from ingestion of contaminated unwashed backyard vegetables (30-80 micrograms/kg-d). For the individual who does not consume backyard vegetables, therefore, almost the whole dose of MA or MO would be due to contacting contaminated surfaces with skin.

Adult↗
PubMed1994

Lead-contaminated drinking water in bulk-water storage tanks--Arizona and California, 1993.

Lead poisoning is a major environmental health problem for children in the United States (1,2): during 1988-1991, approximately 1.7 million U.S. children aged 1-5 years had elevated blood lead levels (BLLs) (> or = 10 micrograms/dL) (3). To determine the source of lead exposure for children with BLLs > or = 20 micrograms/dL, the Arizona Department of Health Services (ADHS) conducts environmental investigations. In 1993, as a result of investigations of increased BLLs in two children in southwestern Arizona, ADHS detected lead levels approximately 30 times the Environmental Protection Agency (EPA) action level of 15 parts per billion (ppb) in bulk-delivered drinking water in the homes of these children. Because two of the three companies that supplied bulk water to southwestern Arizona were based in California, ADHS notified the California State Department of Health Services (CSDHS) about the problem. As a result, CSDHS conducted a separate investigation and identified one child with an elevated BLL whose drinking water sources included bulk-delivered water with lead levels exceeding EPA standards. This report summarizes the investigations of elevated BLLs in these three children and high lead levels in bulk-delivered drinking water in Arizona and California.

Arizona↗
PubMed1994

Lyme disease in northwestern coastal California.

To determine the incidence of physician-diagnosed Lyme disease in an endemic area of California, an active surveillance program was implemented in Lake, Mendocino, Sonoma, and southern Humboldt counties. More than 200 medical care providers were called monthly for their list of suspected cases of Lyme disease. Pertinent information was abstracted from the medical record of each patient. Of 153 cases of possible early Lyme disease ascertained from July 1991 to December 1992, 37% consisted of physician-diagnosed erythema migrans. Only 58% of erythema migrans rashes were at least 5 cm in diameter. An additional 43 patients had suspicious rashes not classified as erythema migrans. Of 166 patients with possible late-stage Lyme disease, 31% had specific clinical symptoms and 75% had a positive serologic test. With an incident case defined as physician-diagnosed erythema migrans of at least 5 cm in diameter, the annual incidence of Lyme disease in northwestern coastal California according to active surveillance only was 5.5 per 100,000. The rate of Lyme disease in California is substantially lower than that in the Atlantic northeastern United States. Many suspected cases of Lyme disease in this endemic area do not meet surveillance criteria, which are intentionally restrictive. Although some of the illnesses not meeting surveillance criteria may be due to infection with Borrelia burgdorferi, it appears that Lyme disease is being overdiagnosed in this area.

Adolescent↗
PubMed1994

Update: coccidioidomycosis--California, 1991-1993.

Coccidioidomycosis is an infection caused by the fungus Coccidioides immitis, which resides in the soil in some areas of Arizona, California, Nevada, New Mexico, Texas, and Utah. Infection can occur when airborne, infective arthroconidia are inhaled. Symptomatic coccidioidomycosis, which occurs in approximately 40% of all infections, has a wide clinical spectrum, including mild influenza-like illness, severe pneumonia, and disseminated disease. Beginning in 1991, the number of cases of coccidioidomycosis reported annually to the California Department of Health Services (CDHS) increased dramatically (1) (Figure 1). This report summarizes the occurrence of coccidioidomycosis in California during 1991-1993.

California↗
PubMed1994

California's suicide decline, 1970-1990.

From 1970 to 1990 California experienced a 32% decline in suicide, which was particularly pronounced among women, non-whites, the young, and urban dwellers. Suicide declines of over 50% were recorded in San Francisco and Los Angeles, and large decreases occurred in other coastal counties. Additionally, California was the only one of 51 states to show a consistent decline in teenage and young-adult suicide (accompanied by an 88% decrease in teenage drug and other poisoning deaths). Initial investigation of death certification, accident and homicide trends, economic measures, and prevention efforts did not produce an explanation for a suicide decrease of California's magnitude. However, the state does display anomalous trends in certain social measures (reduced divorce, rising non-White population, and rising homicide) that point to multifactorial hypotheses including demographic changes and changed attitudes toward violence. Review of the accuracy of past suicide certification procedures nationally is also indicated.

Adolescent↗
PubMed1995

Drug-resistant Mycobacterium tuberculosis in California, 1991 to 1992.

To determine the proportion and distribution of drug-resistant Mycobacterium tuberculosis in California, we surveyed all California counties for drug-susceptibility test results for initial isolates from tuberculosis cases counted during the first quarters of 1991 and 1992. Overall, drug-susceptibility test results were not available for 17% of isolates. Among isolates with available test results, the proportion with resistance to isoniazid averaged 8.7%, and the proportion with resistance to at least 2 drugs, multidrug resistance, averaged 5.9% during these two quarters. The proportion of isolates with drug resistance did not change substantially during these time periods. The proportion with combined isoniazid and rifampin resistance remained stable at about 1.1%. Among persons whose isolates were tested for drug resistance, those with a known previous diagnosis of tuberculosis (relative risk [RR] = 2.6; 95% confidence interval [CI], 1.6 to 4.3; P < .01) and persons who were foreign born (RR = 1.7; 95% CI, 1.1 to 2.7; P = .014) were more likely to have isoniazid-resistant organisms. These statewide data suggest that the initial tuberculosis treatment regimen in California should include 4 antituberculosis drugs, as recommended by the American Thoracic Society and the Centers for Disease Control and Prevention for areas with a prevalence of isoniazid resistance of 4% or greater. The lack of test results for 1 in 6 patients with tuberculosis suggests the need for improved physician and laboratorian education to implement the recommendations that drug susceptibility be tested on all initial isolates.

Adolescent↗
PubMed1996

AIDS-related experiences of primary care physicians in rural California, 1995.

A telephone survey was conducted of primary care physicians in nonmetropolitan counties of California. In a random sample of those counties reporting fewer than 30 cases of the acquired immunodeficiency syndrome (AIDS) as of December 1994, all physicians in practice were called; in counties reporting from 31 to 150 cases of AIDS as of the same date, a 30% random sample was selected for interviewing. Completion rates were 82% in the smallest counties and 70% in the larger counties (overall 72%). Two thirds of physicians reported that they had seen a patient positive for the human immunodeficiency virus and were providing continuing care for the disease. In all, 60% of physicians had seen a patient with AIDS. In these counties, there were 653 primary care physicians and 873 patients living with AIDS. The proportion of physicians providing care to persons with AIDS was twice that reported in previous surveys done in Los Angeles, California. In the interval (1985-1994), there was a 20-fold increase in the number of AIDS cases in California. In the nonmetropolitan areas, the number of AIDS cases in late 1994 was 290 times that reported in 1985.

Acquired Immunodeficiency Syndrome↗
PubMed1996

California's Proposition 186: lessons from a single-payer health care reform ballot initiative campaign.

Proposition 186 was an initiative on the November 1994 California ballot which proposed to establish a state single-payer health care program. Although Prop 186 was overwhelmingly defeated in the November 1994 election (73% No, 27% Yes), it accomplished many things. Model legislation was developed showing the feasibility of a specific single-payer program for California. It was placed on the ballot by an unprecedented volunteer signature-gathering effort and was the largest grassroots political campaign fund-raising effort in California history. A novel strategy for the discussion of complex issues through 1500 house parties was launched. Prop 186 was defeated by an insurance industry-led coalition with an anti-government message. Lessons for future efforts include increasing the size and duration of the grassroots organizing and educational effort, and decreasing reliance on conventional political campaign tactics and the mainstream media.

California↗
PubMed1996

Why is the treatment of work-related injuries so costly? New evidence from California.

There is growing evidence that workers' compensation insurers are charged substantially more than health insurers for the treatment of similar injuries. The first study of the problem, conducted in Minnesota in 1987, found that both overutilization of services and price discrimination contributed to the charge differential. This article applies the Minnesota model to 1991-1993 data on health care charges and payments from California. Approximately 13,000 persons with work-related injuries are compared to approximately 3,600 persons with similar injuries that occurred off the job. Despite important differences in the populations and workers' compensation laws in California and Minnesota, workers' compensation insurers are charged more than health insurers for the treatment of similar injuries in both states. The difference in California's payments is attributable to using more health care providers and services to treat workers' compensation patients. The results do not support the hypothesis that work-related injuries cost more to treat because they are more severe than similar injuries occurring off the job.

Accidents, Occupational↗
PubMedDate not supplied

Low-cost cigarettes and smoking behavior in California, 1990-1993.

Low-cost generic cigarettes grew dramatically in market share between 1990 and 1993, raising concerns that some smokers might view generics as an alternative to quitting. We report sociodemographic predictors of generic brand choice among a cross-sectional sample of California smokers and investigate changes in brand choice in a longitudinal sample of California smokers between 1990 and 1992. We also focus on brand preferences among California adolescents. One third of smokers who switched cigarette brands between 1990 and 1992 switched to generics. Non-Hispanic whites, rural residents, and lower income smokers were twice as likely to buy generics as other smokers were. Heavy cigarette consumption was strongly associated with smoking generic cigarettes. Women appeared more price-sensitive in cigarette purchasing than men did, and generic brands were the most frequently purchased cigarettes for female smokers older than age 45. Generics were less popular among adolescents than among adults. Generic cigarettes provide a low-cost alternative to price-sensitive smokers, but further studies are needed to establish the role and influence of generic cigarettes on smoking prevalence and public health. Medical Subject Headings (MeSH): smoking, smoking cessation, adolescent behavior, women, prevalence.

Adolescent↗
PubMedDate not supplied

California residential air exchange rates and residence volumes.

UNLABELLED: Air exchange rate data from two residential indoor air quality studies are presented. In the first investigation, over 500 residences in Southern California were sampled for three one-week periods from 1984 to 1985. Those data provided seasonal information for a broad range of residential characteristics in a large metropolitan area. In the second study, a probability sample of nearly 300 residences were sampled for a two-day period during the winter of 1991-1992 throughout the state of California. Air exchange rate is summarized by season, geographic area, and appliance type. Residence volumes are presented by cooking and heating appliance. The data approximately followed lognormal distributions. IMPLICATIONS: Indoor air quality and human exposure models often require estimates of air exchange rate and residence volumes. Application of those models to California residences can be improved by using the data distributions provided in this manuscript. Data distributions presented for heating and cooking appliances are useful for modeling the impact of indoor sources specific for those appliance types. Measured air exchange rate is also useful for modeling energy use for heating and cooling in residences.

Air Pollution, Indoor↗
PubMed1995

Prevalence of anal sex among heterosexuals in California and its relationship to other AIDS risk behaviors.

This paper describes the prevalence of anal sex among heterosexual adults in California and investigates the relationship of anal sex to other risk behaviors associated with AIDS and STDs. The study consisted of telephone interviews with a household probability sample of 3,545 California adults undersampling those age 44 and older. Seven percent of the sexually active respondents, 8% of males, and 6% of females reported having anal sex at least once a month during the year prior to the survey. Of these, most engage in this activity one to five times per month, and about 60% report never using condoms. Younger respondents and those who were not married were more likely to report anal intercourse. Respondents who had anal sex were more likely to report standard AIDS risks and lifestyle risks associated with STDs, and to engage in recreational use of drugs and alcohol. Both anal sex and condom use during anal intercourse were poorly predicted by these demographic and risk variables. It is concluded that a non-trivial proportion of California heterosexual adults engages in anal sex regularly, most without condoms, and those who have anal sex are more likely to have other risk behaviors associated with AIDS and STDs. These results suggest that anal sex must be addressed specifically in clinical and educational programs designed to reduce the spread of AIDS.

Adolescent↗
PubMed1996

Estimates of retailers willing to sell tobacco to minors--California, August-September 1995 and June-July 1996.

The prevalence of tobacco use among adolescents is increasing, and the most common source of tobacco products for persons aged < 18 years (minors) is retail stores. In 1991, an estimated 29.6 million packs of cigarettes were sold illegally to minors in California, and an estimated 255 million packs were sold illegally to minors nationwide. Federal law (i.e., the Synar Amendment) enacted in July 1992 requires all states that receive federal funds for prevention and treatment of substance abuse to have and enforce laws prohibiting the sale or distribution of tobacco to minors, conduct annual statewide inspections of over-the-counter tobacco outlets and vending machines to assess the statewide rate of illegal tobacco sales to minors, and develop a plan to decrease the illegal sales rate to < or = to 20% over several years. On September 28, 1994, California enacted the Stop Tobacco Access to Kids Enforcement (STAKE) Act, which requires that 1) tobacco retailers (i.e., vendors) post warning signs at each point of purchase and check the identification of persons who appear aged < or = to 18 years; 2) the California Department of Health Services (CDHS) develop a statewide enforcement program and establish a toll-free telephone number for reporting observed illegal tobacco sales to minors and 3) CDHS annually assess and report the rate of illegal sales of tobacco products to minors. This report describes the retailer education and enforcement program and summarizes the results of the first two annual assessments (Youth Tobacco Purchase Surveys [YTPSs]). The findings indicate that, from August-September 1995 to June-July 1996, among over-the-counter tobacco outlets the percentage of retailers who asked for age identification increased substantially, the percentage of stores displaying warning signs on age restrictions increased, and the percentage of retailers willing to sell tobacco products to minors decreased.

Adolescent↗
PubMed1997

Behavioral Risk Factor Survey of Korean Americans--Alameda County, California, 1994.

Asians/Pacific Islanders (APIs) account for an increasing proportion of all racial/ ethnic minority groups in the United States: during 1980-1990, the number of persons in this group increased approximately 99%. Among APIs in the United States, Korean Americans are the fifth largest subgroup. In Alameda County, California, APIs comprise 15% of the population, and Korean Americans account for 5% of that group. To assess behavioral risk factors among Korean Americans in Alameda County, Asian Health Services (a nonprofit community clinic) and the Center for Family and Community Health at the University of California, Berkeley, conducted a household telephone survey from August 1994 through February 1995. This report summarizes findings from that survey, which indicate significant differences in the prevalences of some behavioral risk factors and preventive health practices between men and women and between Korean Americans and the total California population.

Adult↗