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PubMed2004

Pesticides and PCBs in sediments and fish from the Salton Sea, California, USA.

The Salton Sea, the largest manmade lake in California, is officially designated by the State of California as an agricultural drainage reservoir. The purpose of this study was to determine organochlorine and organophosphorous pesticides, as well as polychlorinated biphenyl (PCB) concentrations in sediments and fish tissues in the Salton Sea and evaluate the relative ecological risk of these compounds. Sediment samples were taken during 2000-2001 and fish tissues (Tilapia mossambique, Cynoscion xanthulu) were collected in May 2001. All samples were analyzed for 12 chlorinated pesticides, 6 organophosphorus pesticides, and 55 polychlorinated biphenyl (PCB) congeners. SigmaDichlorodiphenyltrichloroethane (SigmaDDT) and total PCB concentrations observed in sediments ranged from 10 to 40 and 116 to 304 ng/g dry wt, respectively. DDT/DDD ratios in sediments and fish tissues of the northern Sea in 2001 indicated recent DDT exposure. Lindane, dieldrin, dichlorodiphenylethane (DDE) and total PCB concentrations detected in sediments exceeded probable effect levels established for freshwater ecosystems, and pp-DDE and total PCB concentrations were higher than effect range-median values developed for marine and estuarine sediments. In fish liver, concentrations of endrin and SigmaDDT exceeded threshold effect level established for invertebrates. SigmaDDT concentrations detected in fish tissues were higher than threshold concentrations for the protection of wildlife consumers of aquatic biota. DDE concentrations in fish muscles tissues were above the 50 ng/g concentration threshold for the protection of predatory birds. Dimethoate, diazinon, malathion, chlorpyrifos, disulfoton varied from < or = 0.15 to 9.5 ng/g dry wt in sediments and from < or = 0.1 to 80.3 ng/g wet wt in fish tissues. Disulfoton was found in relatively high concentrations (up to 80.3 ng/g) in all organs from Tilapia and Corvina. These results demonstrate continued contamination of specific organochlorine compounds in sediments and resident fish species of the Salton Sea.

Analysis of Variance↗
PubMed2005

GIS-facilitated spatial epidemiology of tick-borne diseases in coyotes (Canis latrans) in northern and coastal California.

Ixodes pacificus is the main tick vector for transmission of Anaplasma phagocytophilum and Borrelia burgdorferi to large vertebrates in California. The present study was undertaken in I. pacificus-infested counties in California to examine spatial and temporal relationships among A. phagocytophilum and B. burgdorferi-exposed coyotes with vegetation type and climate. The overall A. phagocytophilum and B. burgdorferi seroprevalences were 39.5% (N=215) and 18.9% (N=148), respectively, with no association with sex. PCR for A. phagocytophilum and B. burgdorferi was negative in all blood and kidney samples. Increased seroprevalence was a positive function of rainfall. Ehrlichial seropositivity was increased in blue-oak foothill pine, montane hardwood, and redwood vegetation regions, and decreased in coastal sagebrush and cropland. Increased exposure to B. burgdorferi occurred in blue oak woodland.

Anaplasma phagocytophilum↗
PubMed2005

Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women.

BACKGROUND: Mounting evidence suggests that lesbians and bisexual women may be at especially elevated risk for the harmful health effects of alcohol and tobacco use. METHODS: We report findings from the California Women's Health Survey (1998-2000), a large, annual statewide health surveillance survey of California women that in 1998 began to include questions assessing same-gender sexual behavior. RESULTS: Overall, homosexually experienced women are more likely than exclusively heterosexually experienced women to currently smoke and to evidence higher levels of alcohol consumption, both in frequency and quantity. Focusing on age cohorts, the greatest sexual orientation disparity in alcohol use patterns appears clustered among women in the 26-35-year-old group. We also find that recently bisexually active women report higher and riskier alcohol use than women who are exclusively heterosexually active. By contrast, among homosexually experienced women, those who are recently exclusively homosexually active do not show consistent evidence of at-risk patterns of alcohol consumption. DISCUSSION: Findings underscore the importance of considering within-group differences among homosexually experienced women in risk for tobacco and dysfunctional alcohol use.

Adolescent↗
PubMed2005

Unmet need for recommended preventive health services among clients of California syringe exchange programs: implications for quality improvement.

BACKGROUND: Comprehensive preventive services are recommended for injection drug users (IDU), including screening tests, vaccinations, risk reduction counseling, and sterile syringes. Syringe exchange programs (SEP) may facilitate receipt of preventive services by IDUs, but whether SEP clients receive recommended preventive care is not known. We examined use of recommended preventive services by clients of 23 SEPs throughout California. METHODS: Five hundred and sixty SEP clients were recruited from 23 SEPs throughout California between March and September 2003. Receipt of 10 recommended preventive services and source of care (SEP versus non-SEP providers) was ascertained from client interviews. RESULTS: On average, SEP clients received only 13% of recommended preventive services and 49% of clients received none of the recommended services. Of services that were received, 76% were received from SEPs. In multivariate analysis, use of drug treatment and more frequent SEP visits were associated with receipt of recommended preventive services by clients. CONCLUSIONS: SEPs are often the only source of preventive care for their IDU clients. Still, SEP clients fail to receive most recommended preventive services. Interventions to increase use of preventive services and improve the quality of preventive care received by IDUs, such as increased access to drug treatment and SEPs, are needed.

California↗
PubMed2005

HIV surveillance in theory and practice: assessing the acceptability of California's non-name HIV surveillance regulations.

In 2002, California adopted a non-name system for HIV case reporting. This study focused on the acceptability of a non-name reporting system among key stakeholders implementing the system. We conducted qualitative research during the pre- and post-implementation period of the non-name HIV reporting regulations. During both study periods we conducted key informant in-depth interviews (n = 48 and 52, respectively) with health department surveillance staff, laboratory personnel, health care providers and clinic staff; and we conducted four focus group discussions (n = 28 and 30, respectively) with representatives of community-planning group members and advocacy groups. We found that overall, California's non-name HIV reporting regulations were acceptable to most key stakeholders. Acceptability of a non-name system was highest among advocates and healthcare providers. Views of health department staff varied across the four counties, with some expressing a strong preference of a names based system and others accepting the non-name system.

California↗
PubMed2004

HLA-DRB1 and -DQB1 alleles in mestizo patients with Vogt-Koyanagi-Harada's disease in Southern California.

We evaluated human leukocyte antigen (HLA)-DRB1 and -DQB1 alleles as genetic markers for Vogt-Koyanagi-Harada (VKH) disease in Mestizo patients in Southern California. Mestizo individuals with VKH disease (n = 29) at two institutions were evaluated. Typing of HLA-DRB1 and DQB1 genes was performed using DNA-based techniques. Gene frequencies were compared to Mestizo individuals living in Southern California. All patients had HLA-DRB1*01, DRB1*04, DQB1*03 or DQB1*05, or a combination of these genes. The gene frequency of combined HLA-DR4 alleles was increased when compared to controls. The frequencies of HLA-DRB1*0404 and DRB1*0407 were increased compared to controls, but were not significant after Bonferroni correction. Three patients had the HLA-DRB1*0410 allele; this allele was not found in controls. All HLA-DRB1*01 positive patients had the DRB1*0102 subtype. No HLA-DQB1 allele was significantly increased compared to controls. This study is the first to identify a possible association between HLA-DRB1*0404 and VKH disease, as well as to find DRB1*0102 and DRB1*0410 in Mestizo patients.

Alleles↗
PubMed2005

New genotypes and factors associated with Cryptosporidium detection in mussels (Mytilus spp.) along the California coast.

A 3 year study was conducted to evaluate mussels as bioindicators of faecal contamination in coastal ecosystems of California. Haemolymph samples from 4680 mussels (Mytilus spp.) were tested for Cryptosporidium genotypes using PCR amplification and DNA sequence analysis. Our hypotheses were that mussels collected from sites near livestock runoff or human sewage outflow would be more likely to contain the faecal pathogen Cryptosporidium than mussels collected distant to these sites, and that the prevalence would be greatest during the wet season when runoff into the nearshore marine environment was highest. To test these hypotheses, 156 batches of sentinel mussels were collected quarterly at nearshore marine sites considered at higher risk for exposure to livestock runoff, higher risk for exposure to human sewage, or lower risk for exposure to both faecal sources. Cryptosporidium genotypes detected in Haemolymph samples from individual mussels included Cryptosporidium parvum, Cryptosporidium felis, Cryptosporidium andersoni, and two novel Cryptosporidium spp. Factors significantly associated with detection of Cryptosporidium spp. in mussel batches were exposure to freshwater outflow and mussel collection within a week following a precipitation event. Detection of Cryptosporidium spp. was not associated with higher or lower risk status for exposure to livestock faeces or human sewage sources. This study showed that mussels can be used to monitor water quality in California and suggests that humans and animals ingesting faecal-contaminated water and shellfish may be exposed to both host-specific and anthropozoonotic Cryptosporidium genotypes of public health significance.

Animals↗
PubMed2006

The impact of realized access to care on health-related quality of life: a two-year prospective cohort study of children in the California State Children's Health Insurance Program.

OBJECTIVE: To examine the effect of realized access to care (problems getting care, access to needed care) on health-related quality of life (HRQOL) in the California State Children's Health Insurance Program. STUDY DESIGN: This was a prospective cohort study (n = 4,925; 70.5% [3438] had complete data). Surveys were taken at enrollment and after 1 and 2 years in the program. Parents and children reported HRQOL (PedsQL 4.0 Generic Core Scales). Repeated-measures analysis accounted for within-person correlation and adjusted for baseline PedsQL, baseline realized access, race/ethnicity, language, chronic health condition, and having a regular physician. RESULTS: Realized access to care during the prior year was related to HRQOL for each subsequent year. Foregone care and problems getting care were associated with decrements of 3.5 (P < .001) and 4.5 (P < .001) points for parent proxy-report PedsQL and with decrements of 3.2 (P < .001) and 4.4 (P < .001) points for child self-report PedsQL. Improved realized access resulted in higher PedsQL scores, continued realized access resulted in sustained PedsQL scores, and foregone care resulted in cumulative declines in PedsQL scores. CONCLUSIONS: Realized access to care is associated with statistically significant and clinically meaningful changes in HRQOL in children enrolled in the California State Children's Health Insurance Program.

Adolescent↗
PubMed2004

Effects of the California graduated driver licensing program.

PROBLEM: On July 1, 1998, in an effort to ameliorate the problem of high teenage driver crash rates, California implemented a graduated driver licensing system (GDLS). METHOD: Data on injury crashes of 16- and 17-year-old drivers from a pre-GDLS year were compared with data from two post-GDLS years. Per-capita crash rate ratios were adjusted for changes in crash rates of 25- to 34-year-old drivers, who were unaffected by the GDLS. Prevented numbers and 95% confidence intervals were estimated. RESULTS: Fatal or severe injury crash rates were significantly lower during each of the two post-GDLS years (adjusted rate ratios (RR)=0.72 and 0.83, for 2000 vs. 1997 and 2001 vs. 1997, respectively). Significant rate reductions were observed for all crash types, particularly for struck object (RR=0.71 and 0.80, for 2000 vs. 1997 and 2001 vs. 1997, respectively) and non-collision (RR=0.63 and 0.72, for 2000 vs. 1997 and 2001 vs. 1997, respectively). Minor injury crash rates were also lower during post-GDLS years (RR=0.87 and 0.90, for 2000 vs. 1997 and 2001 vs. 1997, respectively). Percent reductions were notably larger during the hours of the late night driving restriction (midnight-5 a.m.) (RR=0.79 and 0.87, for 2000 vs. 1997 and 2001 vs. 1997, respectively). SUMMARY: The implementation of the California GDLS was followed by large reductions in the rate of injury-producing motor-vehicle crashes. IMPACT ON INDUSTRY: This evaluation supports previous evidence that GDLS is an effective countermeasure to adolescent motor-vehicle crashes and their associated injuries. States with a traditional licensing system may prevent adolescent driver crashes by adopting a GDLS. Future studies should examine factors that influence teenager compliance with GDLS provisions and identify approaches to improving compliance.

Accidents, Traffic↗
PubMed2005

Nasopharyngeal cancer in the California Hmong, 1988-2000.

Although previous studies document elevated nasopharyngeal cancer incidence in the American Hmong, a descriptive analysis is lacking. The present case-series aims to identify important features of head and neck cancers in the California Hmong, specifically nasopharyngeal cancer. We assessed incident head and neck cancers identified by the California Cancer Registry from 1988-2000 for incidence, mortality and descriptive comparisons between the Hmong, non-Hispanic Whites (NHW) and Asian/Pacific Islanders (API). Nasopharyngeal cancer was the most frequent Hmong cancer (39 of 51 cases) with incidence 23 times greater than in NHW. Nasopharyngeal cancer mortality rates for Hmong, NHW and API were 10.4, 0.2 and 1.7/100,000 respectively. Hmong were more likely to be diagnosed with remote tumors and less likely to receive treatment. A public health disparity clearly exists regarding nasopharyngeal cancer in the Hmong. Education on culturally appropriate healthcare and efforts to encourage diagnosis and treatment are necessary to reduce this disparity.

Adult↗
PubMed2005

Residential mobility in the California Teachers Study: implications for geographic differences in disease rates.

BACKGROUND: Especially for cancers with long latency periods, such as breast cancer, the issue of residential mobility hinders ecologic analyses seeking to examine the role of environmental contaminants in chronic disease etiology. This study describes and evaluates characteristics associated with residential mobility in a sub-sample of the California Teachers Study (CTS) cohort. METHODS: In 2000, lifetime residential histories were collected for a sub-sample of 328 women enrolled in the CTS; women's degree of residential mobility and associated factors were analyzed. RESULTS: While most women moved many times during their lives (average = 8.9), the average number of years at their residence when they enrolled in the study was reasonably long (15.1 years). Age strongly predicted duration at current residence but was not related to the number of lifetime residences. After adjusting for age, California-born women and women living in high socioeconomic status (SES) neighborhoods were significantly more residentially stable. Agreement between self-reported urbanization of recent residences and that based on census data of the geocoded residences was very good (80% concordant). Among women currently living in urban areas, an average of 43.3 years, or 77%, of their lifetimes were spent in urban residences; among women currently living in a rural area, an average of 37.3 years, or 67% of their lifetimes were spent in rural residences. CONCLUSIONS: This suggests that analyses of incidence rates based on current residence, while not capturing a woman's full exposure history, may reasonably reflect some aspect of longer term chronic exposures, especially those related to urbanization, at least in professional women.

Adult↗
PubMed2006

Governing stem cell research in California and the USA: towards a social infrastructure.

Owing to the restrictive human embryonic stem cell (hESC) policies of the US government, the question of whether to pursue human embryonic stem cell experiments has dominated the ethical and political discourse concerning such research. Explicit attention must now turn to problems of implementing the research on a large scale: in the 2004 US elections, California voters approved a state initiative for stem cell research, earmarking $3 billion in direct spending over 10 years. This article explores three ethical and political problem areas emerging out of the California program, the resolution of which will help set the trajectory of hESC research in the US and abroad, and then proposes an institutional approach to help address them: a network of public stem cell banks in the US that feature transparent and shared governance.

California↗
PubMed2005

Access to urologic care for children in California: Medicaid versus private insurance.

OBJECTIVES: To compare the access to urologic care for a child with cryptorchidism insured by Medi-Cal versus one insured by private insurance. Medi-Cal (California State Medicaid) is a joint state and federal health insurance program that plays a significant role in providing healthcare coverage to low-income children. METHODS: A total of 54 randomly chosen urology offices throughout California were surveyed by telephone to determine whether the office accepted pediatric patients, accepted Medi-Cal, and when the earliest appointment date would be for a patient with Medi-Cal versus one with private insurance. RESULTS: Of the 46 practices that accepted pediatric patients, 96% offered a new patient appointment to a child with private insurance, but only 41% were willing to offer an appointment to a child with Medi-Cal (P < 0.0001). Of the offices that would not see a child with Medi-Cal, 75% were unable to recommend a urology office that might accept Medi-Cal. CONCLUSIONS: Children insured by Medi-Cal have significantly less access to necessary urologic care compared with children with private insurance.

California↗
PubMed2006

Babesia conradae, sp. Nov., a small canine Babesia identified in California.

Small piroplasms as a cause of canine babesiosis have usually been identified as Babesia gibsoni. Recent genetic studies suggested that small piroplasms are more likely comprised of at least three genotypically distinct species. In southern California, canine babesiosis caused by a small piroplasm has been documented since 1990. Morphological characteristics of this parasite include a small (0.3-3.0 microm) intraerythrocytic merozoite stage with predominantly ring, piriform, tetrad, amoeboid, or anaplasmoid forms. Transmission electron microscopic images of merozoites demonstrate the presence of an apical complex consisting of an inner subplasmalemmal membrane and rhoptries. Based on phylogenetic analyses of the 18S rRNA and the ITS-2 genes, the Californian small piroplasm isolate is more closely related to piroplasm isolates from wildlife and humans in the western United States than it is to B. gibsoni. Molecular and morphologic evidence supports naming the small piroplasm from southern California as a distinct species, Babesia conradae.

Animals↗
PubMed2006

Culicoides bottimeri as a vector of Haemoproteus lophortyx to quail in California, USA.

Arthropod sampling via periodic direct bird examination and regular light trapping was conducted between June 2000 and October 2002 to survey for potential vectors of Haemoproteus lophortyx to nonnative, captive-raised bobwhite quail (Colinus virginianus) in northern California, USA. Examination of individual bobwhite quail (from 5 weeks of age through adult, total n=76) was conducted on several dates during the transmission period (June-October). No ectoparasites, including hippoboscid flies (reported as Haemoproteus vectors to wild quail in early literature), were collected from the birds. Trapping with ultraviolet light suction traps near the quail revealed nine species of biting midges (Culicoides spp.). Of these, 94% were C. bottimeri, which was abundant near the birds, and 65% of collected C. bottimeri were engorged with blood. C. bottimeri adult activity began in late-April, slightly before the onset of disease in the quail. Activity peaked between July and late-September, coincident with maximum reported transmission, and adult activity ceased by early-November. Nonengorged C. bottimeri had a parity rate of 43.6% overall, suggesting excellent survival for biological transmission of a pathogen like H. lophortyx. A controlled study was done injecting a macerated slurry of pooled, nonengorged, wild-caught C. bottimeri into the peritoneum of 1-day-old bobwhite quail hatchlings held in insect-proof containers. Blood smears 13-19 days later confirmed H. lophortyx infection in zero controls but all insect-injected quail. Biting midges, especially C. bottimeri, transmit H. lophortyx to captive quail and probably are the dominant vector to native California quail (Callipepla californica) as well.

Animals↗
PubMed2005

Seasonal tertiary wastewater treatment in California: an analysis of public health benefits and costs.

A number of communities in the Central Valley of California have requested that seasonally based effluent limits be developed for their wastewater treatment facilities. These seasonal limits would be based on disinfected secondary treatment during the winter and disinfected tertiary treatment during the rest of the year. Such a request for seasonal limits raises a significant water quality policy question with regard to the costs and relative benefits of tertiary treatment during the winter season. A benefit-cost analysis for winter season tertiary wastewater treatment in California's Central Valley is presented here. The assumed societal benefit of winter tertiary treatment is enhanced water quality for recreational purposes, and thus reduced risk to public health. Based on the results of this analysis, between four and sixteen million recreation events would need to occur annually region-wide during the winter to justify the costs of winter tertiary treatment. A similar method and the information described herein could be used by the state water quality regulatory agency to develop a risk-based policy to consider seasonal limits.

California↗
PubMed2005

Smoking prevalence and correlates among Chinese- and Filipino-American adults: findings from the 2001 California Health Interview Survey.

OBJECTIVES: We report prevalence rates and correlates of cigarette smoking among a population-based sample of Chinese- and Filipino-American adults together with rates found in other racial/ethnic groups in California. METHODS: All analyses are based on the 2001 California Health Interview Survey. RESULTS: The proportion of current smokers among males was lowest among Chinese Americans (14%), followed by Non-Hispanic Whites (19%), Hispanics (20%), African Americans (22%), Filipino Americans (24%), American Indians/Alaska Natives (29%), and Pacific Islanders (32%). The proportion of current smokers among females was lowest among Chinese Americans (6%), followed by Hispanics (8%), Filipino Americans (11%), Non-Hispanic Whites (17%), African Americans (20%), Pacific Islander (21%), and American Indians/Alaska Natives (32%). Smoking rates were higher among foreign-born versus U.S.-born Asian males. CHIS data show an opposite effect among Asian women: acculturation to the U.S. is associated with increased smoking prevalence rates. Multivariate analyses with Chinese and Filipino respondents showed that the likelihood of smoking varied among foreign-born versus U.S.-born men (OR 2.59 for Chinese, 1.42 for Filipino, 2.01 for all Asian men combined) and for foreign-born versus U.S.-born women (OR 0.41 for Chinese, 0.38 for Filipino, and 0.59 for all Asian women combined). CONCLUSION: Public health intervention efforts should take into account Asian ethnic subgroup, gender, and acculturation status in targeting high-risk smoking groups.

Adult↗
PubMed2002

Responses of teenagers and their parents to California's graduated licensing system.

In 1998, California adopted a strong graduated licensing system that lengthened the learner's permit stage from 1 month to a mandatory 6 months and introduced passenger and nighttime restrictions for initial license holders. The passenger restriction (no passengers younger than 20 for the first 6 months) is stronger than such restrictions in any other state; the nighttime ban is relatively weak, not beginning until midnight. Surveys were undertaken to learn what teenagers and their parents thought about the new requirements and how they responded to them. Two groups of beginning California license holders were surveyed three times during the first year of licensure; their parents were interviewed twice. One group (n = 543) was subject to the graduated licensing requirements, the other (n = 814) was not. Parents strongly endorsed the new system. The vast majority approved of the new permit requirements and the nighttime and passenger restrictions. Among parents whose children were subject to the new requirements, 79% were strongly in favor of the new system and only 4% were neutral or opposed. Teenagers were less favorable toward the new requirements. Most approved of the new learner's permit rules, and the majority of teenagers favored the night restriction, but only about one-third endorsed the passenger restriction. Compliance with the new rules was not close to universal, but the new licensing system resulted in young people holding their learner's permits longer, accumulating more practice driving prior to licensure and decreased the amount of reported driving after midnight and transportation of teenagers when initially licensed. Most teenagers subject to the new rules said they were able to do the activities they wanted despite the changes; almost three-quarters said they were not affected much by either the nighttime or passenger restriction. Overall the results indicate that the new licensing system is accepted favorably by teenagers and their parents and has substantially increased the types of behaviors that collectively should lead to crash and injury reductions.

Accidents, Traffic↗