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Organophosphorus pesticides in storm-water runoff from southern California (USA).

Large quantities of the organophosphorus (OP) pesticides diazinon and chlorpyrifos are applied to California (USA) watersheds every year, but few data are available on the sources of OP pesticides in urban watersheds. The goal of this study was to characterize diazinon and chlorpyrifos concentrations from different land uses indicative of source categories in urban southern California watersheds. This characterization included analysis of 128 runoff samples from eight different land uses over five storm events. Diazinon was consistently detected (93% of samples) during this study, whereas chlorpyrifos was not consistently detected (12% of samples). The mixed agricultural land use had the highest flow weighted mean (FWM) concentration of diazinon (4076 ng/L), which exceeded the next-highest land-use categories (commercial and residential) by one to two orders of magnitude (324-99 ng/L, respectively). Open space had the lowest concentration of diazinon (<20 ng/L). Concentrations of diazinon at replicate land-use sites and during replicate storm events at the same site were highly variable. The difference in diazinon FWM concentrations among replicate sites ranged from 1.5-fold to 45-fold. The difference in diazinon FWM concentrations among storms at the same site ranged from 1.25-fold to 30-fold. Part of this variability is a response to the temporal patterns observed within a storm event. The majority of land-use site-events had peak concentrations before peak flow indicating a first-flush effect, but this was not always a predictable temporal trend. The first-flush effect was rarely evident in terms of mass loadings because flows can range orders of magnitude during a single event in highly impervious urban watersheds. Flow variability thus overwhelms the variability in diazinon concentrations attributable to the first-flush effect.

California↗

Hepatitis A--related mortality in California, 1989-2000: analysis of multiple cause-coded death data.

OBJECTIVES: We estimated the hepatitis A (HA) mortality rate in California, assessed demographic differences in HA-related mortality, and examined comorbidities listed on death certificates in order to provide information for health policy and planning related to HA vaccination. METHODS: We identified HA-related deaths in California from 1989 to 2000 with multiple-cause-of-death files and calculated mortality rates and rate ratios. RESULTS: We identified 402 HA-related deaths between 1989 and 2000; the annual age-adjusted HA-related mortality rate was 1.20 deaths per 1 million persons. Older individuals, men, Latinos, and American Indians/Alaska Natives had elevated mortality rates. Liver conditions and non-A viral hepatitis infections were more common among HA-related deaths than among all other deaths. CONCLUSIONS: Current immunization practices should be reevaluated and the expansion of current vaccination guidelines for groups that have elevated HA-related mortality rates should be considered.

Adolescent↗

Sterilized in the name of public health: race, immigration, and reproductive control in modern California.

In exploring the history of involuntary sterilization in California, I connect the approximately 20,000 operations performed on patients in state institutions between 1909 and 1979 to the federally funded procedures carried out at a Los Angeles County hospital in the early 1970s. Highlighting the confluence of factors that facilitated widespread sterilization abuse in the early 1970s, I trace prosterilization arguments predicated on the protection of public health. This historical overview raises important questions about the legacy of eugenics in contemporary California and relates the past to recent developments in health care delivery and genetic screening.

California↗

Outcomes of drug and alcohol treatment programs among American Indians in California.

OBJECTIVES: We examined differences in substance abuse treatment outcomes between American Indians and their non-American Indian counterparts in California, during 2000 to 2002. METHODS: A total of 368 American Indians and a matched sample of 368 non-American Indians from 39 substance abuse treatment programs in 13 California counties were assessed at multiple time points. Records on arrests, driving while under the influence of alcohol or drugs, and mental health care were obtained 1 year before and 1 year after treatment entry. Differences in pretreatment characteristics, services received, treatment satisfaction, treatment completion and retention, and outcomes were examined. RESULTS: Pretreatment problems were similarly severe among American Indians and non-American Indians. About half in both groups either completed treatment or stayed in treatment more than 90 days; American Indians in residential care had significantly shorter treatment retention. American Indians received fewer individual sessions and out-of-program services, especially for alcohol abuse, but were nevertheless generally satisfied with their treatment. Both groups improved after treatment, with American Indians demonstrating greater reductions in arrests than non-American Indians. CONCLUSION: American Indians benefit from substance abuse treatment programs, although the type and intensity of services offered could be improved.

Adult↗

Chlamydia trachomatis and Neisseria gonorrhoeae infections among men and women entering California prisons.

OBJECTIVE: We estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection among newly arriving inmates at 6 California prisons. METHODS: In this cross-sectional study in 1999, urine specimens collected from 698 men aged 18 to 25 years and 572 women aged 18 years or older were tested at intake for C trachomatis and N gonorrhoeae using ligase chain reaction. An analysis of demographic and arrest-related correlates of C trachomatis and N gonorrhoeae infection was performed. RESULTS: The overall C trachomatis prevalence was 9.9% (95% CI=7.8%, 12.3%) among men aged 18 to 25 years, 8.9% (95% CI = 2.9%, 22.1%) among women aged 18 to 25 years, and 3.3% (95% CI=2.0%, 5.1%) among women overall. Three N gonorrhoeae cases were detected with an overall prevalence of 0.24% (95% CI=0.05%, 0.69%). CONCLUSIONS: The prevalence of C trachomatis infection at entry to California prisons, especially among young female and male inmates, was high, which supports routine screening at entry into prison. In addition, screening in a jail setting where most detainees are incarcerated before entry into the prison setting may provide an excellent earlier opportunity to identify these infections and treat disease to prevent complications and burden of infection in this high-risk population.

Adolescent↗

Disability and preventive cancer screening: results from the 2001 California Health Interview Survey.

OBJECTIVE: We sought to evaluate preventive cancer screening compliance among adults with disability in California. METHODS: We used data from the 2001 California Health Interview Survey to compare disabled and nondisabled adults for differences in preventive cancer screening behaviors. Compliance rates for cancer screening tests (mammography, Papanicolaou test, prostate-specific antigen, sigmoidoscopy/colonoscopy, and fecal occult blood test) between the 2 subpopulations were evaluated. RESULTS: Women with disabilities were 17% (Papanicolaou tests) and 13% (mammograms) more likely than women without disabilities to report noncompliance with cancer screening guidelines. Interactions between disability and reports of a doctor recommendation on cervical cancer screening were significant; women with disabilities had a lower likelihood of receiving a recommendation. Men with disabilities were 19% less likely than men without disabilities to report a prostate-specific antigen test within the last 3 years. CONCLUSIONS: secondary to structural and/or clinical factors underpinning the differences found.

California↗

Ascertainment of Hispanic ethnicity on California death certificates: implications for the explanation of the Hispanic mortality advantage.

OBJECTIVES: We determined the size and correlates of underascertainment of Hispanic ethnicity on California death certificates. METHODS: We used 1999 to 2000 vital registration data. We compared Hispanic ethnicity reported on the death certificate to Hispanic ethnicity derived from birthplace for the foreign-born and an algorithm that used first and last name and percentage of Hispanics in the county of residence for the US-born. We validated death certificate nativity by comparing data with that in linked Social Security Administration records. RESULTS: Ethnicity and birthplace information was concordant for foreign-born Hispanics, who have mortality rates that are 25% to 30% lower than those of non-Hispanic Whites. Death certificates likely underascertain deaths of US-born Hispanics, particularly at older ages, for persons with more education, and in census tracts with lower percentages of Hispanics. Conservative correction for under-ascertainment eliminates the Hispanic mortality advantage for US-born men. CONCLUSIONS: Hispanic ethnicity is accurately ascertained on the California death certificate for immigrants. Immigrant Hispanics have lower age-adjusted mortality rates than do non-Hispanic Whites. For US-born Hispanics, the mortality advantage compared with non-Hispanic Whites is smaller and may be explained by underreporting of Hispanic ethnicity on the death certificate.

Adolescent↗

Cesarean section, fetal monitoring, and perinatal mortality in California.

The rate of cesarean section in California has been growing at a compound rate of about 10 per cent per annum since 1969, coinciding with the advent of fetal monitoring. It is of interest, therefore, to study the distribution and efficacy of obstetric interventions. Information derived from the 1977 California birth cohort and a survey questionnaire was used to study the factors associated with the rate of cesarean section in 323 hospitals. Significant positive correlations were observed between the cesarean rate (CSR) and hospital factors indicative of a high degree of technology, including the proportion of labors electronically monitored. Significant negative correlations were observed between the CSR and hospital-specific variables suggestive of socioeconomically underprivileged patient populations. Other factors being constant, hospitals characterized by prepayment health care financing also had lower CSRs. A standaridized mortality ratio (SMR) based on 2.3 million births in the 1970--1976 cohorts was used to adjust the 1977 hospital specific perinatal mortality rates for birth weight, gestational age, sex, race, and plurality. The results show that hospitals which intervene technologically in a large proportion of births have lower risk adjusted perinatal mortality rates.

Adolescent↗

The California Automated Mortality Linkage System (CAMLIS).

The California Automated Mortality Linkage System (CAMLIS), established in 1981 to facilitate the conduct of follow-up studies in the State of California, employs a combination of deterministic and probabilistic linkage decision criteria to perform the death clearance function. The system was evaluated against four traditional death clearance procedures and the performance of each procedure measured in terms of measures of sensitivity and specificity. Only one procedure was associated with a specificity lower than 0.99; for that one, the specificity was 0.93. There was much greater fluctuation in the observed sensitivity levels. In one of the procedures, CAMLIS demonstrated a sensitivity of 0.97 versus 0.79 for the Social Security Administration. A comparison against the National Death Index (NDI) produced sensitivities of 0.89 for CAMLIS and 0.94 for the NDI. An assessment of manual search procedures using a file of Japanese names produced a CAMLIS sensitivity measure of 0.92 compared with 0.93 for the manual search. Another manual search procedure using microfiche copies of the state death index produced a CAMLIS sensitivity of 0.97; in this evaluation, the sensitivity of the manual search was defined as 1.0. Another measure of performance of a death clearance procedure is its predictive value in identifying a person who has died; CAMLIS generated predictive values in these evaluations that ranged from 0.93 through 0.99, contrasted with the NDI value of 0.59.

California↗

An assessment of the California Child Passenger Restraint Requirement.

To evaluate the California Child Passenger Restraint Law requiring children under four years of age to be transported in car seats, we examined monthly injury and fatality levels from January 1978 to December 1983 for children 0-3 and 4-7 years of age using Box-Jenkins time series models. A significant 8.36 per cent reduction in injuries was found for the 0-3 year old age group, but no significant reduction in injuries was found for 4-7 year olds. No significant reduction in fatalities was found for either age group. A similar analysis of injuries and fatalities in Texas, a state without a car seat law, showed no significant reductions in either injuries or fatalities. There was no change in the number of California 0-3 year olds in the years after the law was enacted.

Accidents, Traffic↗

Model Standards impact on local health department performance in California.

An evaluation of a state-local negotiation process to implement Model Standards in 18 California local health departments was conducted during 1985-87. Model Standards specific to California were developed by state and local public health officials for seven programs. Nine counties participated in state-local negotiations to set performance standards in these seven programs. During the two-year effort, greater use of Model Standards and more improvement in local program performance occurred in local health departments that participated in the state-local negotiation process. The use of Model Standards appeared to contribute to establishing program priorities, emphasizing the measurement of outcomes, improving data management systems, and evaluating the current performance of programs. While this state-local negotiation process is suggested as the preferred approach to encouraging the use of Model Standards in local health departments, it must be recognized that this process requires time and commitment of resources from both the state and local levels.

California↗

Young children who drown in hot tubs, spas, and whirlpools in California: a 26-year survey.

A survey of drownings in hot tubs, spas, and whirlpools in California 1960-85 suggests a person- and site-specific profile. The identified 74 deaths occurred mostly in White children, under two years of age, in Southern California, during the late afternoons, from May through August. From 1967 to 1985, the drowning rate increased tenfold. The deaths were associated with access to the water, lack of supervision, neuromotor handicaps, and entrapment by suction. Educational and environmental control efforts are required to reduce the incidence.

Baths↗

Compliance with the 1992 California motorcycle helmet use law.

To evaluate helmet use in California before and after the introduction of an unrestricted helmet use law on January 1, 1992, observations of motorcycles and their riders were made at 60 locations in seven California counties, twice before and four times after the law was introduced. Helmet use increased from about 50% in 1991 to more than 99% throughout 1992. Compliance was achieved despite variations in helmet use by motorcycle design and road type. Seven percent of riders used nonstandard helmets after the law. With adequate enforcement, unrestricted helmet use laws can achieve almost 100% compliance and reduce the number of people riding motorcycles.

California↗

Reducing cigarette consumption in California: tobacco taxes vs an anti-smoking media campaign.

OBJECTIVES: The purpose of this study was to examine the relative effects of taxation vs an anti-smoking media campaign on cigarette consumption in California. METHODS: Quarterly cigarette sales data reported by the California State Board of Equalization between 1980 and 1992 were used to estimate a time-series model, adjusted for seasonal variations and time trends. RESULTS: The estimated results show that sales of cigarettes were reduced by 819 million packs from the third quarter of 1990 through the fourth quarter of 1992 owing to an additional 25-cent state tax increase, while the anti-smoking media campaign reduced the cigarette sales by 232 million packs during the same period. CONCLUSIONS: Both taxation and anti-smoking media campaigns are effective means of reducing cigarette consumption. The strength of those effects, however, is influenced by the magnitude of the taxes and the amount of media campaign expenditures.

California↗

Homicide risk among immigrants in California, 1970 through 1992.

According to the death certificates of the 65,510. California residents who died of homicide from 1970 through 1992, foreign-born persons are overrepresented in the homicides of California residents. Analysis of homicide data for 15- to 34-year-olds (n = 38,774), who account for a majority of all homicide victims indicated that immigrant-to-nonimmigrant risk patterns differed by ethnicity and across time. During the 23-year study period, foreign-born Whites, Hispanics, and Asians and others were at significantly higher risk and foreign-born Blacks were at a statistically similar risk of homicide compared with their US-born counterparts (risk ratio = 2.12, 1.24, 1.72, and 0.60, respectively).

Adolescent↗

Transmission of Mycobacterium tuberculosis in a California State Prison, 1991.

OBJECTIVES: An investigation was conducted to determine whether ongoing transmission of Mycobacterium tuberculosis was occurring in a California state prison. METHOD: Prison pharmacy records were used to identify cases of active tuberculosis (TB). RESULTS: Ten of the 18 cases of active TB treated at the facility during 1991 were diagnosed at the prison that same year (an incidence of 184 per 100,000). Three inmates were infectious for a total of 7 months while imprisoned. The prevalence of TB skin test-positivity among inmates was 30%, and the incidence of new infection attributable to incarceration was 5.9 per 100 inmates per year. CONCLUSIONS: Transmission of M. tuberculosis may be occurring in the California prison system.

Adult↗

Determining injury at work on the California death certificate.

OBJECTIVES: This study examined decisions of California Country Coroner's offices in determining injury at work and identified factors influencing this decision. METHODS: Surveys were sent to California County Coroner's offices (response rate = 93%). The survey included 23 vignettes that required the respondent to determine whether the fatality involved an injury at work. The Rasch method was used to determine internal consistency in endorsing vignettes and to determine overall endorsability of vignettes based on underlying factors. RESULTS: Respondents showed internal consistency but much disagreement in their endorsement of vignettes. Decedents who were performing paid work or were on their work site during working hours were almost unanimously endorsed as having incurred an injury at work. Non-payment, travel/transportation, suicide, and nontraditional work sites and work hours led to disagreement and uncertainty among respondents. CONCLUSIONS: Coroners have different methods of determining injury at work on the death certificate, and available guidelines do not define many of the ambiguous situations encountered by coroners.

Accidents, Occupational↗

The underreporting of deaths of American Indian children in California, 1979 through 1993.

OBJECTIVES: This study linked birth and death certificates to determine misclassification of deaths of American Indian children in California. METHODS: Birth records for 1979 to 1993 were matched with mortality records through a computerized system. RESULTS: The number of deaths to American Indians was estimated to be three to four times greater than that reported on death certificates. Children in urban counties and those who died before 1987 were more likely to be misclassified. CONCLUSIONS: California death certificates identify less than one third of the deaths among American Indian children. Adjusting for racial misclassification provides a more accurate accounting of child mortality among American Indians.

Adolescent↗