Cumulative Impact of Environmental Pollution and Population Vulnerability on Pediatric Asthma Hospitalizations: A Multilevel Analysis of CalEnviroScreen.

The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the extent to which the composite scores of the CalEnviroScreen tool are associated with pediatric asthma hospitalization. This was a retrospective analysis of California hospital discharge data from 2010 to 2012. Children who were hospitalized for asthma-related conditions, were aged 0-14 years, and resided in California were included in analysis. Rates of hospitalization for asthma-related conditions among children residing in California were calculated. Poisson multilevel modeling was used to account for individual- and neighborhood-level risk factors. Every unit increase in the CalEnviroScreen Score was associated with an increase of 1.6% above the mean rate of pediatric asthma hospitalizations (rate ratio (RR) = 1.016, 95% confidence interval (CI) = 1.014-1.018). Every unit increase in racial/ethnic segregation and diesel particulate matter was associated with an increase of 1.1% and 0.2% above the mean rate of pediatric asthma, respectively (RR = 1.011, 95% CI = 1.010-1.013; RR = 1.002, 95% CI = 1.001-1.004). The CalEnviroScreen is a unique tool that combines socioecological factors and environmental indicators to identify vulnerable communities with major health disparities, including pediatric asthma hospital use. Future research should identify mediating factors that contribute to community-level health disparities

College Students’ Utilization of Protective Alcohol-Use Behaviors: Effects of Age, Gender, and Year in School

Background and Purpose: College drinking is a major public health concern with four out of every five college students reporting alcohol use. The authors examined the frequency with which students utilized 11 protective alcohol use behaviors from the 2011 American College Health Association – National College Health Assessment (ACHA – NCHA – II). The effects of age, gender, and year in school on each of these behaviors were also examined. Methods: A total of 1,082 randomly selected students attending a California State University institution completed a web-based version of the NCHA-II. Descriptive statistics were conducted to describe the sample and the protective behaviors. Logistic regression analysis were conducted to assess the associations between each behavior with age, gender, and year in school. Results: The most frequently utilized behavior was staying with the same friends. Compared to undergraduate students, graduate students were more likely to utilize protective behaviors, and males were more likely than females to utilize the majority of these behaviors. Conclusions: This study provides support for the implementation of alcohol-related interventions in different sectors of the university, such as dormitories and fraternities

Barriers Associated with Cardiovascular Disease and the Impact of Primary Care Leading to Necessary Emergency Department Visits in The Central Valley

Purpose: The research identified barriers associated with cardiovascular disease and the impact of primary care leading to emergency department (ED) visits in the Central Valley. Methods: A semi-structured 16-question interview was conducted at St. Agnes Medical Center in order to gain a fuller understanding of the involvement of primary care providers and their interactions in educating individuals about CVD. Results: 54 of the total 63 participants report having access to primary care however, some patients expressed they never had access to a cardiologist. Many of the participants (41 of 63) were confident that their care providers were greatly knowledgeable. A total of 46 of the 63 participants felt adequately cared for, while eight of the participants felt that the care, they received was not adequate by reporting that the care was bad or inadequate. Participants expressed that there were some challenges in receiving accessibility of care and many faced socioeconomic challenges. Conclusion: There have been many studies focusing on readmission rates with the expansion of ACA. However, none specifically evaluates a region within a state that has multiple socio-economic challenges and the use of primary care visits in relation to cardiovascular disease emergency department visits. There are many socioeconomic factors that, when not favorable, can lead to inadequate care towards the patient. Therefore, strategies to improve the care provided to diagnosed patients should be informed and guided by the influence that these socio-economic factors have with regard to the healthcare experience

Hybridization as a threat in climate relict Nuphar pumila (Nymphaeaceae)

Field studies and conceptual work on hybridization-mediated extinction risk in climate relicts are extremely rare. Nuphar pumila (Nymphaeaceae) is one of the most emblematic climate relicts in Europe with few isolated populations in the Alpine arc. The extent of introgression with related lowland and generalist species Nupharlutea has never been studied using molecular methods. All biogeographical regions where N.pumila naturally occurs in the neighbourhood of the Alpine arc were sampled and studied using nuclear microsatellite markers. Furthermore, we used forward-in-time simulations and Approximate Bayesian Computation to check whether an introgression scenario fits with the observed admixture patterns and estimated the demographic parameters associated with this process. Our study confirms ongoing hybridization between N.pumila and N.lutea and validates it by the use of population models. More than 40 % of investigated N.pumila individuals were admixed and hybrids were found in over 60 % of studied populations. The introgression is bidirectional and is most likely a result of very recent gene flow. Our work provides strong evidence for rapid extinction risk and demographic swamping between specialized climatic relicts and closely related generalists. The remaining pure populations of N.pumila are rare in the Alpine arc and deserve high conservation priority

Structural Determinants of Asthma in a Predominantly Hispanic/Latinx Population

Asthma is the most disparate common disease by race/ethnicity (Oh et al., 2016). To lessen the racial/ethnic gap in asthma, one must understand the mediating pathways in which a social construct such as race/ethnicity is linked to asthma. The aim of this dissertation is to investigate variations in asthma in association with individual- and neighborhood-level discrimination that this closely linked with racial/ethnic composition across three studies. Study 1 is an ecological design and investigates housing quality in association with asthma emergency department (ED) visits among a Hispanic/Latinx population. This study illustrates that housing quality moderates the effect of poverty on asthma ED visits where communities of affluence tend to attenuate the effects of poverty on asthma. More specifically, the effect of poverty on asthma tends to increase as expected in older housing communities where affluent communities have very low rates and poor communities have very high rates. However, the effect of poverty on asthma tends to be different in newer housing developments where affluent communities tend to have higher rates than expected and poor communities have even higher rates of asthma. Study 2 is an ecological analysis and builds on Study 1 by adding air pollution (i.e., ozone and particulate matter 2.5) and environmental degradation sites (e.g., hazardous waste sites) to the model. This study shows that air pollution is positively associated with asthma ED visits (RR = 1.2, 95% CI 1.16 – 1.25). Environmental degradation sites are positively associated with asthma ED visits (RR = 1.09, 95% CI 1.04 – 1.13). Study 3 investigates major life experiences of discrimination and ever being diagnosed with asthma. The study shows that having two or more major life experiences of discrimination, such as being denied a housing loan due to race/ethnicity, is associated with 1.2 times odds increase in ever being diagnosed with asthma in comparison to those who reported one or fewer major life experiences of discrimination. In Conclusion, structural determinants of asthma manifest in different ways at differing levels. This dissertation shows that historical policies of housing and mortgage loan discrimination are linked to present-day asthma ED visits through housing quality. Moreover, concentrations of air pollution and environmental degradation sites increase the risk for asthma ED visits across census tracts. Finally, through self-reported data, the systematic denial of mortgage loans, job promotions, and living in specific neighborhoods is associated with increased risk for ever being diagnosed with asthma. Together, these three studies suggest that racial/ethnic disparities in asthma are at least in part due to the places where people live. Future research should focus on developing a deeper understanding of how community shapes racial/ethnic disparities in asthma to understand the commodities that promote health. Policy implications range from improvement of housing conditions, air pollution, and environmental degradation sites to opportunities of implicit bias training

Cumulative Impact of Environmental Pollution and Population Vulnerability on Pediatric Asthma Hospitalizations: A Multilevel Analysis of CalEnviroScreen

The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the extent to which the composite scores of the CalEnviroScreen tool are associated with pediatric asthma hospitalization. This was a retrospective analysis of California hospital discharge data from 2010 to 2012. Children who were hospitalized for asthma-related conditions, were aged 0–14 years, and resided in California were included in analysis. Rates of hospitalization for asthma-related conditions among children residing in California were calculated. Poisson multilevel modeling was used to account for individual- and neighborhood-level risk factors. Every unit increase in the CalEnviroScreen Score was associated with an increase of 1.6% above the mean rate of pediatric asthma hospitalizations (rate ratio (RR) = 1.016, 95% confidence interval (CI) = 1.014–1.018). Every unit increase in racial/ethnic segregation and diesel particulate matter was associated with an increase of 1.1% and 0.2% above the mean rate of pediatric asthma, respectively (RR = 1.011, 95% CI = 1.010–1.013; RR = 1.002, 95% CI = 1.001–1.004). The CalEnviroScreen is a unique tool that combines socioecological factors and environmental indicators to identify vulnerable communities with major health disparities, including pediatric asthma hospital use. Future research should identify mediating factors that contribute to community-level health disparities

Has the Affordable Care Act Influenced Cardiology Disease Rates in the San Joaquin Valley?

Purpose: The study provides a summary of Cardio Vascular Disease (CVD) in the San Joaquin Valley (SJV) and the burden held on residents despite the increased number of insured under the Affordable Care Act (ACA). Methods: Patient Discharge Data were collected from the Office of Statewide Planning and Development (OSHPD) from 2010-2017. With a range of Age 40 to 64. Patients all reside in the San Joaquin Valley (Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, and Tulare). The American Community Survey (ACS) was used for population estimates. Regression was used to model the effects of the ACA on severity diagnosis and length of stay.Results: From the result, CVD patients from the age of 40-64 declined. Many individuals appeared in 2013 with county indigent or self-pay and changed in 2015 to Medi-Cal. Overall, rates of hospitalization decreased. However, regression analysis suggested an increase in severity diagnoses and an increase in the length of stay after the ACA was implemented.Conclusion: The study provides a summary of Cardio Vascular Disease (CVD) in the San Joaquin Valley (SJV) and the burden held on residents despite the increased number of insured under the Affordable Care Act (ACA). The evaluation of discharge data demonstrates the positive impact the ACA has for those suffering from CVD in SJV

Poor People Are Hospitalized Three Times More for Mental Health Services than the Non-Poor in Central Valley California

Introduction: Providing health insurance to the poor has become a standard policy response to health disparities between the poor and the non-poor. It is often assumed that if the poor people are given health insurance, they will use preventative care, which will prevent more expensive emergency visits and inpatient hospitalization, and in turn, it will save healthcare cost in the long run. This paper presents the findings from our study in California about what happens to the poor when they are given health insurance. The purpose of the study was to understand how the healthcare system in California treats the poor patients differently than the non-poor. Method: Using multivariate logistic regressions, this study analyzed a large patient discharge data (PDD) from the California Office of Statewide Planning and Development (OSHPD) for eight counties in the Central Valley California (N = 423,640). First, utilizing International Classification of Diseases (ICD 10) as diagnostic criteria, mental-health vs. non-mental health hospitalization rates were estimated. Second, health insurance status was used as a proxy measure of poverty of the patients. Using chi-Square, the probability of hospitalization for mental health services was estimated based on their insurance types. Finally, using step-wise logistic regression, the odds of mental health hospitalization was estimated conditional on individual characteristics, health insurance types, and geographic characteristics. Findings: When the poor people were given health insurance, they were three times more likely to be hospitalized for mental health services than the non-poor. The more than three-fold variation in mental health hospitalization was not driven by demographic or geographic characteristics. The findings are new and have important implications for the healthcare policies for the poor. Further studies are needed to understand the extent to which the disproportionately high rate of mental health hospitalizations of the poor are driven by the provider-induced needs