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

Understanding Traditional Hmong Health and Prenatal Care Beliefs, Practices, Utilization and Needs

Objective: To increase understanding of traditional Hmong health and prenatal care beliefs, practices, utilization and needs and their perceptions toward the utilization of Western health care. Specific Aims: The aims of this project are: 1) Collect primary quantitative and qualitative data on the prenatal health care beliefs, practices, utilization, and needs of the Hmong men and women from three of the highest Hmong populated counties in Central California; 2) Better understanding of traditional Hmong prenatal and health care practices; 3) Highlight barriers to prenatal care for Hmong; and 4) Use findings to inform next steps. Setting: California’s Central Valley Hmong American Communities: Fresno, Merced, and San Joaquin counties. Methods: A convenience sample of 99 Hmong women of child-bearing age (18-35) and 74 Hmong men of child-bearing age (18-45) were recruited through partnership with a Hmong health collaborative and within communities by word of mouth and snowball sampling. Hmong, bilingual graduate students obtained informed consent and conducted 45-60 minute face-to-face interviews including structured and other questions. Descriptive bivariate analysis and multivariate modeling explored how receipt of appropriate prenatal care is related to Hmong respondent demographics, cultural perspectives and health care experiences Findings: Hmong residents utilize both Western and traditional medicines due to lack of complete trust in Western medicine. Respondents reported using over the counter pregnancy tests and more than half (52%) sought prenatal care six weeks after confirming pregnancy. Almost half (45%) are not satisfied with their experience using Western medicine. About 60% report a disconnect between Western and Hmong medicine. Language access and lack of cultural competence training were also at the forefront of the concerns. Conclusion: Hmong residents utilize and rely on Western health care, yet they cannot abandon their cultural and traditional health care practices due to new cultural setting. In order to provide equitable and effective health care, clinicians need to be able to function effectively within the context of the cultural beliefs, behaviors, and needs of consumers and their communities. Failing to provide culturally supportive and respectable health care for Hmong residents can increase costs for individuals and society through increased hospitalizations and complications.http://www.fresnostate.edu/chhs/ccchhs/institutes-programs/CVHPI/index.shtm

Initiation of Sexual Intercourse and Safe Sex Practices: An Evidence-Based Replication of Reducing the Risk

Purpose and Background: This study aimed to (1) identify predictors of initiation of sexual intercourse before program implementation, and (2) assess the one-year impact of Reducing the Risk (RTR) on the delay of sexual intercourse initiation and safe sex practices among a predominantly Latino sample of 9th graders in Tulare County. RTR is an evidence-based program designed to delay initiation of adolescent sexual intercourse, and increase safe practices among those who are already sexually active. The program was implemented in Tulare County; whose average teen birth rate for 2009-2011 was 60.2 per 1,000 teens aged 15-19. Methods: Baseline and one-year follow-up data were collected on 390 students, beginning in their 9th grade year (53% female, 72.2% Latino/Hispanic). Students participated in a school-based pregnancy prevention program (RTR) and answered questions on HIV/STIs knowledge, attitudes about abstinence and teen pregnancy, parent communication, sexual intercourse, and safe sex practices. Results: Over one in eight students were sexually active at baseline. Overall, students reported long-term increases in HIV/STI knowledge and parent communication, decreases in intentions to have sexual intercourse and positive attitudes about teen pregnancy. Controlling for baseline differences, sexually active students reported fewer positive attitudes about abstinence. Conclusion: RTR may be more effective in preventing pregnancy and HIV/STIs among students who are not yet sexually active. Further, RTR does appear to successfully impact students who have already initiated sexual intercourse decisions to practice safe sex; however, not to become abstinent

Using network theory to identify the causes of disease outbreaks of unknown origin.

The identification of undiagnosed disease outbreaks is critical for mobilizing efforts to prevent widespread transmission of novel virulent pathogens. Recent developments in online surveillance systems allow for the rapid communication of the earliest reports of emerging infectious diseases and tracking of their spread. The efficacy of these programs, however, is inhibited by the anecdotal nature of informal reporting and uncertainty of pathogen identity in the early stages of emergence. We developed theory to connect disease outbreaks of known aetiology in a network using an array of properties including symptoms, seasonality and case-fatality ratio. We tested the method with 125 reports of outbreaks of 10 known infectious diseases causing encephalitis in South Asia, and showed that different diseases frequently form distinct clusters within the networks. The approach correctly identified unknown disease outbreaks with an average sensitivity of 76 per cent and specificity of 88 per cent. Outbreaks of some diseases, such as Nipah virus encephalitis, were well identified (sensitivity = 100%, positive predictive values = 80%), whereas others (e.g. Chandipura encephalitis) were more difficult to distinguish. These results suggest that unknown outbreaks in resource-poor settings could be evaluated in real time, potentially leading to more rapid responses and reducing the risk of an outbreak becoming a pandemic

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

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

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