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As societal challenges involving sustainable development increase, the need to effectively integrate this inherently multidisciplinary topic into existing curricula becomes more pressing. Multidisciplinary, team-taught, project-based instruction has shown effectiveness in teaching teamwork, communication, and life-long learning skills, and appreciation for other disciplines. Unfortunately, this instruction mode has not been widely adopted, largely due to its resource-intensiveness. Our proposed co-instruction model of multidisciplinary senior project administration was tested to see if it could effectively teach sustainability topics and duplicate the known benefits of team-taught instruction, while overcoming its resource-intensiveness. A case study of a co-instructed senior project was undertaken with students and faculty from electrical and mechanical engineering, business, political science, and industrial design. The participating students were compared to the control group, i.e. students who chose to complete a traditional disciplinary senior project instead. Extensive assessment was performed with pre/post quizzes, online surveys, focus groups, and course deliverables. The multidisciplinary projects outperformed traditional senior projects in 4 out of the 5 participating courses. However, the students in the multidisciplinary project rated their satisfaction with the experience lower on average than the control group. A strong, positive correlation between students' project satisfaction and rating of other instruction aspects (0.50 < r < 0.7, p < 0.01) was discovered, which has implications for all project-based instruction. Participating faculty generally found the process illuminating and engaged in scholarship and creative endeavors as a result.

Background: In the past decade, there have been substantial advances in our understanding of the pathobiology of pediatric acute kidney injury (AKI). In particular, animal models and studies focused on the relationship between kidney development, nephron number, and kidney health have identified a number of heterogeneous pathophysiologies underlying AKI. Despite this progress, gaps remain in our understanding of the pathobiology of pediatric AKI. Methods: During the 26th Acute Disease Quality Initiative (ADQI) Consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations for opportunities to advance translational research in pediatric AKI. The current state of research understanding as well as gaps and opportunities for advancement in research was discussed, and recommendations were summarized. Results: Consensus was reached that to improve translational pediatric AKI advancements, diverse teams spanning pre-clinical to epidemiological scientists must work in concert together and that results must be shared with the community we serve with patient involvement. Public and private research support and meaningful partnerships with adult research efforts are required. Particular focus is warranted to investigate the pediatric nuances of AKI, including the effect of development as a biological variable on AKI incidence, severity, and outcomes. Conclusions: Although AKI is common and associated with significant morbidity, the biologic basis of the disease spectrum throughout varying nephron developmental stages remains poorly understood. An incomplete understanding of factors contributing to kidney health, the diverse pathobiologies underlying AKI in children, and the historically siloed approach to research limit advances in the field. The recommendations outlined herein identify gaps and outline a strategic approach to advance the field of pediatric AKI via multidisciplinary translational research. [ABSTRACT FROM AUTHOR]

Systematic endeavors to take computer science (CS) and computational thinking (CT) to scale in middle and high school classrooms are underway with curricula that emphasize the enactment of authentic CT skills, especially in the context of programming in block-based programming environments. There is, therefore, a growing need to measure students' learning of CT in the context of programming and also support all learners through this process of learning computational problem solving. The goal of this research is to explore hypothesis-driven approaches that can be combined with data-driven ones to better interpret student actions and processes in log data captured from block-based programming environments with the goal of measuring and assessing students' CT skills. Informed by past literature and based on our empirical work examining a dataset from the use of the Fairy Assessment in the Alice programming environment in middle schools, we present a framework that formalizes a process where a hypothesis-driven approach informed by Evidence-Centered Design effectively complements data-driven learning analytics in interpreting students' programming process and assessing CT in block-based programming environments. We apply the framework to the design of Alice tasks for high school CS to be used for measuring CT during programming.

Wildfires constitute a growing source of extremely high levels of particulate matter that is less than 2.5 microns in diameter (PM2.5). Recently, toxicologic and epidemiologic studies have shown that PM2.5 generated from wildfires may have a greater health burden than PM2.5 generated from other pollutant sources. This study examined the impact of PM2.5 on hospitalizations for respiratory diseases in California between 2006 and 2019 using a health impact assessment approach that considers differential concentration‐response functions (CRF) for PM2.5 from wildfire and non‐wildfire sources of emissions. We quantified the burden of respiratory hospitalizations related to PM2.5 exposure at the zip code level through two different approaches: (a) naïve (considering the same CRF for all PM2.5 emissions) and (b) nuanced (considering different CRFs for PM2.5 from wildfires and from other sources). We conducted a Geographically Weighted Regression to analyze spatially varying relationships between the delta (i.e., the difference between the naïve and nuanced approaches) and the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI). A higher attributable number of respiratory hospitalizations was found when accounting for the larger health burden of wildfire PM2.5. We found that, between 2006 and 2019, the number of hospitalizations attributable to PM2.5 may have been underestimated by approximately 13% as a result of not accounting for the higher CRF of wildfire‐related PM2.5 throughout California. This underestimation was higher in northern California and areas with higher SVI rankings. The relationship between delta and SVI varied spatially across California. These findings can be useful for updating future air pollution guideline recommendations. Plain Language Summary: Climate change is leading to an increase in the frequency and intensity of extreme weather events, including wildfires. Wildfire smoke is a large source of particulate matter (i.e., fine inhalable particles) that could have a greater health burden than particulate matter from other sources (e.g., vehicle or industrial emissions). We aimed to quantify the burden of respiratory hospitalizations related to all particulate matter exposure in California for the years 2006–2019 with and without considering the differential health burden of wildfire smoke. We then compared these two approaches to quantify the number of respiratory hospitalizations that may have been underestimated in the past by not taking into account the higher health burden of wildfire smoke. We found that throughout California, between 2006 and 2019, we may have underestimated the number of respiratory hospitalizations attributable to particulate matter exposure by approximately 410,000 (13%). This underestimation was higher in northern California and in vulnerable areas. These results may be helpful for updating recommendations in upcoming air pollution guidelines and for protecting communities at higher risk from wildfire smoke. Key Points: By not considering the differential health burden of wildfire PM2.5, we underestimate the number of hospitalizations attributable to PM2.5In California, between 2006 and 2019, the number of hospitalizations attributable to PM2.5 may have been underestimated by approximately 13%Underestimation of PM2.5‐attributable hospitalizations was higher in vulnerable areas [ABSTRACT FROM AUTHOR]

Purpose: To examine how local health care resources impact travel patterns of patients age 65 and older across the rural urban continuum. Methods: Information on inpatient hospital discharges was drawn from complete 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for New York, California, and Florida, and the 2003 hospital discharge file for Pennsylvania. The study population was Medicare patients with admissions for ambulatory care sensitive conditions. Analysis was at the patient-level, and area contextual variables were developed at the Primary Care Service Area (PCSA) level. Local resources considered included inpatient supply, provider supply, supply of international medical graduates, and critical access hospitals (CAHs) in the patient's PCSA. Findings: Findings generally confirmed enhanced retention of the elderly in local markets with greater availability of community resources, although we observed considerable heterogeneity across states. Community resource variables such as median household income or inpatient hospital capacity were stronger and more consistent predictors along the urban rural continuum than any of the provider or CAH variables. Only in California and New York did we see significant effects for provider supply or CAH, but they were robust across the 2 states and models of travel propensity, always reducing the travel propensity. Conclusions: Findings support policies aimed at augmenting supplies of critical access hospitals in rural communities, and increasing primary care physicians and hospital resources in both rural and urban communities.

271 Background: Many studies have shown that fatigue is associated with poor outcomes such as quality of life and physical function in breast cancer survivors.Early treatment of symptoms that result in persistent fatigue may be a strategy to mitigate long-term fatigue.As a result, we studied symptoms and developed risk estimates for patients that are most likely to develop fatigue by pre-surgery and follow up among patients treated on the I-SPY 2 neoadjuvant trial. I-SPY 2 is a phase-II adaptive trial for high-risk early-stage breast cancer patients. Methods: In this retrospective cohort study of 306 women undergoing neoadjuvant chemotherapy +/- targeted therapy, patients complete electronic surveys of symptoms via 34 PRO-CTCAE items and QOL via 9 PROMIS instruments. Fatigue is collected as part of the PROMIS survey and scored using Health Measures. Study timepoints are screening (SC), weekly study treatment (ST), 12 weeks (12w), pre-surgery (PS) and at 1, 6, 12 and 24 months (FU1-FU4) following surgery. Correlation between symptoms and fatigue at equal timepoints was quantified using spearman correlations and BH-adjusted p-values. For symptom odds analysis, symptoms were binarized such that those that had an average grade of mild or above (severity), rarely or above (frequency) or a little bit or above (interference) between ST weeks 1-6 were considered present. Clinically significant (CS) increase in fatigue was defined as an increase >=0.5 standard deviation (SD) in mean from baseline. Logistic regression was used to determine odds ratios of factors associated with fatigue. Results: Baseline PROMIS fatigue mean score was 47.14 (SD 9.31) with a median of 47.45. A CS increase in fatigue from baseline was seen in 55% of patients at 12w, and 61% of patients pre-surgery. Of the patients that had a CS increase in fatigue at any point prior to surgery, 45.7% had persistent fatigue through FU1-4. Symptoms associated with Fatigue at 12w were shortness of breath, headache, and nausea (P< 0.03). At PS, fatigue was significantly correlated with GI symptoms, neuropathy, and shortness of breath (P< 0.03). Risk estimates for patients that filled out symptom surveys at early timepoints (weeks 1-6) and also had fatigue were evaluated. Patients with early GU (genitourinary) symptoms had higher risk of fatigue at IR (OR=9.33, p=0.02, 88.9% in cases vs 33.3% in controls). Patients with early GI symptoms at PS (OR=8.56, p=0.03, 90.1% vs 50%), or FU2-4 (OR= 5.88 and 7.36, p= 0.04 and 0.02, 80% vs 39.1% and 81.8% vs 36.3%) also had a higher risk of developing fatigue. Conclusions: A CS increase in fatigue during treatment and follow up is seen in the majority of patients and is associated with a large number of persistent symptoms. [ABSTRACT FROM AUTHOR]

159 Background: Lung cancer is the leading cause of cancer death in Alabama, with an estimated 2,550 deaths in 2024. Non-small cell lung cancer (NSCLC) represents 85% of these cases. Despite national guidelines recommending comprehensive biomarker testing (CBT) for metastatic NSCLC, significant disparities persist in the utilization of CBT and targeted therapies among Alabama residents. Methods: In March 2024, we launched the "Alabama Access" initiative – a partnership between the LUNGevity Foundation and the O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham – to foster academic and community oncology partnerships to increase access to biomarker-driven treatments. We used a population health science and geospatial mapping approach to visualize oncology practices serving counties with Alabama's highest lung cancer burden. Practices in Walker, Dothan, Marengo, Morgan, Jackson, Marshall, and Montgomery counties were identified as the highest priority based on annual mortality rates. Key interventions will include virtual molecular tumor boards and oncology navigation to facilitate the integration of resources and expertise and ensure that patients in nonacademic practices benefit from the latest advances in precision oncology. After roll-out, we will collect feasibility and acceptability data around program integration. Results: Our analysis revealed that 62.0% of the state's population resides in Primary Care Health Professional Shortage Areas (HPSAs), and 58 out of 67 counties are classified as Medically Underserved Areas. The poverty rate in 89.6% of counties surpasses the national average, contributing to higher lung cancer incidence and mortality rates, with 62.0% of cases diagnosed at advanced stages. The state also shows a higher smoking prevalence, affecting 97.0% of counties compared to national figures. We will present practice-level testing data, including barriers to CBT. Conclusions: This pilot aims to mitigate disparities in CBT through enhanced collaboration between academic and community oncology settings. Integrating molecular navigation into community practices will be pivotal in disseminating program information and collecting data on current testing practices to improve overall lung cancer care quality in Alabama. [ABSTRACT FROM AUTHOR]

Increases in wildfire activity across the Western US pose a significant public health threat. While there is evidence that wildfire smoke is detrimental for respiratory health, the impacts on cardiovascular health remain unclear. This study evaluates the association between fine particulate matter (PM2.5) from wildfire smoke and unscheduled cardiorespiratory hospital visits in California during the 2004–2009 wildfire seasons. We estimate daily mean wildfire‐specific PM2.5 with Goddard Earth Observing System‐Chem, a global three‐dimensional model of atmospheric chemistry, with wildfire emissions estimates from the Global Fire Emissions Database. We defined a "smoke event day" as cumulative 0‐1‐day lag wildfire‐specific PM2.5 ≥ 98th percentile of cumulative 0–1 lag day wildfire PM2.5. Associations between exposure and outcomes are estimated using negative binomial regression. Results indicate that smoke event days are associated with a 3.3% (95% CI: [0.4%, 6.3%]) increase in visits for all respiratory diseases and a 10.3% (95% CI: [2.3%, 19.0%]) increase for asthma specifically. Stratifying by age, we found the largest effect for asthma among children ages 0–5 years. We observed no significant association between exposure and overall cardiovascular disease, but stratified analyses revealed increases in visits for all cardiovascular, ischemic heart disease, and heart failure among non‐Hispanic white individuals and those older than 65 years. Further, we found a significant interaction between smoke event days and daily average temperature for all cardiovascular disease visits, suggesting that days with high wildfire PM2.5 concentrations and high temperatures may pose greater risk for cardiovascular disease. These results suggest substantial increases in adverse outcomes from wildfire smoke exposure and indicate the need for improved prevention strategies and adaptations to protect vulnerable populations. Plain Language Summary: Due to continued climate change, wildfire activity has increased in recent years and poses a significant public health threat. In this study, we investigated the impact of increased wildfire smoke exposure on cardiovascular and respiratory emergency department (ED) visits. We found that smoke events are linked to a > 3% increase of respiratory ED visits with a > 10% increase for asthma specifically, with the largest effect seen in children 0–5 years of age. We did not find an increase in cardiovascular visits for the entire population, but we did observe significant increases in several cardiovascular outcomes for individuals 65 years of age and older as well as for non‐Hispanic white individuals. Key Points: Consecutive days of wildfire smoke PM2.5 exposure can significantly impact respiratory and cardiovascular health outcomesIschemic heart disease and failure highest in adults 65+; heart failure elevated in non‐Hispanic white and non‐Hispanic Black populationsWhen combined with increase in temperature, wildfire smoke exposure is associated with increased risk of cardiovascular disease [ABSTRACT FROM AUTHOR]

Extreme heat and ozone are co-occurring exposures that independently and synergistically increase the risk of respiratory disease. To our knowledge, no joint warning systems consider both risks; understanding their interactive effect can warrant use of comprehensive warning systems to reduce their burden. We examined heterogeneity in joint effects (on the additive scale) between heat and ozone at small geographical scales. A within-community matched design with a Bayesian hierarchical model was applied to study this association at the zip code level. Spatially varying relative risks due to interaction (RERI) were quantified to consider joint effects. Determinants of the spatial variability of effects were assessed using a random effects metaregression to consider the role of demographic/neighborhood characteristics that are known effect modifiers. A total of 817,354 unscheduled respiratory hospitalizations occurred in California from 2004 to 2013 in the May to September period. RERIs revealed no additive interaction when considering overall joint effects. However, when considering the zip code level, certain areas observed strong joint effects. A lower median income, higher percentage of unemployed residents, and exposure to other air pollutants within a zip code drove stronger joint effects; a higher percentage of commuters who walk/bicycle, a marker for neighborhood wealth, showed decreased effects. Results indicate the importance of going beyond average measures to consider spatial variation in the health burden of these exposures and predictors of joint effects. This information can be used to inform early warning systems that consider both heat and ozone to protect populations from these deleterious effects in identified areas. [ABSTRACT FROM AUTHOR]

Recent studies suggest that air pollutant exposure may increase the incidence of mental health conditions, however research is limited. We examined the association between ozone (O3) and fine particles (PM2.5) and emergency department (ED) visits related to mental health outcomes, including psychosis, neurosis, neurotic/stress, substance use, mood/affective, depression, bipolar, schizotypal/delusional, schizophrenia, self-harm/suicide, and homicide/inflicted injury, from 2005 through 2013 in California. Air monitoring data were provided by the U.S. EPA's Air Quality System Data Mart and ED data were provided by the California Office of Statewide Health Planning and Development. We used the time-series method with a quasi-Poisson regression, controlling for apparent temperature, day of the week, holidays, and seasonal/long-term trends. Per 10 parts per billion increase, we observed significant cumulative 7-day associations between O3 and all mental health [0.64%, 95% confidence interval (CI): 0.21, 1.07], depression [1.87%, 95% CI: 0.62, 3.15], self-harm/suicide [1.43%, 95% CI: 0.35, 2.51], and bipolar [2.83%, 95% CI: 1.53, 4.15]. We observed 30-day lag associations between O3 and neurotic disorder [1.22%, 95% CI: 0.48, 1.97] and homicide/inflicted injury [2.01%, 95% CI: 1.00, 3.02]. Same-day mean PM2.5 was associated with a 0.42% [95% CI: 0.14, 0.70] increase in all mental health, 1.15% [95% CI: 0.62, 1.69] increase in homicide/inflicted injury, and a 0.57% [95% CI: 0.22, 0.92] increase in neurotic disorders per 10 μg/m3 increase. Other outcomes not listed here were not statistically significant for O3 or PM2.5. Risk varied by age group and was generally greater for females, Asians, and Hispanics. We also observed seasonal variation for outcomes including but not limited to depression, bipolar, schizophrenia, self-harm/suicide, and homicide/inflicted injury. Ambient O3 or PM2.5 may increase the risk of mental health illness, though underlying biological mechanisms remain poorly understood. Findings warrant further investigation to better understand the impacts of air pollutant exposure among vulnerable groups. [ABSTRACT FROM AUTHOR]

Sugar-sweetened beverages (SSBs) increase chronic disease risk. We estimated the impact on employee health and health care spending of banning SSB sales in California-based health care organizations. We used survey data from a large, multisite health care organization in California, sampling 2,276 employees three months before and twelve months after a workplace SSB sales ban was imposed. We incorporated the survey data into a simulation model to estimate chronic disease incidence and costs. We estimated that an SSB ban as effective as the one observed would save about $300,000 per 10,000 people over ten years among similar employers, as a result of averted health care and productivity spending-- after both SSB sales losses and non-SSB beverage sales gains were accounted for. Sales bans would typically need to reduce SSB consumption by 2.2 ounces per person per day for lost revenue to be fully offset if there were no increase in non-SSB beverage sales. [ABSTRACT FROM AUTHOR]

Exposure to ambient fine particulate matter (particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5)) during pregnancy is associated with preterm birth (PTB), a leading cause of infant morbidity and mortality. Results from studies attempting to identify etiologically relevant exposure periods of vulnerability have been inconsistent, possibly because of failure to consider the time-to-event nature of the outcome and lagged exposure effects of PM2.5. In this study, we aimed to identify critical exposure windows for weekly PM2.5 exposure and PTB in California using California birth cohort data from 2005–2010. Associations were assessed using distributed-lag Cox proportional hazards models. We assessed effect-measure modification by race/ethnicity by calculating the weekly relative excess risk due to interaction. For a 10-μg/m3 increase in PM2.5 exposure over the entire period of gestation, PTB risk increased by 11% (hazard ratio = 1.11, 95% confidence interval: 1.09, 1.14). Gestational weeks 17–24 and 36 were associated with increased vulnerability to PM2.5 exposure. We find that non-Hispanic black mothers may be more susceptible to effects of PM2.5 exposure than non-Hispanic white mothers, particularly at the end of pregnancy. These findings extend our knowledge about the existence of specific exposure periods during pregnancy that have the greatest impact on preterm birth. [ABSTRACT FROM AUTHOR]

In this paper, we discuss subjective well-being of college students in a mid-size public comprehensive university in California. We discuss two measures of well-being: overall life satisfaction and the U-index calculated using the Day Reconstruction Method. Although overall life satisfaction and the U-index tend to be fairly correlated they do capture different aspects of subjective well-being. According to Kahneman and Krueger, factors like ethnicity, income, and education are more closely related to overall life satisfaction than to the U-index. In addition, they suggest that adaptation to changes in our life circumstances as measured by overall life satisfaction may be different from the U-index. We examine the relationships between these variables in the case of college students. Gender, income and hours of sleep are the most significant factors that related to the U-index. On the other hand, life satisfaction is significantly related to gpa, household income, race/ethnicity, percentage of college costs paid by family and hours of sleep. We explore differences in how students choose to spend their time and the U-index associated with different activities to explain our findings. These findings can have important implications for how we attend to the needs of different sections of the student population to help them succeed. [ABSTRACT FROM AUTHOR]

Background and objectives: The Community Eligibility Provision (CEP), a universal free school meals policy, increases school meal participation by allowing schools in low-income areas to provide free breakfast and lunch to all students; however, its impact on obesity remains uncertain. The objective of this study is to estimate the association of CEP with child obesity. Methods: School obesity prevalence was calculated using BMI measurements collected annually between 2013 and 2019 from students in California public schools in grades 5, 7, and 9. To estimate the association of CEP with obesity, we used a difference-in-differences approach for staggered policy adoption with an outcome regression model conditional on covariates, weighted by student population size. Results: The analysis included 3531 CEP-eligible schools using school-level obesity prevalence calculated from 3 546 803 BMI measurements. At baseline, on average, 72% of students identified as Hispanic, 11% identified as white, 7% identified as Black, and 80% were eligible for free or reduced-price meals. Baseline obesity prevalence was 25%. Schools that participated in CEP were associated with a 0.60-percentage-point net decrease in obesity prevalence after policy adoption (95% confidence interval: -1.07 to -0.14 percentage points, P = .01) compared with eligible, nonparticipating schools, corresponding with a 2.4% relative reduction, given baseline prevalence. Meals served increased during this period in CEP-participating schools only. Conclusions: In a balanced sample of California schools, CEP participation was associated with a modest net decrease in obesity prevalence compared with eligible, nonparticipating schools. These findings add to the growing literature revealing potential benefits of universal free school meals for children's well-being. [ABSTRACT FROM AUTHOR]

Few investigations have explored temperature and birth outcomes. In a retrospective cohort study, we examined apparent temperature, a combination of temperature and relative humidity, and term low birth weight (LBW) among 43,629 full-term LBW infants and 2,032,601 normal-weight infants in California (1999–2013). The California Department of Public Health provided birth certificate data, while meteorological data came from the California Irrigation Management Information System, US Environmental Protection Agency, and National Centers for Environmental Information. After considering several temperature metrics, we observed the best model fit for term LBW over the full gestation (per 10-degrees-Fahrenheit (°F) increase in apparent temperature, 13.0% change, 95% confidence interval: 4.1, 22.7) above 55°F, and the greatest association was for third-trimester exposure above 60°F (15.8%, 95% confidence interval: 5.0, 27.6). Apparent temperature during the first month of pregnancy exhibited no significant risk, while the first trimester had a significantly negative association, and second trimester, last month, and last 2 weeks had slightly increased risks. Mothers who were black or older, delivered male infants, or gave birth during the warm season had infants at the highest risks. This study provides further evidence for adverse birth outcomes from heat exposure for vulnerable subgroups of pregnant women. [ABSTRACT FROM AUTHOR]

The association between ambient temperature and morbidity has been explored previously.However, the association between temperature and mental health-related outcomes, including violence and self-harm, remains relatively unexamined. For the period 2005-2013, we obtained daily counts of mental health-related emergency room visits involving injuries with an external cause for 16 California climate zones from the California Office of Statewide Health Planning and Development and combined them with data onmean apparent temperature, a combination of temperature and humidity. Using Poisson regression models, we estimated climate zone-level associations and then used random-effects metaanalyses to produce overall estimates. Analyseswere stratified by season (warm: May-October; cold: November-April), race/ethnicity, and age. During the warm season, a 10°F (5.6°C) increase in same-day mean apparent temperature was associated with 4.8% (95% confidence interval (CI): 3.6, 6.0), 5.8% (95% CI: 4.5, 7.1), and 7.9% (95% CI: 7.3, 8.4) increases in the risk of emergency room visits for mental health disorders, self-injury/suicide, and intentional injury/homicide, respectively. High temperatures during the cold season were also positively associated with these outcomes. Variations were observed by race/ethnicity, age group, and sex, with Hispanics, whites, persons aged 6-18 years, and females being at greatest risk for most outcomes. Increasingmean apparent temperaturewas found to have acute associations with mental health outcomes and intentional injuries, and these findings warrant further study in other locations. [ABSTRACT FROM AUTHOR]

Background: Racial/ethnic disparities in preterm birth (PTB) are well documented in the epidemiological literature, but little is known about the relative contribution of different social and environmental determinants of such disparities in birth outcome. Furthermore, increased focus has recently turned toward modifiable aspects of the environment, including physical characteristics, such as neighborhood air pollution, to reduce disparities in birth outcomes. OBJECTIVES: To apply decomposition methods to understand disparities in preterm birth (PTB) prevalence between births of non-Hispanic black individuals and births of non-Hispanic white individuals in California, according to individual demographics, neighborhood socioeconomic environment, and neighborhood air pollution. Methods: We used all live singleton births in California spanning 2005 to 2010 and estimated PTBs and other adverse birth outcomes for infants borne by non-Hispanic black mothers and white mothers. To compare individual-level, neighborhood-level, and air pollution [Particulate Matter, 2.5 micrometers or less (PM2.5) and nitrogen dioxide (NO2)] predictors, we conducted a nonlinear extension of the Blinder-Oaxaca method to decompose racial/ethnic disparities in PTB. Results: The predicted differences in probability of PTB between black and white infants was 0.056 (95% CI: 0.054, 0.058). All included predictors explained 37.8% of the black-white disparity. Overall, individual (17.5% for PTB) and neighborhood-level variables (16.1% for PTB) explained a greater proportion of the black-white difference in birth outcomes than air pollution (5.7% for PTB). Conclusions: Our results suggest that, although the role of individual and neighborhood factors remains prevailing in explaining black-white differences in birth outcomes, the individual contribution of PM2.5 is comparable in magnitude to any single individual- or neighborhood-level factor. [ABSTRACT FROM AUTHOR]

Background: Particulate matter (PM) has been documented to contribute to preterm delivery. However, few studies have investigated the relationships between individual constituents of fine PM (PM2.5 ) and preterm delivery, and factors that may modify their associations.Methods: In this study, we examined the associations between several prenatal exposure metrics to PM2.5 and 23 constituents of PM2.5 and preterm delivery in California from 2000 to 2006. In a retrospective cohort study including 231 637 births, we conducted logistic regression analyses adjusting for maternal, infant, temporal, geographic, and neighbourhood characteristics.Results: We observed increased risk for preterm delivery with full-gestational exposure for several PM2.5 constituents. Per interquartile range increase, ammonium (21.2%, 95% confidence interval (CI) 17.1, 25.4), nitrate (18.1%, 95% CI 14.9, 21.4) and bromine (16.7%, 95% CI 13.2, 20.3) had some of the largest increased risks. Alternatively, some PM2.5 constituents were inversely associated with preterm delivery, including chlorine (-8.2%, 95% CI -10.3, -6.0), sodium (-13.2%, 95% CI -15.2, -11.3), sodium ion (-11.9%, 95% CI -14.1, -9.6) and vanadium (-19.2%, 95% CI -25.3, -12.6). Greater associations between PM2.5 constituents and preterm delivery were observed for Blacks and Asians, older mothers, and those with some college education compared to their reference groups, as well as for births with gestational ages from 32 to 34 weeks.Conclusions: PM2.5 constituents ammonium, nitrate and bromine, often linked to traffic and biomass combustion, were most associated with increased risk of preterm delivery in California. Certain demographic subgroups may be particularly impacted. [ABSTRACT FROM AUTHOR]

Background: Despite the prediction that temperatures are expected to increase in the future, little is known about the health effects of increasing temperatures on pregnant women. The objective of this study was to investigate the impact of apparent temperature on spontaneous preterm delivery (PTD).Methods: A case-crossover study of 14,466 singleton spontaneous preterm deliveries occurring between January 1, 1995 and December 31, 2009 among Kaiser Permanente Northern California (KPNC) members was conducted. Preterm deliveries were identified through KPNC's Electronic Health Records (EHR) data. Data on gestational age at delivery, infant sex, and maternal address were also extracted from KPNC's EHR and linked to meteorologic and air pollution monitoring data based on residential zip code.Results: An 11.6% (95% CI: 4.1, 19.7) increase in spontaneous PTD was associated with a 10 °F (5.6 °C) increase in weekly average (lag06) apparent temperature, during the warm season. During the cold season, increases in apparent temperature did not significantly impact the overall effect of spontaneous PTD (6.2%, (95% CI: -3.0, 16.2) per 10 °F (5.6 °C) increase in weekly average (lag06) apparent temperature). Significant differences in the relationship between apparent temperature and spontaneous PTD emerged for region, gestational age and infant sex, during the cold season. No significant differences emerged for air pollutants.Conclusions: Our findings provide evidence for an increase in the odds of spontaneous PTD associated with increases in apparent temperature, especially during the warm season. [ABSTRACT FROM AUTHOR]

Objectives. To estimate changes in sugar-sweetened beverage (SSB) and water consumption 3 years after an SSB tax in Berkeley, California, relative to unexposed comparison neighborhoods. Methods. Data came from repeated annual cross-sectional beverage frequency questionnaires from 2014 to 2017 in demographically diverse Berkeley (n = 1513) and comparison (San Francisco and Oakland; n = 3712) neighborhoods. Pretax consumption (2014) was compared with a weighted average of 3 years of posttax consumption. Results. At baseline, SSBs were consumed 1.25 times per day (95% confidence interval [CI] = 1.00, 1.50) in Berkeley and 1.27 times per day (95% CI = 1.13, 1.42) in comparison city neighborhoods. When we adjusted for covariates, consumption in Berkeley declined by 0.55 times per day (95% CI = −0.75, −0.35) for SSBs and increased by 1.02 times per day (95% CI = 0.54, 1.50) for water. Changes in consumption in Berkeley were significantly different from those in the comparison group, which saw no significant changes. Conclusions. Reductions in SSB consumption were sustained in demographically diverse Berkeley neighborhoods over the first 3 years of an SSB tax, relative to comparison cities. These persistent, longer-term reductions in SSB consumption suggest that SSB taxes are an effective policy option for jurisdictions focused on improving public health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies have explored ozone's connection to asthma and total respiratory emergency department visits (EDVs) but have neglected other specific respiratory diagnoses despite hypotheses relating ozone to respiratory infections and allergic responses. OBJECTIVE: We examined relationships between ozone and EDVs for respiratory visits, including specifically acute respiratory infections (ARI), asthma, pneumonia, chronic obstructive pulmonary disease (COPD), and upper respiratory tract inflammation (URTI). METHODS: We conducted a multi-site time-stratified case-crossover study of ozone exposures for approximately 3.7 million respiratory EDVs from 2005 through 2008 among California residents living within 20 km of an ozone monitor. Conditional logistic regression was used to estimate associations by climate zone. Random effects meta-analysis was then applied to estimate pooled excess risks (ER). Effect modification by season, distance from the monitor and individual demographic characteristics (i.e., age, race/ethnicity, sex, and payment method), and confounding by other gaseous air pollutants were also investigated. Meta-regression was utilized to explore how climate zone-level meteorological, demographic, and regional differences influenced estimates. RESULTS: We observed ozone-associated increases in all respiratory, asthma, and ARI visits, which were slightly larger in the warm season [asthma ER per 10-ppb increase in mean of same and previous 3 days ozone exposure (lag[sub 03]) = 2.7%, 95% CI: 1.5, 3.9; ARI ER[sub lag03] = 1.4%, 95% CI: 0.8, 1.9]. EDVs for pneumonia, COPD, and URTI were also significantly associated with ozone exposure over the whole year, but typically more consistently so during the warm season. CONCLUSIONS: Short-term ozone exposures among California residents living near an ozone monitor were positively associated with EDVs for asthma, ARI, pneumonia, COPD, and URTI from 2005 through 2008. Those associations were typically larger and more consistent during the warm season. Our findings suggest that these outcomes should be considered when evaluating the potential health benefits of reducing ozone concentrations. [ABSTRACT FROM AUTHOR]

Recent studies have linked elevated apparent temperatures with adverse birth outcomes, such as preterm delivery, but other birth outcomes have not been well studied. We examined 8,510 fetal deaths (≥20 weeks' gestation) to estimate their association with mean apparent temperature, a combination of temperature and humidity, during the warm season in California (May-October) from 1999 to 2009. Mothers whose residential zip codes were within 10 km of a meteorological monitor were included. Meteorological data were provided by the California Irrigation Management Information System, the US Environmental Protection Agency, and the National Climatic Data Center, while the California Department of Public Health provided stillbirth data. Using a time-stratified case-crossover study design, we found a 10.4% change (95% confidence interval: 4.4, 16.8) in risk of stillbirth for every 10°F (5.6°C) increase in apparent temperature (cumulative average of lags 2-6 days). Risk varied by maternal race/ethnicity and was greater for younger mothers, less educated mothers, and male fetuses. The highest risks were observed during gestational weeks 20-25 and 31-33. No associations were found during the cold season (November-April), and the observed associations were independent of air pollutants. This study adds to the growing body of literature identifying pregnant women and their fetuses as subgroups vulnerable to heat exposure. [ABSTRACT FROM AUTHOR]

This work is devoted to the study of geophysical data by using different spline interpolation techniques. A spatial analysis of the California earthquakes geological data was performed, some of the methods proved to be more efficient than others depending on the number of data points considered. Overall, this class of interpolation surface proved to be a very powerful tool for analyzing geophysical data. [ABSTRACT FROM AUTHOR]

Recent studies have suggested an association between air pollution and stillbirth. In this California study, we examined the records of 13,999 stillbirths and 3,012,270 livebirths occurring between 1999 and 2009. Using a retrospective cohort design and logistic regression models, we calculated the odds of stillbirth associated with each pollutant exposure by trimester and throughout the entire pregnancy. Covariates considered in the model included infant sex, maternal demographic characteristics, season of lastmenstrual period, apparent temperature, air basin of mother's residence, and year of conception. In single-pollutant models, we found that a 10-μg/m3 increase in particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (odds ratio (OR) = 1.06, 95% confidence interval (CI): 0.99, 1.13) and a 10-ppb increase in nitrogen dioxide (OR = 1.08, 95% CI: 1.03, 1.13) during the entire pregnancy were associated with stillbirth. A 10-ppb increase in ozone exposure during the third trimester was also associated with a slightly elevated risk (OR = 1.03, 95% CI: 1.01, 1.05). These ozone and nitrogen dioxide findings were fairly stable after adjustment in 2-pollutantmodels. However, adjustment for nitrogen dioxide attenuated the fullpregnancy-particulate matter relationship. No significant associations were found for sulfur dioxide or carbon monoxide. These findings support growing evidence of an association between air pollution and adverse birth outcomes. [ABSTRACT FROM AUTHOR]

This study assesses the changes in access to care in minority communities by examining the association between preventable hospitalization rates and racial/ethnic composition of the community during 1995-2005. Using hospital discharge data from Healthcare Cost and Utilization Project State Inpatient Database of the Agency for Healthcare Research and Quality in 5 states and focusing on the nonelderly adults and elderly age groups, the study includes a multivariate cross-sectional design using preventable hospitalization rates by primary care service area as the outcome and racial/ethnic compositions of total hospital discharges by resident population in the primary care service area as the primary explanatory variables. The study indicates increases in barriers faced by minority adults in accessing primary care over time, with no similar evidence for the elderly subgroup. [ABSTRACT FROM AUTHOR]

The behavioral value of travel time is an important factor for evaluating alternative transportation facility or service improvement projects based on road user-benefit approach. This article presents the behavioral value of travel time with reference to home-based school tour in California. Initially a single value of travel time is quantified from multinomial logit and nested logit (NL) model estimate. Later random parameter logit (RPL) model is employed by specifying a random component for the travel time attribute. The values of travel time emanating from RPL model estimate are quantified across student population by assuming different types of tent-shaped random distributions such as triangular and normal. In this study the value of travel time is investigated separately for two types of home-based school tour: grade school and college-university. Overall this study examines the effect of alternative logit model specifications on quantification of value of travel time. The study is demonstrated using household travel diary data of the state of California, which is revealed preference in nature. [ABSTRACT FROM PUBLISHER]

Abstract: Relationships between prenatal exposure to fine particles (PM2.5) and birth weight have been observed previously. Few studies have investigated specific constituents of PM2.5, which may identify sources and major contributors of risk. We examined the effects of trimester and full gestational prenatal exposures to PM2.5 mass and 23 PM2.5 constituents on birth weight among 646,296 term births in California between 2000 and 2006. We used linear and logistic regression models to assess associations between exposures and birth weight and risk of low birth weight (LBW; <2500g), respectively. Models were adjusted for individual demographic characteristics, apparent temperature, month and year of birth, region, and socioeconomic indicators. Higher full gestational exposures to PM2.5 mass and several PM2.5 constituents were significantly associated with reductions in term birth weight. The largest reductions in birth weight were associated with exposure to vanadium, sulfur, sulfate, iron, elemental carbon, titanium, manganese, bromine, ammonium, zinc, and copper. Several of these PM2.5 constituents were associated with increased risk of term LBW. Reductions in birth weight were generally larger among younger mothers and varied by race/ethnicity. Exposure to specific constituents of PM2.5, especially traffic-related particles, sulfur constituents, and metals, were associated with decreased birth weight in California. [Copyright &y& Elsevier]

Although respiratory disease has been strongly connected to fine particulate air pollution (particulate matter <2.5 μm in diameter (PM2.5)), evidence has been mixed regarding the effects of coarse particles (particulate matter from 2.5 to 10 μm in diameter), possibly because of the greater spatial heterogeneity of coarse particles. In this study, we evaluated the relationship between coarse particles and respiratory emergency department visits, including common subdiagnoses, from 2005 to 2008 in 35 California counties. A time-stratified case-crossover design was used to help control for time-invariant confounders and seasonal influences, and the study population was limited to those residing within 20 km of pollution monitors to mitigate the influence of spatial heterogeneity. Significant associations between respiratory emergency department visits and coarse particle levels were observed. Asthma visits showed associations (for 2-day lag, excess risk per 10 μg/m3 = 3.3%, 95% confidence interval: 2.0, 4.6) that were robust to adjustment by other common air pollutants (particles <2.5 μm in diameter, ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide). Pneumonia and acute respiratory infection visits were not associated, although some suggestion of a relationship with chronic obstructive pulmonary disease visits was present. Our results indicate that coarse particle exposure may trigger asthma exacerbations requiring emergency care, and reducing exposures among asthmatic persons may provide benefits. [ABSTRACT FROM PUBLISHER]

The degree of element mobility in subduction metamorphism has generated much debate; some workers advocate considerable mobility during metamorphism, whereas others postulate minimal mobility. We assess this issue by examination of major and trace element concentrations and Pb-, Nd-isotopic data for 39 mafic metavolcanic rocks from the Franciscan subduction complex, related units of coastal California, and the Feather River ultramafic belt of the northern Sierra Nevada, California; these samples span a wide range of metamorphic grade. We conclude that these rocks, despite their metamorphism up to eclogite facies, preserve protolith major and trace elemental compositions and isotopic ratios, with the exception of some mobile large ion lithophile elements such as Ba, Pb, and to a smaller extent La, U, and Sr. Thus subduction metamorphism of these metabasalts occurred in a largely closed system. Lack of light rare earth element enrichment in the rocks demonstrates lack of chemical exchange with subducted metasediments. Relatively low SiO2 content (<48 wt.%) of many of the metamorphic rocks and the lack of correspondence between silica depletion and metamorphic grade suggests that the silica depletion resulted from seafloor hydrothermal alteration before subduction. In spite of demonstrated mobility of Pb, and possible mobility of Nd, isotopic ratios of Pb and Nd were not modified during subduction metamorphism. In contrast to our results from metabasaltic rocks, our analysis of actinolite-rich rinds from high-grade Franciscan mélange blocks suggests some chemical exchange between metachert and the overlying mantle. The increasing enrichment in Ba and Pb with increasing metamorphic grade suggests that Ba- and Pb-rich fluids interacted more intensely with metabasalt at the higher grades of metamorphism. Comparison of these results with studies of the active Mariana forearc suggests that fluids interacting with the mantle wedge up-dip of the region of magma genesis are derived from subducting sediments overlying the down-going plate. [ABSTRACT FROM AUTHOR]

Abstract: Investigators have consistently demonstrated associations between elevated temperatures and mortality worldwide. Few have recently focused on identifying vulnerable subgroups, and far fewer have determined whether at least some of the observed effect may be a manifestation of mortality displacement. We examined mean daily apparent temperature and mortality in 13 counties in California during the warm season from 1999 to 2006 to identify age and disease subgroups that are at increased risk, and to evaluate the potential effect of mortality displacement. The time-series method using the Poisson regression was applied for data analysis for single lag days of 0–20 days, and for cumulative average lag days of five and ten days. Significant associations were observed for the same-day (excess risk=4.3% per 5.6°C increase in apparent temperature, 95% confidence interval: 3.4, 5.2) continuing up to a maximum of three days following apparent temperature exposure for non-accidental mortality. Similar risks were found for mortality from cardiovascular diseases, respiratory diseases, and among children zero to 18 years of age, and adults and the elderly 50 years and older. Since no significant negative effects were observed in the following single or cumulative days, evidence of mortality displacement was not found. Thus, the effect of temperature on mortality appears to be an event that occurs within three days following exposure, and requires immediate attention for prevention. [Copyright &y& Elsevier]

With temperatures expected to increase because of climate change, it is essential to study the health outcomes of elevated temperature in vulnerable populations, such as expectant mothers. In this study, the authors estimated the association between heat and humidity, as measured by apparent temperature, and preterm delivery. They conducted a case-crossover analysis of almost 60,000 births spanning 16 counties in California that occurred from 1999 to 2006 between May and September. The authors identified cases of preterm birth from a state registry of births, which were combined with meteorologic and air pollution monitoring data based on residential zip code. High ambient temperature was significantly associated with preterm birth for all mothers, regardless of maternal racial/ethnic group, maternal age, maternal education, or sex of the infant. Results indicated that an 8.6% increase (95% confidence interval: 6.0, 11.3) in preterm delivery was associated with a 10°F (5.6°C) increase in weekly average (lag06) apparent temperature. Greater associations were observed for younger mothers, blacks, and Asians. These associations were independent of air pollutants. Given the significant associations for apparent temperature and preterm delivery found in this study, more large-scale studies of temperature and preterm delivery are warranted. [ABSTRACT FROM PUBLISHER]

Several investigators have documented the effect of temperature on mortality, although fewer have studied its impact on morbidity. In addition, little is known about the effectiveness of mitigation strategies such as use of air conditioners (ACs). The authors investigated the association between temperature and hospital admissions in California from 1999 to 2005. They also determined whether AC ownership and usage, assessed at the zip-code level, mitigated this association. Because of the unique spatial pattern of income and climate in California, confounding of AC effects by other local factors is less likely. The authors included only persons who had a temperature monitor within 25 km of their residential zip code. Using a time-stratified case-crossover approach, the authors observed a significantly increased risk of hospitalization for multiple diseases, including cardiovascular disease, ischemic heart disease, ischemic stroke, respiratory disease, pneumonia, dehydration, heat stroke, diabetes, and acute renal failure, with a 10°F increase in same-day apparent temperature. They also found that ownership and usage of ACs significantly reduced the effects of temperature on these health outcomes, after controlling for potential confounding by family income and other socioeconomic factors. These results demonstrate important effects of temperature on public health and the potential for mitigation. [ABSTRACT FROM PUBLISHER]

Although studies suggest that air pollution is linked to perinatal outcomes, the geographic characterization of exposure to pollution differs between the studies. We compared neighborhood- and county-level measures of air pollution exposure, while examining the association between particulate matter less than 2.5?µm in aerodynamic diameter (PM2.5) and birth weight among full-term births in California in 2000. To reduce the effects of demographic variability, our analysis was limited to two populations of 8579 non-Hispanic white and 8114 Hispanic mothers who were married, between 20 and 30 years of age, completed at least a high school education, and gave birth for the first time. Measurements from the nearest monitor, and average and distance-weighted average of monitors within a 5-mile radius from each mother's residence (constituting neighborhood metrics) and the mean of monitors within each mother's county of residence were considered. PM2.5 measurements, provided by the California Air Resources Board, were calculated to correspond to each mother's 9-month gestation period. Although metrics within the 5-mile radii and the county were highly correlated (r2=0.78), the county-level metric provided a stronger association between PM2.5 and birth weight (ß=-4.04, 95%confidence interval=-6.71,-1.37) than the metric for the average of all monitors within 5-miles (ß=-1.38, 95%confidence interval=-3.36, 0.60) among non-Hispanic white mothers; similar results were observed among the Hispanic sample of mothers. Consequently, inferences from studies using different definitions of air pollution exposure may not be comparable.Journal of Exposure Analysis and Environmental Epidemiology (2004) 14, 391-396. doi:10.1038/sj.jea.7500336 [ABSTRACT FROM AUTHOR]

Discusses the right microclimates for growing wine grapes in California. Importance of sunlight, moisture and temperature on achieving the right ripeness for making wine; Climate factor in viticulture; Climate regions of California's wine-growing areas; Effect of microclimate on the quality of wine; Vineyards found in the state.

Discusses neodymium (Nd) and strontium (Sr) isotopic geochemistry and tectonics of ridge subduction and middle Cenozoic volcanism in western California. Geologic background of the study area; Major and trace element geochemistry; Petrogenesis of the Coast Range and Santa Maria volcanic rocks; Tectonic models for volcanism.

Describes Nd and Sr isotopic data that indicate that early Miocene volcanism in the Santa Maria Province (SMP) of west-central California was a direct result of ridge-trench interactions. East Pacific Rise interaction with a subduction zone along the California margin during the Early Miocene; Depleted-mantle reservoir juxtaposed beneath the continental margin and was erupted to form basalts.

An abstract of the article "Myocardial fibrosis and ventricular strain indices in post-fontan single ventricle patients: cardiac MR assessment and prognostic significance," by Sanmit K. Basu and colleagues is presented.

The association between ambient temperature and mortality has been established worldwide, including the authors prior study in California. Here, they examined cause-specific mortality, age, race/ethnicity, gender, and educational level to identify subgroups vulnerable to high ambient temperature. They obtained data on nine California counties from May through September of 1999–2003 from the National Climatic Data Center (countywide weather) and the California Department of Health Services (individual mortality). Using a time-stratified case-crossover approach, they obtained county-specific estimates of mortality, which were combined in meta-analyses. A total of 231,676 nonaccidental deaths were included. Each 10°F (∼4.7°C) increase in mean daily apparent temperature corresponded to a 2.6% (95% confidence interval (CI): 1.3, 3.9) increase for cardiovascular mortality, with the most significant risk found for ischemic heart disease. Elevated risks were also found for persons at least 65 years of age (2.2%, 95% CI: 0.04, 4.0), infants 1 year of age or less (4.9%, 95% CI: −1.8, 11.6), and the Black racial/ethnic group (4.9%, 95% CI: 2.0, 7.9). No differences were found by gender or educational level. To prevent the mortality associated with ambient temperature, persons with cardiovascular disease, the elderly, infants, and Blacks among others should be targeted. [ABSTRACT FROM AUTHOR]

Though fine particulate matter (PM 2.5) has decreased in the United States (U.S.) in the past two decades, the increasing frequency, duration, and severity of wildfires significantly (though episodically) impairs air quality in wildfire-prone regions and beyond. Increasing PM 2.5 concentrations derived from wildfire smoke and associated impacts on public health require dedicated epidemiological studies. Main sources of PM 2.5 data are provided by government-operated monitors sparsely located across U.S., leaving several regions and potentially vulnerable populations unmonitored. Current approaches to estimate PM 2.5 concentrations in unmonitored areas often rely on big data, such as satellite-derived aerosol properties and meteorological variables, apply computationally-intensive deterministic modeling, and do not distinguish wildfire-specific PM 2.5 from other sources of emissions such as traffic and industrial sources. Furthermore, modelling wildfire-specific PM 2.5 presents a challenge since measurements of the smoke contribution to PM 2.5 pollution are not available. Here, we aim to use statistical methods to isolate wildfire-specific PM 2.5 from other sources of emissions. Our study presents an ensemble model that optimally combines multiple machine learning algorithms (including gradient boosting machine, random forest and deep learning), and a large set of explanatory variables to, first, estimate daily PM 2.5 concentrations at the ZIP code level, a relevant spatiotemporal resolution for epidemiological studies. Subsequently, we propose a novel implementation of an imputation approach to estimate the wildfire-specific PM 2.5 concentrations that could be applied geographical regions in the US or worldwide. Our ensemble model achieved comparable results to previous machine learning studies for PM 2.5 prediction while avoiding processing larger, computationally intensive datasets. Our study is the first to apply a suite of statistical models using readily available datasets to provide daily wildfire-specific PM 2.5 at a fine spatial scale for a 15-year period, thus providing a relevant spatiotemporal resolution and timely contribution for epidemiological studies. [ABSTRACT FROM AUTHOR]

Climate change continues to increase the frequency, intensity, and duration of heat events and wildfires, both of which are associated with adverse pregnancy outcomes. Few studies simultaneously evaluated exposures to these increasingly common exposures. We investigated the relationship between exposure to heat and wildfire smoke and preterm birth (PTB). In this time-stratified case-crossover study, participants consisted of 85,806 California singleton PTBs (20–36 gestational weeks) from May through October of 2015–2019. Birthing parent ZIP codes were linked to high-resolution daily weather, PM 2.5 from wildfire smoke, and ambient air pollution data. Heat day was defined as a day with apparent temperature >98th percentile within each ZIP code and heat wave was defined as ≥2 consecutive heat days. Wildfire-smoke day was defined as a day with any exposure to wildfire-smoke PM 2.5. Conditional logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (CI) comparing exposures during a hazard period (lags 0–6) compared to control periods. Analyses were adjusted for relative humidity, fine particles, and ozone. Wildfire-smoke days were associated with 3.0% increased odds of PTB (OR lag0 : 1.03, CI: 1.00–1.05). Compared with white participants, associations appeared stronger among Black, Hispanic, Asian, and American Indians/Alaskan Native participants. Heatwave days (OR lag2 : 1.07, CI: 1.02–1.13) were positively associated with PTB, with stronger associations among those simultaneously exposed to wildfire smoke days (OR lag2 : 1.19, CI: 1.11–1.27). Similar findings were observed for heat days and when other temperature metrics (e.g., maximum, minimum) were used. Heat and wildfire increased PTB risk with evidence of synergism. As the occurrence and co-occurrence of these events increase, exposure reduction among pregnant people is critical, especially among racial/ethnic minorities. • Wildfire exposure is associated with higher risks of preterm birth. • Unusually hot days and heatwaves are also associated with preterm birth risks. • Co-exposures of heat and wildfires have compounding effects. • Communities of color are more susceptible to these exposures. • The crossover nature of this study controls for time-invariant confounding. [ABSTRACT FROM AUTHOR]

Objective. To examine associations between birth weight and air pollution among full-term infants in California. Methods. We matched exposure data collected from air pollution monitors for small particles (PM2.5 ) and carbon monoxide (CO) to California birth records for singleton births delivered at 40 weeks' gestation in 2000 using the locations of the monitors and mother's residence. Pollution measurements collected within 5 miles of the mother's residence, averaged for the time period corresponding to the duration of pregnancy and each trimester, were used as exposure variables. Logistic and linear regression models were used to estimate the associations between the pollution measures and 2 pregnancy outcomes: small for gestational age (SGA) and birth weight. Variations of the models were used to examine the robustness of the findings. Results. The adjusted odds ratio for SGA for exposure in the highest compared with lowest quartile of PM2.5 was 1.26 (95% confidence interval [CI]: 1.03-1.50). We found no association between CO and birth weight or SGA after controlling for maternal factors and PM2.5 (mean birth weight difference: 2.6 g; 95% CI: -20.6 to 25.8). The difference in mean birth weight for infants with a 9-month exposure in the highest quartile of PM2.5 compared with that of infants who were exposed in the lowest quartile was -36.1 g (95% CI: -16.5 g to -55.8 g); this difference was similar after controlling for CO. We did not find PM2.5 exposure during a particular trimester most important for assessing birth weight; trimester-level associations were similar to those found using the 9-month exposure variable. Conclusions. We found an increased odds of SGA and a small difference in mean birth weight between infants with the highest and lowest exposures to PM2.5 but not CO. These findings have important implications for infant health because of the ubiquitous exposure to fine particula... [ABSTRACT FROM AUTHOR]

Associations between ambient air pollution and stillbirth have recently been explored, but most studies have focused on long-term (trimester or gestational averages) rather than short-term (within one week) air pollution exposures. To evaluate whether short-term exposures to criteria air pollutants are associated with increased risk of stillbirth. Using air pollution and fetal death certificate data from 1999 to 2009, we assessed associations between acute prenatal air pollution exposure and stillbirth in California. In a time-stratified case-crossover study, we analyzed single day and/or cumulative average days (up to a 6 day lag) of exposure to fine (PM 2.5) and coarse particles (PM 10-2.5), ozone (O 3), nitrogen dioxide (NO 2), sulfur dioxide (SO 2), and carbon monoxide (CO) for mothers estimated to reside within 10 km of a pollution monitor based on reported zip code. We also examined potential confounding by apparent temperature or co-pollutants, and effect modification by maternal demographic factors, fetal sex, gestational age, and cause of stillbirth. Stillbirth cases in the primary analyses ranged between 1,203 and 13,018, depending on the pollutant. For an IQR increase in SO 2 (lag 4), O 3 (lag 4), and PM 10-2.5 (lag 2), we found a 2.8% (95% confidence interval (CI) 0.2%, 5.5%), 5.8% (95% CI 1.6%, 10.1%), and 6.1% (95% CI 0.1%, 12.4%) increase in the odds of stillbirth, respectively. Additional adjustment by apparent temperature had little effect on the SO 2 association but slightly attenuated O 3 (adjusted % change: 4.2% (95% CI -0.2%, 8.9%) and PM 10-2.5 (5.7% (95% CI -1.1%, 13.0%)) associations, while other co-pollutants had minimal impact. Associations were observed specifically for stillbirths from obstetric complications and in women with higher educational attainment. This study provides evidence for associations between prenatal short-term air pollution exposure, specifically SO 2 , O 3 , and PM 10-2.5, and stillbirth in California and warrants replication of findings in other settings. • Prior studies of short-term air pollution as triggers of stillbirth are limited. • Our study shows evidence linking stillbirth with exposure to SO 2 , PM 10-2.5 and O 3. • These associations appear more evident among more educated mothers. • The pathway may involve obstetric complications such as placental abruption. [ABSTRACT FROM AUTHOR]

Wildfire smoke has been associated with adverse respiratory outcomes, but the impacts of wildfire on other health outcomes and sensitive subpopulations are not fully understood. We examined associations between smoke events and emergency department visits (EDVs) for respiratory, cardiovascular, diabetes, and mental health outcomes in California during the wildfire season June–December 2016–2019. Daily, zip code tabulation area-level wildfire-specific fine particulate matter (PM 2.5) concentrations were aggregated to air basins. A "smoke event" was defined as an air basin-day with a wildfire-specific PM 2.5 concentration at or above the 98th percentile across all air basin-days (threshold = 13.5 μg/m3). We conducted a two-stage time-series analysis using quasi-Poisson regression considering lag effects and random effects meta-analysis. We also conducted analyses stratified by race/ethnicity, age, and sex to assess potential effect modification. Smoke events were associated with an increased risk of EDVs for all respiratory diseases at lag 1 [14.4%, 95% confidence interval (CI): (6.8, 22.5)], asthma at lag 0 [57.1% (44.5, 70.8)], and chronic lower respiratory disease at lag 0 [12.7% (6.2, 19.6)]. We also found positive associations with EDVs for all cardiovascular diseases at lag 10. Mixed results were observed for mental health outcomes. Stratified results revealed potential disparities by race/ethnicity. Short-term exposure to smoke events was associated with increased respiratory and schizophrenia EDVs. Cardiovascular impacts may be delayed compared to respiratory outcomes. • WF-specific PM 2.5 concentrations were used to identify smoke events in California. • Smoke events were associated with increased respiratory and schizophrenia EDVs. • Delayed positive associations observed for cardiovascular EDVs after smoke event. • Results were robust to co-pollutants adjustment and smoke event definition. • Higher risk of diabetes EDVs for people who are Hispanic than people who are White. [ABSTRACT FROM AUTHOR]