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Background: Outdoor air pollution, including ozone (O3) pollution, and childhood family environments may interact and impact asthma exacerbations in children. Previous epidemiology studies have primarily focused on stress in the home, rather than support, and whether psychosocial factors modify the association between pollution and health outcomes, rather than whether pollution exposure modifies associations between psychosocial factors and health outcomes. Methods: Data from the cross-sectional 2003 representative, population-based California Health Interview Survey were linked with air quality monitoring data on O3 pollution from the California Air Resources Board. Adolescents (N = 209) ages 12–17 who reported an asthma diagnosis and lived within 5 mi of the nearest air monitoring station had linked O3 data for a 12-month period preceding the survey interview date. Adolescents reported perceived available support from an adult at home and frequency of asthma symptoms. Results: In unadjusted models, for adolescents living in high O3 pollution regions, greater perceived support was related to lower asthma symptom frequency. Follow-up analyses suggested that the most plausible interpretation of the interaction was that O3 exposure modified the association between perceived support and symptom frequency. O3 × perceived support interactions were not statistically significant after adjusting for covariates. Conclusions: These data provide preliminary evidence that the association between the lack of support in the home environment and worse asthma symptoms may be stronger in areas with higher O3 exposure. Future work may benefit from incorporating personal pollution exposure assessments, comprehensive family environment assessments, and longitudinal follow-up of asthma exacerbations over time. [ABSTRACT FROM AUTHOR]

There has been mounting evidence for the beneficial effect of green space on mental health among adults, but studies on the same topics are lacking for teens in the US. This study aimed to fill in this research gap by utilizing data from California Health Interview Survey (CHIS) 2011-2014. A total of 81,102 households (composed of 4538 teens and 81,102 adults) were retained for main analyses. Surrounding greenness was assessed by the Normalized Difference Vegetation Index (NDVI) within varying buffers of home residence. Survey logistic regressions accounted for sampling weights and design were conducted to examine the effects of greenness on serious psychological distress (SPD), adjusted for major socio-demographic factors, neighborhood socioeconomic status (SES) and co-respondent's psychological distress level within the same household. An inter-quartile increment of NDVI in 350 m buffer predicted decreased odds of SPDs by 36% in teens (OR = 0.64, 95% CI = [0.46, 0.91]). Mediation analyses revealed that this association remained almost unchanged even after adjusting for social cohesion. The NDVI-SPD association of adults was found to be significant only in the older group (OR = 0.81, 95% CI = [0.68, 0.95]). This study is one of the first population-based US studies extending the epidemiological evidence for benefits of green space on mental health from adults to teens. [ABSTRACT FROM AUTHOR]

• Short-term daily total PM 2.5 exposure is associated with work loss due to sickness. • Association of PM 2.5 with work loss becomes stronger when exposed to higher wildfire smoke. • Federal and state PM 2.5 standards could be further strict to protect public health. Few studies investigated the impact of particulate matter (PM 2.5) on some symptom exacerbations that are not perceived as severe enough to search for medical assistance. We aimed to study the association of short-term daily total PM 2.5 exposure with work loss due to sickness among adults living in California. We included 44,544 adult respondents in the workforce from 2015 to 2018 California Health Interview Survey data. Daily total PM 2.5 concentrations were linked to respondents' home addresses from continuous spatial surfaces of PM 2.5 generated by a geostatistical surfacing algorithm. We estimated the effect of a 2-week average of daily total PM 2.5 exposure on work loss using logistic regression models. About 1.69% (weighted percentage) of adult respondents reported work loss in the week before the survey interview. The odds ratio of work loss was 1.45 (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.03, 2.03) when a 2-week average of daily total PM 2.5 exposure was higher than 12 µg/m3. The OR for work loss was 1.05 (95% CI: 0.98, 1.13) for each 2.56ug/m3 increase in the 2-week average of daily total PM 2.5 exposure, and became stronger among those who were highly exposed to wildfire smoke (OR = 1.06, 95% CI: 1.00, 1.13), compared to those with lower wildfire smoke exposure (OR = 1.04, 95% CI: 0.79, 1.39). Our findings suggest that short-term ambient PM 2.5 exposure is positively associated with work loss due to sickness and the association was stronger among those with higher wildfire smoke exposure. It also indicated that the current federal and state PM 2.5 standards (annual average of 12 µg/m3) could be further strengthened to protect the health of the citizens of California. [ABSTRACT FROM AUTHOR]

Objective: We examined the existence of disparities in receipt of appropriate diabetes care among California's fee-for-service Medicaid beneficiaries and the effectiveness of a telephonic-based disease management program delivered by a disease management vendor on the reduction of racial/ethnic disparities in diabetes care.Research Design and Methods: We conducted an intervention-control cohort study to test the effectiveness of a 3-year-long disease management program delivered to Medicaid fee-for-service beneficiaries aged 22 to 75 with a diagnosis of diabetes in Los Angeles and Alameda counties. The outcome measures were the receipt of at least one hemoglobin A1c (HbA1c) test, LDL cholesterol test, and retinal examination each year. We used generalized estimating equations models with logit link to analyze the claims data for a cohort of beneficiaries in two intervention counties (n = 2,933) and eight control counties (n = 2,988) from September 2005 through August 2010.Results: Racial/ethnic disparities existed in the receipt of all three types of testing in the intervention counties before the program. African Americans (0.66; 95% CI 0.62-0.70) and Latinos (0.77; 95% CI 0.74-0.80) had lower rates of receipt for HbA1c testing than whites (0.83; 95% CI 0.81-0.85) in the intervention counties. After the intervention, the disparity among African Americans and Latinos compared with whites persisted in the intervention counties. For Asian Americans and Pacific Islanders, the disparity in testing rates decreased. We did not find similar disparities in the control counties.Conclusions: This disease management program was not effective in reducing racial/ethnic disparities in diabetes care in the most racially/ethnically diverse counties in California. [ABSTRACT FROM AUTHOR]

This study examines whether the "Emission Reduction Plan for Ports and Goods Movement" in California reduced air pollution exposures and emergency room visits among California Medicaid enrollees with asthma and/or chronic obstructive pulmonary disease. We created a retrospective cohort of 5608 Medicaid enrollees from ten counties in California with data from 2004 to 2010. We grouped the patients into two groups: those living within 500 m of goods movement corridors (ports and truck-permitted freeways), and control areas (away from the busy truck or car permitted highways). We created annual air pollution surfaces for nitrogen dioxide and assigned them to enrollees' home addresses. We used a quasi-experimental design with a difference-in-differences method to examine changes before and after the policy for cohort beneficiaries in the two groups. The reductions in nitrogen dioxide exposures and emergency room visits were greater for enrollees in goods movement corridors than those in control areas in post-policy years. We found that the goods movement actions were associated with 14.8% (95% CI, −24.0% to −4.4%; P = 0.006) and 11.8% (95% CI, −21.2% to −1.2%; P = 0.030) greater reduction in emergency room visits for the beneficiaries with asthma and chronic obstructive pulmonary disease, respectively, in the third year after California's emission reduction plan. These findings indicate remarkable health benefits via reduced emergency room visits from the significantly improved air quality due to public policy interventions for disadvantaged and susceptible populations. • This is the first study to assess the specific long-term and large-scale regulatory actions on air quality and health. • The California Goods Movement interventions was associated with substantial reductions in NO2 exposures. • The intervention also led to reductions in emergency room visits among Medicaid beneficiaries with respiratory diseases. • This paper contributed to scientific methods for assessing the health effects of regulatory actions. [ABSTRACT FROM AUTHOR]

To increase HIV testing, in 2008 California's governor signed the first piece of legislation in the USA to require private health plans to cover the cost of HIV testing regardless of whether testing is related to a primary diagnosis. This study assesses the impacts of the bill on coverage, testing rate, and cost for 22,190,000 Californians. All targeted individuals had some form of coverage for HIV testing before the mandate. If minimum expansion of coverage occurs, overall expenditures on HIV testing are projected to increase by US$554,000 in the year following the adoption of the law. If testing broadens to comply with the Centers for Disease Control and Prevention (CDC) testing guidelines, annual expenditures are projected to increase by US$10,151,000. This policy change could serve as a step toward making HIV testing a routine screening test. However, the impact of this mandate largely depends on people's awareness and willingness to adopt the CDC guidelines. [ABSTRACT FROM AUTHOR]

Background. The California Legislature requires health maintenance organizations (HMOs) to expand coverage for pediatric asthma self-management educational services under two scenarios: education in clinic settings (to include group education) for symptomatic children; education in clinic and community settings (to include home- or school-based education) for children with uncontrolled asthma. Objective. This study aims to determine the impacts of the bill on coverage, utilization, and costs. Methods. The study population includes 503,000 children ages 1-17 years with symptomatic asthma and 134,000 children with uncontrolled asthma insured by California HMOs. The net effects of the expansion of coverage on costs were estimated after factoring in both the new costs associated with increases in utilization of expanded asthma self-management education as well as the cost savings resulting from reduced asthma-related emergency room visits and hospitalizations. Results. All children enrolled in HMOs in California are covered for clinic-based individual asthma self-management education, though alternative methods, such as group health education classes, and home- or school-based education services are less frequently or not covered at all by HMOs. The cost estimate for expansion of clinic-based education services to children with symptomatic asthma was approximately $5 million; and expansion of clinic and community-based education services to children with uncontrolled asthma was approximately $1 million annually if utilization increased by 10%. Conclusions. Our findings suggest that expansion of coverage for pediatric asthma self-management education is not very costly, especially for children with uncontrolled asthma given the potential improvements in asthma outcomes. Further evaluation of feasibility for implementation of community-based education is needed. [ABSTRACT FROM AUTHOR]

Objectives. To aid state and local policymakers, program planners, and community advocates, we created estimates of the percentage of the population lacking health insurance in small geographic areas of California. Methods. We modeled probabilities of uninsurance using state-level, multiyear data from the US Census Bureau's Current Population Survey. The models were applied to population projection data from a commercial vender (Claritas). We updated the population data using the most recently available census and survey data to reflect intercensual population changes. Legislative district boundary files were merged into the updated population projections. Finally, calibration ensured the consistency and stability of the estimates when they were aggregated. Results. Health insurance coverage among nonelderly persons varied widely across assembly districts, from 10% to 44%. The utility of local-level estimates was most apparent when the variations in subcounty uninsured rates in Los Angeles County (19%-44%) were examined. Conclusions. Stable and useful estimates of health insurance rates for small areas such as legislative districts can be created through use of multiple sources of publicly available data. (Am J Public Health. 2007;97:731-737.) [ABSTRACT FROM AUTHOR]

This research was designed to validate data collected through a survey—an inexpensive way to provide information for quality measurement. The survey was sent to health maintenance organization (HMO) enrollees who had given birth(s) between October 1, 1994, and May 31, 1995. The responses were compared with the medical records. A sample of 407 women was randomly selected from the completed surveys. Medical records were reviewed for 89.9% (362/407) of the sample based on medical record availability. Over 98% of responses agreed with the medical record information regarding whether there were cesarean sections for previous deliveries (K = 1.0), cesarean section for recent delivery (κ = 0.95), and vaginal birth after cesarean section (κ = 0.96). Over 99% of the mothers agreed with the information regarding whether the newborn birth weight was under 2500 g (κ = 0.91). The findings strongly support the validation of this instrument. Using this validated instrument enables health plans to cost-effectively obtain crucial information. [ABSTRACT FROM PUBLISHER]

• Integrate multiple types of measures of an air pollutant into one single modeling framework. • Deal with repeated measures for annual air pollution model development. • Difference-in-difference analysis to identify differential improvements in air pollution exposure. Over the past decade, researchers and policy-makers have become increasingly interested in regulatory and policy interventions to reduce air pollution concentrations and improve human health. Studies have typically relied on relatively sparse environmental monitoring data that lack the spatial resolution to assess small-area improvements in air quality and health. Few studies have integrated multiple types of measures of an air pollutant into one single modeling framework that combines spatially- and temporally-rich monitoring data. In this paper, we investigated the differential effects of California emissions reduction plan on reducing air pollution between those living in the goods movement corridors (GMC) that are within 500 m of major highways that serve as truck routes to those farther away or adjacent to routes that prohibit trucks. A mixed effects Deletion/Substitution/Addition (D/S/A) machine learning algorithm was developed to model annual pollutant concentrations of nitrogen dioxide (NO 2) by taking repeated measures into consideration and by integrating multiple types of NO 2 measurements, including those through government regulatory and research-oriented saturation monitoring into a single modeling framework. Difference-in-difference analysis was conducted to identify whether those living in GMC demonstrated statistically larger reductions in air pollution exposure. The mixed effects D/S/A machine learning modeling result indicated that GMC had 2 ppb greater reductions in NO 2 concentrations from pre- to post-policy period than far away areas. The difference-in-difference analysis demonstrated that the subjects living in GMC experienced statistically significant greater reductions in NO 2 exposure than those living in the far away areas. This study contributes to scientific knowledge by providing empirical evidence that improvements in air quality via the emissions reductions plan policies impacted traffic-related air pollutant concentrations and associated exposures most among low-income Californians with chronic conditions living in GMC. The identified differences in pollutant reductions across different location domains may be applicable to other states or other countries if similar policies are enacted. [ABSTRACT FROM AUTHOR]

Background: Policies protecting children from exposure to secondhand smoke (SHS) may help prevent SHS-related negative health outcomes in children and discourage them from intending to smoke in the future. In this study, we assess the impact of California's 2007 smoke-free vehicle law on changes in middle and high school students' reported exposure to smoking in cars. Secondary aims included assessing the association of student-reported exposure to smoking in vehicles and lifetime asthma diagnosis and future intentions to smoke., Methods: Population-weighted data from the California Student Tobacco Survey and the National Youth Tobacco Survey were used to evaluate California and national trends, respectively. Weighted logistic regression models using California Student Tobacco Survey 2011 data assessed the association between the number of days of exposure to smoking in cars and student-reported lifetime asthma diagnosis as well as intention to smoke in the future., Results: The proportion of California students reporting exposure to smoking in cars in the last 7 days declined <1% annually from 2001 through 2005, but declined 12% annually from 2007 to 2011. National trends did not show comparable declines after 2006. Students reporting exposure to smoking in vehicles were more likely to report having ever been diagnosed with asthma and intending to smoke in the future than students who were not exposed to SHS., Conclusions: These findings support the legislative intent that public policies that are designed to protect children from exposure to smoking in vehicles will yield better adolescent health outcomes and a lower risk of future adolescent cigarette smoking., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

Objective: We examined the existence of disparities in receipt of appropriate diabetes care among California's fee-for-service Medicaid beneficiaries and the effectiveness of a telephonic-based disease management program delivered by a disease management vendor on the reduction of racial/ethnic disparities in diabetes care., Research Design and Methods: We conducted an intervention-control cohort study to test the effectiveness of a 3-year-long disease management program delivered to Medicaid fee-for-service beneficiaries aged 22 to 75 with a diagnosis of diabetes in Los Angeles and Alameda counties. The outcome measures were the receipt of at least one hemoglobin A1c (HbA1c) test, LDL cholesterol test, and retinal examination each year. We used generalized estimating equations models with logit link to analyze the claims data for a cohort of beneficiaries in two intervention counties (n = 2,933) and eight control counties (n = 2,988) from September 2005 through August 2010., Results: Racial/ethnic disparities existed in the receipt of all three types of testing in the intervention counties before the program. African Americans (0.66; 95% CI 0.62-0.70) and Latinos (0.77; 95% CI 0.74-0.80) had lower rates of receipt for HbA1c testing than whites (0.83; 95% CI 0.81-0.85) in the intervention counties. After the intervention, the disparity among African Americans and Latinos compared with whites persisted in the intervention counties. For Asian Americans and Pacific Islanders, the disparity in testing rates decreased. We did not find similar disparities in the control counties., Conclusions: This disease management program was not effective in reducing racial/ethnic disparities in diabetes care in the most racially/ethnically diverse counties in California., (© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.)

Increasing diabetes prevalence has been found to be a primary driver of increased health care costs in the United States. This policy brief examines the impact of diabetes on hospitalizations and related hospitalization costs in California. Using 2011 hospital patient discharge data and annual financial data from the Office of Statewide Health Planning and Development (OSHPD), this study found that patients with diabetes represented 31 percent of hospitalizations in California in 2011 among patients 35 years or older, including 39 percent of African-American and Asian-American patients and 43 percent of Latino patients. Moreover, these hospitalizations cost nearly $2,200 more per hospitalization than those for patients without diabetes, regardless of the primary reason for the hospitalization. Given that approximately 90-95 percent of diagnosed diabetes among adults is type 2 diabetes and is therefore preventable, public health measures can and should be taken to relieve the burden of type 2 diabetes. Such measures include promoting a healthy diet and regular physical activity and providing adequate access to primary and specialty care.

Introduction: Asthma is one of the leading causes of school absenteeism. Previous studies have shown that school absenteeism is related to family income of individual students. However, there is little research examining whether school absenteeism is related to school-level concentration of low-income students, independent of family income. The objective of this study was to examine whether the proportion of low-income students at a school was related to school absenteeism due to asthma., Methods: Using data from the 2007 California Health Interview Survey, a population-based survey of California households, we examined the association between attending schools with high concentrations of low-income students and missing school because of asthma, adjusting for demographic characteristics, asthma severity, and health insurance status. Schools with high concentrations of low-income students were identified on the basis of the percentage of students participating in the free and reduced-price meal program, data publicly available from the California Department of Education., Results: Students attending schools with the highest concentrations of low-income students were more likely to miss school because of asthma. Students from low-income families, younger students, those with more frequent asthma symptoms, or those taking prescription asthma medications also were more likely to miss school because of asthma., Conclusion: The use of school-level interventions to decrease school absenteeism due to asthma should be explored, especially in schools with high concentrations of low-income students. Potential interventions could include school-based asthma education and disease management or indoor and outdoor air pollution control.

Background: The San Joaquin Valley (SJV) in California ranks among the worst in the USA in terms of air quality, and its residents report some of the highest rates of asthma symptoms and asthma-related emergency department (ED) visits and hospitalisations in California. Using California Health Interview Survey data, the authors examined associations between air pollution and asthma morbidity in this region., Methods: Eligible subjects were SJV residents (2001 California Health Interview Survey) who reported physician-diagnosed asthma (n=1502, 14.6%). The authors considered two outcomes indicative of uncontrolled asthma: (1) daily or weekly asthma symptoms and (2) asthma-related ED visits or hospitalisation in the past year. Based on residential zip code, subjects were assigned annual average concentrations of ozone, PM(10) and PM(2.5) for the 1-year period prior to the interview date from their closest government air monitoring station within an 8 km (5 miles) radius., Results: Adjusting for age, gender, race/ethnicity, poverty level and insurance status, the authors observed increased odds of experiencing daily or weekly asthma symptoms for ozone, PM(10) and PM(2.5) (OR(ozone) 1.23, 95% CI 0.94 to 1.60 per 10 ppb; OR(PM10) 1.29, 95% CI 1.05 to 1.57 per 10 microg/m(3); and OR(PM2.5) 1.82; 95% CI 1.11 to 2.98 per 10 microg/m(3)). The authors also observed increased odds of asthma-related ED visits or hospitalisations for ozone (OR 1.49, 95% CI 1.05 to 2.11 per 10 ppb) and a 29% increase in odds for PM(10) (OR 1.29, 95% CI 0.99 to 1.69 per 10 microg/m(3))., Conclusions: Overall, these findings suggest that individuals with asthma living in areas of the SJV with high ozone and particulate pollution levels are more likely to have frequent asthma symptoms and asthma-related ED visits and hospitalisations.

Background: Despite extensive evidence that air pollution affects childhood asthma, state-level and national-level tracking of asthma outcomes in relation to air pollution is limited., Objectives: Our goals were to evaluate the feasibility of linking the 2001 California Health Interview Survey (CHIS), air monitoring, and traffic data; estimate associations between traffic density (TD) or outdoor air pollutant concentrations and childhood asthma morbidity; and evaluate the usefulness of such databases, linkages, and analyses to Environmental Public Health Tracking (EPHT)., Methods: We estimated TD within 500 feet of residential cross-streets of respondents and annual average pollutant concentrations based on monitoring station measurements. We used logistic regression to examine associations with reported asthma symptoms and emergency department (ED) visits/hospitalizations., Results: Assignment of TD and air pollution exposures for cross-streets was successful for 82% of children with asthma in Los Angeles and San Diego, California, Counties. Children with asthma living in high ozone areas and areas with high concentrations of particulate matter < 10 microm in aerodynamic diameter experienced symptoms more frequently, and those living close to heavy traffic reported more ED visits/hospitalizations. The advantages of the CHIS for asthma EPHT include a large and representative sample, biennial data collection, and ascertainment of important socio-demographic and residential address information. Disadvantages are its cross-sectional design, reliance on parental reports of diagnoses and symptoms, and lack of information on some potential confounders., Conclusions: Despite limitations, the CHIS provides a useful framework for examining air pollution and childhood asthma morbidity in support of EPHT, especially because later surveys address some noted gaps. We plan to employ CHIS 2003 and 2005 data and novel exposure assessment methods to re-examine the questions raised here.

In 2005, three million Californians reported that they had current asthma. Despite advances in therapy, asthma remains a disease that is not optimally controlled in many Californians. Inadequately controlled asthma can result in missed work and school and emergency department visits. Asthma was responsible for an estimated 1.9 million missed days of school and two million days of missed work in California in 2005. In addition, more than 475,000 children and adults in California went to the emergency department or urgent care center because of asthma. There are 659,000 children and adults who suffer from asthma symptoms every day or every week (22% of those with current asthma). These Californians suffering from frequent asthma symptoms have higher rates of missing school or work due to their asthma, visiting the emergency department or urgent care for their asthma, and rating their overall health as fair or poor. Improvements in access to health care, asthma management and avoidance of triggers can help these Californians reduce the severity of their asthma burden. Using data from the 2005 California Health Interview Survey (CHIS 2005), this policy brief examines the burden associated with frequent asthma symptoms among those with current asthma, and identifies key opportunities for reducing and controlling disease activity in these asthma sufferers. Asthma is a chronic disease that causes the airways of the lungs to become inflamed and more sensitive to constriction, making it harder to breathe. Current asthma refers to people who have been diagnosed with asthma and who report they still have asthma, or have had an episode or attack in the previous year. Frequent asthma symptoms are defined as experiencing asthma symptoms every day or every week.

Purpose: To investigate whether frequent asthma symptoms (daily/weekly symptoms) can be attributed to traffic-related exposures, poverty, and/or vulnerabilities., Methods: Annual average daily vehicle traffic density (TD) within 500 feet of 2001 California Health Interview Survey respondents' residential cross streets was calculated. Logistic regression analyses were performed to evaluate the association between annual average TD and frequent asthma symptoms with income as a confounder and a modifier., Results: After adjustment for age, sex, and race/ethnicity, a 92% increase in frequent asthma symptoms was observed among those in high TD and a 50% increase among those in medium TD compared to those in low TD. Adjustment for poverty did not change these estimates, but individuals in poverty were twice more likely to experience frequent symptoms. Furthermore, delays in care, a poor/fair health status, current/previous smoking, overweight/obese, or unemployment showed independent associations with frequent asthma symptoms. Analyses stratified on income indicated greater estimated traffic effects for asthmatics in poverty, whereas the estimates for asthmatics above the poverty level moved closer toward the null., Conclusions: Traffic-related exposures, poverty and vulnerabilities all increased the risk of frequent asthma symptoms. Those in poverty appeared to be more strongly affected by heavy traffic near their residences.

Research Objective: To create prevalence estimates of asthma symptoms for California legislative districts., Data Sources: Three main data sources were used for this study: 2001 California Health Interview Survey, 2000 Census, and 2000-2002 March Current Population Surveys., Study Design: Secondary data analyses were conducted from cross-sectional data to distribute the joint probability of ever having an asthma diagnosis and symptoms in the last 12 months within an Assembly district. We applied hierarchical logistic regressions to estimate the parameters for selected survey and census data that predicted the probabilities of diagnosed asthmatics with asthma symptoms. Predictors included individual-level variables and contextual variables at zip code levels., Principal Findings: Asthma symptom prevalence geographically varied by age within and across Assembly districts throughout California., Conclusions: With modest investments in establishing analytic data files and estimating regression parameters for target conditions, small area estimation (SAE) procedures can create health data estimates not otherwise available at the sub-county level. Applying SAE procedures to asthma symptom prevalence suggest that these data can become essential reference tools for advocates and policy makers currently addressing this and other public health concerns in the state.

Many Californians with asthma are exposed to environmental conditions in the home-such as the presence of tobacco smoke and furry pets-which can trigger asthma symptoms. In addition, many who have not been diagnosed with asthma experience asthma-like breathing problems when exposed to these same indoor conditions. Nearly 1.9 million California adults and 890,000 children have active asthma (7.3% of all adults and 10.4% of all children). Among those with active asthma, 970,000 adults and 300,000 children suffered from symptoms at least monthly in 2003. An additional 2.6 million California adults and 810,000 children who had not been diagnosed with asthma suffered from asthma-like symptoms such as wheezing in 2003 (11.1% of all adults and 9.3% of all children). A Publication of the UCLA Center for Health Policy Research Using results from the 2003 California Health Interview Survey (CHIS 2003), this policy brief examines the association of asthma symptoms and asthma-like breathing problems with smoking and the presence of tobacco smoke in the home, and with the presence of dogs and cats in the home. This brief presents the prevalence of monthly asthma symptoms among adults and children with active asthma and the prevalence of wheezing and other asthma-like symptoms in the previous year among those not diagnosed with asthma. Active asthma refers to being diagnosed with asthma and also reporting that one still has asthma and/or that one experienced an asthma attack in the past year. There are a number of known environmental triggers in the home, including environmental tobacco smoke, animal dander, dust mites, cockroaches, molds and pollens. This brief discusses those triggers for which CHIS 2003 collected useful data. Other triggers have also been found to significantly contribute to breathing problems.

In California, nearly 2.8 million adults and children (8%) had active asthma in 2003. Of Californians with active asthma, 890,000 are children (ages 0-17) and 1.8 million are adults (age 18 and above). The prevalence of active asthma varies by racial and ethnic group, with racial and ethnic minority groups affected more adversely by asthma. They are more likely to go to the emergency department for asthma care, miss more school and work days because of asthma, and have poorer health status. They are also more likely to lack access to health care and to live in conditions associated with asthma exacerbations. Among California children, the prevalence of active asthma varies by racial and ethnic groups-with the highest prevalence among African Americans (17%) and American Indians/Alaska Natives (17%), followed by whites (10%), Latinos (7%) and Asians (7%; Exhibit 1). Among adults, American Indians/Alaska Natives have the highest prevalence of active asthma (13%), followed by African Americans (10%), whites (9%), Asians (5%) and Latinos (5%). The National data similarly show that both African Americans and American Indians have higher current asthma prevalence rates than non- Hispanic whites.

In California, 4.5 million adults, adolescents and children had been diagnosed with asthma (13% of all Californians) in 2003, up from four million (12%) in 2001. This increase is consistent in younger children, adolescents and adults (Exhibit 1). Nationally, 10% of the population has been diagnosed with asthma. Among the 4.5 million Californians diagnosed with asthma, more than 2.5 million suffered from an asthma attack or other asthma symptoms in 2003 (56% of those diagnosed). An additional 3.4 million Californians who have not been diagnosed with asthma-10% of all Californians-suffer from asthma-like breathing problems. Some of these respondents might have other respiratory conditions, while others are likely to have asthma that has not been diagnosed. Based on data from the 2003 California Health Interview Survey (CHIS 2003), this policy brief examines the prevalence of lifetime asthma diagnoses and asthma symptoms, as well as the prevalence of asthma-like breathing problems in the absence of an asthma diagnosis. Where possible, it also describes how prevalence has changed since 2001, based on data from CHIS 2001. Lifetime prevalence refers to people who have ever been diagnosed with asthma by a doctor. The prevalence of asthma symptoms refers to people who report having been diagnosed with asthma and who also reported experiencing an asthma attack or other asthma symptoms in the past year. The prevalence of asthma-like symptoms refers to people who have not been diagnosed with asthma but who experienced breathing problems, such as wheezing or whistling in the chest in the past year.

Nearly 40% of California adults age 45 and older reported being diagnosed with high blood pressure, according to the 2001 California Health Interview Survey (CHIS 2001). High blood pressure, also called hypertension, is known as "the silent killer" because it often has no symptoms. If left unchecked and untreated, uncontrolled high blood pressure can lead to heart failure, kidney failure, heart attack and stroke. This policy brief provides data of diagnosed high blood pressure rates for California legislative districts and counties for adults age 45 and older. The first of its kind subcounty data in this policy brief are estimates created by a small-area methodology, based on rates from CHIS 2001 that are applied to population data from the 2000 Census and 2002 California Department of Finance.

Asthma is a chronic lung condition characterized by wheezing, breathlessness, chest tightness, and nighttime or early morning coughing; it has been on the rise in the United States over the past two decades. In California, about three million children and adults who have ever been diagnosed with asthma also experienced asthma symptoms at least once in 2002. This policy brief provides data for California legislative districts to highlight the variation in asthma symptom prevalence for children and adults across the state. Asthma symptom prevalence rates at the district level are estimates created by a small-area methodology, based on rates from the 2001 California Health Interview Survey (CHIS 2001) that are applied to population data from the 2000 Census and 2002 California Department of Finance. This first-of-its-kind sub-county data are relevant for policy makers, advocates, and medical providers to illuminate the problem of asthma throughout California and within local communities.

Nearly 1.5 million California children ages 0-17 did not have health insurance coverage for all or part of the year in 2002. However, almost two-thirds of these uninsured children were eligible for one of the state's two public health insurance programs--Medi-Cal or Healthy Families. Uninsured children who were eligible but not enrolled in these programs were spread throughout the state, with wide variations between local areas. This policy brief presents data on children ages 0-17 in California who did not have health insurance coverage for some or all of the year and who were eligible for the Medi-Cal or Healthy Families programs. These data highlight the geographic variations in children's uninsured eligibility rates for state Assembly, Senate and Congressional districts, as well as for counties and the Los Angeles Service Planning Areas (SPAs). Uninsured-eligibility rates at local levels were estimated by applying a small-area methodology to multiple data sources, including the 2001 California Health Interview Survey (CHIS 2001), 2000-2002 Current Population Surveys, and the 2000 Census.