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Objectives. To examine whether local cannabis policies and retail availability are associated with cannabis use and problematic cannabis use (PCU) among adolescents in Northern California. Methods. The sample comprised adolescents aged 13 to 17 years screened for past-year cannabis use during well-child visits in 2021. Exposures included local bans on cannabis storefront retailers, policy protectiveness, and retail proximity and density. Outcomes included self-reported past-year cannabis use and PCU diagnoses. Modified Poisson regression models adjusted for sociodemographics. Results. The sample (n = 103 134) was 51.1% male with a median age of 15 years (interquartile range [IQR] = 14–16 years); 5.5% self-reported cannabis use, and 0.3% had diagnosed PCU. Adolescents had a lower prevalence of cannabis use in jurisdictions that banned storefront retailers (adjusted prevalence rate [APR] = 0.857; 95% confidence interval [CI] = 0.814, 0.903 vs allowed), banned delivery (APR = 0.751; 95% CI = 0.710, 0.795 vs allowed), or had more policy protections (APR range = 0.705–0.800). Lower PCU prevalence was also found among those in jurisdictions that banned (vs allowed) storefront retailers (APR = 0.786; 95% CI = 0.629, 0.983) or delivery (APR = 0.783; 95% CI = 0.616, 0.996). Longer drive time and lower density of storefront retailers were associated with a lower cannabis use prevalence. Conclusions. More protective cannabis policies and less retail availability were associated with a lower prevalence of adolescent cannabis use and PCU. (Am J Public Health. 2024;114(S8):S654–S663. https://doi.org/10.2105/AJPH.2024.307787) [ABSTRACT FROM AUTHOR]

In recent years legal rules to regulate causes of death have begun to appear. One example of this relates to the term "excited delirium" which has been subject to challenge by medical and legal professionals. Human rights activists have pushed against its usage by law enforcement and medical death investigators. The passing of the California Assembly Bill 360 restricting the use of the term is an example of this. Legislatively mandating, or banning causes of death poses an interesting challenge for death investigators. The lack of uniform guidance on how deaths should be classified across different jurisdictions and the variations in linguistic and causation-based language in cause of death statements may have influenced this development. Legislation that seeks to enforce ways of documenting the cause of a death, which is in effect an expert medical opinion, presents significant future challenges in expert testimony. [ABSTRACT FROM AUTHOR]

Prehospital initiation of buprenorphine treatment for Opioid Use Disorder (OUD) by paramedics is an emerging potential intervention to reach patients at greatest risk for opioid-related death. Emergency medical services (EMS) patients who are at high risk for overdose deaths may never engage in treatment as they frequently refuse transport to the hospital after naloxone reversal. The potentially important role of EMS as the initiator for medication for opioid use disorder (MOUD) in the most high-risk patients has not been well described. This project relies on four interventions: a public access naloxone distribution program, an electronic trigger and data sharing program, an "Overdose Receiving Center," and a paramedic-initiated buprenorphine treatment. For the final intervention, paramedics followed a protocol-based pilot that had an EMS physician consultation prior to administration. There were 36 patients enrolled in the trial study in the first year who received buprenorphine. Of those patients receiving buprenorphine, only one patient signed out against medical advice on scene. All other patients were transported to an emergency department and their clinical outcome and 7 and 30 day follow ups were determined by the substance use navigator (SUN). Thirty-six of 36 patients had follow up data obtained in the short term and none experienced any precipitated withdrawal or other adverse outcomes. Patients had a 50% (18/36) rate of treatment retention at 7 days and 36% (14/36) were in treatment at 30 days. In this small pilot project, paramedic-initiated buprenorphine in the setting of data sharing and linkage with treatment appears to be a safe intervention with a high rate of ongoing outpatient treatment for risk of fatal opioid overdoses. [ABSTRACT FROM AUTHOR]

The authors discuss two articles in the issue which showed how California's oil and gas development excessively exposes persistently marginalized populations to preventable health relevant hazards. Topics include evidence that African American communities are particularly affected, the health protection potential offered by California's regulatory measures compared to any other state, and examples of where a precautionary health-protective policy for oil and gas development was implemented.

The COVID-19 pandemic spurred some regulators in the USA to require occupational health and safety programs to prevent COVID-19 transmission in workplaces. The objective of this study was to describe such state and federal regulations enacted between January 2020 and January 2022. Regulations, including emergency temporary standards (ETS) and permanent standards, were identified through a search of Nexis Uni and Bloomberg Law and review of US OSHA websites and the Federal Register. Full texts were reviewed for regulatory scope, hazard and exposure definitions, determination of exposure or risk levels, and control strategies. Four state (California, Michigan, Virginia, and Oregon) and two federal regulations were identified. All regulations described respiratory aerosols as the primary source of SARS-CoV-2 and recognized person-to-person transmission by droplet, airborne, and contact routes. Only the US OSHA ETS for healthcare explicitly stated that inhalation of respiratory particles was the most likely method of COVID-19 transmission. The Virginia, Michigan, and Oregon regulations described different categories of risk defined by exposure frequency and duration or specific workplace activities. California described exposure as places and times when employees come into contact or congregate with other people. The US OSHA ETS for healthcare described exposure as involving close contact with suspected or confirmed COVID-19 patients. While all of the state regulations required strategies from across the hierarchy, only the Virginia regulations specifically incorporated the hierarchy of controls. Only the California and Virginia regulations explicitly linked control strategies to the transmission route, while Virginia demarcated control strategies by risk level. Oregon linked risk level to occupancy levels and physical distancing requirements and referred to the use of a layered approach for transmission control. The US OSHA ETS for healthcare defined droplet and airborne precautions but made no mention of the hierarchy of controls or risk levels. Respirators were discussed in most of the regulations. The first Michigan regulation explicitly required respirators appropriate to exposure risk. The California regulations noted that respirators protect the wearer while face coverings protect people around the wearer. These regulations offer insights for a permanent US OSHA infectious disease regulation, such as the need to consider a range of transmission modes including near- and far-range aerosol inhalation, endemic and novel pathogens, workplaces beyond healthcare settings, factors that contribute to exposure and risk, the hierarchy of controls, the role of vaccination, and the importance of written exposure assessment and infection prevention plans. [ABSTRACT FROM AUTHOR]

BACKGROUND: The presence of contaminants in cannabis presents a potential health hazard to recreational users and susceptible patients with medical conditions. Because of the federally illegal status of cannabis, there are no unified regulatory guidelines mitigating the public health risk of cannabis contaminants. OBJECTIVE: To inform further research and provide solutions to the public health risk of cannabis contaminants at a national level, we examined the current landscape of state-level contaminant regulations, and cannabis contaminants of concern, as well as patient populations susceptible to contaminants. METHODS: We examined the regulatory documents for medical and recreational cannabis in all legalized U.S. jurisdictions and compiled a complete list of regulated contaminants, namely, pesticides, inorganics, solvents, microbes, and mycotoxins. We data mined the compliance testing records of 5,654 cured flower and 3,760 extract samples that accounted for ~6% of California's legal cannabis production in 2020-2021. We also reviewed the publicly available medical cannabis use reports to tabulate the susceptible patient populations. RESULTS: As of 18 May 2022, 36 states and the District of Columbia listed a total of 679 cannabis contaminants as regulated in medical or recreational cannabis, including 551 pesticides, 74 solvents, 12 inorganics, 21 microbes, 5 mycotoxins, and 16 other contaminants. Different jurisdictions showed significant variations in regulated contaminants and action levels ranging up to four orders of magnitude. A failure rate of 2.3% was identified for flowers and 9.2% for extracts in the California samples. Insecticides and fungicides were the most prevalent categories of detected contaminants, with boscalid and chlorpyrifos being the most common. The contaminant concentrations fell below the regulatory action levels in many legalized jurisdictions, indicating a higher risk of contaminant exposure. Cannabis use reports indicated usage in several patient populations susceptible to contamination toxicity, including cancer (44,318) and seizure (21,195) patients. DISCUSSION: Although individual jurisdictions can implement their policies and regulations for legalized cannabis, this study demonstrates the urgent need to mitigate the public health risk of cannabis contamination by introducing national-level guidelines based on conventional risk assessment methodologies and knowledge of patients' susceptibility in medical use. [ABSTRACT FROM AUTHOR]

In recent decades, wildfires have destroyed growing numbers of homes in the United States. Wildfire recovery has emerged as a critical time to reduce future vulnerability, yet we lack knowledge of how rebuilding efforts unfold over time, and are shaped by resident and housing characteristics, land use planning, and government regulations. We used a case study approach to document housing recovery a decade post-event for the Highway 31 fire in suburban South Carolina, and the Station fire in exurban California (both in 2009). We found divergent rebuilding and mitigation outcomes; rebuilding was rapid after the Highway 31 fire (all but one house rebuilt) but minimal (11.7% houses rebuilt) after the Station fire where a complex setting and regulation regime effected an 'unmanaged retreat.' We discuss implications for post-fire recovery programming and the need for longitudinal research as the world faces increasing wildfire losses. [ABSTRACT FROM AUTHOR]

Amid unprecedented political polarization, the United States continues to grapple with the simultaneous crises of COVID‐19 and systemic racism. We examine potential predictors of COVID‐19 mask wearing at the intersection of these crises, with particular attention to the behavior of conservatives and young people, who have resisted compliance with efforts to contain the spread of COVID‐19. Specifically, we investigate perceptions of racial/ethnic inequities in the healthcare system and civic values as predictors of COVID‐19 mask‐wearing frequency and potential moderators of the relationship between political orientation and COVID‐19 mask‐wearing frequency. Diverse college students at a university in southern California participated in our longitudinal survey, which was initiated prior to the COVID‐19 pandemic (N = 431). We found that perceptions of inequities and civic values predicted mask wearing, whereas political conservatism was negatively related to mask wearing. Further, conservative participants were more likely to wear masks if they reported greater perceptions of inequities. Our results provide a foundation for future research that may inform targeted public health interventions aimed at encouraging responsible COVID‐19 behavior and fostering dialogue on systemic equities in a contentious political environment. [ABSTRACT FROM AUTHOR]

Objective: We quantified the association between public compliance with social distancing measures and the spread of SARS-CoV-2 during the first wave of the epidemic (March–May 2020) in 5 states that accounted for half of the total number of COVID-19 cases in the United States. Methods: We used data on mobility and number of COVID-19 cases to longitudinally estimate associations between public compliance, as measured by human mobility, and the daily reproduction number and daily growth rate during the first wave of the COVID-19 epidemic in California, Illinois, Massachusetts, New Jersey, and New York. Results: The 5 states mandated social distancing directives during March 19-24, 2020, and public compliance with mandates started to decrease in mid-April 2020. As of May 31, 2020, the daily reproduction number decreased from 2.41-5.21 to 0.72-1.19, and the daily growth rate decreased from 0.22-0.77 to –0.04 to 0.05 in the 5 states. The level of public compliance, as measured by the social distancing index (SDI) and daily encounter-density change, was high at the early stage of implementation but decreased in the 5 states. The SDI was negatively associated with the daily reproduction number (regression coefficients range, –0.04 to –0.01) and the daily growth rate (from –0.009 to –0.01). The daily encounter-density change was positively associated with the daily reproduction number (regression coefficients range, 0.24 to 1.02) and the daily growth rate (from 0.05 to 0.26). Conclusions: Social distancing is an effective strategy to reduce the incidence of COVID-19 and illustrates the role of public compliance with social distancing measures to achieve public health benefits. [ABSTRACT FROM AUTHOR]

Objective: Determine compliance with and effectiveness of California regulations in reducing farmworkers' heat-related illness (HRI) risk and identify main factors contributing to HRI. Methods: In a cross-sectional study of Latino farmworkers, core body temperature (CBT), work rate, and environmental temperature (WBGT) were monitored over a work shift by individual ingestible thermistors, accelerometers, and weather stations, respectively. Multiple logistic modeling was used to identify risk factors for elevated CBT. Results: Although farms complied with Cal/OSHA regulations, worker training of HRI prevention and hydration replacement rates were insufficient. In modeling (AOR [95% CI]) male sex (3.74 [1.22 - 11.54]), WBGT (1.22 [1.08 - 1.38]), work rate (1.004 [1.002 - 1.006]), and increased BMI (1.11 [1.10 - 1.29]) were all independently associated with elevated CBT. Conclusion: Risk of HRI was exacerbated by work rate and environmental temperature despite farms following Cal/OSHA regulations. [ABSTRACT FROM AUTHOR]

Objective: California's Senate Bill 277 (SB277) was mandated to reduce the prevalence of measles by eliminating personal belief exemptions. This study evaluated seven county‐level records to determine the impact of SB277 on immunizations among kindergarteners in Northern California. Design: This study used a quantitative postintervention secondary data analysis. Sample: This study included three kindergarten schools in seven Northern California counties during three academic years from 2015 to 2019. Measurements: Sixty‐three previously collected school measurements involving 4,626 students were included in a secondary analysis. The study used grouped logistic regression to evaluate the variations in immunization compliance records (2015–16 vs. 2017–18 and 2018–19) among kindergartners in seven counties. Results: This study found no significant differences in (1) overall county‐level measures and (2) the likelihood that kindergartners would be current with measles–mumps–rubella (MMR; OR = 1.12, CI = 0.79–1.62) or be up‐to‐date with five immunizations (OR = 1.08, CI = 0.77–1.52) post‐SB277 versus pre‐SB277. Conclusion: This study showed that SB277 had a small clinical but nonstatistically significant impact on kindergartners' up‐to‐date with up‐to‐date rates of compliance with five immunizations and those current with two doses of MMR in seven Northern California counties. Despite the passing of SB277, vaccine‐hesitant parents have continued to seek alternatives to immunizations. [ABSTRACT FROM AUTHOR]

In 2019, San Francisco, California, prohibited the sale of electronic cigarettes lacking US Food and Drug Administration authorization. JUUL then promoted a ballot initiative (Proposition C) to replace San Francisco's e-cigarette legislation with legislation JUUL wrote that required future legislation to be approved by the voters. JUUL promoted Proposition C as a way to reduce youth e-cigarette use while allowing adult choice. Health groups argued that JUUL's measure could nullify San Francisco's prohibition on selling flavored tobacco products. Health groups benefitted from having an established campaign network that recently defended the flavor ban. They successfully framed Proposition C as a tobacco industry ploy to undo San Francisco's e-cigarette regulations, particularly the prohibition on selling flavored tobacco products. JUUL ended its campaign on September 30, 2019, and the measure failed on election day, with 82% voting against it. Lessons learned from the campaign include the importance of framing an industry initiative as a threat to local public health lawmaking and the potential for the e-cigarette issue to attract parents as new leaders and engage a powerful constituency to support tobacco control measures. [ABSTRACT FROM AUTHOR]

How should legislators write a law regulating a brand-new technology that they may not yet fully understand? With the advent of blockchain and other advanced computational technologies, this generation of legislators faces more complex questions than their predecessors. Drawing on the author's experience as a member of California's Blockchain Working Group, this Article offers guidance to lawmakers, lawyers, and industry leaders seeking to draft effective laws regulating real-life applications of blockchain technology. This cutting-edge Article will do two things for its readers: (1) encourage them to be informed participants in conversations relating to federal and state blockchain regulation, and (2) offer a snapshot of these regulatory processes early in the development of blockchain technology, which will prove to be useful in coming years. Blockchain technology and its applications will continue developing quickly, regardless of how governments frame regulation. Everyone--including industry players, members of the public, and governments themselves--will benefit if lawmakers can strike the right balance between innovation and public protection. [ABSTRACT FROM AUTHOR]

The article examines trends and patterns in the implementation of cessation programs and health insurance surcharges for tobacco use in the small-business sector, under the Affordable Care Act (ACA), in the U.S. from 2016-2018. Topics discussed include decline in the use of increased premiums for tobacco users among small-business employers, incidence of noncompliance with the ACA, and changes in the prevalence of tobacco cessation programs.

This article assesses the protections provided by state research laws for participants in mobile application (mobile app) mediated health research conducted by independent scientists, citizen scientists, and patient researchers. Prior scholarship in this area focuses on the lack of application of: (1) federal regulations governing research conducted or funded by one of sixteen signatory federal departments and agencies (the Common Rule); and (2) separate federal regulations promulgated by the Food and Drug Administration applicable to research conducted in anticipation of a submission to the FDA for approval of a drug or medical device. This article builds on this prior scholarship by carefully examining state research laws and suggesting ways in which these laws could be improved to better protect participants of mobile appmediated research conducted by independent scientists, citizen scientists, and patient researchers. [ABSTRACT FROM AUTHOR]

This article describes and explains why the state of California has long played a leadership role in adopting innovative and stringent environmental standards. It argues that critical roles have been played by the state's attractive natural environment, the extent of threats to its environmental quality, the material interest of citizens in protecting the natural environmental around where they lived, and the support of business interests who stood to benefit from protecting the state's many environmental amenities. These dynamics are illustrated by several historical examples, which have laid the basis for the state's current environmental policy initiatives. It concludes by generalizing from the experiences of California in order to explore the role of politics and public policies in promoting more sustainable business practices. [ABSTRACT FROM AUTHOR]

Objectives: Research is limited on tobacco retailers' perceptions of the Food and Drug Administration's (FDA) tobacco regulatory authority overall, and less exists related to retailers in predominantly African-American or other racial/ethnic neighborhoods. We assessed differences in perceptions of the FDA's tobacco regulatory authority and barriers to compliance among retailers in African-American and non-African-American neighborhoods in Los Angeles, California. Methods: Overall, 700 tobacco retailer interviews assessed demographic characteristics and perceptions of the FDA. Results: Retailers in African-American neighborhoods self-identified as Hispanic/Latino (43.9% vs 39.6% non-African-American), African-American (21.2% vs 2.6% non- African-American) or Asian (19.7% vs 19.5% non-African-American). Retailers in African-American neighborhoods were significantly less likely to perceive the FDA as a trustworthy source (p = .03; vs non-African-American), but more likely to report that they do not know the federal rules (p = .002), do not understand the federal rules (p = .004), and that tobacco companies encourage them not to follow the federal rules (p = .04). Conclusions: Tobacco control agencies can use this information about retailer perceptions to design education/training materials in order to increase trust, mitigate barriers, and enhance compliance. [ABSTRACT FROM AUTHOR]

This article analyzes the early years of 20th-century air pollution control in Los Angeles. In both scholarship and public memory, mid-century efforts at the regional level were overshadowed by major federal developments, namely the Clean Air Act and creation of the US Environmental Protection Agency in 1970. Yet the mid-century local experience was highly consequential and presaged many subsequent challenges that persist today. The article begins with an exploration of the existential, on-the-ground misery of smog in Los Angeles during the 1940s and 1950s. The article examines the role that scientific evidence on smog did and did not play in regulation, the reasons smog control galvanized support across various constituencies in the region, and, finally, some of mid-century air pollution's limits. [ABSTRACT FROM AUTHOR]

Objective: Ambulance patient offload time (APOT) also known colloquially as "Wall time" has been described in various jurisdictions but seems to be highly variable. Any attempt to improve APOT requires the use of common definitions and standard methodology to measure the extent of the problem. Methods: An Ambulance Offload Delay Task Force in California developed a set of standard definitions and methodology to measure APOT for transported 9-1-1 patients. It is defined as the time "interval between the arrival of an ambulance at an emergency department and the time that the patient is transferred to an ED gurney, bed, chair or other acceptable location and the ED assumes responsibility for care of the patient." Local EMS agencies voluntarily reported data according to the standard methodology to the California EMS Authority (State agency). Results: Data were reported for 9-1-1 transports during 2017 from 9 of 33 local EMS Agencies in California that comprise 37 percent of the state population. These represent 830,637 ambulance transports to 126 hospitals. APOT shows significant variation by EMS agency with half of the agencies demonstrating significant delays. Offload times vary markedly by hospital as well as by region. Three-fourths of hospitals detained EMS crews more than one hour, 40% more than two hours, and one-third delayed EMS return to service by more than three hours. Conclusion: This first step to address offload delays in California consists of standardized definitions for data collection to address the significant variability inherent in obtaining data from 33 local agencies, hundreds of EMS provider agencies, and 320 acute care hospital Emergency Departments that receive 9-1-1 ambulance transports. The first year of standardized data collection of ambulance patient offload times revealed significant ambulance patient offload time delays that are not distributed uniformly, resulting in a substantial financial burden for some EMS providers in California. [ABSTRACT FROM AUTHOR]

The article discusses updates about the regulation of pesticides in cannabis in California as of April 2019. Topics mentioned include the goal of California's Bureau of Cannabis Control to protect consumers in the state's market, the scope of California's impact on cannabis policy, safety, and consumption in the U.S., and the decision of the U.S. Environmental Protection Agency not to approve any pesticides for use on cannabis.

• Health experts have urged governments to regulate legal cannabis like alcohol. • Research empirically evaluating alcohol-cannabis policy alignment is sparse. • Across California, local governments were not regulating cannabis like alcohol. • Lessons learned from regulating alcohol are not always applied to cannabis. • Political processes that compromise public health must be investigated. Public health experts have urged governments around the world to regulate newly legalized cannabis as they do alcohol to effectively and efficiently protect health. However, research evaluating the alignment of alcohol and cannabis policies is sparse. We assessed similarities and differences in local alcohol and cannabis control policies across California, and characterized localities adopting distinct policy approaches. Using standard legal epidemiologic techniques, we collected and coded local alcohol and cannabis control policies relevant to public health for 12 California counties and all incorporated cities within them (N=241). We assessed whether localities were equally stringent on alcohol and cannabis policies by comparing overall restrictiveness (summed policy scores) and 9 specific provisions that applied to both substances. We captured distinct local alcohol-cannabis policy approaches using latent class analysis, and examined this classification in relation to local demographic, socioeconomic, political, and retail market characteristics. All 241 localities permitted alcohol sales, while 71% banned cannabis sales. Among those that did not ban cannabis sales, more stringent alcohol policy scores were associated with more stringent cannabis policy scores (linear regression coefficient: 0.16 [95% CI: 0.07, 0.25]). Local governments rarely adopted the same provisions for alcohol and cannabis (e.g., limits on hours of sale, advertising restrictions), and only two regulated the co-location of cannabis and alcohol outlets. Localities that were restrictive on alcohol yet permissive on cannabis (12%) were more urban, politically progressive, and had more low-income and racial/ethnic minority residents. Localities that were more permissive on alcohol and restrictive on cannabis (51%) were more socioeconomically advantaged. We found few similarities between local alcohol and cannabis control policies. California's experience suggests that, as governments around the world legalize cannabis, lessons learned from regulating alcohol are not routinely applied to cannabis, particularly in communities distinguished by high social and economic advantages. [ABSTRACT FROM AUTHOR]

The California drug transparency bill (SB-17), signed into law in October 2017, seeks to promote transparency in pharmaceutical pricing, enhance understanding about pharmaceutical pricing trends, and assist in managing pharmaceutical costs. This article examines the legal and regulatory aspects of SB-17, explores legal challenges to the law, compares it to other state efforts to address rising drug prices, and discusses how California can maximize the impact of SB-17 by coupling the law with other incentives. While SB-17 might not significantly reduce drug prices, the new law represents a meaningful step for one state seeking to negotiate the political and legal boundaries of state action to rein in drug prices. [ABSTRACT FROM AUTHOR]

California became very successful in controlling rising health care costs by promoting price competition through market-based, managed care policies. However, recent data reveal that the state has not been able sustain its initial success in controlling growth in hospital prices. Two powerful trends emerged in California that eroded the conditions needed to sustain price competition. To ensure timely access to emergency hospital services, government regulators enacted regulations that had the unintended effect of giving hospitals tremendous leverage when contracting with health plans. Also, antitrust authorities allowed hospitals to consolidate into multihospital systems by adding members that were not direct competitors in local markets. The combined effect of these policies and consolidation trends was a substantial reduction in the competitiveness of provider markets in California, which reduced health plans' ability to leverage competitive provider markets and negotiate lower prices and other benefits for their members. Policy makers can and should act to restore competitive conditions. [ABSTRACT FROM AUTHOR]

Background: Policies to mitigate climate change by reducing greenhouse gas (GHG) emissions can yield public health benefits by also reducing emissions of hazardous co-pollutants, such as air toxics and particulate matter. Socioeconomically disadvantaged communities are typically disproportionately exposed to air pollutants, and therefore climate policy could also potentially reduce these environmental inequities. We sought to explore potential social disparities in GHG and co-pollutant emissions under an existing carbon trading program-the dominant approach to GHG regulation in the US and globally.Methods and Findings: We examined the relationship between multiple measures of neighborhood disadvantage and the location of GHG and co-pollutant emissions from facilities regulated under California's cap-and-trade program-the world's fourth largest operational carbon trading program. We examined temporal patterns in annual average emissions of GHGs, particulate matter (PM2.5), nitrogen oxides, sulfur oxides, volatile organic compounds, and air toxics before (January 1, 2011-December 31, 2012) and after (January 1, 2013-December 31, 2015) the initiation of carbon trading. We found that facilities regulated under California's cap-and-trade program are disproportionately located in economically disadvantaged neighborhoods with higher proportions of residents of color, and that the quantities of co-pollutant emissions from these facilities were correlated with GHG emissions through time. Moreover, the majority (52%) of regulated facilities reported higher annual average local (in-state) GHG emissions since the initiation of trading. Neighborhoods that experienced increases in annual average GHG and co-pollutant emissions from regulated facilities nearby after trading began had higher proportions of people of color and poor, less educated, and linguistically isolated residents, compared to neighborhoods that experienced decreases in GHGs. These study results reflect preliminary emissions and social equity patterns of the first 3 years of California's cap-and-trade program for which data are available. Due to data limitations, this analysis did not assess the emissions and equity implications of GHG reductions from transportation-related emission sources. Future emission patterns may shift, due to changes in industrial production decisions and policy initiatives that further incentivize local GHG and co-pollutant reductions in disadvantaged communities.Conclusions: To our knowledge, this is the first study to examine social disparities in GHG and co-pollutant emissions under an existing carbon trading program. Our results indicate that, thus far, California's cap-and-trade program has not yielded improvements in environmental equity with respect to health-damaging co-pollutant emissions. This could change, however, as the cap on GHG emissions is gradually lowered in the future. The incorporation of additional policy and regulatory elements that incentivize more local emission reductions in disadvantaged communities could enhance the local air quality and environmental equity benefits of California's climate change mitigation efforts. [ABSTRACT FROM AUTHOR]

The article reports on the U.S. states that tend to defy the policies and regulations of U.S. President Donald Trump in 2017 and 2018. It mentions the move of the Californian government to protect its peoplr from environmental pollution through the use of civil courts. It cites the case People of the State of California v Atlantic Richfield Company et al, as a case that deals on the environmental condition of the state.

In response to startling statistics in the increasing number of workplace violence (WPV) incidents against health care workers, California employers across the continuum of care are preparing their organizations to comply with California Occupational Safety and Health Administration (CAL/OSHA) regulation SB 1299. This groundbreaking legislation requires hospitals and other health care settings to implement written strategic prevention plans and broaden the identification and reporting of incidents related to WPV. Also included in the law is a minimum staff education requirement and formal risk identification and mitigation plans. The occupational health nurse will play a critical role in preparing health care organizations and staff in this endeavor. [ABSTRACT FROM AUTHOR]

The article discusses what the authors refer to as the benefits associated with making climate change the focus of U.S. public health policy as of 2017, and it mentions the Intergovernmental Panel on Climate Change (IPCC) and the impact of climate change on human health. Disaster preparedness and clean fuel technologies are examined, along with executive orders, greenhouse gas mitigation policies, and affordable housing in places such as California.

Mitigating the spread of COVID-19 requires that people understand the need for and engage in protective behaviors. Given the complexity and rapid progression of media information about the pandemic, health literacy could be essential to acquiring the accurate beliefs, concern for societal risks, and appreciation of restrictive policies needed to motivate these behaviors. Yet with the increasingly politicized nature of COVID-related issues in the United States, health literacy could be an asset for those with more liberal views but less so for those with more conservative views. This study tested a hypothesized model proposing that political views moderate the associations of health literacy with COVID-19 protective behaviors as well as the mediational roles of accurate and inaccurate COVID-19 beliefs, concern for society, and governmental control attitudes. We surveyed residents in three diverse regions of California in June 2020 (N = 669) and February 2021 (N = 611). Participants completed measures of health literacy, political views, and COVID-19 beliefs and behaviors. Moderated mediational analyses largely supported the proposed model with both samples. Health literacy was associated with more accurate COVID-19 beliefs, less inaccurate COVID-19 beliefs, greater concern for societal risks, more positive attitudes regarding restrictive government control, more protective behavior, less risky behavior, and stronger vaccine intentions; beliefs, concern for society, and governmental control attitudes mediated the health literacy-behavior relationships. As predicted, however, these associations of health literacy with adaptive beliefs, attitudes, and behaviors varied according to political views. The direct and mediated relationships were held for participants with more liberal views and, to a lesser extent, for those with moderate views, but they were weaker or absent for participants with more conservative views. These findings contribute new evidence of processes linking health literacy with adaptive beliefs, attitudes, and behaviors and how social and political contexts can shape those processes. • Health literacy was linked with more favorable COVID-related beliefs and behaviors. • Relationships of health literacy with these outcomes varied by political views. • Health literacy predicted outcomes primarily for those with more liberal views. [ABSTRACT FROM AUTHOR]

Objectives: To systematically assess barriers delaying home respiratory equipment requisition and to evaluate for temporal correlation between delays and emergency room or hospitalization episodes. Background: Initiation of home respiratory treatments is delayed because of delays in delivery of durable medical equipment (DME). This study assesses root causes of such delays from a system perspective. We also describe clinical consequences by measuring emergency room visits and hospitalization days for temporal correlations. Methods: We conducted a retrospective review of DME ordering records from April 2011 to March of 2012. Settings: Outpatient DME records in Pediatric Pulmonary Division. Results: Of 164 available orders studied, deliveries were made as followed: 31 (19%) within 24 hr: IB (59%) oxygen orders and 10 (32%) nebulizer orders 50 (30%) within 1 week: 25 (50%) nebulizer orders and 10 (20%) oxygen orders Delays: 45 (27%) delivered > 1 month: Bilevel positive airway pressure (BPAP) = 16 (36%) Oxygen = 12 (26%) Cough assist device = 7 (16%) Nebulizer = 5 (11%) Miscellaneous devices = 5 (11%) Analysis of barriers includes (a) type of insurance, (b) human error, (c) communication barrier, (d) deficit in training or knowledge, (e) no clear policy, (f) differences in clinical policy/standard, (g) no DME benefit, (h) no clinical justification, and (i) error in communication/record keeping. Six patients with 7 emergency department (ED) visits and 4 inpatient admissions, totaling 24 hospital days, were temporally associated with delays in delivery of equipment over 30 days. Conclusion: One half of commonly used DMEs were delivered within the first week. One quarter of more expensive required more steps for approval. Twenty-nine ED/hospital days with respiratory morbidities were temporally associated with delays. [ABSTRACT FROM AUTHOR]

Aims To determine whether the density of marijuana dispensaries in California, USA, in 2012-13 was related to violent and property crimes, both locally and in adjacent areas, during a time in which local law enforcement conducted operations to reduce the number of storefront medical marijuana dispensaries. Design Data on locations of crimes and medical marijuana dispensaries as well as other covariates were collected for a sample of 333 Census block groups. Setting Long Beach, California, USA from January 2012 to December 2013. Observations A total of 7992 space-time observations (from 333 Census block groups over 24 time-points). Measurements Outcome measures focused on block-group counts of violent and property crimes. Predictors were numbers of local and adjacent-area medical marijuana dispensaries. Covariates included markers of alcohol availability as well as area demographic and economic characteristics. Findings After adjustment for covariates, density of medical marijuana dispensaries was unrelated to property and violent crimes in local areas but related positively to crime in spatially adjacent areas [incident rate ratio (IRR) = 1.0248, CI (1.0097, 1.0402) for violent crime, IRR = 1.0169, CI (1.0071, 1.0268) for property crime]. Conclusions Using law enforcement to reduce medical marijuana dispensaries in California appears to have reduced crime in residential areas near to, but not in, these locations. [ABSTRACT FROM AUTHOR]

Needle exchange is one of the most effective public health interventions to prevent the transmission of infectious disease by injecting drug users. Despite the preponderance of scientific evidence, US federal funding for needle exchange programmes has been banned since 1988. This prohibition has resulted in the lack of a centralised policy on needle exchange and has given birth to a patchwork of diverse practices and regulations throughout the nation. This article focuses on how various local players interpreted the meaning of needle exchange through the debate on an unauthorised site in Fresno, California. In exploring a specific context, this study delineates the narratives used to outline competing views about needle exchange and to offer a snapshot of how the issue of widespread injecting drug use was handled in an impoverished and socially conservative region of the United States. [ABSTRACT FROM AUTHOR]