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Open Access Publications from the University of California

Scholarly Works (18 results)

  • Article
  • Peer Reviewed
California Agriculture, Volume 69, Issue 3 (2015)

High up-front costs and uncertain return on investment make it difficult for land managers to economically justify large-scale fuel treatments, which remove trees and other vegetation to improve conditions for fire control, reduce the likelihood of ignition, or reduce potential damage from wildland fire if it occurs. In the short-term, revenue from harvested forest products can offset treatment costs and broaden opportunities for treatment implementation. Increasingly, financial analysis of fuel treatments is also incorporating long-term savings through reduced fire suppression costs, which can be difficult to quantify. This paper reviews the findings and lessons from recent modeling work evaluating the potential relationship between fuel treatments and avoided fire suppression costs. Across studies, treatments are generally predicted to reduce future fire suppression costs, although the magnitude of savings is unlikely to fully offset fuel treatment costs. This funding gap highlights the importance of forest product revenues in facilitating landscape-scale treatment. Factors influencing the effects of fuel treatment investments on fire suppression costs include the causal pathway linking treatment inputs to suppression cost outcomes; the spatiotemporal uncertainty of wildfire-treatment interactions; and the scale of fuel treatment programs.

    Cover page: Modeling fuel treatment impacts on fire suppression cost savings: A review
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2021)

    Objectives

    Health equity is crucial to population health. To achieve this aim, extensive monitoring efforts beyond traditional disparities research are required. This analysis assesses trends in health equity for children from 1997 to 2018.

    Methods

    Health equity in a given year is calculated using a previously developed measure as the mean weighted departure of individual health from the best achievable level of health. This criterion is defined as the median health of the most socially privileged identifiable group: white, non-Latinx boys in upper-income households. Using more than 20 years of data from the National Health Interview Survey, we apply this methodology to six measures of child health: parent-reported health status, school days missed due to illness or injury in the past year, a strength and difficulties questionnaire score, emotional difficulties, a toddler mental health indicator score, and toddler depression. We separately calculate racial/ethnic and income disparities. Monte Carlo simulation is used to assess whether trends are statistically significant.

    Results

    Health equity among children increased gradually over the past 2 decades, with five of the six measures demonstrating upward trends. Improvements in health equity are stronger among younger children (age 0-3 and 4-7). Unlike previous work examining adults, both types of disparities narrowed over the study period.

    Conclusions for practice

    Progress on health equity requires accountability to an objective metric. This analysis suggests some improvement over the past two decades, although these gains are under threat from potential decreases in government spending on programs affecting children and the COVID-19 pandemic.
      Creative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2024)
      Health equity is fundamental to improving the health of populations, but in recent decades progress towards this goal has been mixed. To better support this mission, a deeper understanding of the local heterogeneity within population-level health equity is vital. This analysis presents trends in average health and health equity in the United States at the local level from 1990 to 2019 using three different health outcomes: mortality, self-reported health status, and healthy days. Furthermore, it examines the association between these measures of average health and health equity with several structural factors. Results indicate growing levels of geographic inequality disproportionately impacting less urbanized parts of the country, with rural counties experiencing the largest declines in health equity, followed by Medium and Small Metropolitan counties. Additionally, lower levels of health equity are associated with poorer local socioeconomic context, including several measures that are proxies for structural racism. Altogether, these findings strongly suggest social and economic factors play a pivotal role in explaining growing levels of geographic health inequality in the United States. Policymakers invested in improving health equity must adopt holistic and upstream approaches to improve and equalize economic opportunity as a means of fostering health equity.
        Cover page: Trends and structural factors affecting health equity in the United States at the local level, 1990–2019
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2016)
        There is growing evidence that millions of adults have gained insurance coverage under the Affordable Care Act, but less is known about how access to and affordability of care may be changing. This study used data from the Health Reform Monitoring Survey to describe changes in access and affordability for nonelderly adults from September 2013, just prior to the first open enrollment period in the Marketplace, to March 2015, after the end of the second open enrollment period. Overall, we found strong improvements in access to care for all nonelderly adults and across income and state Medicaid expansion groups. We also found improvements in the affordability of care for all adults and for low- and moderate-income adults. Despite this progress, there were still large gaps in access and affordability in March 2015, particularly for low-income adults.
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2019)

          Importance

          Health equity is an often-cited goal of public health, included among the 4 overarching goals of the Department of Health and Human Services' Healthy People 2020. Yet it is difficult to find summary assessments of national progress toward this goal.

          Objectives

          To identify variation in several measures of health equity from 1993 to 2017 in the United States and to test whether there are significant time trends.

          Design, setting, and participants

          Survey study using 25 years of data, from January 1, 1993, to December 31, 2017, from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System to assess trends in health equity and health justice by race/ethnicity, sex, and income in 3 categories by year.

          Main outcomes and measures

          Health equity was assessed separately for each of 2 health constructs: healthy days-the average of physical and mental healthy days over the previous 30 days-and general health in 5 categories, rescaled to approximate a continuous variable. For each health construct, average health was calculated along with 4 measures of health equity: disparities across 3 income groups; black-white disparities; health justice-a measure of the correlation of health outcomes with income, race/ethnicity and sex; and a summary health equity metric.

          Results

          Among the 5 456 006 respondents, the mean (SD) age was 44.5 (12.7) years; 3 178 688 (58.3%) were female; 4 163 945 (76.3%) were non-Latinx white; 474 855 (8.7%) were non-Latinx black; 419 542 (7.7%) were Latinx; and 397 664 (7.3%) were of other race/ethnicity. The final sample included 5 456 006 respondents for self-reported health and 5 349 527 respondents for healthy days. During the 25-year period, the black-white gap showed significant improvement (year coefficient: healthy days, 0.021; 97.5% CI, 0.012 to 0.029; P < .001; self-reported health, 0.030; 97.5% CI, 0.025 to 0.035; P < .001). The health equity metric for self-reported health showed no significant trend. For healthy days, the Health Equity Metric declined over time (year coefficient: healthy days, -0.025; 97.5% CI, -0.033 to -0.017; P < .001). Health justice declined over time (year coefficient: healthy days, -0.045; 97.5% CI, -0.053 to -0.038; P < .001; self-reported health, -0.035; 97.5% CI, -0.046 to-0.023; P < .001), and income disparities worsened (year coefficient: healthy days, -0.060; 97.5% CI, -0.076 to -0.044; P < .001; self-reported health, -0.029; 97.5% CI, -0.046 to -0.012; P < .001).

          Conclusions and relevance

          Results of this analysis suggest that there has been a clear lack of progress on health equity during the past 25 years in the United States. Achieving widely shared goals of improving health equity will require greater effort from public health policy makers, along with their partners in medicine and the sectors that contribute to the social determinants of health.
            Creative Commons 'BY' version 4.0 license
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2021)

            Importance

            The consequences of school closures for children's health are profound, but existing evidence on their effectiveness in limiting severe acute respiratory syndrome coronavirus 2 transmission is unsettled.

            Objective

            To determine the independent associations of voluntary behavioral change, school closures, and bans on large gatherings with the incidence and mortality due to coronavirus disease 2019 (COVID-19).

            Design, setting, and participants

            This population-based, interrupted-time-series analysis of lagged independent variables used publicly available observational data from US states during a 60-day period from March 8 to May 18, 2020. The behavioral measures were collected from anonymized cell phone or internet data for individuals in the US and compared with a baseline of January 3 to February 6, 2020. Estimates were also controlled for several state-level characteristics.

            Exposures

            Days since school closure, days since a ban on gatherings of 10 or more people, and days since residents voluntarily conducted a 15% or more decline in time spent at work via Google Mobility data.

            Main outcomes and measures

            The natural log of 7-day mean COVID-19 incidence and mortality.

            Results

            During the study period, the rate of restaurant dining declined from 1 year earlier by a mean (SD) of 98.3% (5.2%) during the study period. Time at work declined by a mean (SD) of 40.0% (7.9%); time at home increased by a mean (SD) of 15.4% (3.7%). In fully adjusted models, an advance of 1 day in implementing mandatory school closures was associated with a 3.5% reduction (incidence rate ratio [IRR], 0.965; 95% CI, 0.946-0.984) in incidence, whereas each day earlier that behavioral change occurred was associated with a 9.3% reduction (IRR, 0.907; 95% CI, 0.890-0.925) in incidence. For mortality, each day earlier that school closures occurred was associated with a subsequent 3.8% reduction (IRR, 0.962; 95% CI, 0.926-0.998), and each day of advance in behavioral change was associated with a 9.8% reduction (IRR, 0.902; 95% CI, 0.869-0.936). Simulations suggest that a 2-week delay in school closures alone would have been associated with an additional 23 000 (95% CI, 2000-62 000) deaths, whereas a 2-week delay in voluntary behavioral change with school closures remaining the same would have been associated with an additional 140 000 (95% CI, 65 000-294 000) deaths.

            Conclusions and relevance

            In light of the harm to children of closing schools, these findings suggest that policy makers should consider better leveraging the public's willingness to protect itself through voluntary behavioral change.
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2021)

              Rationale

              Health equity is a significant concern of public health, yet a comprehensive assessment of health equity in the United States over time is lacking. While one might presume that overall health will improve with rising living standards, no such presumption is warranted for health equity, which may decline even as average health improves.

              Objectives

              To assess trends in national and state-level health equity in mortality for people up to age 25, ages 25-64 and aged 65 and older.

              Methods

              A health equity metric was calculated as the weighted mean life expectancy relative to a benchmark level, defined as the life expectancy of the most socially-privileged subpopulation (white, non-Latinx males with a college education or higher).We analyzed 114,558,346 death records from the National Center for Health Statistics, from January 1, 1969 to December 31, 2019 to estimate health equity annually at the national and state-level. Using ICD-9/ICD-10 classification codes, inequities in health were decomposed by major causes of death.

              Results

              From 1969 to 2019, health equity in the United States improved (+0.36 points annually [95% CI 0.31-0.41]), albeit at a slower rate over the last two decades (+0.08 points annually [95% CI 0.03-0.14] from 2000 to 2019, compared to +0.57 points annually from 1969 to 2000 [95% CI 0.50-0.65]). Health equity among those under 25 improved substantially (+0.82 points annually [95% CI 0.75-0.89]) but remained flat for adults 25-64 (-0.01 points annually [95% CI -0.03-0.003]) For those over 65, health equity displayed a downward trend (-0.08 points annually [95% CI -0.09 to -0.07]). Gains in equity from reduced unintentional injuries and homicides have been largely offset by rising mortality attributable to drug overdoses.

              Conclusions

              The US is failing to advance health equity, especially for adults. Keeping policy-makers accountable to a summary measure of health equity may help coordinate efforts at improving population health.
                Cover page: Trends in health equity in mortality in the United States, 1969–2019
                • Thesis
                • Peer Reviewed
                UCLA Electronic Theses and Dissertations (2022)

                Monitoring the well-being of children and adolescents is essential for improving overall population health. However, with only a few exceptions, direct measures of well-being are not currently collected at scale in the United States. Multidimensional indices of outcome indicators related to well-being have been proposed as an alternative, but existing indices have several weaknesses. This dissertation implements a novel methodology to derive an improved index of the outcome indicators of child and adolescent well-being that can be applied to existing population data. Using a nationally representative longitudinal panel, model selection and regression techniques are implemented to estimate the relationship between a collection of standard outcome indicators of well-being with several subjective scales collected directly from children and adolescents. This process results in an index methodology based on their actual lived experiences, making it a more child-centric measure. Within the panel, higher scores on the index are associated with improved health and higher earnings in young adulthood. When subsequently applying the methodology to population macrodata from 2000 to 2019, we find that the outcome indicators of child and adolescent well-being, as measured by the index, improved consistently throughout the past two decades. This overall advance was accompanied by some convergence in disparities by geography and race/ethnicity, but significant inequities remain. However, the progress exhibited by the outcome indicators of well-being contrasts sharply with recent declines in other measures of child and adolescent mental health. This contradiction suggests that the outcome indicators, which at one point tracked reasonably well alongside the subjective well-being of children and adolescents, are no longer performing as expected. Researchers, policymakers, advocates, and practitioners should therefore collectively recommit to expanding population health monitoring systems to better capture the most essential aspects of child and adolescent well-being.

                  Cover page: Improving Child and Adolescent Well-Being Measurement for Population Health Assessment
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2023)
                  CONTEXT: In recent years, stakeholders in public health have emphasized measuring young peoples well-being as a more holistic and upstream approach to understanding their health and development. However, summarizing the available indicators of well-being in ways that strengthen ongoing policy and community efforts remains a challenge. PROGRAM: Our objective was to develop a measurement framework of young peoples well-being that would be engaging and actionable to a broad and diverse set of stakeholders in California. IMPLEMENTATION: We began with a scan of the relevant literature documenting previous efforts to measure young peoples well-being, both within the United States and internationally. Subsequently, we individually interviewed a set of key informants and then convened a multidisciplinary panel of experts to solicit feedback on our approach. Throughout this iterative and collaborative process, we developed and refined a measurement framework based on the information provided across these various sources. EVALUATION: Findings suggest data dashboards are a promising approach for presenting a parsimonious yet holistic picture of young peoples well-being. Dashboards can highlight well-beings multidimensionality by categorizing indicators over different domains. Our framework organizes indicators over 5 types: child-centric, subjective well-being, contextual determinants, developmental, and equity-focused. The design and flexibility of dashboards can also highlight important gaps in data collection that are of interest to end users such as indicators not yet collected among the broader population. Furthermore, dashboards can include interactive features, such as selecting key data elements, that can help communities articulate priority areas for policy action, thereby generating momentum and enthusiasm for future iterations and improvements. DISCUSSION: Data dashboards are well suited for engaging a variety of stakeholders on complex multidimensional concepts such as young peoples well-being. However, to fulfill their promise, they should be codesigned and codeveloped through an iterative process with the stakeholders and community members they intend to serve.
                    Cover page: Dashboards as Mechanisms for Community Empowerment: Developing a Prototype for Child and Adolescent Well-being in California.
                    • Article
                    • Peer Reviewed
                    UCLA Previously Published Works (2021)
                    ABSTRACT IMPACT: This study provides public health and K-12 school districts with a pragmatic, flexible, adaptable model showing COVID-19 transmission dynamics, using local data and program elements that are modifiable and with an online model for easy use, to enable safe and equitable re-opening and maintenance of in-person learning. OBJECTIVES/GOALS: School closures resulting from the COVID-19 pandemic disrupt student education and health and exacerbate inequities. Public health agencies and school districts currently lack pragmatic models to assess the effects of potential strategies for resuming and maintaining in-person learning on outcomes such as transmission and attendance. METHODS/STUDY POPULATION: This study explored how various combinations of transmission-mitigating interventions affect health and learning outcomes in a range of underlying epidemiological conditions. The CTSA science team developed a conceptual framework and an agent-based simulation model with parameters including prevalence, transmission, testing, preventive and responsive actions, infection control, population behavior and awareness, and the potential impact of vaccine adoption and exemption policies. The team partnered with a large school district to ensure relevance of the program components to decision-making. RESULTS/ANTICIPATED RESULTS: The model shows that no single program element or condition ensures safety. Combining interventions can result in synergy in the mitigation efforts. Even without testing, an efficient health screening process with forthcoming risk reporting, combined with on-campus infection control, can reduce on-campus transmission. The resulting model is accessible online to enable exploration of likely scenarios. It is adaptable as COVID-19 science evolves, including for testing and vaccines. DISCUSSION/SIGNIFICANCE OF FINDINGS: This research provides public health agencies and school districts with a model that couples local conditions with programmatic elements to help inform the local COVID-19 response, recognizing that decisions about the school community are often complex politically, technically, and operationally when it comes to addressing a health crisis.
                      Cover page: 83649 Modeling COVID-19 infection dynamics and program interventions for K-12 school re-opening
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