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Open Access Publications from the University of California

Scholarly Works (9 results)

  • Article
Tobacco Control Policy Making: United States (2000)

Proposition 28, titled the Repeal of Proposition 10 Tobacco Surtax Initiative Statute, would repeal the $.50 tax per pack of cigarettes (and commensurate tax on other tobacco products) enacted on by Proposition 10, passed on November 3, 1998. Proposition 28 would dismantle the California Children and Families First Program, a statewide trust to fund programs for early childhood education, also enacted through Proposition 10. It also prohibits the passage of additional taxes on tobacco products by voter mandate.

People are sensitive to the price of cigarettes and other tobacco products. Imposition of the 50 cent tax by Proposition 10 (combined with a wholesale price increase imposed by the tobacco industry to pay for the Master Settlement Agreement that ended state tobacco litigation) substantially reduced cigarette consumption.

Repealing the tax could substantially increase cigarette consumption and associated disease and medical costs if the price of cigarettes drops.

We analyzed two scenarios, which bracket the likely effects if Proposition 28 passes:

1. The tobacco industry raises wholesale prices to increase industry revenues.

• Since there is no retail price change, there will be no changes in consumption or tobacco-related disease.

• Industry revenues would increase by $617 million.

2. The tobacco industry does not change wholesale prices, so the retail price of cigarettes drops and consumption increases.

• There would be an additional 114 million packs of cigarettes consumed, increasing industry revenues by $220 million.

• There would be an increase in teen smoking, between 7,800 and 46,500 new youth smokers.

• An additional 102 low birth weights due to maternal smoking, for an additional $2 million in direct medical costs for the first year following the repeal of the tax.

• An additional combined total of 78 heart attacks and strokes for Californians over 35 years of age for an increase of $3 million in direct medical costs for the first year following the repeal of the tax.

• Over the longer term, annual medical costs of smoking-induced disease will increase by $500 million annually, with an additional 1,800 annual deaths due to active smoking.

• Increase in costs for diseases related to secondhand smoke, especially in childhood diseases caused or exacerbated by secondhand smoke including SIDS, middle ear infections, asthma, bronchitis, pneumonia, and lung cancer, including

• 50 to 90 additional low birth weight infants

• 5 additional cases of SIDS

• 3,400-8,100 additional physician office visits for middle ear infections

• 40 to 135 new asthma cases in children

• 2,000 to 5,200 additional asthma attacks in children

• 780 to 1,600 cases of bronchitis and pneumonia in children

• 16 additional lung cancer deaths

• 180 to 320 additional heart disease deaths

These two cases bracket the likely effects of enactment of Proposition 28. The actual effect will probably be somewhere between these two scenarios.

    Cover page: Analysis of Proposition 28: Repeal of Proposition 10 Tobacco Surtax Initiative Statute
    • Article
    Tobacco Control Policy Making: United States (1999)

    The tobacco industry's trend of giving generously to California legislators continued in the 1997-1998 election cycle. Between January 1, 1997, and December 31, 1998, the tobacco industry contributed $615,145 to state legislators and legislative candidates.

    Since 1991-1992, campaign contributions to legislative candidates and parties by the tobacco industry favored the party in power. However, in the 1997-1998 election cycle, reflecting increasingly partisan contributions by the tobacco industry, Republicans received 81 percent of tobacco industry campaign contributions even though the Democrats controlled both houses of the Legislature.

    The tobacco industry contributed a total of $848,635 to state legislators and legislative candidates, state constitutional officers, political parties and party controlled committees for the 1997-1998 election cycle. This total is less than the three previous election cycles in the 1990s, and is in part most likely due to the passage of Proposition 208, which placed spending limits on individuals, corporations, and PACs for 1997.

    On a per member basis, California legislators received more money than the members of Congress, $5,117 per member compared to $4,373 per member. For the 1997-1998 election cycle, Senator Minority Leader Ross Johnson (R- Irvine) the top recipient in California Senate ($111,500) received more money than Senator Lauch Faircloth (R-North Carolina), the top recipient in the United States Senate ($87,999). In addition, Assembly Minority Leader Bill Leonard (R- Rancho Cucamonga) received more tobacco industry campaign contributions ($82,250) than Representative Edward Whitfield (R-Kentucky), who was the top recipient of tobacco industry campaign contributions in the House of Representatives ($34,000).

    On January 1, 1998, California enacted the country's first state-wide smoke free bar law as an extension of the state smoke free workplace law. The tobacco industry attempted nine times to either delay the enactment of the law, or have the law repealed. The tobacco industry, working primarily through the National Smokers' Alliance, sought to undermine the law by depicting the issue as unfair to small businesses, and problematic in terms of enforcement. Even so, health advocates prevented the law from being repealed.

    In November 1998, California elected a Democrat to the governorship for the first time since 1982. Governor Gray Davis had begun to remedy the actions of the Wilson Administration in debilitating the state funded California Tobacco Control Program. Though the funding levels for the Proposition 99 programs were at the voted mandated levels, two suits filed against the state for misappropriation of Proposition 99 funds in 1991 and 1995 remain pending. Governor Davis vetoed $32 million the Legislature had appropriated for anti-smoking education programs.

    On June 12, 1997, the State of California became the 37th state to file suit against the tobacco industry. The state sought damages for violations of California Business and Professions Code and recovery of public health care expenditures for tobacco related disease. The state's claims for medicaid reimbursement were dismissed. The remaining claims were consolidated with the City of Los Angeles, the City and County of San Francisco et al., and two private citizen suits against the tobacco industry. These suits were settled by the Multi-State Master Settlement Agreement in November 1998. California will receive approximately $25 billion of the $206 billion settlement over the next 25 years from the industry. In September 1999, the Legislature passed a bill to have these funds dedicated for health services in the state.

    Other civil action suits against the tobacco industry are scheduled to be heard beginning in January 2000. These suits are mainly union trust fund suits against the industry, as well as local government failure to warn suits under Proposition 65, the state's toxic enforcement act.

    In November 1998, the California voters passed Proposition 10, which resulted in the creation of local agencies throughout the state that will promote child development programs and educational campaigns. The proposition won by a vote of 50.5% to 49.5%, despite the $29,397,147 the tobacco industry spent to defeat it. The program is funded by an additional $.50 tax on cigarettes, and a commensurate tax increase on other tobacco products. The tax increase, along with a price hike from the industry, sales of cigarettes in California decreased 28.6 percent for the first 6 months of 1999.

      Cover page: Turning the Tide: Tobacco Industry Political Influence and Tobacco Policy Making in California 1997-1999
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2018)
      Community-level approaches for pediatric asthma management rely on locally collected information derived primarily from two sources: claims records and school-based surveys. We combined claims and school-based surveillance data, and examined the asthma-related risk patterns among adolescent students. Symptom data collected from school-based asthma surveys conducted in Oakland, CA were used for case identification and determination of severity levels for students (high and low). Survey data were matched to Medicaid claims data for all asthma-related health care encounters for the year prior to the survey. We then employed recursive partitioning to develop classification trees that identified patterns of demographics and healthcare utilization associated with severity. A total of 561 students had complete matched data; 86.1% were classified as high-severity, and 13.9% as low-severity asthma. The classification tree consisted of eight subsets: three indicating high severity and five indicating low severity. The risk subsets highlighted varying combinations of non-specific demographic and socioeconomic predictors of asthma prevalence, morbidity and severity. For example, the subset with the highest class-prior probability (92.1%) predicted high-severity asthma and consisted of students without prescribed rescue medication, but with at least one in-clinic nebulizer treatment. The predictive accuracy of the tree-based model was approximately 66.7%, with an estimated 91.1% of high-severity cases and 42.3% of low-severity cases correctly predicted. Our analysis draws on the strengths of two complementary datasets to provide community-level information on children with asthma, and demonstrates the utility of recursive partitioning methods to explore a combination of features that convey asthma severity.
        Cover page: Optimizing community-level surveillance data for pediatric asthma management
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2020)

        Background

        Ambient environmental pollutants have been shown to adversely affect respiratory health in susceptible populations. However, the role of simultaneous exposure to multiple diverse environmental pollutants is poorly understood.

        Objective

        We applied a multidomain, multipollutant approach to assess the association between pediatric lung function measures and selected ambient air pollutants and pesticides.

        Methods

        Using data from the US EPA and California Pesticide Use Registry, we reconstructed three months prior exposure to ambient air pollutants ((ozone (O3), nitrogen dioxide (NO2), particulate matter with a median aerodynamic diameter < 2.5 μm (PM2.5) and <10 μm (PM10)) and pesticides (organophosphates (OP), carbamates (C) and methyl bromide (MeBr)) for 153 children with mild intermittent or mild persistent asthma from the San Joaquin Valley of California, USA. We implemented Bayesian kernel machine regression (BKMR) to estimate the association between simultaneous exposures to air pollutants and pesticides and lung function measures (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75)).

        Results

        In BKMR analysis, the overall effect of mixtures (pollutants and pesticides) was associated with reduced FEV1 and FVC, particularly when all the environmental exposures were above their 60th percentile. For example, the effect of the overall mixture at the 70th percentile (compared to the median) was a -0.12SD (-50 mL, 95% CI: -180 mL, 90 mL) change in the FEV1 and a -0.18SD (-90 mL, 95% CI: -240 mL, 60 mL) change in the FVC. However, 95% credible intervals around all of the joint effect estimates contained the null value.

        Conclusion

        At this agricultural-urban interface, we observed results from multipollutant analyses, suggestive of adverse effects on some pediatric lung function measures following a cumulative increase in ambient air pollutants and agricultural pesticides. Given the uncertainty in effect estimates, this approach should be explored in larger studies.
          Cover page: The joint effect of ambient air pollution and agricultural pesticide exposures on lung function among children with asthma
          • Article
          • Peer Reviewed
          UC Berkeley Previously Published Works (2016)

          Background

          Organophosphate pesticides are heavily used in agriculture, and adverse associations with respiratory health in occupational settings have been reported. However, most of the evidence comes from studies where there were no biomarkers of exposure and no objective outcome measurement. Non-occupational chronic effects among residents living in agricultural communities are less well described.

          Objective

          To evaluate associations between early-life organophosphate exposure and lung function of children living in an agricultural community.

          Methods

          Participants were 279 children from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) longitudinal birth cohort. The area under the curve for organophosphate exposure was determined by urinary diethyl and dimethyl dialkylphosphate metabolites of organophosphate pesticides, which were measured five times during childhood (6-60 months). Spirometry was performed at age 7 years. Regression models controlled for maternal smoking during pregnancy, season of birth, particulate matter concentrations with aerodynamic diameter ≤2.5 μm (PM2.5), breast feeding duration, mould and pets at home, distance of home from a highway, food insecurity, maternal education, season of spirometry, sex, height and technician.

          Results

          Childhood diethyl, dimethyl and total dialkylphosphate concentrations were associated with significant decreases in lung function at age 7. Specifically, we found lower FEV1, (L/s) (ß=-0.16, 95% CI -0.30 to -0.02, p=0.03) and FVC (L) (ß=-0.17, 95% CI -0.34 to 0.01, p=0.06) per 10-fold increase of total dialkylphosphate levels.

          Conclusions

          Early-life organophosphate exposure as assessed by dialkylphosphate concentrations was adversely associated with 7-year-old children's lung function.
            Cover page: Decreased lung function in 7-year-old children with early-life organophosphate exposureCreative Commons 'BY-NC-ND' version 4.0 license
            • Article
            • Peer Reviewed
            UC Berkeley Previously Published Works (2018)
            Traditional methods for measuring personal exposure to fine particulate matter (PM2.5) are cumbersome and lack spatiotemporal resolution; methods that are time-resolved are limited to a single species/component of PM. To address these limitations, we developed an automated microenvironmental aerosol sampler (AMAS), capable of resolving personal exposure by microenvironment. The AMAS is a wearable device that uses a GPS sensor algorithm in conjunction with a custom valve manifold to sample PM2.5 onto distinct filter channels to evaluate home, school, and other (e.g., outdoors, in transit, etc.) exposures. Pilot testing was conducted in Fresno, CA where 25 high-school participants ( n = 37 sampling events) wore an AMAS for 48-h periods in November 2016. Data from 20 (54%) of the 48-h samples collected by participants were deemed valid and the filters were analyzed for PM2.5 black carbon (BC) using light transmissometry and aerosol oxidative potential (OP) using the dithiothreitol (DTT) assay. The amount of inhaled PM2.5 was calculated for each microenvironment to evaluate the health risks associated with exposure. On average, the estimated amount of inhaled PM2.5 BC (μg day-1) and OP [(μM min-1) day-1] was greatest at home, owing to the proportion of time spent within that microenvironment. Validation of the AMAS demonstrated good relative precision (8.7% among collocated instruments) and a mean absolute error of 22% for BC and 33% for OP when compared to a traditional personal sampling instrument. This work demonstrates the feasibility of new technology designed to quantify personal exposure to PM2.5 species within distinct microenvironments.
              Cover page: Personal Exposure to PM2.5 Black Carbon and Aerosol Oxidative Potential using an Automated Microenvironmental Aerosol Sampler (AMAS).
              • Article
              • Peer Reviewed
              UC Davis Previously Published Works (2018)
              Dairy workers experience a high degree of bioaerosol exposure, composed of an array of biological and chemical constituents, which have been tied to adverse health effects. A better understanding of the variation in the magnitude and composition of exposures by task is needed to inform worker protection strategies. To characterize the levels and types of exposures, 115 dairy workers grouped into three task categories on nine farms in the high plains Western United States underwent personal monitoring for inhalable dust, endotoxin, 3-hydroxy fatty acids (3-OHFA), muramic acid, ergosterol, and ammonia through one work shift. Eighty-nine percent of dairy workers were exposed to endotoxin at concentrations exceeding the recommended exposure guidelines (adjusted for a long work shift). The proportion of workers with exposures exceeding recommended guidelines was lower for inhalable dust (12%), and ammonia (1%). Ergosterol exposures were only measurable on 28% of samples, primarily among medical workers and feed handlers. Milking parlor workers were exposed to significantly higher inhalable dust, endotoxin, 3-OHFA, ammonia, and muramic acid concentrations compared to workers performing other tasks. Development of large modern dairies has successfully made progress in reducing worker exposures and lung disease prevalence. However, exposure to endotoxin, dust, and ammonia continues to present a significant risk to worker health on North American dairies, especially for workers in milking parlors. This study was among the first to concurrently evaluate occupational exposure to assayable endotoxin (lipid A), 3-hydroxy fatty acids or 3-OHFA (a chemical measure of cell bound and noncell-bound endotoxins), muramic acid, ergosterol, and ammonia among workers on Western U.S. dairies. There remains a need for cost-effective, culturally acceptable intervention strategies integrated in OHS Risk Management and production systems to further optimize worker health and farm productivity.
                Cover page: Personal exposure of dairy workers to dust, endotoxin, muramic acid, ergosterol, and ammonia on large-scale dairies in the high plains Western United States
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2022)
                Limited studies examine how prenatal environmental and social exposures jointly impact perinatal health. Here we investigated relationships between a neighborhood-level combined exposure (CE) index assessed during pregnancy and perinatal outcomes, including birthweight, gestational age, and preterm birth. Across all participants, higher CE index scores were associated with small decreases in birthweight and gestational age. We also observed effect modification by race; infants born to Black pregnant people had a greater risk of preterm birth for higher CE values compared to White infants. Overall, our results suggest that neighborhood social and environmental exposures have a small but measurable joint effect on neonatal indicators of health.
                  Cover page: Associations between combined exposure to environmental hazards and social stressors at the neighborhood level and individual perinatal outcomes in the ECHO-wide cohort
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2023)
                  Tools for assessing multiple exposures across several domains (e.g., physical, chemical, and social) are of growing importance in social and environmental epidemiology because of their value in uncovering disparities and their impact on health outcomes. Here we describe work done within the Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Study to build a combined exposure index. Our index considered both environmental hazards and social stressors simultaneously with national coverage for a 10-year period. Our goal was to build this index and demonstrate its utility for assessing differences in exposure for pregnancies enrolled in the ECHO-wide Cohort Study. Our unitless combined exposure index, which collapses census-tract level data into a single relative measure of exposure ranging from 0-1 (where higher values indicate higher exposure to hazards), includes indicators for major air pollutants and air toxics, features of the built environment, traffic exposures, and social determinants of health (e.g., lower educational attainment) drawn from existing data sources. We observed temporal and geographic variations in index values, with exposures being highest among participants living in the West and Northeast regions. Pregnant people who identified as Black or Hispanic (of any race) were at higher risk of living in a "high" exposure census tract (defined as an index value above 0.5) relative to those who identified as White or non-Hispanic. Index values were also higher for pregnant people with lower educational attainment. Several recommendations follow from our work, including that environmental and social stressor datasets with higher spatial and temporal resolutions are needed to ensure index-based tools fully capture the total environmental context.
                    Cover page: Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort
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