Introduction

COVID-19 continues to impact vulnerable populations disproportionally. Identifying modifiable risk factors could lead to targeted interventions to reduce infections. The purpose of this study is to identify risk factors for testing positive for SARS-CoV-2.

Methods

Using electronic health records collected from a large ambulatory care system in northern and central California, the study identified patients who had a test for SARS-CoV-2 between 2/20/2020 and 3/31/2021. The adjusted effect of active and passive smoking and other risk factors on the probability of testing positive for SARS-CoV-2 were estimated using multivariable logistic regression. Analyses were conducted in 2021.

Results

Of 556 690 eligible patients in our sample, 70 564 (12.7%) patients tested positive for SARS-CoV-2. Younger age, being male, racial/ethnic minorities, and having mild major comorbidities were significantly associated with a positive SARS-CoV-2 test. Current smokers (adjusted OR: 0.69, 95% CI: 0.66-0.73) and former smokers (adjusted OR: 0.92, 95% CI: 0.89-0.95) were less likely than nonsmokers to be lab-confirmed positive, but no statistically significant differences were found when comparing passive smokers with non-smokers. The patients with missing smoking status (25.7%) were more likely to be members of vulnerable populations with major comorbidities (adjusted OR ranges from severe: 2.52, 95% CI = 2.36-2.69 to mild: 3.28, 95% CI = 3.09-3.48), lower income (adjusted OR: 0.85, 95% CI: 0.85-0.86), aged 80 years or older (adjusted OR: 1.11, 95% CI: 1.07-1.16), have less access to primary care (adjusted OR: 0.07, 95% CI: 0.07-0.07), and identify as racial ethnic minorities (adjusted OR ranges from Hispanic: 1.61, 95% CI = 1.56-1.65 to Non-Hispanic Black: 2.60, 95% CI = 2.5-2.69).

Conclusions

Our findings suggest that the odds of testing positive for SARS-CoV-2 were significantly lower in smokers compared to nonsmokers. Other risk factors include missing data on smoking status, being under 18, being male, being a racial/ethnic minority, and having mild major comorbidities. Since those with missing data on smoking status were more likely to be members of vulnerable populations with higher smoking rates, the risk of testing positive for SARS-CoV-2 among smokers may have been underestimated due to missing data on smoking status. Future studies should investigate the risk of severe outcomes among active and passive smokers, the role that exposure to tobacco smoke constitutes among nonsmokers, the role of comorbidities in COVID-19 disease course, and health disparities experienced by disadvantaged groups.

Abstract: The future of coastal wetlands will depend on the combined effects of climate change and human impacts from urbanization and coastal management. Disentangling the effects of these factors is difficult, but satellite imagery archives provide a way to track biological and physical changes in wetlands over recent decades to reveal how coastal wetlands have been changing in response to climate and human drivers. In this study, we used Landsat to monitor the conditions of 32 coastal wetlands in southern California from 1984 to 2019 and identify environmental and human drivers of these trends. Wetland conditions were characterized by vegetation greenness, using the normalized difference vegetation index (NDVI), and by habitat composition, derived from areal estimates of wetland and subtidal habitats. Overall, wetlands displayed three types of long‐term response: greening and gaining wetland (10), greening and losing wetland (16), and browning and losing wetland (6). Regional environmental drivers with overall positive effects on wetland NDVI were sea level, wave height, and precipitation, whereas stream discharge, vapor pressure deficit, and air temperature had negative or nonlinear effects. Wetland area change was primarily correlated with sea level, but response was highly contextual among sites. Negative trends in wetland NDVI and area were more common in larger sites with low elevations and in sites with open inlets. Restoration had mixed effects, with only half of the restored sites showing positive changes in NDVI and wetland area post‐restoration. The important work of managing and restoring urban coastal wetlands is complicated by variability and context and requires us to account for the influence of humans and climate as we build a regional understanding of historic, present, and future wetland health.