School of Public Health

California’s state government, employers and households are concerned about the future affordability of healthcare. We use health expenditure data from the Centers for Medicare & Medicaid Services’ Office of the Actuary to forecast California’s health expenditures from 2013 to 2022 and identify factors driving expenditure increases. Real health expenditures per capita (2013$) are forecasted to increase from $8,398 to $11,421 (or 36%), resulting in health expenditures increasing from 14.5% to 16.0% of California’s economy. Expenditure increases are mostly driven by gains in real income per capita (40-60%), followed by medical-specific inflation (23%), an aging population (14%), and insurance coverage gains (8%). The -4% to 16% residual is attributable to changes in the volume and mix of services and technology. Several innovations could potentially dampen these increases, such as shared-risk, value-based payment models, practice redesign initiatives, lower cost settings and healthcare professionals, many of which are found in accountable care organizations.

Adult salmon that stray when they escape into non-natal streams to spawn is a natural phenomenon that promotes population growth and genetic diversity, but excessive stray rates impede adult abundance restoration efforts. Adult San Joaquin River (SJR) Basin fall-run Chinook salmon (Oncorhynchus tshawytscha) that return to freshwater to spawn migrate through the San Francisco Bay and Sacramento–San Joaquin River Delta (Delta). The Delta has been heavily affected by land development and water diversion. During the fall time-period for the years 1979 to 2007 Delta pumping facilities diverted on average 340% of the total inflow volume that entered the Delta from the SJR. The hypothesis tested in this paper is that river flow and Delta exports are not significantly correlated with SJR salmon stray rates. Adult coded-wire-tagged salmon recoveries from Central Valley rivers were used to estimate the percentage of SJR Basin salmon that strayed to the Sacramento River Basin. SJR salmon stray rates were negatively correlated (P = 0.05) with the average magnitude of pulse flows (e.g., 10 d) in mid- to late-October and positively correlated (P = 0.10) with mean Delta export rates. It was not possible to differentiate between the effects of pulse flows in October and mean flows in October and November on stray rates because of the co-linearity between these two variables. Whether SJR-reduced pulse flow or elevated exports causes increased stray rates is unclear. Statistically speaking the results indicate that flow is the primary factor. However empirical data indicates that little if any pulse flow leaves the Delta when south Delta exports are elevated, so exports in combination with pulse flows may explain the elevated stray rates. For management purposes, we developed two statistical models that predict SJR salmon stray rate: (1) flow and export as co-independent variables; and (2) south Delta Export (E) and SJR inflow (I) in the form of an E:I ratio.

In this article, we describe an elective course using readers’ theater with students in the health care professions and the arts. Readers' theater is a technique used for the performance of literature in which texts are staged with minimal production values and scripts are not fully memorized. These techniques are drawn upon more commonly in theater and performance studies classrooms, but we found them to be effective as tools for connecting future health care providers with their local communities. With a central theme of age and aging, we chose non-dramatic works of literature and adapted them for dramatic readings at retirement communities in Berkeley and Oakland, California.

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OBJECTIVE: Compliance with elementary school physical education law is low. School district-led PE audit, feedback, and coaching (PEAFC), along with funding credentialed teachers, demonstrated the potential for improving compliance with law in New York City public schools. However, the likely scalable approach of PEAFC, alone, has not been rigorously tested in other districts. METHODS: Two-year pilot cluster-RCT in 10 Bay Area, California elementary schools (mean enrollment 421; 66 % Latino; 92 % free or reduced-price meal eligible). Five schools were randomized to receive PEAFC. Physical education lessons (n = 168) were observed using the System for Observing Fitness Instruction Time in Fall 2022, Spring 2023, and Spring 2024. Linear mixed effects models examined the impact of PEAFC on between-group changes in law compliance (using scheduled and estimated physical education minutes) and lesson time in moderate-to-vigorous physical activity (MVPA). RESULTS: There were no statistically significant differences in changes in scheduled or estimated minutes between times between groups. Students in both intervention (10 % increase; 95 % CI: 2.17 %, 17.41 %) and control (9 % increase; 95 % CI: 2.61 %, 14.42 %) schools increased lesson time in MVPA, but there was not a statistically significant difference in change between groups. DISCUSSION: PEAFC did not impact physical education law compliance or lesson time spent in MVPA. In the absence of credentialed physical education teachers to provide mandated minutes, PEAFC may be limited in its potential to increase compliance with state mandates. Hiring credentialed physical education teachers in elementary schools may be the most effective way to support compliance with state physical education laws.

The key characteristics (KCs) of carcinogens are the properties common to known human carcinogens that can be used to search for, organize, and evaluate mechanistic data in support of hazard identification. A limiting factor in this approach is that relevant in vitro and in vivo assays, as well as corresponding biomarkers and endpoints, have been only partially documented for each of the 10 KCs (Smith MT, Guyton KZ, Kleinstreuer N et al. The key characteristics of carcinogens: relationship to the hallmarks of cancer, relevant biomarkers, and assays to measure them. Cancer Epidemiol Biomarkers Prev 2020;29:1887-903. https://doi.org/10.1158/1055-9965.EPI-19-1346). To address this limitation, a comprehensive database is described that catalogues these previously described methods and endpoints/biomarkers pertinent to the 10 KCs of carcinogens as well as those referenced as supporting evidence for each KC in the International Agency of Research on Cancer Monograph Volumes 112-131. Our comprehensive mapping of KCs to assays and endpoints can be used to facilitate mechanistic data searches, presents a useful tool for searching for assays and endpoints relevant to the 10 KCs, and can be used to create a roadmap for utilizing data to evaluate the strength of the evidence for each KC. The KC-Assay database is available to the public on the web at https://kcad.cchem.berkeley.edu and acts as a 'living document', with the ability to be updated and refined. Database URL: https://kcad.cchem.berkeley.edu.

BACKGROUND: DNA methylation (DNAm) is a developmentally dynamic epigenetic process; yet, most epigenome-wide association studies (EWAS) have examined DNAm at only one timepoint or without systematic comparisons between timepoints. Thus, it is unclear whether DNAm alterations during certain developmental periods are more informative than others for health outcomes, how persistent epigenetic signals are across time, and whether epigenetic timing effects differ by outcome. METHODS: We applied longitudinal meta-regression models to published meta-analyses from the PACE consortium that examined DNAm at two timepoints-prospectively at birth and cross-sectionally in childhood-in relation to the same child outcome (ADHD symptoms, general psychopathology, sleep duration, BMI, asthma). These models allowed systematic comparisons of effect sizes and statistical significance between timepoints. Furthermore, we tested correlations between DNAm regression coefficients to assess the consistency of epigenetic signals across time and outcomes. Finally, we performed robustness checks, estimated between-study heterogeneity, and tested pathway enrichment. RESULTS: Our findings reveal three new insights: (i) across outcomes, DNAm effect sizes are consistently larger in childhood cross-sectional analyses compared to prospective analyses at birth; (ii) higher effect sizes do not necessarily translate into more significant findings, as associations also become noisier in childhood for most outcomes (showing larger standard errors in cross-sectional vs prospective analyses); and (iii) DNAm signals are highly time-specific, while also showing evidence of shared associations across health outcomes (ADHD symptoms, general psychopathology, and asthma). Notably, these observations could not be explained by sample size differences and only partly to differential study-heterogeneity. DNAm sites changing associations were enriched for neural pathways. CONCLUSIONS: Our results highlight developmentally-specific associations between DNAm and child health outcomes, when assessing DNAm at birth vs childhood. This implies that EWAS results from one timepoint are unlikely to generalize to another. Longitudinal studies with repeated epigenetic assessments are direly needed to shed light on the dynamic relationship between DNAm, development and health, as well as to enable the creation of more reliable and generalizable epigenetic biomarkers. More broadly, this study underscores the importance of considering the time-varying nature of DNAm in epigenetic research and supports the potential existence of epigenetic timing effects on child health.

Legal scholarship and caselaw suggest that exposure to peer racial harassment in school (PRHS) harms student mental health and can derail students’ academic trajectories. Legal precedents call on schools to intervene to reduce student exposure to PRHS when feasible. However, little quantitative social science has explored the impacts of PRHS, explored whether exposure to PRHS varies by racial group, or identified structural factors that may protect against PRHS. We review data from over 350,000 California 6th–12th-grade students in nearly 1000 schools and estimate that exposure to PRHS is related to a twenty-percentage-point-higher depressive symptom rate for students of all racial groups, that Black students are significantly more likely to experience PRHS, that being in a school with a race-matched school counselor or psychologist is related to lower rates of both PRHS and depressive symptoms, but that White students are more likely than students of other backgrounds to be in a school where the mental health workforce reflects their racial background. The results suggest a need to reduce exposure to PRHS, particularly for Black students, and that expanding the diversity of school mental health providers could be a pathway to protecting students against PRHS and its attendant harms.

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