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.

Diverse representation and inclusion are stated priorities for scientific institutions and professional societies, including the Society for Epidemiologic Research (SER). Prior studies have reported persistent underrepresentation and exclusion of marginalized groups across the sciences. We conducted a representation and inclusion survey among SER affiliates in 2021, following up on a similar 2018 survey. In 2021, we observed broad representation from diverse groups across multiple dimensions. However, across both surveys we found persistent underrepresentation of several marginalized groups, including Black or African American and Hispanic/Latinx people. Some groups reported feeling excluded in both the 2018 and 2021 surveys, and there was disproportionately high representation from a subset of higher-ranked US academic institutions. For several indicators of inclusion, perceptions of inclusion were more positive among White respondents compared to other respondents. Opportunities to work towards achieving SER’s diversity and inclusion aims include increasing outreach to epidemiology trainees and Minority Serving Institutions, addressing cultural and financial barriers to participation, and improving access for epidemiologists with disabilities. Iterative follow-up work with diversity and inclusion scholars could improve our understanding of barriers to diversity and inclusion within SER and, more broadly, the field of epidemiology.

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Implications for school health

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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.

We report the detection of a Shigella sonnei outbreak from a small investigation in the San Francisco Bay area, California, USA, in 2024. By combining outbreak investigation with genomic sequencing, we show the utility of phylodynamics to aid outbreak investigations of bacterial pathogens by state or local public health departments.

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.