Cardiovascular health and proximity to urban oil drilling in Los Angeles, California.

BACKGROUND: Although ~18 million people live within a mile from active oil and gas development (OGD) sites in the United States, epidemiological research on how OGD affects the health of nearby urban residents is sparse. Thousands of OGD sites are spread across Los Angeles (LA) County, California, home to the largest urban oil production in the country. Air pollution and noise from OGD may contribute to cardiovascular morbidity. OBJECTIVE: We examined the association between proximity to OGD and blood pressure in a diverse cohort of residents in LA. METHODS: We recruited residents in South LA who lived <1 km from an OGD site. We collected three blood pressure measurements for each participant and used the second and third measurements to calculate averages for systolic blood pressure (SBP) and diastolic blood pressure (DBP) separately. We conducted multivariable linear regression to examine the relationship between distance to OGD sites and continuous SBP and DBP, adjusting for BMI, smoking status, distance to freeway, sex, age, and use of antihypertension medications, with a random effect for household. We examined effect measure modification by BMI category and smoking category. RESULTS: Among the 623 adult participants, we found that for every 100 meter increase in distance from the OGD site, DBP was reduced by an average of 0.73 mmHg (95% CI: -1.26, -0.21) in this population. We observed stronger effects of proximity to OGD site on DBP among never smokers and among participants with a healthy BMI. The associations observed between proximity to OGD site and SBP were weaker but followed the same patterns as those for DBP. IMPACT: Our study suggests that living near urban oil drilling sites is significantly associated with greater diastolic blood pressure in urban Los Angeles communities. This research improves understanding of impacts from living nearby drilling operations on the health and welfare of this community, which is critical to inform public health relevant strategies.

Mobile daily diaries to characterize stressors and acute health symptoms in an environmental justice neighborhood.

Low-income communities and communities of color face multiple, cumulative environmental and social burdens. Methods development in environmental justice research has largely focused on spatial and quantitative approaches. Less attention has been paid to developing methodologies that help collect information on everyday stressors and quality of life experiences for residents in overburdened communities. Mixed methods approaches can be one way to structure study designs that help consider how residents experience environmental and socioeconomic impacts in a localized community context. In neighborhoods burdened by cumulative stressors, traditional cross-sectional epidemiological research designs can also be challenging, as well as limited or narrow in their application. However, repeat sampling of measures within a vulnerable population can approach a quasi-experimental design and help consider variations within residents in a single neighborhood as well as better parse relationships between exposures and outcomes. Through a community-academic partnership with university partners, local community partners, and a local promotores de salud (community health workers) network, we pilot tested a novel mobile daily diary approach in both English and Spanish in an urban, predominantly immigrant community in South Los Angeles as a potential method to collect information on daily stress, environmental quality, and health status/symptoms. We collected resident responses via a once per day 7-day SMS/text messaging survey. We sought to gather granular data on daily resident experiences of air pollution and environmental hazards. Residents reported acute health symptoms and stressors, with repeat measures demonstrating how residents might rank, categorize, or cope with stressors. We find that residents in environmental justice communities record variation in their daily diary responses and document changes in environmental quality, stressors, and odors. Refining this type of method could enable a more rigorous examination of co-occurrences of environmental quality and acute health symptoms. This approach supports the inclusion of residents in the research process and helps more systematically integrate open-ended environmental health relevant data in environmental justice efforts. Used with measured data such as air monitoring or health measures, mixed methods generated data can help support efforts that aim to alleviate sources of daily stress, alongside efforts to reduce overall pollution burdens. Mobile daily diaries can be one way to capture variable responses to environmental quality, acute health symptoms, and stressors.

Personal care product use among diverse women in California: Taking Stock Study.

BACKGROUND: Personal care product use may contribute to elevated body burdens of consumer product chemicals among women of color; however, racial/ethnic differences in product use has been understudied. Community-engaged research can support the recruitment of diverse participants. OBJECTIVE: To document personal care product use among a diverse group of women (aged 18-34 years) living in California. METHODS: Through a community-academic partnership, we surveyed 357 women in California about product use information for 54 cosmetic, hair, menstrual/intimate care, and leave-on and rinse-off personal care products. We compared type and frequency of product use among Black, Hispanic/Latinx, Asian, and White women. We also summarized use of scented products and reasons women select products. RESULTS: Women reported using a median of 8 products daily, with some women reporting up to 30 products daily. Hispanic/Latinx and Asian women used more cosmetics, and Black women used more hair and menstrual/intimate products than other women. Of the 54 products compared, there were significant differences in use by race/ethnicity for 28 products, with the largest number of significant differences between Black and White women. SIGNIFICANCE: There is growing information on chemical exposures from personal care products and consequent adverse health effects, with implications for health disparities. Yet, there remains limited information on the range and types of products used by diverse racial/ethnic communities. This study helps close an important gap on product use inventories that can enable more informed public health interventions to limit exposures from personal care products.

Respiratory health, pulmonary function and local engagement in urban communities near oil development.

BACKGROUND: Modern oil development frequently occurs in close proximity to human populations. Los Angeles, California is home to the largest urban oil field in the country with thousands of active oil and gas wells in very close proximity to homes, schools and parks, yet few studies have investigated potential health impacts. The neighborhoods along the Las Cienagas oil fields are situated in South LA, densely populated by predominantly low-income Black and Latinx families, many of whom are primarily Spanish-speakers. METHODS: A cross-sectional community-based study was conducted between January 2017 and August 2019 among residents living <1000 m from two oil wells (one active, one idle) in the Las Cienagas oil field. We collected self-reported acute health symptoms and measured FEV1 (forced expiratory volume in the first second of exhalation) and FVC (forced vital capacity). We related lung function measures to distance and direction from an oil and gas development site using generalized linear models adjusted for covariates. RESULTS: A total of 961 residents from two neighborhoods participated, the majority of whom identify as Latinx. Participants near active oil development reported significantly higher prevalence of wheezing, eye and nose irritation, sore throat and dizziness in the past 2 weeks. Among 747 valid spirometry tests, we observe that living near (less than 200 m) of oil operations was associated with, on average, -112 mL lower FEV1 (95% CI: -213, -10) and -128 mL lower FVC (95% CI: -252, -5) compared to residents living more than 200 m from the sites after adjustments for covariates, including age, sex, height, proximity to freeway, asthma status and smoking status. When accounting for predominant wind direction and proximity, we observe that residents living downwind and less than 200 m from oil operations have, on average, -414 mL lower FEV1 (95% CI: -636, -191) and -400 mL lower FVC (95% CI: -652, -147) compared to residents living upwind and more than 200 m from the wells. CONCLUSIONS: Living nearby and downwind of urban oil and gas development sites is associated with lower lung function among residents, which may contribute to environmental health disparities.

Effect of 2 Interventions on Cervical Cancer Screening Guideline Adherence.

INTRODUCTION: This study sought to determine whether a provider mobile phone application, used with or without a patient educational tool accessed on a computer tablet, would promote adherence to guidelines for cervical cancer screening and management of abnormal cytology in young women. METHODS: The study was conducted as a prospective cohort study in which 14 Family Planning, Access, Care, and Treatment provider clinics were randomized to 1 of 2 arms: (1) provider mobile phone application only or (2) provider mobile phone application plus patient educational tool. The provider mobile phone application gave information to providers regarding cervical cancer screening and management of abnormal cytology. The patient educational tool accessed on a computer tablet was a patient-centered educational tool. Each arm was compared with clinic control groups (no intervention) in a 2:1 ratio (control:intervention). Claims data were used to calculate and compare 18-month cytology (Pap) and colposcopy rates before the intervention and during the 18 months using the Poisson mixed-effect regression model. A sensitivity analysis examined the differences in the rate of change between each arm and controls. The study took place between July 2015 and December 2016, and analysis was performed in 2019. RESULTS: The clinics randomized to the provider mobile phone application plus patient educational tool arm and their control group achieved similar 18-month Pap rates (0.52, 95% CI=0.37, 0.74 and 0.68, 95% CI=0.53, 0.86, respectively) as well as the provider mobile phone application arm and their control group (0.44, 95% CI=0.33, 0.58 and 0.41, 95% CI=0.34, 0.51; p-values >0.1). In the sensitivity analysis, the difference in the rate of change in Pap rates for the provider mobile phone application plus patient educational tool arm and their control group before and during the intervention was -0.22 and -0.09, respectively (p=0.02), but no differences were seen between the provider mobile phone application arm and their control group. No significant changes were observed for colposcopy rates. CONCLUSIONS: Providing clinicians and patients with information on guidelines had no demonstrable effect on 18-month Pap and colposcopy rates in the regression model; however, results from the sensitivity analysis for the patient educational tool were encouraging. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02270021.

Using Gas-Phase Air Quality Sensors to Disentangle Potential Sources in a Los Angeles Neighborhood.

In the late summer of 2016, our team deployed a network of low-cost air quality sensing systems in partnership with community-based organizations in a neighborhood in South Los Angeles, California. Residents of this community were concerned about possible emissions from local oil and gas activity, however in addition to these potential emissions, the neighborhood is also subject to a complex mixture of pollutants from other nearby sources including major highways. For this deployment, metal-oxide VOC sensors were quantified to provide methane (CH4) and total non-methane hydrocarbon (TNMHCs) concentration estimates. This data along with other sensor signals, meteorological data, and community member observations was used to examine the composition and possible origins of observed emissions. The sensor network displayed expected environmental trends and highlighted short-term elevations in CH4 and/or TNMHCs, which we were then able to investigate more closely. The results indicated that sources of both combusted and volatilized hydrocarbons were likely affecting air quality throughout the community, including near the site of the local oil and gas activity. This deployment may serve as a model for how multi-sensor systems deployed in networks can be leveraged to better understand sources in complex areas, potentially supporting future community-based air quality research.

Youth Engaged Participatory Air Monitoring: A 'Day in the Life' in Urban Environmental Justice Communities.

Air pollution in Southern California does not impact all communities equally; communities of color are disproportionately burdened by poor air quality and more likely to live near industrial facilities and freeways. Government regulatory monitors do not have the spatial resolution to provide air quality information at the neighborhood or personal scale. We describe the A Day in the Life program, an approach to participatory air monitoring that engages youth in collecting data that they can then analyze and use to take action. Academics partnered with Los Angeles-based youth environmental justice organizations to combine personal air monitoring, participatory science, and digital storytelling to build capacity to address local air quality issues. Eighteen youth participants from four different neighborhoods wore portable personal PM2.5 (fine particles <2.5 µm in diameter) monitors for a day in each of their respective communities, documenting and mapping their exposure to PM2.5 during their daily routine. Air monitoring was coupled with photography and videos to document what they experienced over the course of their day. The PM2.5 exposure during the day for participants averaged 10.7 µg/m3, although the range stretched from <1 to 180 µg/m3. One-third of all measurements were taken <300 m from a freeway. Overall, we demonstrate a method to increase local youth-centered understanding of personal exposures, pollution sources, and vulnerability to air quality.

Trends in Cervical Cancer Screening in California's Family Planning Program.

OBJECTIVE: Guidelines recommend 3-year cervical cancer screening intervals to avoid unnecessary invasive procedures; however, regular testing remains critical. We evaluated trends in cervical cancer screening among low-income women receiving family planning-related services and their association with patient and provider characteristics. MATERIALS AND METHODS: Using claims and enrollment data from California's publicly funded family planning program, we identified 540,026 women with a clinician visit at 216 sites between 2011 and 2015. We calculated guideline adherent cervical cancer testing rates for 6-month periods among women aged 21 to 24, 25 to 29, and 30 to 64 years. We also calculated guideline adherent chlamydia testing for women aged 21 to 24 years. RESULTS: Having a 3-year cervical cancer screening test declined for all age groups. The odds of cervical cancer screening declined for women aged 21 to 24 years by an estimated 11% every 6 months (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.89-0.90), a significantly greater decline than for the other age groups. Among women aged 21 to 29 years, the decrease was significantly larger for Latina (ratio of ORs = 0.95, 95% CI = 0.95-0.96) and Spanish-speaking (ratio of ORs = 0.95, 95% CI = 0.95-0.96) women compared with non-Latina and non-Spanish-speaking women. A smaller decline was seen for chlamydia screening. CONCLUSIONS: Changes in screening interval guidelines are associated with overall decreased screening. This trend was strongest among women aged 21 to 24 years, even as they continued to be screened appropriately for chlamydia, suggesting many missed opportunities. Efforts to reduce unnecessary cervical cancer screening should be monitored to maintain appropriate screening rates to avoid advanced-stage diagnoses and higher health care costs.

Community-Based Health and Exposure Study around Urban Oil Developments in South Los Angeles.

Oilfield-adjacent communities often report symptoms such as headaches and/or asthma. Yet, little data exists on health experiences and exposures in urban environments with oil and gas development. In partnership with Promotoras de Salud (community health workers), we gathered household surveys nearby two oil production sites in Los Angeles. We tested the capacity of low-cost sensors for localized exposure estimates. Bilingual surveys of 205 randomly sampled residences were collected within two 1500 ft. buffer areas (West Adams and University Park) surrounding oil development sites. We used a one-sample proportion test, comparing overall rates from the California Health Interview Survey (CHIS) of Service Planning Area 6 (SPA6) and Los Angeles County for variables of interest such as asthma. Field calibrated low-cost sensors recorded methane emissions. Physician diagnosed asthma rates were reported to be higher within both buffers than in SPA6 or LA County. Asthma prevalence in West Adams but not University Park was significantly higher than in Los Angeles County. Respondents with diagnosed asthma reported rates of emergency room visits in the previous 12 months similar to SPA6. 45% of respondents were unaware of oil development; 63% of residents would not know how to contact local regulatory authorities. Residents often seek information about their health and site-related activities. Low-cost sensors may be useful in highlighting differences between sites or recording larger emission events and can provide localized data alongside resident-reported symptoms. Regulatory officials should help clarify information to the community on methods for reporting health symptoms. Our community-based participatory research (CBPR) partnership supports efforts to answer community questions as residents seek a safety buffer between sensitive land uses and active oil development.

Association of access to publicly funded family planning services with adolescent birthrates in California counties.

OBJECTIVES: We examined the association of adolescent birthrates (ABRs) with access to and receipt of publicly funded family planning services in California counties provided through 2 state programs: Medi-Cal, California's Medicaid program, and the Family Planning, Access, Care, and Treatment (Family PACT) program. METHODS: Our key data sources included the California Health Interview Survey and California Women's Health Survey, Medi-Cal and Family PACT claims data, and the Birth Statistical Master File. We constructed a linear regression analysis measuring the relationship of access to and receipt of family planning services with ABRs when controlling for counties' select covariates. RESULTS: The regression analysis indicated that a higher access rate to Family PACT in a county was associated with a lower ABR (B = -0.19; P < .01) when controlling for unemployment rate, percentage of foreign-born adolescents, and percentage of adult low-income births. CONCLUSIONS: Efforts to reduce ABRs, specifically in counties that had persistently high rates are critical to achieving a healthy future for the state and the nation. Family PACT played a crucial role in helping adolescents avoid unintended and early childbearing.

Barriers to adolescents' getting emergency contraception through pharmacy access in California: differences by language and region.

CONTEXT: In California, emergency contraception is available without a prescription to females younger than 18 through pharmacy access. Timely access to the method is critical to reduce the rate of unintended pregnancy among adolescents, particularly Latinas. METHODS: In 2005-2006, researchers posing as English- and Spanish-speaking females-who said they either were 15 and had had unprotected intercourse last night or were 18 and had had unprotected sex four days ago-called 115 pharmacy-access pharmacies in California. Each pharmacy received one call using each scenario; a call was considered successful if the caller was told she could come in to obtain the method. Chi-square tests were used to assess differences between subgroups. In-depth interviews with 22 providers and pharmacists were also conducted, and emergent themes were identified. RESULTS: Thirty-six percent of all calls were successful. Spanish speakers were less successful than English speakers (24% vs. 48%), and callers to rural pharmacies were less successful than callers to urban ones (27% vs. 44%). Although rural pharmacies were more likely to offer Spanish-language services, Spanish-speaking callers to these pharmacies were the least successful of all callers (17%). Spanish speakers were also less successful than English speakers when calling urban pharmacies (30% vs. 57%). Interviews suggested that little cooperation existed between pharmacists and clinicians and that dispensing the method at clinics was a favorable option for adolescents. CONCLUSIONS: Adolescents face significant barriers to obtaining emergency contraception, but the expansion of Spanish-language services at pharmacies and greater collaboration between providers and pharmacists could improve access.

Estimates of pregnancies averted through California's family planning waiver program in 2002.

CONTEXT: During its first year of operation (1997-1998), California's family planning program, Family PACT, helped more than 750,000 clients to avert an estimated 108,000 pregnancies. Given subsequent increases in the numbers of clients served and contraceptive methods offered by the program, updated estimates of its impact on fertility are needed. METHODS: Claims data on contraceptives dispensed were used to estimate the number of pregnancies experienced by women in the program in 2002. Medical record data on methods used prior to enrollment were used to predict client fertility in the absence of the program. Further analyses examined the sensitivity of these estimates to alternative assumptions about contraceptive failure rates, contraceptive continuation and contraceptive use in the absence of program services. RESULTS: Almost 6.4 million woman-months of contraception, provided primarily by oral contraceptives (57%), barrier methods (19%) and the injectable (18%), were dispensed through Family PACT during 2002. As a result, an estimated 205,000 pregnancies-which would have resulted in 79,000 abortions and 94,000 births, including 21,400 births to adolescents-were averted. Changing the base assumptions regarding contraceptive failure rates or method use had relatively small effects on the estimates, whereas assuming that clients would use no contraceptives in the absence of Family PACT nearly tripled the estimate of pregnancies averted. CONCLUSION: Because all contraceptive methods substantially reduce the risk of pregnancy, Family PACT's impact on preventing pregnancy lies primarily in providing contraceptives to women who would otherwise not use any method.