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Open Access Policy Deposits

This series is automatically populated with publications deposited by UC Berkeley School of Public Health researchers in accordance with the University of California’s open access policies. For more information see Open Access Policy Deposits and the UC Publication Management System.

Cover page of Forecasts and Drivers of Health Expenditure Growth in California

Forecasts and Drivers of Health Expenditure Growth in California

(2015)

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.

Cover page of Delta Flow Factors Influencing Stray Rate of Escaping Adult San Joaquin River Fall-Run Chinook Salmon (<em>Oncorhynchus tshawytscha</em>)

Delta Flow Factors Influencing Stray Rate of Escaping Adult San Joaquin River Fall-Run Chinook Salmon (Oncorhynchus tshawytscha)

(2012)

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.

 

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Cover page of Moral Imagination Takes the Stage: Readers’ Theater in a Medical Context

Moral Imagination Takes the Stage: Readers’ Theater in a Medical Context

(2006)

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.

Cover page of A pilot cluster-randomized controlled trial of an audit, feedback, and coaching intervention on compliance with elementary physical education laws and student physical activity during lesson time

A pilot cluster-randomized controlled trial of an audit, feedback, and coaching intervention on compliance with elementary physical education laws and student physical activity during lesson time

(2025)

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.

Cover page of A pilot cluster-randomized controlled trial of an audit, feedback, and coaching intervention on compliance with elementary physical education laws and student physical activity during lesson time.

A pilot cluster-randomized controlled trial of an audit, feedback, and coaching intervention on compliance with elementary physical education laws and student physical activity during lesson time.

(2025)

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.

Cover page of A School Mental Health Provider Like Me: Links Between Peer Racial Harassment, Depressive Symptoms, and Race-Matched School Counselors and Psychologists

A School Mental Health Provider Like Me: Links Between Peer Racial Harassment, Depressive Symptoms, and Race-Matched School Counselors and Psychologists

(2025)

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.

Cover page of Wealth is health: High economic status in Cameroon correlates with protective gear use in traffic injuries and improved clinical outcomes

Wealth is health: High economic status in Cameroon correlates with protective gear use in traffic injuries and improved clinical outcomes

(2025)

Introduction

Africa is the least motorized populated continent, yet it experiences the highest traffic fatality rate. Despite laws mandating helmet and seatbelt use, data on protective gear use among Cameroonian road traffic injury (RTI) patients remains sparse.

Methods

We extracted Cameroon Trauma Registry data prospectively collected from 10 hospitals during July 2022 to December 2023. Protective gear users wore helmets in motorcycle and seatbelts/car seats in vehicle crashes. We categorized patients into five economic clusters based on ownership of durable goods using parallel distance matrix computation. We analyzed associations between continuous variables with Wilcoxon rank-sum and categorical variables with χ 2 and multivariate logistic regression. Our primary outcome was in-hospital death or major disability at discharge.

Results

Among 3,554 RTI patients, 303 (9%) used protective gear. A larger proportion of patients who did not use protective gear were designated as majorly disabled or dead (20% vs. 16%, p < 0.001). The greatest percentage of protective gear users belonged to the richest cluster, while the poorest cluster patients comprised the smallest proportion of protective gear users (13% vs. 3%, p < 0.001). The richest cluster demonstrated the smallest percentage of major disability or death (13%), while the poorest cluster had the greatest percentage (28%, p < 0.001). When controlling for age, protective gear use, and injury severity, the three poorest clusters showed the greatest odds of major disability or death (cluster 3: adjusted odds ratio [AOR], 2.34; 95% confidence interval [CI], 1.58-3.46; cluster 4: AOR, 2.09; 95% CI, 1.59-2.74; cluster 5: AOR, 2.38; 95% CI, 1.24-4.58).

Conclusion

Greater economic status is associated with increased protective gear use during RTIs in Cameroon. Despite suffering the most severe outcomes, the poorest patients remain less likely to use protective gear. Enforcement of protective gear laws and economic incentives such as price subsidies for helmets and seatbelts would particularly benefit the most vulnerable population.

Level of evidence

Prognostic and Epidemiological; Level IV.

Cover page of Parasite and vector circadian clocks mediate efficient malaria transmission.

Parasite and vector circadian clocks mediate efficient malaria transmission.

(2025)

Malaria transmission begins when Anopheles mosquitos deposit saliva and Plasmodium parasites during a bloodmeal. As Anopheles mosquitos are nocturnal, we investigated whether their salivary glands are under circadian control, anticipating bloodmeals and modulating parasite biology for host encounters. Here we show that approximately half of the mosquito salivary gland transcriptome, particularly genes essential for efficient bloodmeals such as anti-blood clotting factors, exhibits circadian expression. Furthermore, measuring haemoglobin levels, we demonstrate that mosquitos prefer to feed and ingest more blood at nighttime. Notably, we show a substantial subset of the salivary-gland-resident parasite transcriptome cycling throughout the day, indicating that this stage is not transcriptionally quiescent. Among the sporozoite genes undergoing rhythmic expression are those involved in parasite motility, potentially modulating the ability to initiate infection at different times of day. Our findings suggest a circadian tripartite relationship between the vector, parasite and mammalian host that together modulates malaria transmission.

Cover page of Immigrant status and citizenship relationships with epigenetic aging in a representative sample of United States adults.

Immigrant status and citizenship relationships with epigenetic aging in a representative sample of United States adults.

(2025)

BACKGROUND: Immigrant status and citizenship influence health and well-being, yet their associations with DNA methylation (DNAm)-based biomarkers of aging - key predictors of healthspan and lifespan, also known as epigenetic aging - remain underexplored. METHODS: Using a representative sample of 2,336 United States (U.S.) adults from the 1999-2000 and 2001-2002 cycles of the National Health and Nutrition Examination Survey (NHANES), we analyzed cross-sectional associations of immigrant status and U.S. citizenship with seven epigenetic aging biomarkers: HannumAge, HorvathAge, SkinBloodAge, PhenoAge, GrimAge2, DNAm Telomere Length, and DunedinPoAm. RESULTS: After adjusting for demographic factors, immigrants had 2.53-year lower GrimAge2 measures (95%CI: -3.44, -1.63, p < 0.001) compared to non-immigrants. U.S. citizens had 1.98-year higher GrimAge2 measures (95%CI: 0.66, 3.30, p = 0.005) compared to non-citizens. The GrimAge2 associations with immigrant status (β = -1.04-years, 95%CI: -1.87, -0.21, p = 0.02) and citizenship (β = 1.35-years, 95%CI: 0.38, 2.32, p = 0.02) were attenuated after adjusting for other lifestyle/health variables. Immigrant status and citizenship were associated with estimated levels of several GrimAge2 DNAm component proteins, including adrenomedullin and C-reactive protein. CONCLUSION: Our results support the paradigm of the immigrant mortality advantage and highlight the potential value of epigenetic age measures in studying socioeconomic and broader factors influencing citizen and immigrant health.