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Wang P, Williams RJ, Chen W, Wang F, Shamout M, Tanz LJ, Herzig CTA, Oakley LP, Peak CM, Heinzerling A, Al-Shawaf M, Melstrom P, Marynak K, Tynan MA, Agaku IT, Kumagai K. Chemical Composition of Electronic Vaping Products from School Grounds in California. Nicotine Tob Res 2024:ntae042. [PMID: 38407960 DOI: 10.1093/ntr/ntae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Indexed: 02/27/2024]
Abstract
INTRODUCTION The use of electronic vaping products (EVPs) containing nicotine, marijuana, and/or other substances remains prominent among youth; with EVPs containing nicotine being the most commonly used tobacco product among youth since 2014. However, a detailed understanding of the chemical composition of these products is limited. METHODS During February 25th-March 15th, 2019, a total of 576 EVPs, including 233 e-cigarette devices (with 43 disposable vape pens) and 343 e-liquid cartridges/pods/bottled e-liquids, were found or confiscated from a convenience sample of 16 public high schools in California. Liquids inside 251 vape pens and cartridges/pods/bottled e-liquids were analyzed using a gas chromatography/mass spectrometry (GC/MS). For comparison, new JUUL pods, the most commonly used e-cigarette among youth during 2018-2019, with different flavorings and nicotine content were purchased and analyzed. RESULTS For e-cigarette cartridges/pods/bottled e-liquids, nicotine was detected in 204 of 208 (98.1%) samples. Propylene glycol (PG) and vegetable glycerin (VG) were dominant solvents in nicotine-containing EVPs. Among 43 disposable vape pen devices, cannabinoids such as tetrahydrocannabinol (THC) or cannabidiol (CBD) were identified in 39 of 43 (90.1%) samples, of which 3 contained both nicotine and THC. Differences in chemical compositions were observed between confiscated or collected JUULs and purchased JUULs. Measured nicotine was inconsistent with labels on some confiscated or collected bottled e-liquids. CONCLUSIONS EVPs from 16 participating schools were found to widely contain substances with known adverse health effects among youth, including nicotine and cannabinoids. There was inconsistency between labeled and measured nicotine on the products from schools. IMPLICATIONS This study measured the main chemical compositions of EVPs found at 16 California public high schools. Continued efforts are warranted, including at the school-level, to educate, prevent and reduce youth use of EVPs.
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Affiliation(s)
- Ping Wang
- Air Quality Section, California Department of Public Health, Richmond, CA, USA
| | - Rebecca J Williams
- California Tobacco Control Program, California Department of Public Health, Sacramento, CA, USA
| | - Wenhao Chen
- Air Quality Section, California Department of Public Health, Richmond, CA, USA
| | - Flavia Wang
- Air Quality Section, California Department of Public Health, Richmond, CA, USA
| | - Mays Shamout
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren J Tanz
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn T A Herzig
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa P Oakley
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Corey M Peak
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy Heinzerling
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Occupational Health Branch, California Department of Public Health, Richmond, CA, USA
| | - Maeh Al-Shawaf
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Melstrom
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristy Marynak
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael A Tynan
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Israel T Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kazukiyo Kumagai
- Air Quality Section, California Department of Public Health, Richmond, CA, USA
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Gibb K, Beckman S, Vergara XP, Heinzerling A, Harrison R. Extreme Heat and Occupational Health Risks. Annu Rev Public Health 2024; 45. [PMID: 38166501 DOI: 10.1146/annurev-publhealth-060222-034715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Climate change poses a significant occupational health hazard. Rising temperatures and more frequent heat waves are expected to cause increasing heat-related morbidity and mortality for workers across the globe. Agricultural, construction, military, firefighting, mining, and manufacturing workers are at particularly high risk for heat-related illness (HRI). Various factors, including ambient temperatures, personal protective equipment, work arrangements, physical exertion, and work with heavy equipment may put workers at higher risk for HRI. While extreme heat will impact workers across the world, workers in low- and middle-income countries will be disproportionately affected. Tracking occupational HRI will be critical to informing prevention and mitigation strategies. Renewed investment in these strategies, including workplace heat prevention programs and regulatory standards for indoor and outdoor workers, will be needed. Additional research is needed to evaluate the effectiveness of interventions in order to successfully reduce the risk of HRI in the workplace. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Kathryn Gibb
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA;
| | - Stella Beckman
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA;
| | | | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA;
| | - Robert Harrison
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA;
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Gandhi SA, Heinzerling A, Flattery J, Fazio JC, Alam A, Cummings KJ, Harrison RJ. Active Surveillance of Engineered Stone Workers Facilitates Early Identification of Silicosis: A Discussion of Surveillance of Occupational Lung Diseases. New Solut 2023; 33:119-129. [PMID: 37649363 DOI: 10.1177/10482911231189503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Silicosis in workers exposed to respirable crystalline silica while fabricating engineered stone products is an emerging respiratory health issue. We describe silicosis in engineered stone workers in California and examine clinical features by the source of identification. Cases were identified passively using hospital-based patient discharge data or actively through outreach and medical testing following enforcement investigation. Outcomes were examined based on the source of case identification. We identified 18 cases diagnosed between 2006 and 2020. Cases identified passively compared to other identification methods were associated with lower percent predicted forced vital capacity (FVC) (P ≤ .01), forced expiratory volume in 1 s (FEV1) (P ≤ .01), and diffusing capacity of the lungs for carbon monoxide (DLCO) (P < .01) at the time of diagnosis and were more likely to be identified following death or lung transplant (P = .01). Our experience demonstrates delays in diagnosis and case identification when relying on passive surveillance methods. Enhanced public health surveillance systems can improve the early detection of occupational lung disease and inform future prevention policies.
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Affiliation(s)
- Sheiphali A Gandhi
- Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Amy Heinzerling
- California Department of Public Health, Occupational Health Branch, Richmond, CA, USA
| | - Jennifer Flattery
- California Department of Public Health, Occupational Health Branch, Richmond, CA, USA
| | - Jane C Fazio
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Asim Alam
- California Pacific Medical Center, Division of Pulmonary and Critical Care Medicine, San Francisco, CA, USA
| | - Kristin J Cummings
- California Department of Public Health, Occupational Health Branch, Richmond, CA, USA
| | - Robert J Harrison
- California Department of Public Health, Occupational Health Branch, Richmond, CA, USA
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4
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Gandhi SA, Heinzerling A, Flattery J, Cummings KJ. Occupational Contributions to Respiratory Health Disparities. Clin Chest Med 2023; 44:635-649. [PMID: 37517841 PMCID: PMC10861114 DOI: 10.1016/j.ccm.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Occupation is an important contributor to disparities in respiratory disease, affecting financial status, health-care access, and exposure to hazardous substances. Although occupation and associated exposures are included in the socioecological models, work exposures remain persistently absent from research on health inequities and their contribution to health. This article focuses on the occupational contribution to disparities in asthma, chronic obstructive pulmonary disease, silicosis, coronavirus disease 2019, and lung cancer. Because occupational exposures are largely preventable through proper workplace controls, the recognition of occupational causes of disease can provide an opportunity for interventions to bring about health equity.
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Affiliation(s)
- Sheiphali A Gandhi
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, 2330 Post St Ste 460, San Francisco, CA 94115, USA
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA
| | - Jennifer Flattery
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA.
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5
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Fazio JC, Gandhi SA, Flattery J, Heinzerling A, Kamangar N, Afif N, Cummings KJ, Harrison RJ. Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California. JAMA Intern Med 2023; 183:991-998. [PMID: 37486642 PMCID: PMC10366949 DOI: 10.1001/jamainternmed.2023.3295] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/27/2023] [Indexed: 07/25/2023]
Abstract
Importance Silicosis associated with inhalation of respirable crystalline silica among engineered stone countertop fabrication workers is an emerging health concern. Objective To describe clinical, socioeconomic, and occupational characteristics of patients diagnosed with silicosis associated with engineered stone in California. Design, Setting, and Participants This case series included reported cases of silicosis associated with fabrication of engineered stone countertops, as identified by statewide surveillance by the California Department of Public Health (2019-2022). Data analysis was performed from October 2022 to March 2023. Exposures Patient interviews and medical record abstractions were used to assess occupational exposure to respirable crystalline silica, including duration of work tenure and preventive measures undertaken. Main Outcomes and Measures Demographics, clinical characteristics, health care utilization, and clinical outcomes were obtained, including vital status, hypoxia, and lung transplant. Results This case series identified 52 male patients meeting inclusion criteria; median (IQR) age was 45 (40-49) years, and 51 were Latino immigrants. Ten (19%) were uninsured, and 20 (39%) had restricted-scope Medi-Cal; 25 (48%) presented initially to an emergency department. A delay in diagnosis occurred in 30 (58%) patients, most commonly due to alternative initial diagnoses of bacterial pneumonia (9 [30%]) or tuberculosis (8 [27%]). At diagnosis, 20 (38%) patients had advanced disease (progressive massive fibrosis) with severely or very severely reduced forced expiratory volume in 1 second in 8 (18%) and 5 (11%), respectively. Of the cases, 10 (19%) were fatal; median (IQR) age at death was 46 (38-51) years, and 6 patients (12%) were alive with chronic resting hypoxia. Eleven were referred for lung transplant: 3 underwent transplant with 1 fatality; 7 were declined transplant, with 6 fatalities; and 1 died prior to listing. Median (IQR) work tenure was 15 (10-20) years; 23 (45%) reported use of water suppression for dust mitigation, and 25 (48%) continued to fabricate stone after being diagnosed with silicosis. Conclusions and Relevance In this case series performed in California, silicosis associated with occupational exposure to dust from engineered stone primarily occurred among young Latino immigrant men. Many patients presented with severe disease, and some cases were fatal.
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Affiliation(s)
- Jane C. Fazio
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Occupational Health Branch, California Department of Public Health, Richmond
- Division of Pulmonary, Critical Care, and Sleep Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - Sheiphali A. Gandhi
- Occupational Health Branch, California Department of Public Health, Richmond
- Division of Occupational, Environmental, and Climate Medicine, University of California, San Francisco
| | - Jennifer Flattery
- Occupational Health Branch, California Department of Public Health, Richmond
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, Richmond
| | - Nader Kamangar
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Division of Pulmonary, Critical Care, and Sleep Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - Nawal Afif
- Division of Pulmonary, Critical Care, and Sleep Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - Kristin J. Cummings
- Occupational Health Branch, California Department of Public Health, Richmond
| | - Robert J. Harrison
- Occupational Health Branch, California Department of Public Health, Richmond
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6
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Wong J, Cummings KJ, Gibb K, Rodriguez A, Heinzerling A, Vergara XP. Risk factors for COVID-19 among Californians working outside the home, November 2020 - May 2021. Am J Ind Med 2023; 66:233-242. [PMID: 36694299 DOI: 10.1002/ajim.23459] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/09/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Higher incidences of COVID-19 mortality and outbreaks have been found in certain industries and occupations. Workplace factors, including working in close proximity to others and contact with the public can facilitate SARS-CoV-2 transmission, especially without appropriate protective measures. Limited information is available about workers at highest risk for SARS-CoV-2 infection. METHODS A phone-based, nonprobability study was conducted between November 2020 and May 2021 among California workers who were tested for SARS-CoV-2. Participants were asked about demographics and workplace factors, including industry, occupation, and implementation of COVID-19 mitigation measures. Using the SARS-CoV-2 occupational exposure matrix, three exposure metrics and a combination index were used to categorize occupations. We assessed the association between workplace risks and SARS-CoV-2 test positivity using adjusted logistic regression. RESULTS We enrolled 451 (13%) of 3475 potentially eligible workers in the study: 212 with positive and 239 with negative SARS-CoV-2 test results. Those working very close to others and with the highest combined exposure index had a positive association with SARS-CoV-2 positivity. Primarily indoor workers had a lower odds of test positivity compared to those with any outdoor work. There was no association between public-facing occupations and test positivity. Participants with employers who implemented mitigation measures in all three control categories-engineering, administrative, and personal protective equipment-had lower odds of test positivity than those with fewer mitigation measures. CONCLUSIONS Worker groups with higher risk factors should be prioritized for outreach. Assessment of occupational risk factors collectively can provide insight to inform preventative actions for workers, employers, and public health entities.
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Affiliation(s)
- Jessie Wong
- California Department of Public Health, Occupational Health Branch, Richmond, California, USA.,Public Health Institute, Oakland, California, USA
| | - Kristin J Cummings
- California Department of Public Health, Occupational Health Branch, Richmond, California, USA
| | - Kathryn Gibb
- California Department of Public Health, Occupational Health Branch, Richmond, California, USA.,Public Health Institute, Oakland, California, USA
| | - Andrea Rodriguez
- California Department of Public Health, Occupational Health Branch, Richmond, California, USA.,Public Health Institute, Oakland, California, USA
| | - Amy Heinzerling
- California Department of Public Health, Occupational Health Branch, Richmond, California, USA
| | - Ximena P Vergara
- California Department of Public Health, Occupational Health Branch, Richmond, California, USA.,Heluna Health, City of Industry, California, USA
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7
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Luckhaupt SE, Horter L, Groenewold MR, de Perio MA, Robbins CL, Sweeney MH, Thomas I, Valencia D, Ingram A, Heinzerling A, Nguyen A, Townsend EB, Weber RC, Reichbind D, Dishman H, Kerins JL, Lendacki FR, Austin C, Dixon L, Spillman B, Simonson S, Tonzel J, Krueger A, Duwell M, Bachaus B, Rust B, Barrett C, Morrison B, Owers Bonner KA, Karlsson ND, Angelon-Gaetz K, McClure ES, Kline KE, Dangar D, Reed C, Karpowicz J, Anderson SM, Cantor S, Chaudhary I, Ellis EM, Taylor ML, Sedon A, Kocharian A, Morris C, Samson ME, Mangla AT. COVID-19 Outbreaks Linked to Workplaces, 23 US Jurisdictions, August-October 2021. Public Health Rep 2023; 138:333-340. [PMID: 36482712 PMCID: PMC9742731 DOI: 10.1177/00333549221138294] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August-October 2021. METHODS The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. RESULTS Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non-food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. CONCLUSIONS These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials.
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Affiliation(s)
- Sara E. Luckhaupt
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
- Sara E. Luckhaupt, MD, Centers for Disease
Control and Prevention, COVID-19 Response Team, 1090 Tusculum Ave, MS R-12,
Cincinnati, OH 45226, USA.
| | - Libby Horter
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
- Goldbelt C6, LLC, Chesapeake, VA,
USA
| | - Matthew R. Groenewold
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Marie A. de Perio
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Cheryl L. Robbins
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Marie Haring Sweeney
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Isabel Thomas
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
- ORISE Fellowship, Oak Ridge Associated
Universities, Oak Ridge, TN, USA
| | - Diana Valencia
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Ingram
- Alabama Department of Public Health,
Montgomery, AL, USA
| | | | - Alyssa Nguyen
- California Department of Public Health,
Sacramento, CA, USA
| | - Emily B. Townsend
- Colorado Department of Public Health
and Environment, Denver, CO, USA
| | - Rachel C. Weber
- Colorado Department of Public Health
and Environment, Denver, CO, USA
| | | | - Hope Dishman
- Georgia Department of Public Health,
Atlanta, GA, USA
| | | | | | - Connie Austin
- Illinois Department of Public Health,
Springfield, IL, USA
| | - Liana Dixon
- Kentucky Department for Public
Health, Frankfort, KY, USA
| | | | - Sean Simonson
- Louisiana Department of Health, Baton
Rouge, LA, USA
| | - Julius Tonzel
- Louisiana Department of Health, Baton
Rouge, LA, USA
| | - Anna Krueger
- Maine Center for Disease Control and
Prevention, Augusta, ME, USA
| | | | | | - Britney Rust
- Mississippi Department of Health,
Jackson, MS, USA
| | | | | | - Katharine A. Owers Bonner
- New Hampshire Division of Public
Health Services, Department of Health and Human Services, Concord, NH, USA
| | - Nicole D. Karlsson
- New Hampshire Division of Public
Health Services, Department of Health and Human Services, Concord, NH, USA
| | - Kim Angelon-Gaetz
- North Carolina Department of Health
and Human Services, Raleigh, NC, USA
| | | | | | - Dhara Dangar
- Pennsylvania Department of Health,
Harrisburg, PA, USA
| | - Chasey Reed
- Rhode Island Department of Health,
Providence, RI, USA
| | | | | | - Sophia Cantor
- Texas Department of State Health
Services, Austin, TX, USA
| | | | - Esther M. Ellis
- US Virgin Islands Department of
Health, Christiansted, VI, USA
| | | | | | | | | | | | - Anil T. Mangla
- District of Columbia Department of
Health, Washington, DC, USA
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Spiegel A, Cummings KJ, Flattery J, Harrison R, Heinzerling A. Self-reported silica exposures and workplace protections among engineered stone fabrication workers in California. Am J Ind Med 2022; 65:1022-1024. [PMID: 36214615 DOI: 10.1002/ajim.23432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Ariana Spiegel
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kristin J Cummings
- California Department of Public Health, Occupational Health Branch, Richmond, California, USA
| | - Jennifer Flattery
- California Department of Public Health, Occupational Health Branch, Richmond, California, USA
| | - Robert Harrison
- California Department of Public Health, Occupational Health Branch, Richmond, California, USA
| | - Amy Heinzerling
- California Department of Public Health, Occupational Health Branch, Richmond, California, USA
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Surasi K, Ballen B, Weinberg JL, Materna BL, Harrison R, Cummings KJ, Heinzerling A. Elevated exposures to respirable crystalline silica among engineered stone fabrication workers in California, January 2019-February 2020. Am J Ind Med 2022; 65:701-707. [PMID: 35899403 DOI: 10.1002/ajim.23416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Workers fabricating engineered stone face high risk for exposure to respirable crystalline silica (RCS) and subsequent development of silicosis. In response, the California Division of Occupational Safety and Health (Cal/OSHA) performed targeted enforcement inspections at engineered stone fabrication worksites. We investigated RCS exposures and employer adherence to Cal/OSHA's RCS and respiratory protection standards from these inspections to assess ongoing risk to stone fabrication workers. METHODS We extracted employee personal air sampling results from Cal/OSHA inspection files and calculated RCS exposures. Standards require that employers continue monitoring employee RCS exposures and perform medical surveillance when exposures are at or above the action level (AL; 25 μg/m3 ); exposures above the permissible exposure limit (PEL; 50 μg/m3 ) are prohibited. We obtained RCS and respiratory protection standard violation citations from a federal database. RESULTS We analyzed RCS exposures for 152 employees at 47 workplaces. Thirty-eight (25%) employees had exposures above the PEL (median = 89.7 μg/m3 ; range = 50.7-670.7 μg/m3 ); 17 (11%) had exposures between the AL and PEL. Twenty-four (51%) workplaces had ≥1 exposure above the PEL; 7 (15%) had ≥1 exposure between the AL and PEL. Thirty-four (72%) workplaces were cited for ≥1 RCS standard violation. Twenty-seven (57%) workplaces were cited for ≥1 respiratory protection standard violation. CONCLUSIONS Our investigation demonstrates widespread RCS overexposure among workers and numerous employer Cal/OSHA standard violation citations. More enforcement and educational efforts could improve employer compliance with Cal/OSHA standards and inform employers and employees of the risks for RCS exposure and strategies for reducing exposure.
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Affiliation(s)
- Krishna Surasi
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia, USA
| | - Brittany Ballen
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Justine L Weinberg
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- Public Health Institute, Richmond, Richmond, USA
| | - Barbara L Materna
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
| | - Robert Harrison
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
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Heinzerling A, Vergara XP, Gebreegziabher E, Beckman J, Wong J, Nguyen A, Khan S, Frederick M, Bui D, Chan E, Gibb K, Rodriguez A, Jain S, Cummings KJ. COVID-19 Outbreaks and Mortality Among Public Transportation Workers - California, January 2020-May 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1052-1056. [PMID: 35980867 PMCID: PMC9400527 DOI: 10.15585/mmwr.mm7133a4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Heinzerling A, Nguyen A, Frederick M, Chan E, Gibb K, Rodriguez A, Wong J, Epson E, Watt J, Materna B, Jain S. Workplaces Most Affected by COVID-19 Outbreaks in California, January 2020-August 2021. Am J Public Health 2022; 112:1180-1190. [PMID: 35830667 PMCID: PMC9342810 DOI: 10.2105/ajph.2022.306862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 12/12/2022]
Abstract
Objectives. To describe which industries have the highest burden of COVID-19 outbreaks in California. Methods. We assigned US census industry codes to COVID-19 outbreaks reported to the California Department of Public Health (CDPH) from January 1, 2020, to August 31, 2021, and determined numbers of outbreaks, numbers of outbreak-associated cases, and outbreak incidence levels by industry. We determined characteristics of outbreak-associated cases using individual case data linked to COVID-19 outbreaks. Results. Local health departments reported 19 893 COVID-19 outbreaks and 300 379 outbreak-associated cases to CDPH. The most outbreaks (47.8%) and outbreak-associated cases (54.8%) occurred in the health care and social assistance sector, where outbreak incidence levels were highest in skilled nursing facilities and residential care facilities (1306 and 544 outbreaks per 1000 establishments, respectively). High proportions of outbreaks also occurred in the retail trade (8.6%) and manufacturing (7.9%) sectors. Demographics of outbreak-associated cases varied across industries. Conclusions. Certain California industries, particularly in the health care, manufacturing, and retail sectors, have experienced a high burden of COVID-19 outbreaks during the pandemic. Public Health Implications. Tracking COVID-19 outbreaks by industry may help target prevention efforts, including workforce vaccination. (Am J Public Health. 2022;112(8):1180-1190. https://doi.org/10.2105/AJPH.2022.306862).
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Affiliation(s)
- Amy Heinzerling
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Alyssa Nguyen
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Matt Frederick
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Elena Chan
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Kathryn Gibb
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Andrea Rodriguez
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Jessie Wong
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Erin Epson
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - James Watt
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Barbara Materna
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Seema Jain
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
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12
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Heinzerling A, Cummings KJ, Flattery J, Weinberg JL, Materna B, Harrison R. Radiographic Screening Reveals High Burden of Silicosis among Workers at an Engineered Stone Countertop Fabrication Facility in California. Am J Respir Crit Care Med 2021; 203:764-766. [PMID: 33207123 DOI: 10.1164/rccm.202008-3297le] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Amy Heinzerling
- California Department of Public Health Richmond, California
- CDC Atlanta, Georgia and
| | | | | | - Justine Lew Weinberg
- California Department of Public Health Richmond, California
- Public Health Institute Oakland, California
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13
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Heinzerling A, Laws RL, Frederick M, Jackson R, Windham G, Materna B, Harrison R. Risk factors for occupational heat-related illness among California workers, 2000-2017. Am J Ind Med 2020; 63:1145-1154. [PMID: 33075156 DOI: 10.1002/ajim.23191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND As climate change increases global temperatures, heat-related morbidity and mortality are projected to rise. Outdoor workers and those who perform exertional tasks are particularly susceptible to heat-related illness (HRI). Using workers' compensation data, we aimed to describe rates of occupational HRI in California and identify demographic and occupational risk factors to inform prevention efforts. METHODS We identified HRI cases during 2000-2017 in the California Workers' Compensation Information System (WCIS) using International Classification of Diseases Ninth and Tenth Revision codes, WCIS nature and cause of injury codes, and HRI keywords. We assigned industry and occupation codes using the NIOSH Industry and Occupation Computerized Coding System (NIOCCS). We calculated HRI rates by sex, age group, year, county, industry, and occupation, and estimated confidence intervals using generalized linear models. RESULTS We identified 15,996 HRI cases during 2000-2017 (6.0 cases/100,000 workers). Workers aged 16-24 years had the highest HRI rate (7.6) among age groups, and men (8.1) had a higher rate than women (3.5). Industry sectors with the highest HRI rates were Agriculture, Farming, Fishing, and Forestry (38.6), and Public Administration (35.3). Occupational groups with the highest HRI rates were Protective Services (56.6) and Farming, Fishing, and Forestry (36.6). Firefighters had the highest HRI rate (389.6) among individual occupations. CONCLUSIONS Workers in certain demographic and occupational groups are particularly susceptible to HRI. Additional prevention efforts, including outreach and enforcement targeting high-risk groups, are needed to reduce occupational HRI. Workers' compensation data can provide timely information about temporal trends and risk factors for HRI.
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Affiliation(s)
- Amy Heinzerling
- California Department of Public Health, Center for Healthy Communities, Richmond, California, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rebecca L Laws
- California Department of Public Health, Center for Healthy Communities, Richmond, California, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matt Frederick
- California Department of Public Health, Center for Healthy Communities, Richmond, California, USA
- Public Health Institute, Oakland, California, USA
| | - Rebecca Jackson
- California Department of Public Health, Center for Healthy Communities, Richmond, California, USA
| | - Gayle Windham
- California Department of Public Health, Center for Healthy Communities, Richmond, California, USA
| | - Barbara Materna
- California Department of Public Health, Center for Healthy Communities, Richmond, California, USA
| | - Robert Harrison
- California Department of Public Health, Center for Healthy Communities, Richmond, California, USA
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14
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Shamout M, Tanz L, Herzig C, Oakley LP, Peak CM, Heinzerling A, Hast M, McGowan E, Williams RJ, Hess C, Wang C, Planche S, Herndon S, Martin J, Kansagra SM, Al-Shawaf M, Melstrom P, Marynak K, Tynan MA, Agaku IT, King BA. Notes from the Field: Characteristics of E-cigarette, or Vaping, Products Confiscated in Public High Schools in California and North Carolina - March and May 2019. MMWR Morb Mortal Wkly Rep 2020; 69:1552-1554. [PMID: 33090981 PMCID: PMC7583502 DOI: 10.15585/mmwr.mm6942a7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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15
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Waltenburg MA, Rose CE, Victoroff T, Butterfield M, Dillaha JA, Heinzerling A, Chuey M, Fierro M, Jervis RH, Fedak KM, Leapley A, Gabel JA, Feldpausch A, Dunne EM, Austin C, Pedati CS, Ahmed FS, Tubach S, Rhea C, Tonzel J, Krueger A, Crum DA, Vostok J, Moore MJ, Kempher H, Scheftel J, Turabelidze G, Stover D, Donahue M, Thomas D, Edge K, Gutierrez B, Berl E, McLafferty M, Kline KE, Martz N, Rajotte JC, Julian E, Diedhiou A, Radcliffe R, Clayton JL, Ortbahn D, Cummins J, Barbeau B, Carpenter S, Pringle JC, Murphy J, Darby B, Graff NR, Dostal TKH, Pray IW, Tillman C, Rose DA, Honein MA. Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces. Emerg Infect Dis 2020; 27. [PMID: 33075274 PMCID: PMC7774547 DOI: 10.3201/eid2701.203821] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe coronavirus disease (COVID-19) among US food manufacturing and agriculture workers and provide updated information on meat and poultry processing workers. Among 742 food and agriculture workplaces in 30 states, 8,978 workers had confirmed COVID-19; 55 workers died. Racial and ethnic minority workers could be disproportionately affected by COVID-19.
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16
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Armatas C, Heinzerling A, Wilken JA. Notes from the Field: E-cigarette, or Vaping, Product Use-Associated Lung Injury Cases During the COVID-19 Response - California, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:801-802. [PMID: 32584801 PMCID: PMC7316321 DOI: 10.15585/mmwr.mm6925a5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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17
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Heinzerling A, Armatas C, Karmarkar E, Attfield K, Guo W, Wang Y, Vrdoljak G, Moezzi B, Xu D, Wagner J, Fowles J, Dean C, Cummings KJ, Wilken JA. Severe Lung Injury Associated With Use of e-Cigarette, or Vaping, Products-California, 2019. JAMA Intern Med 2020; 180:861-869. [PMID: 32142111 PMCID: PMC7060503 DOI: 10.1001/jamainternmed.2020.0664] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Since August 2019, more than 2700 patients have been hospitalized with e-cigarette, or vaping, product use-associated lung injury (EVALI) across the United States. This report describes the outbreak in California, a state with one of the highest case counts and with a legal adult-use (recreational) cannabis market. OBJECTIVE To present clinical characteristics and vaping product exposures of patients with EVALI in California. DESIGN, SETTING, AND PARTICIPANTS Case series describing epidemiologic and laboratory data from 160 hospitalized patients with EVALI reported to the California Department of Public Health by local health departments, who received reports from treating clinicians, from August 7 through November 8, 2019. EXPOSURES Standardized patient interviews were conducted to assess vaping products used, frequency of use, and method of product acquisition. Vaping products provided by a subset of patients were tested for active ingredients and other substances. MAIN OUTCOMES AND MEASURES Demographic and clinical characteristics, level of care, and outcomes of hospitalization were obtained from medical record review. RESULTS Among 160 patients with EVALI, 99 (62%) were male, and the median age was 27 years (range, 14-70 years). Of 156 patients with data available, 71 (46%) were admitted to an intensive care unit, and 46 (29%) required mechanical ventilation. Four in-hospital deaths occurred. Of 86 patients interviewed, 71 (83%) reported vaping tetrahydrocannabinol (THC)-containing products, 36 (43%) cannabidiol (CBD)-containing products, and 39 (47%) nicotine-containing products. Sixty-five of 87 (75%) THC-containing products were reported as obtained from informal sources, such as friends, acquaintances, or unlicensed retailers. Of 87 vaping products tested from 24 patients, 49 (56%) contained THC. Vitamin E or vitamin E acetate was found in 41 (84%) of the THC-containing products and no nicotine products. CONCLUSIONS AND RELEVANCE Patients' clinical outcomes and vaping behaviors, including predominant use of THC-containing products from informal sources, are similar to those reported by other states, despite California's legal recreational cannabis market. While most THC products tested contained vitamin E or vitamin E acetate, other underlying cause(s) of injury remain possible. The California Department of Public Health recommends that individuals refrain from using any vaping or e-cigarette products, particularly THC-containing products from informal sources, while this investigation is ongoing.
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Affiliation(s)
- Amy Heinzerling
- Center for Healthy Communities, California Department of Public Health, Richmond.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina Armatas
- Center for Healthy Communities, California Department of Public Health, Richmond
| | - Ellora Karmarkar
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Center for Infectious Diseases, California Department of Public Health, Richmond
| | - Kathleen Attfield
- Center for Healthy Communities, California Department of Public Health, Richmond
| | - Weihong Guo
- Center for Environmental Health, California Department of Public Health, Richmond
| | - Yun Wang
- Center for Environmental Health, California Department of Public Health, Richmond
| | - Gordon Vrdoljak
- Center for Environmental Health, California Department of Public Health, Richmond
| | - Bahman Moezzi
- Center for Environmental Health, California Department of Public Health, Richmond
| | - Dadong Xu
- Center for Environmental Health, California Department of Public Health, Richmond
| | - Jeff Wagner
- Center for Healthy Communities, California Department of Public Health, Richmond
| | - Jefferson Fowles
- Center for Healthy Communities, California Department of Public Health, Richmond
| | - Charity Dean
- Office of the Director, California Department of Public Health, Sacramento
| | - Kristin J Cummings
- Center for Healthy Communities, California Department of Public Health, Richmond
| | - Jason A Wilken
- Center for Healthy Communities, California Department of Public Health, Richmond.,Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia.,US Public Health Service Commissioned Corps, Rockville, Maryland
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18
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Heinzerling A, Stuckey MJ, Scheuer T, Xu K, Perkins KM, Resseger H, Magill S, Verani JR, Jain S, Acosta M, Epson E. Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient - Solano County, California, February 2020. MMWR Morb Mortal Wkly Rep 2020; 69:472-476. [PMID: 32298249 PMCID: PMC7755059 DOI: 10.15585/mmwr.mm6915e5] [Citation(s) in RCA: 315] [Impact Index Per Article: 78.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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19
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Perrine CG, Pickens CM, Boehmer TK, King BA, Jones CM, DeSisto CL, Duca LM, Lekiachvili A, Kenemer B, Shamout M, Landen MG, Lynfield R, Ghinai I, Heinzerling A, Lewis N, Pray IW, Tanz LJ, Patel A, Briss PA. Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping - United States, 2019. MMWR Morb Mortal Wkly Rep 2019; 68:860-864. [PMID: 31581168 PMCID: PMC6776378 DOI: 10.15585/mmwr.mm6839e1] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Electronic cigarettes (e-cigarettes), also called vapes, e-hookas, vape pens, tank systems, mods, and electronic nicotine delivery systems (ENDS), are electronic devices that produce an aerosol by heating a liquid typically containing nicotine, flavorings, and other additives; users inhale this aerosol into their lungs (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis (1). Use of e-cigarettes is commonly called vaping. Lung injury associated with e-cigarette use, or vaping, has recently been reported in most states (2-4). CDC, the Food and Drug Administration (FDA), state and local health departments, and others are investigating this outbreak. This report provides data on patterns of the outbreak and characteristics of patients, including sex, age, and selected substances used in e-cigarette, or vaping, products reported to CDC as part of this ongoing multistate investigation. As of September 24, 2019, 46 state health departments and one territorial health department had reported 805 patients with cases of lung injury associated with use of e-cigarette, or vaping, products to CDC. Sixty-nine percent of patients were males, and the median age was 23 years (range = 13-72 years). To date, 12 deaths have been confirmed in 10 states. Among 514 patients with information on substances used in e-cigarettes, or vaping products, in the 30 days preceding symptom onset, 76.9% reported using THC-containing products, and 56.8% reported using nicotine-containing products; 36.0% reported exclusive use of THC-containing products, and 16.0% reported exclusive use of nicotine-containing products. The specific chemical exposure(s) causing the outbreak is currently unknown. While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, particularly those containing THC. CDC will continue to work in collaboration with FDA and state and local partners to investigate cases and advise and alert the public on the investigation as additional information becomes available.
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20
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Rose C, Heinzerling A, Patel K, Sack C, Wolff J, Zell-Baran L, Weissman D, Hall E, Sooriash R, McCarthy RB, Bojes H, Korotzer B, Flattery J, Weinberg JL, Potocko J, Jones KD, Reeb-Whitaker CK, Reul NK, LaSee CR, Materna BL, Raghu G, Harrison R. Severe Silicosis in Engineered Stone Fabrication Workers - California, Colorado, Texas, and Washington, 2017-2019. MMWR Morb Mortal Wkly Rep 2019; 68:813-818. [PMID: 31557149 PMCID: PMC6762184 DOI: 10.15585/mmwr.mm6838a1] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Silicosis is an incurable occupational lung disease caused by inhaling particles of respirable crystalline silica. These particles trigger inflammation and fibrosis in the lungs, leading to progressive, irreversible, and potentially disabling disease. Silica exposure is also associated with increased risk for lung infection (notably, tuberculosis), lung cancer, emphysema, autoimmune diseases, and kidney disease (1). Because quartz, a type of crystalline silica, is commonly found in stone, workers who cut, polish, or grind stone materials can be exposed to silica dust. Recently, silicosis outbreaks have been reported in several countries among workers who cut and finish stone slabs for countertops, a process known as stone fabrication (2-5). Most worked with engineered stone, a manufactured, quartz-based composite material that can contain >90% crystalline silica (6). This report describes 18 cases of silicosis, including the first two fatalities reported in the United States, among workers in the stone fabrication industry in California, Colorado, Texas, and Washington. Several patients had severe progressive disease, and some had associated autoimmune diseases and latent tuberculosis infection. Cases were identified through independent investigations in each state and confirmed based on computed tomography (CT) scan of the chest or lung biopsy findings. Silica dust exposure reduction and effective regulatory enforcement, along with enhanced workplace medical and public health surveillance, are urgently needed to address the emerging public health threat of silicosis in the stone fabrication industry.
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Abstract
By convention, airborne particles ≤0.1 μm (100 nm) are defined as ultrafine particles (UFPs). UFPs can comprise a large number of particles in particulate matter with aerodynamic diameters ≤2.5 μm (PM2.5). Despite the documented respiratory health effects of PM2.5 and concerns that UFPs might be more toxic than larger particular matter, the effects of UFPs on the respiratory system are not well-described. Even less is known about the respiratory health effects of UFPs among particularly vulnerable populations including children. We reviewed studies examining respiratory health effects of UFPs in children and identified 12 relevant articles. Most (8/12) studies measured UFP exposure using central ambient monitors, and we found substantial heterogeneity in UFP definitions and study designs. No long-term studies were identified. In single pollutant models, UFPs were associated with incident wheezing, current asthma, lower spirometric values, and asthma-related emergency department visits among children. Also, higher exhaled nitric oxide levels were positively correlated with UFP dose among children with asthma or allergy to house dust mites in 1 study. Multivariate models accounting for potential co-pollutant confounding yielded no statistically significant results. Although evidence for a relationship between UFPs and children's respiratory is accumulating, the literature remains inconclusive. Interpretation of existing data is constrained by study heterogeneity, limited accounting for UFP spatial variation, and lack of significant findings from multi-pollutant models.
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Affiliation(s)
- Amy Heinzerling
- Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, Moffitt Room 987, San Francisco, CA, 94143, USA
| | - Joy Hsu
- Epidemic Intelligence Service, Office of Public Health Scientific Services, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-60, Atlanta, GA, 30341, USA
| | - Fuyuen Yip
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-60, Atlanta, GA, 30341, USA
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22
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Itakura K, Lessing J, Sakata T, Heinzerling A, Vriens E, Wisner D, Alvarado M, Esserman L, Ewing C, Hylton N, Hwang ES. The impact of preoperative magnetic resonance imaging on surgical treatment and outcomes for ductal carcinoma in situ. Clin Breast Cancer 2011; 11:33-8. [PMID: 21421520 DOI: 10.3816/cbc.2011.n.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although magnetic resonance imaging (MRI) is a useful imaging modality for invasive cancer, its role in preoperative surgical planning for ductal carcinoma in situ (DCIS) has not been established. We sought to determine whether preoperative MRI affects surgical treatment and outcomes in women with pure DCIS. PATIENTS AND METHODS We reviewed consecutive records of women diagnosed with pure DCIS on core biopsy between 2000 and 2007. Patient characteristics, surgical planning, and outcomes were compared between patients with and without preoperative MRI. Multivariable regression was performed to determine which covariates were independently associated with mastectomy or sentinel lymph node biopsy (SLNB). RESULTS Of 149 women diagnosed with DCIS, 38 underwent preoperative MRI. On univariate analysis, patients undergoing MRI were younger (50 years vs. 59 years; P < .001) and had larger DCIS size on final pathology (1.6 cm vs. 1.0 cm; P = .007) than those without MRI. Mastectomy and SLNB rates were significantly higher in the preoperative MRI group (45% vs. 14%, P < .001; and 47% vs. 23%, P = .004, respectively). However, there were no differences in number of re-excisions, margin status, and margin size between the two groups. On multivariate analysis, preoperative MRI and age were independently associated with mastectomy (OR, 3.16, P = .018; OR, 0.95, P = .031, respectively), while multifocality, size, and family history were not significant predictors. CONCLUSION We found a strong association between preoperative MRI and mastectomy in women undergoing treatment for DCIS. Additional studies are needed to examine the increased rates of mastectomy as a possible consequence of preoperative MRI for DCIS.
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Affiliation(s)
- Kaoru Itakura
- Department of Surgery, University of California, San Francisco, USA
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