Antimicrobial resistance (AMR) is a global health issue expected to worsen with climate change. Excessive & unnecessary exposure to antibiotics leads to AMR, and understanding the pathways of antibiotic exposure can help identify high-risk population, document & understand disparities, & implement interventions. California’s Central Valley is an ideal place to investigate the varied potential pathways for antibiotic exposure. The area is the largest agricultural region in California, healthcare is mostly delivered in rural environments, and the region suffers disproportionally from air pollution and water contamination. Further, individuals living in the Valley have the poorest health outcomes in the state, increasing their risk for the negative health impacts due to AMR.

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