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Aphids are phloem-feeding insects that reduce crop productivity due to feeding and transmission of plant viruses. When aphids disperse across the landscape to colonize new host plants, they will often probe on a wide variety of nonhost plants before settling on a host suitable for feeding and reproduction. There is limited understanding of the diversity of plants that aphids probe on within a landscape, and characterizing this diversity can help us better understand host use patterns of aphids. Here, we used gut content analysis (GCA) to identify plant genera that were probed by aphid vectors of potato virus Y (PVY). Aphids were trapped weekly near potato fields during the growing seasons of 2020 and 2021 in San Luis Valley in Colorado. High-throughput sequencing of plant barcoding genes, trnF and ITS2, from 200 individual alate (i.e., winged) aphids representing nine vector species of PVY was performed using the PacBio sequencing platform, and sequences were identified to genus using NCBI BLASTn. We found that 34.7% of aphids probed upon presumed PVY host plants and that two of the most frequently detected plant genera, Solanum and Brassica, represent important crops and weeds within the study region. We found that 75% of aphids frequently probed upon PVY nonhosts including many species that are outside of their reported host ranges. Additionally, 19% of aphids probed upon more than one plant species. This study provides the first evidence from high-throughput molecular GCA of aphids and reveals host use patterns that are relevant for PVY epidemiology., (© 2024 The Authors. Insect Science published by John Wiley & Sons Australia, Ltd on behalf of Institute of Zoology, Chinese Academy of Sciences.)

Social determinants profoundly impact health. Many primary care practices now seek to screen their patients for health-related social needs (HRSN) and refer them to resources in the community. However, there is little empirical evidence to guide communication with patients in order to ensure their comfort with the process and increase the likelihood that it results in positive outcomes. This paper describes the first phase of the Improving Messaging Around Gaps in Needs and rEfferals (IMAGINE) study-a multi-phase study aiming to develop and test patient-centred messages about screening and referral for HRSN. In this initial qualitative phase, our objective was to identify communication strategies that might make western Colorado primary care patients more comfortable with the HRSN screening and referral process. From May to July 2020 we interviewed 10 staff members responsible for HRSN screening from primary care practices participating in the western Colorado Accountable Health Communities (AHC) initiative and 20 patients from 2 of these practices. We used a rapid qualitative analysis process that involved summarising interview transcripts across key domains of interest and then identifying emergent themes within each domain using a data matrix. Through this process, we examined current communication about HRSN screening, as well as suggestions for messages and other strategies that could improve communication. In most practices, the AHC Screening Tool was handed to patients by front desk staff at check-in with little explanation as to its purpose. Patients and staff alike recommended that patients be provided with information that: normalises the screening and referral process; assures privacy; clarifies that the purpose is to help and support rather than judge or report; emphasises community benefits; and respects patient autonomy. Interviewees also suggested broader strategies to support more effective communication, such as practice staff and clinicians building trusting relationships with patients and understanding and acknowledging the complex structural barriers that often prevent patients from accessing meaningful assistance. These findings provide actionable suggestions for improving communication about HRSN screening and referral in primary care settings. The next steps include developing specific messages based on these findings and testing their impact on screening tool completion rate, referral uptake, and patient-reported comfort with the process., (© 2022 John Wiley & Sons Ltd.)

Context: Colorado is experiencing dramatic changes related to population growth, climate change, and expanded industrial activity. Local and state public health professionals are trying to address a growing array of unique public health issues with stagnant or limited resources., Objectives: To understand, through perspectives from local and state public health professionals, the alignment of contemporary environmental and community health issues with state and local capacity and state environmental public health-tracking priorities., Design: During 2014-2015, we conducted semistructured interviews which informed the development of a statewide survey of Colorado's professionals from public health, emergency management, forestry, and transportation., Setting: This work took place in Colorado., Participants: Fifteen professionals from public (n = 9), academic (n = 4), and private (n = 2) sectors were interviewed. Forty-seven professionals, representing 34 counties and 40 public agencies, completed the 25-minute online survey., Main Outcome Measures: Environmental and community health concerns; contributing factors to environmental concerns; strengths and limitations of capacity to respond to issues; and frequency of community engagement activities., Results: Top environmental health concerns were indoor air pollution (eg, radon), outdoor air pollution, and waste management. Transportation, extreme weather (eg, wildfires), and oil and gas development were most frequently reported as major contributing factors to concerns. Obesity, physical inactivity, and mental illness were the top community health concerns. To remain prepared for emerging challenges, professionals cited a need for more spatiotemporal-refined data related to their top concerns in the environmental public health-tracking database, and support from local, state, and federal agencies, in addition to personnel and funding. To address concerns, participants reported frequently working with government officials, advisory committees, and media outlets., Conclusions: This project illuminates opportunities to strengthen connections between the state's environmental public health-tracking priorities and local-level capacity related to professionals' top concerns. It also suggests reinforcing and broadening partnerships to improve data infrastructure and inform environmental public health priorities., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Cannabis may be a substitute for opioids but previous studies have found conflicting results when using data from more recent years. Most studies have examined the relationship using state-level data, missing important sub-state variation in cannabis access., Objective: To examine cannabis legalization on opioid use at the county level, using Colorado as a case study. Colorado allowed recreational cannabis stores in January 2014. Local communities could decide whether to allow dispensaries, creating variation in the level of exposure to cannabis outlets., Design: Observational, quasi-experimental design exploiting county-level variation in allowance of recreational dispensaries., Subjects: Colorado residents MEASURES: We use licensing information from the Colorado Department of Revenue to measure county-level exposure to cannabis outlets. We use the state's Prescription Drug Monitoring Program (2013-2018) to construct opioid-prescribing measures of number of 30-day fills and total morphine equivalents, both per county resident per quarter. We construct outcomes of opioid-related inpatient visits (2011-2018) and emergency department visits (2013-2018) with Colorado Hospital Association data. We use linear models in a differences-in-differences framework that accounts for the varying exposure to medical and recreational cannabis over time. There are 2048 county-quarter observations used in the analysis., Results: We find mixed evidence of cannabis exposure on opioid-related outcomes at the county level. We find increasing exposure to recreational cannabis is associated with a statistically significant decrease in number of 30-day fills (coefficient: -117.6, p-value<0.01) and inpatient visits (coefficient: -0.8, p-value: 0.03), but not total MME nor ED visits. Counties with no medical exposure prior to recreational legalization experience greater reductions in the number of 30-day fills and MME than counties with prior medical exposure (p=0.02 for both)., Conclusions: Our mixed findings suggest that further increases in cannabis beyond medical access may not always reduce opioid prescribing or opioid-related hospital visits at a population level., (© 2023. The Author(s).)

Background: Approximately 20% of the US population live in states where MAiD is a legal, though highly contentious, practice. Little generalizable data exists on the experiences of MAiD providers who comprise a small, and intentionally hidden, population., Objective: To examine the nature, extent, and consequences of physicians' participation in MAiD., Design: An anonymous, multi-wave, mailed survey (RR= 55%)., Participants: An enriched sample (n=583) of Colorado physicians caring for potential MAiD patients., Main Measures: Physician willingness, preparedness, and participation in a continuum of MAiD activities. Other outcomes include the effects of providing MAiD and the barriers physicians face related to MAiD., Key Results: Overall, 81.1% of respondents were willing to discuss MAiD with a patient, 88.3% to refer for MAiD, 46.3% to be a consultant, and 28.1% to be an attending. Fewer felt prepared to discuss MAiD (54.4%), provide a MAiD referral (62.8%), be a consultant (30.7%), or be an attending (18.0%). More than half of respondents (52.3%) had discussed MAiD with a patient, 27.3% provided a MAiD referral, 12.8% had been a MAiD consultant, and 8.5% had been a MAiD attending. Among MAiD consultants and attendings, 75% reported that their most recent MAiD case was emotionally fulfilling and professionally rewarding, though 75% also reported that it was time consuming and 46.9% reported that it was ethically challenging. Common barriers to physician participation in MAiD include lack of knowledge about MAiD (46.8%), the emotional (45.6%) and time (41.7%) investments, and ethical concerns (41.7%)., Conclusions: Many physicians in our sample are both willing and prepared to discuss MAiD with patients and to provide MAiD referrals. Fewer are prepared and willing to serve as an attending or consultant and fewer have provided these services. MAID consultants and attendings largely report the experience to be emotionally fulfilling and professionally rewarding, but all respondents reported multiple barriers to participation., (© 2021. The Author(s) under exclusive licence to Society of General Internal Medicine.)

Urbanization and elevated selenium can negatively affect aquatic macroinvertebrate communities. These factors are often highly correlated in streams along the Front Range of the Rocky Mountains, USA. Understanding which factor is the primary driver of macroinvertebrate community health would aid in the development of appropriate management actions to mitigate their influence. Data collected from three sites in the Big Thompson River, Colorado, in seven different years from 2006 to 2016 were used to develop a random forest model to determine the relative importance of an index of urbanization and dissolved selenium levels in predicting the relative status of macroinvertebrate communities as measured by Colorado multi-metric index (MMI) scores. Based on the percent increase in mean square error (%incMSE) variable importance measure, dissolved selenium has a greater influence on MMI scores than a development index (19.5% vs 15.2%). There is a significantly negative relationship between MMI scores and dissolved selenium levels. This relationship predicts a MMI score of 29.2 under the current dissolved selenium standard of 4.6 µg/L and 38.6 under the suggested lower standard of 3.1 µg/L. Although improvements in MMI score may result with any reduction in dissolved selenium, other factors may limit the maximum expected MMI scores in the absence of selenium as the intercept of the relationship is 57.9 on a scale of 0-100., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The environmental impacts of cannabis cultivation have been an issue of growing concern, with legalization often framed as a means to introduce regulations that hinder damaging practices. However, the concept of frontier expansion presents the possibility that the widespread establishment of this new industry may institute an additional source of habitat encroachment. Here, through geospatial analysis, we employ Colorado as a case study to investigate the distribution of licensed recreational cannabis cultivators, potential habitat infringement of threatened and endangered species, and LULC change. From 2011 to 2016, licensed cannabis cultivation has resulted in over 67 ha of LULC change toward more developed land uses. In addition, nearly 15 km of new fencing was constructed establishing over 38 ha of fenced areas, and nearly 60 ha of vegetation was cleared. Much of this cannabis-driven LULC change is identified within the habitats of threatened and endangered species, as well as areas recognized as containing high biodiversity values with the potential for conservation. Thus, notable cannabis-driven frontier expansion is evident. Cannabis-driven LULC change is found to be primarily produced by outdoor and greenhouse facilities, as well as operations utilizing mixed-cultivation methods in rural areas. Therefore, policy instruments that inter alia encourage indoor cannabis cultivation in urban areas are recommended and discussed., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Water supply impairment from increased contaminant mobilization and transport after wildfire is a major concern for communities that rely on surface water from fire-prone watersheds. In this article we present a Monte Carlo simulation method to quantify the likelihood of wildfire impairing water supplies by combining stochastic representations of annual wildfire and rainfall activity. Water quality impairment was evaluated in terms of turbidity limits for treatment by modeling wildfire burn severity, postfire erosion, sediment transport, and suspended sediment dilution in receiving waterbodies. Water supply disruption was analyzed at the system level based on the impairment status of water supply components and their contributions to system performance. We used this approach to assess wildfire-water supply impairment and disruption risks for a system of water supply reservoirs and diversions in the Front Range Mountains of Colorado, USA. Our results indicate that wildfire may impair water quality in a concerning 15.7-19.4% of years for diversions from large watersheds. Reservoir impairment should be rare for off-network reservoirs-ranging from at most 0.01% of years for large reservoirs to nearly 2% of years for small reservoirs. System redundancy meaningfully reduced disruption risk for alternative conveyance routes (4.3-25.0% reduction) and almost eliminated disruption risk for a pair of substitutable terminal sources (99.9% reduction). In contrast, dependency among reservoirs on a conveyance route nearly doubled risk of disruption. Our results highlight the importance of considering water system characteristics when evaluating wildfire-water supply risks., (© 2021 Society for Risk Analysis. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)

Expulsion presents a significant risk in Early Care and Education (ECE) settings due to its association with early disadvantage and frequency of use. A statewide survey was conducted to characterize ECE suspension and expulsion (S/E) in Colorado. Child, program, and community-level factors were examined as predictors of S/E, alongside preventative intervention supports capable of reducing S/E. Six hundred and sixty three licensed child care programs participated in the survey, providing information on 19,848 enrolled children, 312 suspensions, and 74 expulsions. A series of multilevel hierarchical regressions were conducted, examining predictors for S/E. Children with IEPs/IFSPs were disproportionately suspended; 2-3-year-olds were disproportionately expelled; and boys, 5-6-year-olds, and children with disabilities were disproportionately suspended and expelled. Center-based programs, lower quality ratings, and "zero tolerance" policies predicted greater use of suspension. In contrast, school-district affiliation and knowledge of how to access infant and early childhood mental health consultation (IECMHC) decreased suspension. Lower levels of regional child poverty predicted higher use of expulsion. Affiliation with a school-district, IECMH consultant-led training, and use of quality coaches predicted decreased expulsion. This study identifies the need for ongoing protection for children with IEPs/ IFSPs and the preventative interventions that mitigate risk for S/E., (© 2021 Michigan Association for Infant Mental Health.)

Background: Accurate assessment of the pulmonary valve can dictate clinical management of patients with right ventricular outflow tract (RVOT) anomalies. Comparisons with available normal reference values are essential for accurate evaluation. The aim of the study was to generate normative data for the pulmonary valve annulus and sino-tubular (ST) junction using CT measurements derived from a heterogeneous pediatric population and create z-scores useful for clinical practice., Methods: Patients without heart disease who underwent cardiac CT between April 2014 and February 2021 ​at Children's Hospital Colorado were included. Minimum and maximum diameter (mm) and cross-sectional area (mm 2 ) for the pulmonary valve annulus and ST junction were measured. Previously validated models were used to normalize the measurements and calculate z-scores. Each measurement was plotted against BSA, and z-score distributions were used as reference lines., Results: Three-hundred-sixty-seven healthy patients with a mean age of 8.8 years (1-21), 56% male, and BSA of 1.1 ​m 2 (0.4-2.1) were analyzed. The Haycock formula was used to present data as predicted values for a given BSA and within equations relating each measurement to BSA. Predicted values and z-score boundaries for all measurements are graphically re-presented., Conclusions: CT-derived normative data for the pulmonary valve annulus and ST junction is reported from a heterogenous cohort of healthy children., Competing Interests: Declaration of competing interest All authors declare that they have received no grants, contracts, other forms of financial supports or relationships with the industry relevant to this paper., (Published by Elsevier Inc.)

Objective: Explore factors influencing patient comfort with and perceived helpfulness of screening for health-related social needs., Methods: In a parallel secondary mixed-methods analysis of data from three primary care clinics, we used logistic regression to examine effects of practice- and patient-level factors on comfort with and perceived helpfulness of social needs screening. We applied narrative analysis to 20 patient interviews to further understand how patients' lived experiences influenced their perceptions of screening., Results: Among 511 patients, receiving an explanation about screening was associated with increased odds of comfort (OR 2.1, 95% CI [1.1-4.30]) and perceived helpfulness (OR 4.7 [2.8-7.8]). Those experiencing more needs were less likely to report comfort (3 + needs vs. 0: OR 0.2 [0.1-0.5]). Narratives elucidated how a history of stigmatizing experiences increased discomfort disclosing needs and captured how relationship quality with healthcare teams influenced perceptions of screening for patients with extensive needs., Conclusion: Practice-level (screening explanation and therapeutic rapport) and patient-level factors (history and extent of needs) are key influences on comfort with and perceived helpfulness of screening., Practice Implications: Good communication about screening benefits all patients. Patients with extensive social needs may require additional sensitivity to their past experiences., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Gentrification, growing income inequality, urban development, and the affordable housing crisis necessitate understanding the impact of the concern of displacement on health - prior to or even in the absence of a displacement event. In this paper, I use the term "exclusionary displacement pressure" to unify the literature on exclusionary displacement and displacement pressure, highlighting the disproportionate and inequitable impacts of displacement pressure among communities of color. Through following 35 residents over 2.5-years (2019-2022) in one predominantly low-income Hispanic/Latinx immigrant neighborhood in Denver, Colorado, I examine how exclusionary displacement pressure shapes their health and wellbeing over time. Through paying attention to how participants' lived experience is shaped by structural vulnerability (e.g. lack of documentation status, inadequate work, limited access to safety net systems), I identify how exclusionary displacement pressure is constantly internalized and responded to as a unique embodied health experience, wearing on individuals over time and reproducing population health inequities. The framework of embodied health experiences captures the wide range of health-related impacts, from diagnosable health conditions to idioms of distress, using participant's own language of suffering to express how they were feeling, battling, and enduring the pressure. Theorizing on structural vulnerability within specific subpopulations with intersecting identities, such as low-income immigrant Hispanic/Latinx communities, provides a bottom-up refinement to existing theories of embodied health. Understanding the place-health experiences of individuals in changing neighborhoods over time is also critically important to define time points at which context-specific supports and interventions are appropriate., (Copyright © 2024 The Author. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Young workers in the United States are injured at higher rates than adults, a trend that has persisted for more than two decades. Despite known risks, young people enter the workforce with little-or-no preparation for the hazards they may face. In 2016, the National Institute for Occupational Safety and Health and American Industrial Hygiene Association developed Safety Matters, a one-hour educational module to raise awareness of workplace safety and health among young people., Method: A pilot project was conducted to evaluate the effectiveness of Safety Matters to positively change workplace safety and health knowledge and attitude scores among a sample of 283 youth in Colorado. Train-the-trainer sessions prepared volunteer safety and health professionals to deliver Safety Matters with fidelity and to conduct the assessment immediately prior to and following the program., Results: After receiving Safety Matters, participants had statistically significant (p < 0.001) increased scores for both workplace safety and health knowledge (Cohen's d = 1.12; large effect size) and importance (attitude) (Cohen's d = 0.51; medium effect size). Although univariate analyses showed knowledge and attitude scores significantly increased for all demographic groups examined, there were statistically significant differences in knowledge scores by participant age (p < 0.01), ethnicity (p < 0.05), and race (p < 0.001) and statistically significant differences in attitude scores by participant race (p < 0.001). However, when race and ethnicity were both used as predictors in a regression model, only race continued to predict statistically significant (p < 0.01) changes in knowledge and attitude., Conclusions: This project introduces a promising, community-based model for a one-hour introduction to workplace safety and health on which future, job-specific safety training can be built., Practical Applications: Safety and health professionals can play a critical role in promoting the health and safety of young workers. Adapting health and safety programs to diverse youth populations may enhance program relevance and receptivity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

PER: and polyfluoroalkyl substances (PFAS) have been measured in aqueous components within landfills. To date, the majority of these studies have been conducted in Florida. This current study aimed to evaluate PFAS concentrations in aqueous components (leachate, gas condensate, stormwater, and groundwater) from four landfills located outside of Florida, in Pennsylvania, Colorado, and Wisconsin (2 landfills). The Pennsylvania landfill also provided the opportunity to assess a leachate treatment system. Sample analyses were consistent across studies including the measurements of 26 PFAS and physical-chemical parameters. For the four target landfills, average PFAS concentrations were 6,900, 22,000, 280, and 260 ng L -1 in the leachate, gas condensate, stormwater, and groundwater, respectively. These results were not significantly different than those observed for landfills in Florida except for the significantly higher PFAS concentrations in gas condensate compared to leachate. For on-site treatment at the Pennsylvania landfill, results suggest that the membrane biological bioreactor (MBBR) system performed similarly as aeration-based leachate treatment systems at Florida landfills resulting in no significant decreases in ∑ 26 PFAS. Overall, results suggest a general consistency across US regions in PFAS concentrations within different landfill liquid types, with the few differences observed likely influenced by landfill design and local climate. Results confirm that leachate exposed to open air (e.g., in trenches or in treatment systems) have lower proportions of perfluoroalkyl acid precursors relative to leachate collected in enclosed pipe systems. Results also confirm that landfills without bottom liner systems may have relatively higher PFAS levels in adjacent groundwater and that landfills in wetter climates tend to have higher PFAS concentrations in leachate., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background and Objectives: Ageism is oftentimes sugarcoated within humor. Paper birthday cards are 1 delivery approach in which ageist messages are perpetuated and reinforced through humor., Research Design and Methods: A convenience sample of birthday cards (k = 227), all indicating a decade of age, were acquired from 7 national retail stores in Colorado Springs, CO. The decades sampled ranged from 21 to 100. With a predeveloped codebook, 3 raters coded the decade birthday cards on various variables, including age group, ageist tone, and humor., Results: Birthday cards intended for age 30-60 contained significantly more ageist messages compared to cards intended for age 21 and age 70-100, which did not show a significant difference from each other. Additionally, birthday cards with humor showed more ageist messages than cards without humor. Characteristics of decade birthday cards were also explored., Discussion and Implications: Consumers need to learn to evaluate these ageist messages in birthday cards to reduce the perpetuation of damaging stereotypes., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Understanding the types of functional challenges faced by adolescents and young adults with disabilities (AYA-WD) can help payers, clinicians, community-based service providers, and policymakers recognize and meet needs. This paper describes state-level prevalence rates for 1) AYA-WD overall and for 2) impairment types singly and in combinations; and 3) examines how rates may differ between those insured by Medicaid versus commercial insurance., Methods: This descriptive study uses Colorado's All Payer Claims Dataset 2014-2018 to identify insured 10- to 26-year-olds (Medicaid only: 333,931; commercially only: 392,444). It then applies the previously validated Children with Disabilities Algorithm (CWDA) and its companion, the Diagnosis-to-Impairment-Type Algorithm (DITA), to compare state-level prevalence rates by insurance source for disability overall and for each of five impairment types singly and in combination., Results: Disability prevalence was greater among the Medicaid-insured AYA-WD by +7.6% points (pp)-Medicaid: 11.9% (47,654/333,931), commercial: 4.3% (16,907/392,444). Most AYA-WD had a single impairment, but the prevalence of AYA-WD with two or more impairments was greater among the Medicaid-insured than the commercially insured (+9.9 pp; Medicaid: 33.5% [15,963/47,654], commercial: 23.7% [3992/16, 907]), as was the prevalence of impairment types that were physical (+6.7 pp; Medicaid: 54.7% [26,054/47,654], commercial: 48.0% [8121/16,907]); developmental (+4.1 pp; Medicaid: 35.4% [16,874/47,654], commercial: 31.3% [5290/16,907]); psychiatric (+6.7 pp; Medicaid 21.3% [10,175/47,654], commercial: 14.6% [2470/16,907]), and intellectual (+9.3 pp; Medicaid: 26.2% [12,501/47,654], commercial: 16.9% [2858/16,907])., Conclusions: CWDA and DITA can be used to understand the rates at which impairment types and combinations occur in a population with childhood-onset disabilities., Competing Interests: Declaration of Competing Interest The authors have indicated that they have no conflicts of interest to disclose., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

We evaluated the sensitivity of estimated PM 2.5 and NO 2 health impacts to varying key input parameters and assumptions including: 1) the spatial scale at which impacts are estimated, 2) using either a single concentration-response function (CRF) or using racial/ethnic group specific CRFs from the same epidemiologic study, 3) assigning exposure to residents based on home, instead of home and work locations for the state of Colorado. We found that the spatial scale of the analysis influences the magnitude of NO 2 , but not PM 2.5 , attributable deaths. Using county-level predictions instead of 1 km 2 predictions of NO 2 resulted in a lower estimate of mortality attributable to NO 2 by ∼ 50 % for all of Colorado for each year between 2000 and 2020. Using an all-population CRF instead of racial/ethnic group specific CRFs results in a 130 % higher estimate of annual mortality attributable for the white population and a 40 % and 80 % lower estimate of mortality attributable to PM 2.5 for Black and Hispanic residents, respectively. Using racial/ethnic group specific CRFs did not result in a different estimation of NO 2 attributable mortality for white residents, but led to ∼ 50 % lower estimates of mortality for Black residents, and 290 % lower estimate for Hispanic residents. Using NO 2 based on home instead of home and workplace locations results in a smaller estimate of annual mortality attributable to NO 2 for all of Colorado by 2 % each year and 0.3 % for PM 2.5 . Our results should be interpreted as an exercise to make methodological recommendations for future health impact assessments of pollution., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Routine vaccination coverage for adolescents living in the rural US is lower than adolescents living in urban areas. We sought to measure the effect of Boot Camp Translation (BCT), a community-based participatory intervention, on rural adolescent vaccination coverage., Methods: A cluster randomized controlled trial was performed September 2018-November 2021 involving 16 rural Colorado counties. Intervention county community members engaged in BCT to develop interventions to improve adolescent vaccination locally. Adolescent vaccination coverage was measured using the Colorado Immunization Information System., Results: For 11-12-year-olds, HPV initiation, HPV up-to-date, MenACWY, and Tdap vaccination coverage was lower post- versus pre-intervention in the control and intervention groups. For 11-12-year-olds in the intervention group, there was no significant difference post- versus pre-intervention in the odds of HPV vaccine initiation (adjusted ratio of odds ratios [aROR] = 0.93, 95 %: 0.85-1.02, p = 0.10) or up-to-date HPV vaccination (aROR: 1.10, 95 % CI: 0.98-1.23, p = 0.11) compared with the control group. Among 11-12-year-olds, the decrease in the proportion vaccinated with MenACWY and Tdap in the intervention group was significantly greater than the control group. Among 13-17-year-olds, there were significant increases in HPV initiation, HPV up-to-date, MenACWY, and Tdap vaccination coverage from pre- to post-intervention for both groups, with no significant differences between groups., Conclusion: 11-12-year-old vaccination coverage decreased slightly from pre- to post-intervention while 13-17-year-old vaccination coverage increased. We saw no effect from the BCT intervention. Our findings about the effectiveness of BCT for improving vaccine uptake may not be generalizable because the study coincided with the COVID-19 pandemic., Clinical Trial Registry: This study was registered with ClinicalTrials.gov, NCT03955757., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sean O’Leary reports financial support was provided by Centers for Disease Control and Prevention (18U01IP001091). Amanda Dempsey reports a relationship with Merck & Co Inc that includes: consulting or advisory and employment. During the study data collection and analysis, Amanda Dempsey served on Advisory Boards for Merck, Sanofi, and Pfizer and has worked as a consultant for Pfizer. None of these companies played a role in this research and she does not receive research funding from these groups. Dr. Dempsey is currently an employee at Merck. All other authors have no conflicts to declare. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Acid mine drainage (AMD) is recognized as a major environmental challenge in the Western United States, particularly in Colorado, leading to extreme subsurface contamination issue. Given Colorado's arid climate and dependence on groundwater, an accurate assessment of AMD-induced contamination is deemed crucial. While in past, machine learning (ML)-based inversion algorithms were used to reconstruct ground electrical properties (GEP) such as relative dielectric permittivity (RDP) from ground penetrating radar (GPR) data for contamination assessment, their inherent non-linear nature can introduce significant uncertainty and non-uniqueness into the reconstructed models. This is a challenge that traditional ML methods are not explicitly designed to address. In this study, a probabilistic hybrid technique has been introduced that combines the DeepLabv3+ architecture-based deep convolutional neural network (DCNN) with an ensemble prediction-based Monte Carlo (MC) dropout method. Different MC dropout rates (1%, 5%, and 10%) were initially evaluated using 1D and 2D synthetic GPR data for accurate and reliable RDP model prediction. The optimal rate was chosen based on minimal prediction uncertainty and the closest alignment of the mean or median model with the true RDP model. Notably, with the optimal MC dropout rate, prediction accuracy of over 95% for the 1D and 2D cases was achieved. Motivated by these results, the hybrid technique was applied to field GPR data collected over an AMD-impacted wetland near Silverton, Colorado. The field results underscored the hybrid technique's ability to predict an accurate subsurface RDP distribution for estimating the spatial extent of AMD-induced contamination. Notably, this technique not only provides a precise assessment of subsurface contamination but also ensures consistent interpretations of subsurface condition by different environmentalists examining the same GPR data. In conclusion, the hybrid technique presents a promising avenue for future environmental studies in regions affected by AMD or other contaminants that alter the natural distribution of GEP., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

We report the discovery of two bluetongue virus serotype 6 (BTV-6) reassortants recovered from a domestic sheep and a free-ranging mule deer in northern Colorado. At the time of this publication, whole-genome sequencing of BTV-6 isolates in the Western U.S. have not been undertaken. These findings reflect the incursive movement of geographically distinct BTV serotypes into important agricultural areas of the U.S. and demonstrate reassortment with regionally circulating serotypes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Long-term (2010-19) water-quality monitoring on the Colorado River downstream from Moab Utah indicated the persistent presence of Bioactive Chemicals (BC), such as pesticides and pharmaceuticals. This stream reach near Canyonlands National Park provides critical habitat for federally endangered species. The Moab wastewater treatment plant (WWTP) outfall discharges to the Colorado River and is the nearest potential point-source to this reach. The original WWTP was replaced in 2018. In 2016-19, a study was completed to determine if the new plant reduced BC input to the Colorado River at, and downstream from, the outfall. Water samples were collected before and after the plant replacement at sites upstream and downstream from the outfall. Samples were analyzed for as many as 243 pesticides, 109 pharmaceuticals, 20 hormones, 51 wastewater indicator chemicals, 20 metals, and 8 nutrients. BC concentrations, hazard quotients (HQs), and exposure activity ratios (EARs) were used to identify and prioritize contaminants for their potential to have adverse biological effects on the health of native and endangered wildlife. There were 22 BC with HQs >1, mostly metals and hormones; and 23 BC with EARs >0.1, mostly hormones and pharmaceuticals. Most high HQs or EARs were associated with samples collected at the WWTP outfall site prior to its replacement. Discharge from the new plant had reduced concentrations of nutrients, hormones, pharmaceuticals, and other BC. For example, all 16 of the hormones detected at the WWTP outfall site had maximum concentrations in samples collected prior to the WWTP replacement. The WWTP replacement had less effect on instream concentrations of metals and pesticides, BC whose sources are less directly tied to domestic wastewater. Study results indicate that improved WWTP technology can create substantial reductions in concentrations of non-regulated BC such as pharmaceuticals, in addition to regulated contaminants such as nutrients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

The archaeological record documenting human history in deserts is commonly concentrated along rivers in terraces or other landforms built by river sediment deposits. Today that record is at risk in many river valleys owing to human resource and infrastructure development activities, including the construction and operation of dams. We assessed the effects of the operations of Glen Canyon Dam - which, since its closure in 1963, has imposed drastic changes to flow, sediment supply and distribution, and riparian vegetation - on a population of 362 archaeological sites in the Colorado River corridor through Grand Canyon National Park, Arizona, USA. We leverage 50 years of evidence from aerial photographs and more than 30 years of field observations and measurements of archaeological-site topography and wind patterns to evaluate changes in the physical integrity of archaeological sites using two geomorphology-based site classification systems. We find that most archaeological sites are eroding; moreover, most are at increased risk of continuing to erode, due to six decades of operations of Glen Canyon Dam. Results show that the wind-driven (aeolian) supply of river-sourced sand, essential for covering archaeological sites and protecting them from erosion, has decreased for most sites since 1973 owing to effects of long-term dam operations on river sediment supply and riparian vegetation expansion on sandbars. Results show that the proportion of sites affected by erosion from gullies controlled by the local base-level of the Colorado River has increased since 2000. These changes to landscape processes affecting archaeological site integrity limit the ability of the National Park Service and Grand Canyon-affiliated Native American Tribes to achieve environmental management goals to maintain or improve site integrity in situ. We identify three environmental management opportunities that could be used to a greater extent to decrease the risk of erosion and increase the potential for in-situ preservation of archaeological sites. Environmental management opportunities are: 1) sediment-rich controlled river floods to increase the aeolian supply of river-sourced sand, 2) extended periods of low river flow to increase the aeolian supply of river-sourced sand, 3) the removal of riparian vegetation barriers to the aeolian transport of river-sourced sand., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The US Geological Survey. Published by Elsevier Ltd.. All rights reserved.)

Tropical forests are well known for their high woody plant diversity. Processes occurring at early life stages are thought to play a critical role in maintaining this high diversity and shaping the composition of tropical tree communities. To evaluate hypothesized mechanisms promoting tropical tree species coexistence and influencing composition, we initiated a census of woody seedlings and small saplings in the permanent 50 ha Forest Dynamics Plot (FDP) on Barro Colorado Island (BCI), Panama. Situated in old-growth, lowland tropical moist forest, the BCI FDP was originally established in 1980 to monitor trees and shrubs ≥1 cm diameter at 1.3 m above ground (dbh) at ca. 5-year intervals. However, critical data on the dynamics occurring at earlier life stages were initially lacking. Therefore, in 2001 we established a 1-m 2 seedling plot in the center of every 5 × 5 m section of the BCI FDP. All freestanding woody individuals ≥20 cm tall and <1 cm dbh (hereafter referred to as seedlings) were tagged, mapped, measured, and identified to species in 19,313 1-m 2 seedling plots. Because seedling dynamics are rapid, we censused these seedling plots every 1-2 years. Here, we present data from the 14 censuses of these seedling plots conducted between the initial census in 2001 to the most recent census, in 2018. This data set includes nearly 1 M observations of ~185,000 individuals of >400 tree, shrub, and liana species. These data will permit spatially-explicit analyses of seedling distributions, recruitment, growth, and survival for hundreds of woody plant species. In addition, the data presented here can be linked to openly-available, long-term data on the dynamics of trees and shrubs ≥1 cm dbh in the BCI FDP, as well as existing data sets from the site on climate, canopy structure, phylogenetic relatedness, functional traits, soil nutrients, and topography. This data set can be freely used for non-commercial purposes; we request that users of these data cite this data paper in all publications resulting from the use of this data set., (© 2023 The Ecological Society of America.)

Background: The cannabis industry has been described using the commercial determinants of health framework because it seeks to increase sales and profits through efforts to change the political environment. To increase understanding of these cannabis industry's efforts, this study describes cannabis industry campaign contributions in Colorado through an analysis of public records., Methods: We reviewed datasets posted online at the Colorado Secretary of State's Transparent in Contribution and Expenditure Reporting (TRACER) Campaign Finance System. We generated descriptive data on cannabis industry contributions to elections and conducted regressions to identify predictors of contributions, and associations between lagged contributions and a legislator's cannabis industry score (how closely aligned lawmaker's legislative history is with the cannabis industry from -1 to 1)., Results: Between 2005-2021, 429 cannabis-affiliated contributors gave $4,658,385 (2021 inflation-adjusted) to 512 electoral committees. Contributions came primarily from non-profits (45%), businesses (27%), and individuals (25%). After recreational legalization in 2012, contributions from non-profit donors with industry ties gave way to contributions from cannabis businesses, business owners, and lobbyists. Cannabis industry contributions to local and state-wide ballot initiative campaigns historically made up the majority of the industry spending, but contributions to candidate committees more than tripled between the 2009-2010 legislative cycle and the 2019-2020 cycle. From 2017-2020, every $10,000 in lagged campaign donations from cannabis industry affiliated contributors was associated with a 0.245-point increase in a legislator's cannabis industry score (p=0.04)., Conclusion: Cannabis-affiliated interests made substantial campaign contributions in Colorado. Public health advocates should monitor industry connections to lawmakers and industry tactics used to mask the source of political contributions. Continued surveillance of the cannabis industry is essential to exposing conflicts of interest and preventing undue industry influence., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: Prior evaluations of the connection between cellphone bans and crashes show unclear results. California, Oregon, and Washington enacted legislation (effective in 2017) to update earlier bans specific to handheld conversation and texting. This study evaluated the relationship between the laws and rear-end rates, a crash type sensitive to visual-manual cellphone use, in California, Oregon, and Washington., Method: Negative binomial regression compared the change in monthly per capita rear-end crash rates in California, Oregon, and Washington before and after the law changes relative to two control states, Colorado and Idaho, during 2015-2019. Analyses examined (a) rear-end crashes with injuries in all three study states, including minor to fatal injuries; and (b) rear-end crashes of all severities in California and Washington, including property-damage-only crashes and crashes with injuries; Oregon was excluded from this analysis because of a 2018 change to its reporting criteria for property-damage-only crashes., Results: Washington's strengthened law was associated with a significant 7.6% reduction in the rate of monthly rear-end crashes of all severities relative to the controls. Law changes in Oregon and Washington were associated with significant reductions of 8.8% and 10.9%, respectively, in the rates of monthly rear-end crashes with injury relative to the controls. California did not experience changes in rear-end crash rates of all severities or with injuries associated with the strengthened law., Conclusion: The results of this study are mixed, with law changes associated with significant reductions in rear-end crash rates in two of the three study states. Differences in the wording of the laws, levels of enforcement, and sanction severity may help explain the divergent results., Practical Application: Crash reductions in Oregon and Washington suggest that enacting legislation that comprehensively bans practically all visual-manual cellphone activity may have made the laws easier to enforce and clarified to drivers that handheld cellphone use is unacceptable in these states., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Urban ammonia (NH 3 ) emissions contribute to poor local air quality and can be transported to rural landscapes, impacting sensitive ecosystems. The Colorado Front Range urban corridor encompasses the Denver Metropolitan Area, rural farmland/rangeland and montane forest between the city and the Rocky Mountains. Reactive nitrogen emissions from the corridor are partly responsible for increased N deposition to the wildland-urban interface (WUI) in this region. To determine the significance of individual NH 3 sources to WUI ecosystems, we measured the concentration and isotopic composition (δ 15 N-NH 3 ) of ambient NH 3(g) from April to October 2018 across a five-site urban to rural gradient in the corridor. The urban sites had higher NH 3 concentrations and δ 15 N-NH 3 values than the rural/suburban sites. Based on isotope mixing models, NH 3 emission source contributions for all sites were fertilizer (12 ± 5.7%), livestock waste (18 ± 12%), vehicles (37 ± 23%), and biomass burning (34 ± 20%). Vehicle contributions were consistent across all months with an average of 35% and summer months showed a peak in biomass burning contributions (40%). As wildfires are projected to increase due to climate change, we stress a need for constraints on the isotopic signature of NH 3 emitted from wildfires. Vehicle emissions contributed the greatest amount of NH 3 (40%) at the urban sites while rural/suburban sites had higher agricultural contributions (41%). Had 2018 not had an anomalously high wildfire season, 46% and 60% of the NH 3 would have been attributed to vehicle emissions at the WUI site and urban sites, respectively. NH 3 emissions have historically been ascribed to agricultural activities but these findings illustrate the universal significance of vehicle emissions and the potential for sustained wildfire activity to be a primary contributor to NH 3 . Air quality (e.g., particulate matter) and nitrogen deposition reduction plans may benefit by including management practices that address vehicle NH 3 emissions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The opioid epidemic in the United States disproportionately affects Medicaid beneficiaries than other groups. This results in a significant financial burden on state Medicaid programs. In this analysis, we investigate the association of medication for opioid use disorder (MOUD) treatment initiation and linkage to ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients. We conducted a retrospective study among adult patients diagnosed with opioid use disorder (OUD) and who had a clinical encounter at a safety-net institution in Denver Colorado in 2020. Three categories of MOUD status of patients were defined: 1) identified with OUD but did not receive MOUD; 2) initiated MOUD but not linked to ongoing treatment and 3) received MOUD and linked to ongoing treatment. Our outcome variable was per-member per-month total healthcare cost. We estimated a multivariable model to test the association between healthcare cost and MOUD status, while controlling for demographic and risk classification variables. We found that in individuals with OUD who initiated MOUD treatment but were not linked to ongoing care had the highest healthcare cost, while those who were linked to ongoing MOUD treatment had the lowest healthcare cost. MOUD treatment is not only effective at addressing the significant morbidity and mortality burden of OUD but also associated with decreased financial cost, which is disproportionately incurred by Medicaid. Additional policy and care delivery changes are needed to focus efforts to improve linkage to ongoing treatment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The lack of watershed-scale estimates of floodplain carbon stocks limits recognition of the important role of floodplains and river corridor restoration in efforts to enhance carbon sequestration. We use the South Platte River watershed of Colorado, USA as a case study to illustrate spatial patterns of, and controls on, floodplain carbon stocks at the watershed scale. This case study illustrates the disproportionate importance of floodplains for soil carbon stocks relative to adjacent uplands and provides an example of how spatially explicit data can be used to prioritize floodplain restoration with regard to carbon sequestration. We use the hydrogeomorphic floodplain tool GFPLAIN to delineate the extent of 100-year floodplains in the South Platte River watershed. We distinguish elevation bands for the steppe, montane, subalpine, and alpine zones. We also differentiate bead (floodplain width/channel width ≥ 5) and string (floodplain width/channel width < 5) reaches within the montane and subalpine zones. Drawing on prior, field-based measurements of organic carbon stock in downed, dead wood and soil in these floodplain types, we estimate total floodplain organic carbon stock based on median values of stock in different floodplain types and the spatial extent of these floodplain types. This estimate includes organic carbon stocks in lake and reservoir sediments in the watershed. Soil constitutes the greatest reservoir of floodplain carbon. The total estimated area of floodplain is 2916 km 2 , which is 4.3 % of the total watershed area of the South Platte River. Our preferred estimate is 42.7 Tg C stock (likely range of 39.1-42.7 Tg). This equates to 11.1 % of a previously estimated overall carbon stock (above and belowground biomass and soil organic carbon) in the entire watershed of 384 Tg C. Floodplains are thus disproportionately important, relative to their surface area, in storing organic carbon in this semiarid watershed. Field measurements of floodplain soil organic carbon stocks from across the globe indicate that this finding is not unique to this watershed, with implications for prioritizing floodplain management and restoration as a means of enhancing carbon sequestration., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objectives: We sought to assess the feasibility and acceptability of an adaptive riding program with dyads (persons living with dementia, family care partners) and a gardening comparison condition., Design: This is a two-arm (adaptive riding and adaptive gardening), mixed methods, convergent, feasibility study that occurred February 2019-June 2019., Interventions: Upon enrollment, dyads (n=9) self-selected into either community-based adaptive riding (n=5) or adaptive gardening (n=4), two complementary interventions in Northern Colorado. Interventions occurred for hour-long, weekly sessions for eight weeks., Outcome Measures: Feasibility was measured with recruitment (actual/planned, response rate, participants enrolled/month) retention, adherence to study procedures (attendance, retention, fidelity), and data collection processes (planned versus collected); and analyzed with descriptive statistics. Acceptability of adaptive riding was measured with pre/post care partner interviews and analyzed using thematic analysis. Afterwards, findings were converged., Results: We recruited n=10/24 dyads (6 dyads per month), with the highest response rates for referrals and in-person events, n=9 dyads enrolled. We adhered to study procedures with attendance (6/8 gardening, 8/8 riding), retention (100%), fidelity (100%) and data collected (98%). Care partners (n=5) found the adaptive riding intervention acceptable with two themes Overall hopes: "Joy in the present moment" and "Experience as a Whole: "Your spirits are lifted," affirming quantitative attendance and retention data., Conclusion: Findings underscore the feasibility and acceptability of including care partners of persons living with dementia in complementary interventions involving horsemanship activities. Feasibility data can guide study designs and implementation processes for other nature-based complementary interventions for this population., Competing Interests: Conflict of interest The authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. None of the authors were involved in the copy-right of Riding in the Moment™ which is held by the University of Wisconsin and occurred after this study., (Copyright © 2022. Published by Elsevier Ltd.)

Extreme risk protection orders (ERPOs), also known as red flag laws, are a potential tool to prevent firearm violence, including mass shootings, but little is currently known about the extent of their use in cases of mass shooting threats or about the threats themselves. We collected and abstracted information from ERPO cases from six states (California, Colorado, Connecticut, Florida, Maryland, and Washington). Ten percent (N = 662) of all ERPO cases (N = 6787) were in response to a threat of killing at least 3 people. Using these cases, we created a typology of multiple victim/mass shooting threats, the most common of which was the maximum casualty threat. The most common target for a multiple victim/mass shooting threat was a K-12 school, followed by businesses, then intimate partners and their children and families. Judges granted 93% of petitions that involved these threats at the temporary ERPO stage and, of those cases in which a final hearing was held, judges granted 84% of final ERPOs. While we cannot know how many of the 662 ERPO cases precipitated by a threat would have resulted in a multiple victim/mass shooting event had ERPO laws not been used to prohibit the purchase and possession of firearms, the study provides evidence at least that ERPOs are being used in six states in a substantial number of these kinds of cases that could have ended in tragedy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Out-of-home storage of personal firearms is one recommended option for individuals at risk of suicide, and statewide online maps of storage locations have been created in multiple states, including Colorado and Washington. We sought to examine both the extent to which firearm retailers and ranges offer temporary, voluntary firearm storage and the perceived barriers to providing this service. We invited all firearm retailers and ranges in Colorado and Washington to complete an online or mailed survey; eligible sites had to have a physical location where they could provide storage. Between June-July 2021, 137 retailers/ranges completed the survey (response rate = 25.1%). Nearly half (44.5%) of responding firearm retailers/ranges in Colorado and Washington State indicated they had ever provided firearm storage. Among those who had ever offered storage, 80.3% currently offered storage while 19.7% no longer did. The majority (68.6%) of participants had not heard of the Colorado/Washington gun storage maps and 82.5% did not believe they were currently listed on the maps. Respondents indicated liability waivers would most influence their decision about whether to start or continue providing temporary, voluntary storage of firearms. Understanding current practices, barriers, and concerns about providing out-of-home storage by retailers and ranges may support development of more feasible approaches for out-of-home firearm storage during times of suicide risk., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: COVID-19 vaccination reduces SARS-CoV-2 infection and transmission. However, evidence is emerging on the degree of protection across variants and in high-transmission settings. To better understand the protection afforded by vaccination specifically in a high-transmission setting, we examined household transmission of SARS-CoV-2 during a period of high community incidence with predominant SARS-CoV-2 B.1.1.7 (Alpha) variant, among vaccinated and unvaccinated contacts., Methods: We conducted a household transmission investigation in San Diego County, California, and Denver, Colorado, during January-April 2021. Households were enrolled if they had at least one person with documented SARS-CoV-2 infection. We collected nasopharyngeal swabs, blood, demographic information, and vaccination history from all consenting household members. We compared infection risks (IRs), RT-PCR cycle threshold values, SARS-CoV-2 culture results, and antibody statuses among vaccinated and unvaccinated household contacts., Results: We enrolled 493 individuals from 138 households. The SARS-CoV-2 variant was identified from 121/138 households (88%). The most common variants were Alpha (75/121, 62%) and Epsilon (19/121, 16%). There were no households with discordant lineages among household members. One fully vaccinated secondary case was symptomatic (13%); the other 5 were asymptomatic (87%). Among unvaccinated secondary cases, 105/108 (97%) were symptomatic. Among 127 households with a single primary case, the IR for household contacts was 45% (146/322; 95% Confidence Interval [CI] 40-51%). The observed IR was higher in unvaccinated (130/257, 49%, 95% CI 45-57%) than fully vaccinated contacts (6/26, 23%, 95% CI 11-42%). A lower proportion of households with a fully vaccinated primary case had secondary cases (1/5, 20%) than households with an unvaccinated primary case (66/108, 62%)., Conclusions: Although SARS-CoV-2 infections in vaccinated household contacts were reported in this high transmission setting, full vaccination protected against SARS-CoV-2 infection. These findings further support the protective effect of COVID-19 vaccination and highlight the need for ongoing vaccination among eligible persons., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Background: The cannabis industry has an interest in creating a regulatory environment which maximizes profits at the cost of public health, similar to the tobacco, alcohol, and food industries. This study sought to describe the cannabis industry's lobbying activities in the Colorado State Legislature over time., Methods: This retrospective observational study analyzed publicly available lobbying expenditures data from fiscal years (FY) 2010-2021. Measures included inflation-adjusted monthly lobbying expenditures by funder and lobbyist, origin of funding, and lobbyist descriptions of cannabis industry clients. This dataset was supplemented with business license documentation, legislative histories, and public testimony., Results: The cannabis industry spent over $7 million (inflation adjusted) from FY 2010-2021 to lobby the Colorado legislature on 367 bills. Over $800,000 (11% of total cannabis spending) was from out-of-state clients. In 48% of lobbyist reports lobbyists did not disclose their funder's cannabis affiliation, and cannabis organizations used strategies that may have obscured the true amount and source of funding. Lobbyists and agencies concurrently represented the alcohol, tobacco, and cannabis industries, possibly facilitating inter-industry alliances when interests align., Conclusion: The cannabis industry dedicated significant resources towards lobbying the Colorado State Legislature on behalf of policies intended to increase cannabis use. Creating transparency about the relationships between the cannabis industry, related industries, and policymakers is essential to ensure appropriate regulation of cannabis products., Competing Interests: Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Background and Objectives: Lesbian, gay, bisexual, and questioning (LGBQ) youth are at greater risk of problematic alcohol use than their heterosexual peers, yet there is a dearth of research examining variability in alcohol use among youth that simultaneously accounts for sexual orientation and gender identity. This paper examines the relationship between alcohol use and intersecting identities of sexual orientation and gender while accounting for this population's disproportionate experiences of depression and dating and sexual violence., Methods: The study used a representative sample (n = 27,621) of high school students. Logistic regressions were used to determine if earlier age at first drink, 30-day alcohol use, and binge drinking were significantly related to intersectional sexual orientation and gender identity. Secondary models added depression, dating violence, and sexual violence to analyses to determine if they explained any of the variance in alcohol use variables in LGBQ and transgender youth., Results: Transgender youth who identified as heterosexual or questioning their sexual orientation were at greatest risk for early initiation of alcohol use and binge drinking. These relationships between intersectional identity and alcohol use became nonsignificant when depression, dating violence, and sexual violence were added to the models., Conclusions and Scientific Significance: This is the first study to examine relationships between intersecting identities of sexual orientation and gender identity and alcohol use among youth. Risky alcohol use among transgender youth may be attributed to experiences of depression, dating violence, and sexual violence impacting these populations. Interventions should focus on reducing transgender youth exposure to violence., (© 2021 American Academy of Addiction Psychiatry.)

Burn severity influences on post-fire recovery of soil-hydraulic properties controlling runoff generation are poorly understood despite the importance for parameterizing infiltration models. We measured soil-hydraulic properties of field-saturated hydraulic conductivity (K fs ), sorptivity (S), and wetting front potential (ψ f ) for four years after the 2013 Black Forest Fire, Colorado, USA, at six sites across a gradient of initial remotely sensed burn severity using the change in the normalized burn ratio (dNBR). These measurements were correlated with soil-physical property measurements of bulk density (ρ b ), loss on ignition (LOI, a measure of soil organic matter), and ground cover composition to provide insight into causal factors for temporal changes in K fs , S, and ψ f . Modeled infiltration using the Smith-Parlange approach parameterized with measured K fs , S, and ψ f further discerned the role of precipitation intensity on runoff generation. Temporal trends of soil-physical properties and ground cover showed influences from initial burn severity. Trends in soil-hydraulic properties, surprisingly, were not strongly influenced by initial burn severity despite inferred effects of ρ b , LOI, and ground cover on trends in K fs and S. Calculations of dNBR at the time of sampling showed strong correlations with K fs and S, demonstrating a new approach for estimating long-unburned K fs and S values, infiltration model parameters after fire, and assessing the time of return to pre-fire values. Simulated infiltration-excess runoff, in contrast, did depend on initial burn severity. Time series of the ratio S 2 /K fs  ≈ ψ f tended to converge between 1 and 10 mm four years after wildfire, potentially (i) defining a long-unburned forest domain of S 2 /K fs and ψ f from 1 to 10 mm with relatively high K fs values, and (ii) providing a new post-fire soil-hydraulic property recovery metric (i.e. S 2 /K fs  ≈ ψ f in the range of 1 to 10 mm) for sites in the Rocky Mountains of the USA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

Background: Using DAs for preference-sensitive decisions is an evidence-based way to improve patient-centered decisions. Reimbursement mandates have increased the need for DAs in ICD care, although none have been formally evaluated. The objectives were to develop and pilot implantable cardioverter-defibrillator (ICD) decision aids (DAs) for patients considering primary prevention ICDs., Methods: Development Phase: An expert panel, including patients and physicians, iteratively developed four DAs: a one-page Option Grid TM conversation aid, a four-page in-depth paper tool, a 17-minute video, and an interactive website. Trial Phase: At three sites, patients with heart failure who were eligible for primary prevention ICDs were randomly assigned 2:1 to intervention (received DAs) or control (usual care). We conducted a mixed-methods evaluation exploring acceptability and feasibility., Results: Twenty-one eligible patients enrolled (15 intervention). Most intervention participants found the DAs to be unbiased (67%), helpful (89%), and would recommend them to others (100%). The pilot was feasible at all sites; however, using clinic staff to identify eligible patients was more efficient than chart review. Although the main goals were to measure acceptability and feasibility, intervention participants trended towards increased concordance between longevity values and ICD decisions (71% concordant vs. 29%, p = .06). Participants preferred the in-depth paper tool and video DAs. Access to a nurse during the decision-making window encouraged questions and improved participant-perceived confidence., Conclusions: Participants felt the DAs provided helpful, balanced information that they would recommend to other patients. Further exploration of this larger context of DA use and strategies to promote independent use related to electrophysiology (EP) visits are needed., (© 2021 Wiley Periodicals LLC.)