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Purpose: Alcohol use and handgun carrying are more prevalent among youth in rural than urban areas and their association may be stronger among rural adolescents. Alcohol use may be modifiable with implications for reducing handgun carrying and firearm‐related harm. We examined the association between lagged alcohol use and subsequent handgun carrying in rural areas and examined variation in the association by developmental stages, hypothesizing that it would be stronger among adolescents than youth adults. Methods: We used a longitudinal sample of 2,002 adolescents from ages 12 to 26 growing up in 12 rural communities in 7 states with surveys collected from 2004 to 2019. We estimated the association of lagged past‐month alcohol use on handgun carrying in the subsequent 12 months using population‐average generalized estimating equations with logistic regression on multiply imputed data. Findings: During adolescence (ages 12‐18), those who drank heavily had 1.43 times the odds (95% CI = [1.01, 2.03]) of subsequent handgun carrying compared to those who did not drink alcohol, and those who consumed alcohol but did not drink heavily had 1.30 times the odds of subsequent handgun carrying compared to those who did not drink (95% CI = [0.98, 1.71]). During young adulthood (ages 19‐26), associations of alcohol use (OR = 1.28; 95% CI = [0.94, 1.63]) and heavy drinking (OR = 1.38; 95% CI = [1.08, 1.68]) were similar to adolescence. Conclusions: Alcohol use and subsequent handgun carrying were positively associated during adolescence and young adulthood among individuals who grew up in rural areas, similar to findings in urban areas. Reducing alcohol use may be an important strategy to prevent handgun carrying and firearm‐related harm among young people in rural areas. [ABSTRACT FROM AUTHOR]

Background: Criminal legal system data are one source for measuring some types of firearm-related harms, including those that do not necessarily result in injury or death, but measurement can be hampered by imprecise criminal code statutes. We quantified the degree of misclassification in Washington state criminal codes for measuring firearm-related crime. Findings: In this study of individuals aged 18 years and older who were convicted of a misdemeanor in Washington Superior Courts from 1/1/2015 through 12/31/2019, we compared firearm-related charges as measured with criminal codes and with manual review of probable cause documents, considered the gold standard. The sample included 5,390 criminal cases. Of these, 77 (1.4%) were firearm-related as measured with criminal codes and 437 (8.1%) were firearm-related as measured via manual record review. In the sample overall, the sensitivity of criminal codes was 17.6% (95% CI 14.2–21.5%), and negative predictive value (NPV) was 93.2% (95% CI 92.5–93.9%). Sensitivity and NPV were higher for cases with exclusively non-violent charges. For all cases and for cases with any violent crime charge, firearm-related crimes described in probable cause documents most often involved explicit verbal threats, firearm possession, and pointing a firearm at or touching a firearm to someone; almost 10% of all cases involved shooting/discharging a firearm. For cases with exclusively non-violent charges, the most common firearm-related crime was unlawful possession. Conclusions: Criminal records can be used for large-scale policy-relevant studies of firearm-related harms, but this study suggests Washington state criminal codes substantially undercount firearm-related crime, especially firearm-related violent crime. [ABSTRACT FROM AUTHOR]

Purpose: In addition to firearm-related intimate partner homicides, approximately 4.5 million adults in the US are threatened or harmed with a firearm by their intimate partner. It is unknown how many children are exposed to firearm-related IPV specifically, but an estimated 8–15 million children are exposed to parental IPV each year in the US. We sought to examine adult help-seeking behaviors when children are exposed or threatened in the context of firearm-related IPV. Methods: Adults with exposure to firearm-related IPV were surveyed using an online, anonymous survey (66.1% eligible respondent completion rate) administered to the YouGov US residents survey panel. Results: We included 244 respondents who endorsed experiencing firearm-related IPV. In homes where children lived during the firearm-related IPV (n = 115), 21.2% (95% Confidence Interval [CI]: 11.2–36.6%) of perpetrators harmed or threatened to harm the children with a firearm. Respondents who lived in those homes endorsed more help-seeking behaviors than respondents who lived without children or in homes where children were not threatened. Conclusion: The high prevalence of help-seeking behaviors reported by adults living with firearm-threatened children indicates both a need and an opportunity to support greater integration of services for IPV victims and children. [ABSTRACT FROM AUTHOR]

Objectives. To determine the frequency of loaded handgun carrying among US adult handgun owners overall and by state concealed carry law status. Methods. Using a nationally representative survey of US firearm-owning adults in 2019, we asked handgun owners (n = 2389) about their past-month handgun carrying behavior. Results. A total of 30.3% (95% confidence interval [CI] = 28.0%, 32.6%) of handgun owners carried handguns monthly, of whom 38.1% (95% CI = 33.6%, 42.7%) did so daily. In permitless carry states, 29.7% (95% CI = 25.9%, 33.9%) of handgun owners carried handguns in the past month, compared with 33.1% (95% CI = 29.9%, 36.3%) in shall issue states and 19.7% (95% CI = 14.9%, 25.5%) in may issue states. Of handgun owners without a permit, 7.5% (95% CI = 4.1%, 13.3%) of those in may issue states and 11.5% (95% CI = 8.5%, 15.4%) of those in shall issues states carried handguns in the past month. Conclusions. In 2019, about 16 million US adult handgun owners carried handguns in the past month (up from 9 million in 2015), and approximately 6 million did so daily (twice the 3 million who did so in 2015). Proportionally fewer handgun owners carried handguns in states where issuing authorities had substantial discretion in granting permits. (Am J Public Health. 2022;112(12):1783–1790. https://doi.org/10.2105/AJPH.2022.307094) [ABSTRACT FROM AUTHOR]

Poverty is an important predictor of child maltreatment. Social policies that strengthen the economic security of low-income families, such as the Earned Income Tax Credit (EITC), may reduce child maltreatment by impeding the pathways through which poverty leads to it. We used variations in the presence and generosity of supplementary EITCs offered at the state level and administrative child maltreatment data from the National Child Abuse and Neglect Data System (NCANDS) to examine the effect of EITC policies on state-level rates of child maltreatment from 2004 through 2017. Two-way fixed effects models indicated that a 10-percentage point increase in the generosity of refundable state EITC benefits was associated with 241 fewer reports of neglect per 100,000 children (95% Confidence Interval [CI] [−449, −33]). An increase in EITC generosity was associated with fewer reports of neglect both among children ages 0–5 (−324 per 100,000; 95% CI [−582, −65]) and children ages 6–17 (−201 per 100,000; 95% CI [−387, −15]). Findings also suggested associations between the EITC and reductions in other types of maltreatment (physical abuse, emotional abuse); however, those did not gain statistical significance. Economic support policies may reduce the risk of child maltreatment, especially neglect, and improve child wellbeing. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a serious public health problem in the United States with adverse consequences for affected individuals and families. Recent reviews of the literature suggest that economic policies should be further investigated as part of comprehensive strategies to address IPV. The Earned Income Tax Credit (EITC) is the nation's largest anti-poverty program for working parents, and especially benefits low-income women with children, who experience an elevated risk of IPV. The EITC may prevent IPV by offering financial resources; such resources may help individuals experiencing IPV leave abusive relationships or address IPV risk factors, thereby preventing entry into abusive relationships. However, the association between EITC generosity and IPV has not been previously examined. We used state-level and individual-level datasets to examine the association between EITC generosity and IPV. Our state-level data source was the nationally representative National Crime Victimization Survey (NCVS; N = ~ 95,000 households per year). For NCVS, we used a difference-in-difference approach to investigate the relationship between state EITC generosity and IPV rates. We also used individual-level longitudinal data from the Fragile Families and Child Well-being Study (n = 13,422 person-waves). Using this cohort of US families at higher risk for IPV, we evaluated associations between estimated EITC benefits based on the mother's state of residence and number of children and self-reported IPV. In both state- and individual-level analyses, no significant association between state EITC benefits and IPV was found. Factors that may account for these null findings include program ineligibility for individuals who separate from abusive spouses. Future research efforts should more closely examine EITC policy implementation processes and the lived experience of participating in anti-poverty programs for people experiencing IPV. [ABSTRACT FROM AUTHOR]

Corollary victims represent approximately 20% of all intimate partner homicides (IPH), and many are children. We used National Violent Death Reporting System (NVDRS) data (2003–2017) to compare all IPH incidents with a child corollary victim (n = 227) to all IPH incidents where a child was present but not killed (n = 350). We examined risk factors for child fatality during an IPH. For each risk factor, we calculated the odds ratio for child death during the IPH, adjusting for multiple comparisons. Perpetrator history of suicidal behavior, rape of the intimate partner victim, a non-biological child of the perpetrator living in the home, and perpetrator job stressors increased odds while prior separation of the IPV victim from the perpetrator decreased the odds of a child death during an IPH incident. To our knowledge, this is the first case-control study using live-controls within NVDRS and can help direct prevention efforts for child death during IPH. [ABSTRACT FROM AUTHOR]

Over 80% of bias-motivated violent victimization is motivated by race or ethnicity and over 50% of bias victimization occurs in non-Hispanic Whites (NHW). Our aim was to determine the risk and health impacts of race/ethnicity-motivated violent victimization by victim race/ethnicity. We examined data from the National Crime Victimization Survey (2003-2015) to estimate violent victimization risk by victim race/ethnicity across race/ethnicity bias victimization, other types of bias victimizations, and non-bias violent victimizations. We examined incident and offender characteristics for race/ethnicity-motivated victimization by victim race/ethnicity. The risk of race/ethnicity-motivated violent victimization was greater for non-Hispanic Blacks (NHB) and Hispanics than for NHWs (incidence rate ratios [IRR] = 1.4; 95% confidence interval [CI] = [1.0, 2.0], and IRR = 1.6; 95% CI = [1.2, 2.1]). This translates into an additional 46.7 incidents per 100,000 person-years (95% CI = [1.4, 92.1]) for the NHB population and an additional 60.3 incidents per 100,000 person-years (95% CI = [20.3, 100.4]) for the Hispanic population. Violent incidents for NHB victims more frequently resulted in injury or medical care. Nearly 40% of NHB victims reported difficulties at school or work related to the incident where only 21.5% of NHWs and 11.7% of Hispanic victims reported similar problems. Roughly 37% of NHB victims identified a NHW offender and 45% of NHW victims identified a NHB offender. Hispanic victims identified NHB or NHW offenders in over 70% of incidents. Although literature suggests that NHWs account for the majority of bias victimizations, the risk of non-fatal violent victimization motivated by race/ethnicity is greater for NHBs and Hispanics. Crimes perpetrated against NHBs are likely more severe and victim/offender racial incongruity is common. Findings provide empiric evidence on race/ethnicity-related structural disadvantage with adverse health consequences. [ABSTRACT FROM AUTHOR]

Oral pre-exposure prophylaxis (PrEP) is highly efficacious but low adherence undermines effectiveness. Depression, common in African women, may be a barrier to consistent PrEP use. We aimed to assess the relationship between depression, psychosocial mediators, and PrEP adherence among South African women. We analyzed data from 174 South African women in HPTN 067, an open-label oral PrEP trial conducted from 2011 to 2013. Participants were followed for 24 weeks. PrEP adherence was measured via Wisepill™ and weekly self-report interview data. We considered participants "adherent" at week 24 if Wisepill™ and interviews indicated that ≥ 80% of expected doses were taken in the prior month. Elevated depressive symptoms were assessed using the 20-item Center for Epidemiological Studies-Depression (CES-D) scale. We used marginal structural models to estimate the effect of elevated symptoms at baseline on PrEP adherence at week 24 and to assess whether the direct effect changed meaningfully after accounting for mediating effects of stigma, social support, and PrEP optimism. High PrEP adherence occurred less often among women with elevated depressive symptoms (N = 35; 44.3%) compared with those without (N = 52; 54.7%; adjusted relative risk [aRR]: 0.79; 95% confidence interval [CI] 0.63–0.99). The effect of elevated depressive symptoms on PrEP adherence persisted in models accounting for the mediating influence of stigma (aRR: 0.74; 95% CI 0.51–0.97) and PrEP optimism (aRR: 0.75; 95% CI 0.55–0.99). We also found a direct effect of similar magnitude and direction when accounting for social support as the mediating variable, although this adjusted relative risk estimate was not statistically significant (aRR: 0.77; 95% CI 0.57–1.03). Depressive symptoms were common and associated with lower PrEP adherence among South African women. Future work is needed to determine whether depression services integrated with PrEP delivery could improve PrEP effectiveness among African women. [ABSTRACT FROM AUTHOR]

Background and aims: Prior studies suggest that colonoscopy may exacerbate inflammatory bowel disease (IBD) symptoms. Thus, our study aimed to determine risk of emergency room (ER) visits associated with colonoscopy among IBD patients and evaluate potential modifiers of this risk. Methods: The study population included IBD patients in the Multi-Payer Claims Database who were >20 years old and had a colonoscopy from 2007–2010. We used a self-controlled risk interval design and mixed-effects Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI) comparing the incidence of ER visits in the 1–4 weeks following colonoscopy (risk interval) to the incidence of ER visits in the 7–10 weeks after colonoscopy (control interval). We also conducted stratified analyses by patient characteristics, bowel preparation type, and medication. Results: There were 212,205 IBD patients with at least 1 colonoscopy from 2007–2010, and 3,699 had an ER visit during the risk and/or control interval. The risk of an ER visit was higher in the 4-week risk interval following colonoscopy compared to the control interval (RR = 1.24; 95% CI: 1.17–1.32). The effect was strongest in those <41 years old (RR = 1.60; 95% CI: 1.21–2.11), in women (RR = 1.32; 95% CI: 1.21–1.44), and in those with sodium phosphate bowel preparation (RR = 2.09; 95% CI: 1.02–4.29). Patients using immunomodulators had no increased risk of ER visits (RR = 0.75; 95% CI: 0.35–1.59). Conclusions: Our results suggest that there is an increased risk of ER visits following colonoscopy among IBD patients, but that immunomodulators and mild bowel preparation agents may mitigate this risk. [ABSTRACT FROM AUTHOR]

Background Chronic Pseudomonas aeruginosa lung infection is associated with significant morbidity and mortality in cystic fibrosis (CF). It is not known whether recent advances in care have affected the rates of chronic infection. We aimed to determine if the rates of developing new chronic P. aeruginosa infection among adolescents and adults with CF significantly changed over time. Methods The cohort consisted of individuals with CF followed in the Cystic Fibrosis Foundation Patient Registry aged ≥13 years without chronic P. aeruginosa at baseline. Multivariable regression models accounting for within-patient correlation were used to assess the change in rate of developing chronic P. aeruginosa infection between 2003 and 2012. Results A total of 15504 individuals were followed for a median of 5 (interquartile range, 2–9) years. The annual rates of developing new chronic P. aeruginosa decreased from 14.3% in 2003 to 6.4% in 2012. After adjusting for potential confounders, relative risk (RR) of developing chronic P. aeruginosa infection decreased significantly over time compared to 2003 (P value test of trend <.001). Compared with 2003, the RR of developing chronic P. aeruginosa infection in 2012 was 0.33 (95% confidence interval, 0.30–0.37). No significant increases in risk of chronic infections with other major CF bacterial pathogens relative to 2003 were identified. Conclusions Among individuals with CF, a significant decrease in the risk and rates of developing chronic P. aeruginosa infection between 2003 and 2012 was observed. Whether this decline results in changes in clinical outcomes warrants further exploration. [ABSTRACT FROM AUTHOR]

“Complete streets” policies require transportation engineers to make provisions for pedestrians, bicyclists, and mass transit users. These policies may make bicycling safer for individual cyclists while increasing the overall number of bicycle fatalities if more people cycle due to improved infrastructure. We merged county-level records of complete streets policies with Fatality Analysis Reporting System counts of cyclist fatalities occurring between January 2000 and December 2015. Because comprehensive county-level estimates of numbers of cyclists were not available, we used bicycle commuter estimates from the American Community Survey and the US Census as a proxy for the cycling population and limited analysis to 183 counties (accounting for over half of the US population) for which cycle commuting estimates were consistently nonzero. We used G-computation to estimate the effect of complete streets policies on overall numbers of cyclist fatalities while also accounting for potential policy effects on the size of the cycling population. Over a period of 16 years, 5,254 cyclists died in these counties, representing 34 fatalities per 100,000 cyclist-years. We estimated that complete streets policies made cycling safer, averting 0.6 fatalities per 100,000 cyclist-years (95% confidence interval: −1.0, −0.3) by encouraging a 2.4% increase in cycling but producing only a 0.7% increase in cyclist fatalities. G-computation is a useful tool for understanding the impact of policy on risk and exposure. [ABSTRACT FROM AUTHOR]

Objectives. To characterize firearm ownership and storage practices in Washington State and assess their relationship with suicide risk factors. Methods. Using Washington State Behavioral Risk Factor Surveillance System data for 2013 to 2016, we conducted survey-weighted multivariable Poisson regression models to obtain prevalence ratios (PRs) and confidence intervals (CIs). Results. Of 34 884 adult respondents, 34.3% (95% CI = 33.7%, 35.0%) reported a firearm in their household, among whom 36.6% (95% CI = 35.4%, 37.7%) stored their firearm locked and unloaded. There were no differences in mental health indicators by firearm ownership or storage practice status. Binge and chronic alcohol use were somewhat more prevalent among adults from firearm-owning households (PR = 1.2;95% CI = 1.1, 1.3; PR = 1.2; 95% CI = 1.1, 1.4, respectively) and among those living in households not practicing safe storage (PR = 1.4; 95% CI = 1.2, 1.7; PR = 1.9; 1.5, 2.3, respectively). Conclusions. Variability in mental health does not explain the substantial increased suicide risk among individuals in firearm-owning households. Greater prevalence of alcohol misuse among adults in firearm-owning households not practicing safe storage highlights the need for suicide prevention interventions. [ABSTRACT FROM AUTHOR]

Objectives. To determine the frequency of loaded handgun carrying among US adult handgun owners, characterize those who carry, and examine concealed carrying by state concealed carry laws. Methods. Using a nationally representative survey of US adults in 2015, we asked handgun owners (n = 1444) about their past-30-day carrying behavior. Results. Among surveyed handgun owners, 24% (95% confidence interval[CI] = 21%, 26%) carried loaded handguns monthly, of whom 35% (95% CI = 29%, 41%) did so daily; 82% (95% CI = 77%, 86%) carried primarily for protection. The proportion of handgun owners who carried concealed loaded handguns in the past 30 days was 21% (95% CI = 12%, 35%) in unrestricted states, 25% (95% CI = 21%, 29%) in shall issue—no discretion states, 20% (95% CI = 16%, 24%) in shall issue—limited discretion states, and 9% (95% CI = 6%, 15%) in may-issue states. Conclusions. We estimate that 9 million US adult handgun owners carry loaded handguns monthly, 3 million do so every day, and most report protection as the main carrying reason. Proportionally fewer handgun owners carry concealed loaded handguns in states that allow issuing authorities substantial discretion in granting carrying permits. [ABSTRACT FROM AUTHOR]

Objective To compare maternal birth complications early versus late in the academic year and to evaluate the impact of resident work hour limitation on the "July effect." Study Design We conducted a retrospective, population-based cohort study of 628,414 singleton births in Washington State from 1987 to 2012 measuring the adjusted risk of maternal peripartum complications early (July/August) versus late (April/May) in the academic year. To control for seasonal outcome variation unrelated to trainees' involvement in care as well as long-term trends in maternal complications unrelated to variation in trainees' effect on outcomes across the academic year, we employed difference-in-differences methods contrasting outcomes at teaching to nonteaching hospitals for deliveries before and after restriction of resident work hours in July 2003. Results Prior to resident work hour limitation in July 2003, women delivering early in the academic year at teaching hospitals suffered more complications (relative risk [RR] 1.05; 95% confidence interval [CI]: 1.00-1.09; p = 0.03). After July 2003, complication risk did not vary significantly across the academic year except at teaching-intensive hospitals, where July/August deliveries experienced fewer complications (RR: 0.95; 95% CI: 0.92-0.98; p = 0.001). Conclusion Women delivering at teaching hospitals early in the academic year suffered a modest but significant increase in complications before but not after resident work hour reform. [ABSTRACT FROM AUTHOR]

Recent studies suggest that epigenetic programming may mediate the relationship between early life environment, including parental socioeconomic position, and adult cardiometabolic health. However, interpreting associations between early environment and adult DNA methylation may be difficult because of time-dependent confounding by life-course exposures. Among 613 adult women (mean age = 32 years) of the Jerusalem Perinatal Study Family Follow-up (2007-2009), we investigated associations between early life socioeconomic position (paternal occupation and parental education) and mean adult DNA methylation at 5 frequently studied cardiometabolic and stress-response genes (ABCA1, INS-IGF2, LEP, HSD11B2, and NR3C1). We used multivariable linear regression and marginal structural models to estimate associations under 2 causal structures for life-course exposures and timing of methylation measurement. We also examined whether methylation was associated with adult cardiometabolic phenotype. Higher maternal education was consistently associated with higher HSD11B2 methylation (e.g., 0.5%-point higher in 9-12 years vs. ≤8 years, 95% confidence interval: 0.1, 0.8). Higher HSD11B2 methylation was also associated with lower adult weight and total and low-density lipoprotein cholesterol. We found that associations with early life socioeconomic position measures were insensitive to different causal assumption; however, exploratory analysis did not find evidence for a mediating role of methylation in socioeconomic position-cardiometabolic risk associations. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The incidence of sports- and recreation-related concussions (SRRCs) in the United States is unknown. More than 44 million youth participate in sports annually, thus understanding the frequency of SRRCs in children is important on a population level. Our objective was to determine the number of SRRCs occurring annually among US youth ≤18 years old. METHODS: We identified SRRCs using 3 national databases: MarketScan, National Electronic Injury Surveillance System, and National High School Sports Related Injury Surveillance System, Reporting Injury Online. We determined the number of SRRCs seen in health care settings (outpatient, inpatient, and emergency department) and SRRCs reported to certified high school athletic trainers (ATCs). We used these data and findings in recently published literature to generate a national estimate of SRRCs. RESULTS: We estimate that between 1.1 and 1.9 million SRRCs occur annually in US children aged ≤18 years. Most children with SRRCs, 511 590 to 1 240 972, were not seen in health care settings. Of children with SRRCs seen in health care settings, most were seen as outpatients with 377 978 visits, compared with between 115 479 and 166 929 ED visits, and between 2886 and 4936 hospitalizations. CONCLUSIONS: This study provides the most accurate and precise estimate to date of the number of concussions among US children annually. SRRCs are a common injury in children. Providers in all health care settings need to be trained in concussion care. There is a need for better surveillance to enhance our understanding of the epidemiology of concussions in youth. [ABSTRACT FROM AUTHOR]

BACKGROUND: Underimmunization of certain immigrant populations can place them at high risk of experiencing vaccine-preventable disease outbreaks. METHODS: We conducted a retrospective cohort study between January 1, 2008, and May 1, 2013, among children included in the Washington State Immunization Information System. We assessed receipt of 1 or more doses of measles-containing, hepatitis A, pneumococcal, and diphtheria-tetanus-acellular pertussis-containing vaccines between 12 and 23 months of age. We compared children with 1 or more parents born in Somalia, Ukraine, Russia, Mexico, or India to children with 2 parents born in the United States. Poisson regression models with robust SEs were used to provide prevalence ratios adjusted for maternal education and number of prenatal visits. RESULTS: We identified 277 098 children, including 65 466 with foreign-born parents. Children of Somali-born parents were less likely to be immunized against measles than children of US-born parents (prevalence ratio: 0.82; 95% confidence interval: 0.80-0.84); this decrease became more pronounced over time (P < .01). No such disparity between these groups was observed with other vaccines. Compared with children of US-born parents, children of Ukrainian-born and Russian-born parents were less likely to be immunized, whereas children of Mexican-born and Indian-born parents were more likely to be immunized with any of the specified vaccines. CONCLUSIONS: We found country-specific patterns of immunization that may reflect underlying cultural or other beliefs. Certain immigrant communities with higher rates of immunization refusal may be at risk for vaccine-preventable diseases and require new forms of public health outreach. [ABSTRACT FROM AUTHOR]

Grandmaternal education may be related to grandchild birth weight (GBW) through maternal early-life development; however, conventional regression models may be endogenously confounded. Alternative models employing explicit structural assumptions may provide incrementally clearer evidence. We used data from the US National Longitudinal Study of Adolescent to Adult Health (1995-2009; 1,681 mother-child pairs) to estimate "direct effects" of grandmaternal educational level (less than high school, high school diploma or equivalent, or college degree) at the time of the mother's birth on GBW, adjusted for maternal life-course factors: maltreatment as a child, education and income as an adult, prepregnancy overweight, and prenatal smoking. Using conventional and marginal structural model (MSM) approaches, we estimated 54-g (95% confidence interval: -14.0, 122.1) and 87-g (95% confidence interval: 10.9, 162.5) higher GBWs per increase in educational level, respectively. The MSM allowed simultaneous mediation by and adjustment for prepregnancy overweight. Estimates were insensitive to alternate structural assumptions and mediator parameterizations. Bias analysis suggested that a single unmeasured confounder would have to have a strong influence on GBW (approximately 150 g) or be greatly imbalanced across exposure groups (approximately 25%) to completely explain the findings. Coupling an MSM with sensitivity analyses provides some evidence that maternal early-life socioeconomic environment is directly associated with offspring birth weight. [ABSTRACT FROM AUTHOR]

Objectives. We investigated whether stricter state-level firearm legislation was associated with lower hospital discharge rates for nonfatal firearm injuries. Methods. We estimated discharge rates for hospitalized and emergency department-treated nonfatal firearm injuries in 18 states in 2010 and used negative binomial regression to determine whether strength of state firearm legislation was independently associated with total nonfatal firearm injury discharge rates. Results. We identified 26 744 discharges for nonfatal firearm injuries. The overall age-adjusted discharge rate was 19.0 per 100000 person-years (state range = 3.3-36.6), including 7.9 and 11.1 discharges per 100 000 for hospitalized and emergency department-treated injuries, respectively. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total (incidence rate ratio [IRR] = 0.60; 95% confidence interval [CI] = 0.44, 0.82), assault-related (IRR = 0.58; 95% CI = 0.34, 0.99), self-inflicted (IRR=0.18; 95% CI = 0.14, 0.24), and unintentional (IRR = 0.53; 95% CI = 0.34, 0.84) nonfatal firearm injuries. Conclusions. There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Limiting firearm access is essential to decreasing teen suicide. Previous efforts have focused on household firearms; however, less is known about firearm access and possession among teens at increased suicide risk. Our objective was to estimate prevalence of firearm possession and access among high school-aged teens with recent depression and/or lifetime history of suicidality (DLHS). METHODS: We conducted a probability-based, cross-sectional Web survey of 1914 parent--teen dyads between June 24, 2020, and July 22, 2020, with data weighted to generate a nationally representative sample of US teenagers (aged 14-18). Logistic regression analyses examined the difference between teens with and without DLHS for: (1) personal firearm possession, (2) perceived firearm access, and (3) method of firearm attainment. RESULTS: Among high school-aged teens, 22.6% (95% confidence interval [CI], 19.4-25.8) reported DLHS, 11.5% (95% CI, 8.7-14.3) reported personal firearm possession, and 44.2% (95% CI, 40.2-48.2) endorsed firearm access. Teens experiencing DLHS had increased perceived access (adjusted odds ratio, 1.56; 95% CI, 1.07-2.28) compared with non-DLHS peers. There was no association between DLHS and personal firearm possession (adjusted odds ratio, 0.97; 95% CI, 0.47-2.00). Among teens reporting firearm possession, those with DLHS were more likely to have acquired it by buying/trading for it (odds ratio, 5.66; 95% CI, 1.17-27.37) and less likely receiving it as a gift (odds ratio, 0.06; 95% CI, 0.01-0.36). CONCLUSIONS: High school-aged teens experiencing DLHS have higher perceived firearm access compared with lower-risk peers. Providers should speak directly to high school-aged teens at increased suicide risk about firearm access, in addition to counseling parents. [ABSTRACT FROM AUTHOR]

Bell’s palsy (BP) is an acute and idiopathic paralysis of the facial nerve, with an estimated incidence ranging from 11.5 per 100,000 person-years to 53.3 per 100,000 person-years in different populations. BP has been reported following immunization with inactivated trivalent influenza vaccine (TIV) and hepatitis B virus (HBV) vaccine. Epidemiologic studies examining this association among children are lacking. From 2001 through 2006, all children aged ≤18 years diagnosed with BP within the Kaiser Permanente Northern California population were identified using International Classification of Diseases, Ninth Revision, code 351.0. All electronically identified cases were reviewed and adjudicated by an otolaryngologist (n = 233). Using a case-centered approach, the authors examined the risk of BP during 3 risk intervals. Immunization with TIV (odds ratio (OR) = 0.7, 95% confidence interval (CI): 0.2, 2.8), HBV vaccine (OR = 0.8, 95% CI: 0.2, 2.4), or any vaccine (treating all vaccines combined; OR = 0.9, 95% CI: 0.6, 1.4) was not associated with increased risk of BP 1–28 days after immunization. Similarly, no association was found between vaccines and BP during the periods 1–14 and 29–56 days following immunization. Results of this study suggest that there is no association between immunization and BP in children. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: A number of new and combination vaccines have been introduced for children in the past two decades. Encephalitis cases occurring within defined time windows following administration of pertussis- or measles-containing vaccines are eligible for compensation by the Vaccine Injury Compensation Program. Due to increased parental concerns about vaccine safety and potential neurologic adverse events following immunization with new and multiple vaccines administered at the same visit, our aim was to determine whether immunizations are associated with an increased risk of encephalitis within defined risk windows. Methods: We reviewed immunization records from 246 pediatric encephalitis cases referred to the California Encephalitis Project between July 1998 and December 2008. We included data on 110 cases who had been immunized in the year prior to the onset of encephalitis (observation period) and had complete immunization records. We used the case-centered method to test whether cases were more likely to have developed encephalitis in defined risk windows—42, 30 and 21 days after any vaccination, 3 days after pertussis-containing vaccines and 5–15 days after measles-virus containing vaccines—compared with the rest of the observation period. Results: All vaccines recommended in the current immunization schedule were represented in our sample. No increased risk of encephalitis was seen following administration of pertussis-containing vaccines, measles-containing vaccines or any number of vaccines administered in a single visit (vaccine episode); the odds ratios and 95% confidence intervals for encephalitis after a vaccine episode were: 1.0 (0.6–1.8) in a 42-day risk window, 0.9 (0.5–1.6) in a 30-day risk window and 1.2 (0.7–2.2) in a 21-day risk window. Conclusion: No association between receipt of currently recommended immunizations and subsequent development of encephalitis was observed in this study. [Copyright &y& Elsevier]

We sought to determine whether oral fluid can be used to assess serum human papillomavirus (HPV) antibody status by enrolling women who had received a prophylactic HPV-16 vaccine in a new follow-up study. After the prophylactic HPV-6/11/16/18 vaccine was licensed in the United States, we administered it to consenting participants. With serologic findings used as the reference standard, The sensitivity of oral fluid was 49.6% (95% confidence interval [CI], 42.0%-57.3%) before and 100% (95% CI, 92.0%-100%) after administration of the quadrivalent vaccine. Oral fluid may have the potential to be used for monitoring of prophylactic HPV vaccines in the future. [ABSTRACT FROM AUTHOR]

Background and objectives: Childhood exposure to domestic violence is common, but the overlap between threats and violence against children and weapon/firearm use has not been well studied. The objectives of this study were to: assess differences in respondent firearm access and the use of weapons in granted domestic violence protection orders (DVPOs) with and without minors (individuals <18 years of age); and characterize the frequency and characteristics of threats and acts of violence against minors. Methods: We conducted a cross-sectional study of a random sample of granted DVPOs from 2014-2020 in King County, Washington. We examined the use of threats, violence, and weapons by restrained individuals (ie, respondents) by reviewing and abstracting information from DVPO case files. Results: Respondent weapon use and firearm possession were more common among DVPOs including minors than DVPOs not including minors (weapon use: 38.2% and 33.0%; firearm possession: 23.1% and 19.1%, respectively). Almost 2 in 3 DVPOs including minors (1338 of 2029) involved threats or violence directed at a minor perpetrated by the DVPO respondent. About 1 in 3 (32.5%) DVPOs documented explicit threats, and 1 in 2 (48.9%) documented violence. Over two-thirds (680 of 993, 68.5%) of acts of violence directed at minors included a weapon. Conclusions: We found higher lethality risk (weapon use and respondent firearm access/ownership) among DVPOs including minors. Many minors experienced threats and acts of violence involving weapons and firearms by DVPO respondents. Evidence-based safety planning strategies and training of judicial officers are needed. [ABSTRACT FROM AUTHOR]

The article presents information on a summary of a case control medical research published in the journal, which evaluates the effectiveness of pertussis vaccines in adolescents and adults. The study illustrates that the effect of acellular pertussis vaccines is abated eventually when given in childhood. This study included participants including both cases and controls from Kaiser Permanente Northern California, a healthcare delivery system.

Objective: To identify factors available to rescuers at the scene of a drowning that predict favourable outcomes.Design: Systematic review and meta-analysis.Data Sources: PubMed, Embase and Cochrane Library were searched (1979-2015) without restrictions on age, language or location and references lists of included articles.Study Selection: Cohort and case-control studies reporting submersion duration, age, water temperature, salinity, emergency services response time and survival and/or neurological outcomes were eligible. Two reviewers independently screened articles for inclusion, extracted data, and assessed quality using GRADE. Variables for all factors, including time and temperature intervals, were categorized using those used in the articles. Random effects meta-analyses, study heterogeneity and publication bias were evaluated.Results: Twenty-four cohort studies met the inclusion criteria. The strongest predictor was submersion duration. Meta-analysis showed that favourable outcome was associated with shorter compared to longer submersion durations in all time cutoffs evaluated: ≤5-6min: risk ratio [RR]=2.90; (95% confidence interval [CI]: 1.73, 4.86); ≤10-11min: RR=5.11 (95% CI: 2.03, 12.82); ≤15-25min: RR=26.92 (95% CI: 5.06, 143.3). Favourable outcomes were seen with shorter EMS response times (RR=2.84 (95% CI: 1.08, 7.47)) and salt water versus fresh water 1.16 (95% CI: 1.08, 1.24). No difference in outcome was seen with victim's age, water temperatures, or witnessed versus unwitnessed drownings.Conclusions: Increasing submersion duration was associated with worse outcomes. Submersion durations <5min were associated with favourable outcomes, while those >25min were invariably fatal. This information may be useful to rescuers and EMS systems deciding when to perform a rescue versus a body recovery. [ABSTRACT FROM AUTHOR]

We examined the effect of early intensive care unit (ICU) adherence to 2007 Brain Trauma Foundation Guideline indicators after traumatic brain injury (TBI) on inpatient mortality at a level 1 trauma center in India (Jay Prakash Narayan Apex Trauma Center [JPNATC]) and Harborview Medical Center (HMC) in U.S. among adults older than 18 years with severe TBI. At each site, ICU Guideline adherence in first 72 hours for 17 indicators was determined and expressed as a percentage. Outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) scores at 3, 6, and 12 months after discharge. JPNATC and HMC Guideline adherence rates were 74.9% [11.0] and 71.6 % (SD ±10.4), and overall in-hospital mortality was 24% and 27%, respectively. At JPNATC, less than 65% ICU Guideline adherence was associated with higher inpatient mortality (adjusted relative risk [aRR], 1.92; 95% confidence interval [CI], 1.11–3.33) and an increase in ICU Guideline adherence rate by 1% was associated with a 3% lower in-hospital mortality (aRR, 0.97; 95% CI, 0.95–0.99). Among patients discharged with a GOS score of 2–4 at JPNATC, 67% improved at 12 months (R 2 = 0.991; P < 0.01; 99% follow-up rate) compared with discharge, but 35%, 25%, and 14% of patients discharged with a GOS score of 3–5 deteriorated at 3, 6, and 12 months to a lower GOS at home. Achieving early ICU adherence to guideline indicators was feasible and associated with significantly lower in-hospital mortality at JPNATC. Although the intracranial pressure (ICP) monitoring rates varied, in-hospitals deaths were similar between the two institutions. Although long-term outcomes generally improved, patients discharged with favorable GOS score often deteriorated at home. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Washington State experienced a pertussis epidemic from October 2011 to December 2012. There was wide variation in incidence by county. The objectives of this study were to determine how the pertussis epidemic affected infant vaccination in Washington State and whether the incidence in counties modified this effect. METHODS: We conducted an ecologic before--after study to compare the proportion of infants up to date (UTD) with a pertussis-containing vaccine at time points before (September 30, 2011), during (September 30, 2012), and after (September 30, 2013) the epidemic. Children aged 3 to 8 months enrolled in the Washington State Immunization Information System with documented county of residence were included. UTD status was determined as ≥1, ≥2, or ≥3 doses of a pertussis-containing vaccine at ages 3, 5, and 7 months, respectively. Generalized linear models with extension to the binomial family and clustered robust standard errors were used to examine differences in the proportion of UTD infants between preepidemic and either epidemic or postepidemic points. The potential modifying effect of pertussis incidence by county was examined. RESULTS: We found no significant difference in statewide UTD status with a pertussis-containing vaccine between preepidemic and either epidemic (absolute difference 2.1%; 95% confidence interval, -1.6 to 5.9) or postepidemic (absolute difference 0.2%; 95% confidence interval, -4.0 to 4.5) time points. There was no significant modification by county pertussis incidence. There was wide variation in the absolute difference in UTD status across counties. CONCLUSIONS: A statewide pertussis epidemic does not appear to have significantly changed the proportion of infants who were UTD with a pertussis-containing vaccine. [ABSTRACT FROM AUTHOR]