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Extreme precipitation‐related hazards like flash floods pose a widespread risk to humans and infrastructure around the world. In the current study, the Fisher information was applied to understand the nonstationarity of the extreme precipitation regimes, whereas copula was used to quantify the likelihood of joint occurrence of two extreme precipitation indices and associated risk assessment in the upper Midwestern United States (UMUS). The trend analysis revealed an increasing trend in 37% of the stations in heavy precipitation amount in the UMUS. The regime shift analysis showed the non‐stationary nature of extreme precipitation in about half of the total stations in UMUS. Further, the bivariate analysis using copula demonstrated the risk of the joint occurrence of extreme precipitation indices potentially causing flash floods. The risk index analysis indicated about 28.8% of stations under moderate, 10.6% of stations under high and 0.4% of stations under very high risk of flash flooding. The results from the study can provide important insights for the (re)design of resilient and sustainable water infrastructure in the changing climate condition and can also inform managers and planners for better response and preparedness toward extreme precipitation‐related hazards in this region. The results from this study can also help in a more accurate risk assessment, especially in the socio‐economically vulnerable community. [ABSTRACT FROM AUTHOR]

Background: Obesity prevalence is significantly higher among Latino boys than girls. Weight status at 12 mo, a significant predictor of childhood obesity, is associated with feeding practices during infancy. Objectives: The objectives were to examine breastfeeding and formula-feeding practices overall and by infant gender and to examine relations among infant gender, milk-feeding practices, and obesity risk among Latino infants over the first year of life. Methods: Latino mother-infant dyads (n = 90) were recruited from a pediatric clinic. Mothers were interviewed at regular intervals (infants aged 2, 4, 6, and 9 mo), and 24-h feeding recalls were conducted when infants were aged 6 and 9 mo. Infants' lengths and weights were retrieved from clinic records to calculate weight-for-length percentiles. A bivariate analysis was conducted to compare feeding practices by gender and mediation analysis to test whether feeding practices mediated the relation between gender and obesity risk. Results: The majority (80%) of mothers were born outside the United States. In early infancy, mixed feeding of formula and breastfeeding was common. At 6 and 9 mo of age, milk-feeding practices differed, with formula feeding more common for boys than girls. At 12 mo, 38% of infants experienced obesity risk (-85th weight-for-length percentile). Infants' obesity risk increased by 18% per 1 oz increase in powdered formula intake. Formula intake among boys was on average 1.42 oz (in dry weight) higher than that among girls, which, in turn, mediated their increased obesity risk (IERR = 1.27, 95% confidence interval: 1.02, 1.90). Conclusions: The increased obesity risk among Latino boys compared with girls at 12 mo was explained by higher rates of formula feeding at 6 and 9 mo of age. Future investigations of cultural values and beliefs in gender-related feeding practices are warranted to understand the differences in obesity risk between Latino boys and girls. [ABSTRACT FROM AUTHOR]

Purpose: The study examines the prevalence and correlates of perceived discrimination across ten Asian American ethnic groups. The goal is to disaggregate an artificially created broad categorization of Asians into subgroups to reveal the existing intragroup differences. Design/methodology/approach: Bivariate and multivariate analyses were based on data from the 2016 National Asian American Survey (NAAS). The exclusion of missing data on all variables used in the analysis revealed a final analytical sample size of 4,276. Findings: Compared to all other Asian American ethnic groups, Cambodians report the lowest frequency of perceived discrimination on all outcome measures. On the contrary, the prevalence of perceived discrimination is highest for Bangladeshis and Indians on lifetime and job-related discrimination and for Indians and Japanese on day-to-day discrimination. Nearly all Asian American ethnic groups are more likely to report one or more types of perceived discrimination than Chinese Americans. The observed relationships disappear for Cambodians, Pakistanis and Japanese but persist for Bangladeshis, Filipinos, Hmong and Indians after controlling for socio-demographic characteristics. Among the socio-demographic controls, gender, birthplace, education and employment status are found to be significant predictors of perceived discrimination. Originality/value: The findings of the study further the discussion on the importance of disaggregating minority groups and considering their heterogeneous experiences of perceptions of discrimination in the United States. [ABSTRACT FROM AUTHOR]

Although the threat of terrorism remains a high priority among Americans, no study has explored the regional differences in perceptions of terrorism in the United States. In order to address the current gap in the literature, the present research specifically examines the fear and risk perceptions of college students regarding the threat of terrorism. The research sample consisted of 1,384 undergraduate students from three major regional universities in the United States. Bivariate and multivariate analyses of the collected data yielded significant regional differences, and uncovered several associations and predictors, such as political identity, that previous studies have not revealed. [ABSTRACT FROM AUTHOR]

In this study, we investigate varying-coefficient models for spatial data distributed over two-dimensional domains. First, we approximate the univariate components and the geographical component in the model using univariate polynomial splines and bivariate penalized splines over triangulation, respectively. The spline estimators of the univariate and bivariate functions are consistent, and their convergence rates are also established. Second, we propose empirical likelihoodbased test procedures to conduct both pointwise and simultaneous inferences for the varying-coefficient functions. We derive the asymptotic distributions of the test statistics under the null and local alternative hypotheses. The proposed methods perform favorably in finite-sample applications, as we show in simulations and an application to adult obesity prevalence data in the United States. [ABSTRACT FROM AUTHOR]

Background: Fatal drug overdoses, now primarily driven by illicit opioids like fentanyl, continue to increase in the United States, reflecting a growing need for prevention and treatment strategies. Preventive interventions have primarily focused on curbing opioid prescribing, and treatment strategies target individuals. However, little is known about the broader social context surrounding these individuals.Objective: This study examines the association between drug overdose mortality and social determinants of health (SDOH) across different levels of influence in the social-ecological model.Methods: Data on drug overdose death and SDOH were collected at the county level for most mid-Atlantic states in 2019. Association between each characteristic and drug overdose mortality was measured through a bivariate analysis. Furthermore, a multivariate analysis was performed to detect risk factors of drug overdose death while adjusting for multiple comparisons. All statistical analyses were performed with SAS version 9.4.Results: SDOH, including violent crime (P < 0.001), access to the Internet (P < 0.001), per capita income (P < 0.001), social vulnerability index (P = 0.001), and access to health care (P < 0.001), demonstrated a statistically significant positive association with drug overdose death. In contrast, vacancy rate was negatively associated with drug overdose mortality (P < 0.001). The association between drug overdose deaths and opioid prescription rates was not statistically significant (P = 0.412).Conclusion: Factors such as violent crime and social vulnerability demonstrated a statistically significant impact on drug overdose mortality. To address drug overdose crisis, health care system, community leaders, and policy makers' strategies should focus on socially vulnerable populations. [ABSTRACT FROM AUTHOR]

Purpose: Challenges ushered by the COVID-19 pandemic led to an increased focus on the mental well-being of the healthcare workforce. Despite the important contribution non-clinician biomedical researchers make to the mission of academic medical centers, the well-being of this unique population remains understudied in the United States. The purpose of this study was to examine the individual and organizational correlates of distress among non-clinician biomedical researchers. Methods: A survey was delivered to employees of a large academic medical center in the southeastern United States, including non-clinician biomedical researchers. Participants were asked to assess their own well-being using the validated Well-Being Index (WBI) tool, resilience, work and nonwork-related stressors and demographic descriptors. Descriptive statistics and bivariate analyses were conducted, and binary logistic regression was used to examine predictors of increased odds of overall distress. Results: Nearly 44% of surveyed non-clinician biomedical researchers met the threshold for high distress which indicates an increased risk of suicidal ideation, turnover intention, and burnout. The major correlates of distress were at the organizational level, including perceived organizational support (OR 0.79, 95% CI 0.70– 0.90), heavy workload and long hours (OR 3.25, 95% CI 1.53– 6.88), inability or lack of support to take time off (OR 2.80, 95% CI 1.03– 7.66) and conflict with supervisor (OR 5.03, 95% CI 1.13– 22.1). While lower individual resilience (OR 0.69, 95% CI 0.54– 0.88) was statistically significantly associated with greater distress, it accounted for less than 10% of the overall variance when controlling for other work-related factors. Conclusion: These findings suggest that developing organizational interventions that address institutional support for non-clinician biomedical researchers within academic medical centers represents an important opportunity to reduce distress within this population. While emphasizing individual resiliency as an important in the pursuit of well-being, it is also the responsibility of the organization to create and foster an environment in which employees can access their own resilience. [ABSTRACT FROM AUTHOR]

We estimate the prevalence and characteristics of violent hate crime victimization of lesbian, gay, bisexual, and transgender (LGBT) people in the United States, and we compare them to non-LGBT hate crime victims and to LGBT victims of violent non-hate crime. We analyze pooled 2017-2019 data from the National Crime Victimization Survey (n persons = 553, 925;n incidents = 32, 470), the first nationally representative and comprehensive survey on crime that allows identification of LGBT persons aged 16 or older. Descriptive and bivariate analysis show that LGBT people experienced 6.6 violent hate crime victimizations per 1,000 persons compared with non-LGBT people's 0.6 per 1,000 persons (odds ratio = 8.30, 95% confidence interval = 1.94, 14.65). LGBT people were more likely to be hate crime victims of sexual orientation or gender bias crime and less likely to be victims of race or ethnicity bias crimes compared to non-LGBT hate crime victims. Compared to non-LGBT victims, LGBT victims of hate crime were more likely to be younger, have a relationship with their assailant, and have an assailant who is white. Compared to LGBT victims of non-hate violence, more LGBT hate crime victims reported experiencing problems in their social lives, negative emotional responses, and physical symptoms of distress. Our findings affirm claims that hate crimes have adverse physical and psychological effects on victims and highlight the need to ensure that LGBT persons who experience hate crime get necessary support and services in the aftermath of the crime. [ABSTRACT FROM AUTHOR]

Evidence on how hot spot policing affects community members' views of police is very limited and inconclusive. Scholars have thus called for further study of community attitudes in hot spots to guide police in the formulation of hot spot strategies—an issue that is especially salient given recent public controversy surrounding policing, particularly in the United States. Using survey responses collected in 2018 from more than 1,000 community members living or working in more than 100 hot spots across 2 mid-sized cities in the United States, this study examines how community members' perceptions of police activities in hot spots relate to their wider attitudes about police. Bivariate and multivariate analyses indicate that community members in hot spots in both cities exhibit more positive attitudes towards police along several dimensions (e.g., trust and confidence in police, views of police legitimacy, and perceptions of police responsiveness and procedural justice) when they see more frequent patrol and when they see positive police-community interactions. They have more negative views of police when they witness higher levels of investigative and enforcement activity. The findings support hot spot policing strategies that emphasize regular, systematic patrol in hot spots, complemented by positive community engagement efforts and problem-solving work. In contrast, they imply that enhanced enforcement activity in hot spots should be used judiciously. [ABSTRACT FROM AUTHOR]

Although visibility of nonbinary gender identities continues to improve in the United States, there is still a paucity of medical literature on the unique needs and experiences of nonbinary individuals. Using the TransPop survey, we compared gender-affirming treatment preferences and societal affirmation among nonbinary individuals, transmen, and transwomen using bivariate analysis and multivariable linear regression. Nonbinary individuals had or desired surgery and hormones at lower rates compared with binary transgender individuals. Nonbinary respondents had lower rates of adjusted and nonadjusted societal affirmation. This study showed variation in both treatment preferences and societal affirmation, which should be considered in clinical care and research studies clustering transgender and nonbinary individuals in analysis. [ABSTRACT FROM AUTHOR]

Influenza is a major cause of morbidity and mortality worldwide. The flu vaccine is the most important strategy to prevent influenza. Studies indicate that individuals with mental health disorders are at an increased risk of comorbid health conditions that predispose them to severe flu complications. This study examined the association between mental distress and influenza vaccine coverage among non-institutionalized adults in the United States. Data was analyzed from the 2016 Behavioral Risk Factor Surveillance System (BRFSS). The analytic sample (453,924) included those with valid information on health-related quality of life (HRQOL) and flu vaccine coverage. Bivariate analysis and logistic regression were performed. Those with infrequent mental distress had 1% (95% confidence interval [CI] 0.96,1.03) lower odds and those with frequent mental distress had 21% (95% CI 0.75,0.82) decrease odds of receiving the flu shot in comparison to those with no mental distress, given all else equal. A negative effect on influenza vaccination rates was observed with frequent mental distress when compared to those with no mental distress. Further studies are warranted to better understand this association. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of burnout among the midwifery workforce and the association between fixed personal and practice characteristics and modifiable organizational factors, specifically practice environment, to burnout among midwives in the United States. Data Source: Primary data collection was conducted via an online survey of the complete national roster of certified nurse‐midwives and certified midwives over 3 weeks in April 2017. Study Design: The study was a cross‐sectional observational survey consisting of 95 items about personal and practice characteristics, respondents' practice environments, and professional burnout. Data Collection Methods: The inclusion criterion was actively practicing midwifery in the United States. Data were analyzed with bivariate analyses to determine the association between personal and practice characteristics and burnout. A hierarchal multilinear regression evaluated the interrelationship between personal and practice characteristics, practice environment, and burnout. Principal Findings: Of the almost one third (30.9%) of certified nurse‐midwives and certified midwives who responded to the survey, 40.6% met criteria for burnout. Weak negative correlations existed between burnout and indicators of career longevity: age (r(2256) = −0.09, p < 0.01), years as a midwife (r(2267) = −0.07, p = 0.01), and years with employer (r(2271) = −0.05, p = 0.02). There were significant relationships between burnout score and patient workload indicators: patients per day in outpatient setting (F(5,2292) = 13.995, p < 0.01), birth volume (F(3,1864) = 8.35, p < 0.01), and patient acuity (F(2,2295) = 20.21, p < 0.01). When the practice environment was entered into the model with personal and practice characteristics, the explained variance increased from 6.4% to 26.5% (F(20,1478) = 27.98, p < 0.01). Conclusions: Our findings suggested that a key driver of burnout among US midwives was the practice environment, specifically practice leadership and participation and support for the midwifery model of care. Structural and personal characteristics contributed less to burnout score than the practice environment, implying that prevention of burnout may be achieved through organizational support and does not require structural changes to the provision of perinatal health. [ABSTRACT FROM AUTHOR]

Background: The continued increase in prevalence of methamphetamine use in the United States has resulted in a significant increase in the number of patients entering treatment for methamphetamine use. However, no robustly efficacious pharmacologic treatment for methamphetamine use or withdrawal has been identified to date after stopping methamphetamine use. Aims: Given the association between methamphetamine withdrawal and relapse during early treatment, this study tested a controlled d-amphetamine withdrawal paradigm among methamphetamine-using individuals. Methods: Treatment-seeking adults who used methamphetamine (N = 34; 47% female; 100% white) were enrolled in a 4-week, randomized, double-blind, placebo-controlled trial in a residential setting, in which all participants were maintained on d-amphetamine (30 mg BID) during week 1, then half were switched to placebo during weeks 2–3. All participants received placebo during week 4. Outcomes included vital signs, withdrawal, cravings for methamphetamine, mood, and cognition. Bivariate analyses tested treatment group differences on baseline demographic and outcome variables. Repeated measures models examined main and interaction effects of treatment over time. Results/Outcomes: Participants were successfully randomized and safely stabilized on d-amphetamine. Craving for methamphetamine increased during weeks 2–3 in the placebo group relative to those on d-amphetamine. Interactions with age and heart rate were noted. Conclusions/Interpretation: To our knowledge, this is the first double-blind, placebo-controlled trial measuring pharmacologic effects of abruptly stopping controlled d-amphetamine administration in adults who use methamphetamine. Results support the potential of this withdrawal paradigm to further examine the efficacy of pharmacologic agents in ameliorating methamphetamine withdrawal symptoms. [ABSTRACT FROM AUTHOR]

This paper extends the understanding of the relation between ADHD and reading comprehension, through examining how this relation differs depending on the quantile an individual falls in for each. Samples from three twin projects around the United States were used (Florida Twin Project, Colorado component of International Longitudinal Twin Study of Early Reading Development, & Western Reserve Reading and Math Projects). Phenotypic analysis using quantile regression showed relations between ADHD related behaviors and reading comprehension to be stronger in the lower quantiles of reading comprehension in two of three samples. A new method was developed extending this analysis into the bivariate genetic space. Results of this quantile genetic analysis revealed that overlapping common environmental influences accounted for a larger proportion of variance in the lower quantiles of these variables in two of three samples. Finally, in all three samples the phenotypic relation was strongest when shared environmental influences accounted for a larger proportion of the overall variance. [ABSTRACT FROM AUTHOR]

Soccer participation in the United States (U.S.) has increased over time, and injuries as well as interest to prevent injuries has become more common. This study described Emergency Department (ED) visits related to concussions, intracranial injuries (ICI), and all-other injuries attributed to soccer play; described healthcare cost and length of hospital stay of soccer-related injuries; and determined independent predictors of concussions, ICI, and all-other soccer injuries leading to ED visits. The study examined soccer-related weighted discharge data from the Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Weighted tabular analysis of univariate and bivariate analyses and weighted and adjusted logistic regression models were conducted. A total of 480,580 of U.S. ED visits related to soccer injuries were available for analysis between 2010 to 2013. Generally, 98% of soccer-related ED visits resulted in routine (treat-and-release) visits. However, the odds of transfer to a short-term hospital following ED evaluation and treatment was more than 37-fold higher for soccer-injured youth and adults diagnosed with ICI when compared to all-other soccer injuries; additionally, these patients showed 28-fold higher odds of being admitted for inpatient care at the ED-affiliated hospital. For concussion, soccer-injured patients with concussion showed nearly 1.5-fold higher odds of being transferred to a short-term hospital than did those with any other soccer injury. Soccer-related ED visits cost more than 700 million in U.S. dollars from 2010 to 2013. Notable differences were noted between concussions, ICI, and all-other soccer injuries presenting to U.S. ED. Albeit underestimated given that this study excludes other forms of health care and treatment for injuries, such as outpatient clinics, over the counter medications and treatment, and rehabilitation, healthcare cost associated with soccer-related injuries presenting to ED is high, and remarkably costly in those with an ICI diagnosis. [ABSTRACT FROM AUTHOR]

Understanding the relationships and sexual behavior of university students will help educators and service-providers meet the reproductive health needs of students. This study aimed to investigate the prevalence of relationship behaviors and their predictors among students attending an American university. A cross-sectional survey was carried out among 924 students attending Central Michigan University. A self-administered structured questionnaire was derived from the World Health Organization and sent via emails to the participants. Descriptive analysis, bivariate and linear regression were used to analyze the data. This study showed that the average age of the first sexual encounter was 18.20 ± 4.31 years and the prevalence of having a girlfriend/boyfriend among university students was 92.1%. In total, 86.9% of students described their relationship as serious, 95.4% of cases announced that their boy/girlfriend was single when they started the relationship and someone who was working or were a full-time student (93.8%). Our results showed that only age was associated with relationship behavior among sociodemographic characteristics as older students had higher relationship behavior scores (OR: 0.09, CI 95% [0.03, 0.16]). There was no association between students' knowledge of risky sexual behavior and sex education (OR: 0.04, CI 95% [0.71–0.17]). Moreover, the history of sex education during school years was not associated with relationship behavior during university years. This study showed that although university students started their sexual relationship at a reasonable age, their knowledge about risky sexual behavior was not significantly associated with sex education. Future interventional studies pointing to the sexual knowledge and behavior of university students are recommended. [ABSTRACT FROM AUTHOR]

Background: Informed consent is an ethical and legal requirement that differs from informed decision-making-a collaborative process that fosters participation and provides information to help patients reach treatment decisions. The objective of this study was to measure informed consent and informed decision-making before major surgery.Study Design: We audio-recorded 90 preoperative patient-surgeon conversations before major cardiothoracic, vascular, oncologic, and neurosurgical procedures at 3 centers in the US and Canada. Transcripts were scored for 11 elements of informed consent based on the American College of Surgeons' definition and 9 elements of informed decision-making using Braddock's validated scale. Uni- and bivariate analyses tested associations between decision outcomes as well as patient, consultation, and surgeon characteristics.Results: Overall, surgeons discussed more elements of informed consent than informed decision-making. They most frequently described the nature of the illness, the operation, and potential complications, but were less likely to assess patient understanding. When a final treatment decision was deferred, surgeons were more likely to discuss elements of informed decision-making focusing on uncertainty (50% vs 15%, p = 0.006) and treatment alternatives (63% vs 27%, p = 0.02). Conversely, when surgery was scheduled, surgeons completed more elements of informed consent. These results were not associated with the presence of family, history of previous surgery, location, or surgeon specialty.Conclusions: Surgeons routinely discuss components of informed consent with patients before high-risk surgery. However, surgeons often fail to review elements unique to informed decision-making, such as the patients' role in the decision, their daily life, uncertainty, understanding, or patient preference. [ABSTRACT FROM AUTHOR]

Background: Prenatal detection (PND) has benefits for infants with hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA), but associations between sociodemographic and geographic factors with PND have not been sufficiently explored. This study evaluated whether socioeconomic quartile (SEQ), public insurance, race and ethnicity, rural residence, and distance of residence (distance and driving time from a cardiac surgical center) are associated with the PND or timing of PND, with a secondary aim to analyze differences between the United States and Canada.Methods: In this retrospective cohort study, fetuses and infants <2 months of age with HLHS or TGA admitted between 2012 and 2016 to participating Fetal Heart Society Research Collaborative institutions in the United States and Canada were included. SEQ, rural residence, and distance of residence were derived using maternal census tract from the maternal address at first visit. Subjects were assigned a SEQ z score using the neighborhood summary score or Canadian Chan index and separated into quartiles. Insurance type and self-reported race and ethnicity were obtained from medical charts. We evaluated associations among SEQ, insurance type, race and ethnicity, rural residence, and distance of residence with PND of HLHS and TGA (aggregate and individually) using bivariate analysis with adjusted associations for confounding variables and cluster analysis for centers.Results: Data on 1862 subjects (HLHS: n=1171, 92% PND; TGA: n=691, 58% PND) were submitted by 21 centers (19 in the United States). In the United States, lower SEQ was associated with lower PND in HLHS and TGA, with the strongest association in the lower SEQ of pregnancies with fetal TGA (quartile 1, 0.78 [95% CI, 0.64-0.85], quartile 2, 0.77 [95% CI, 0.64-0.93], quartile 3, 0.83 [95% CI, 0.69-1.00], quartile 4, reference). Hispanic ethnicity (relative risk, 0.85 [95% CI, 0.72-0.99]) and rural residence (relative risk, 0.78 [95% CI, 0.64-0.95]) were also associated with lower PND in TGA. Lower SEQ was associated with later PND overall; in the United States, rural residence and public insurance were also associated with later PND.Conclusions: We demonstrate that lower SEQ, Hispanic ethnicity, and rural residence are associated with decreased PND for TGA, with lower SEQ also being associated with decreased PND for HLHS. Future work to increase PND should be considered in these specific populations. [ABSTRACT FROM AUTHOR]

Background: As most health professions in the United States have adopted clinical or practice doctorates, there has been an ongoing debate on whether physician assistants (PAs) should transition from a master's to a doctorate as the terminal degree. The authors examined perceived risks, benefits and impact of transitioning to an entry-level PA doctoral degree. Methods: A multi-prong, mixed-methods approach was used that included a literature review and collecting quantitative and qualitative data using a survey and interviews. Bivariate analysis and binomial logistic regression were performed to evaluate relationships between perceptions/perspectives on an entry-level PA doctoral degree and the anticipated impact of it causing more harm than good to the PA profession. Deductive content analysis was used to analyze the qualitative data. Results: Of 636 PA clinicians and students (46% response rate), 457 (72%) disagreed that an entry-level PA doctoral degree should be required. More than half of the respondents (54%) agreed that it should be offered but not required and 380 respondents (60%) agreed that an entry-level doctoral degree would cause more harm than good. Race, educational attainment, occupation, and length of practice as a PA were significantly associated with having a perception of causing more harm. There was strong positive association between the perception of a doctoral degree causing more harm with expectations of having a negative impact on the availability of clinical training sites (OR = 4.39, p <.05). The most commonly cited benefits were parity with other professions and competitive advantage, whereas the perceived risks were increased cost for education, decreased diversity in the profession, and negative impact on the PA/physician relationship. Conclusions: The major takeaway of our study was that perceived benefits and risks are strongly influenced by the lens of the stakeholder. While the majority of PAs and students appear to be not in favor mainly due to the potential harm, the proportion of those in favor is not insignificant and their views should not be ignored. Addressing concerns with key stakeholders could help the PA profession to transition to a doctoral degree with minimal adverse impact. [ABSTRACT FROM AUTHOR]

Introduction: As the use of electronic cigarette (EC) continues to rise in the United States, especially among adolescents and young adults, it is necessary to better understand the factors associated with EC initiation. Specifically, it is unclear how genetic and environmental contributions influence the initiation of EC. Furthermore, the degree to which genetic and environmental influences are shared between EC initiation and conventional cigarette (CC) initiation is unknown.Methods: A sample of young adult twins ages 15-20 (N = 858 individuals; 421 complete twin pairs) was used to estimate the genetic and environmental influences on the liability of initiation unique to EC and CC as well as the degree to which these factors are shared between the two. Approximately 24% of participants initiated the use of EC, 19% initiated the use of CC, and 11% initiated the dual use.Results: Combined contributions of additive genetic and shared environmental influences were significant for CC (ACC = 0.19 [95% confidence interval {CI} = 0-0.79], p = 0.57; CCC = 0.42 [95% CI = 0-0.70], p = 0.13) and EC (AEC = 0.25 [95% CI = 0-0.83, p = 0.44; CEC = 0.42 [95% CI = 0-0.73], p = 0.12), whereas unique environmental influences were significant (ECC = 0.39 [95% CI = 0.18-0.57], p < 0.001; EEC = 0.32 [95% CI = 0.14-0.56], p < 0.001). Results also demonstrated a significant overlap of the unique environmental (rE = 0.87, p < 0.001) and familial influences contributing to correlation between the two phenotypes in the bivariate analysis.Conclusions: These preliminary results suggest that both genes and environmental influences are potential drivers of EC initiation among adolescents and young adults.Implications: This article is the first to use a sample of twin to estimate the contributions of genetic and environmental influences toward EC initiation and estimate the potential for overlapping influences with CC initiation. This study has implications for future debate about the etiology of EC and CC use with respect to potential overlapping genetic and environmental influences. [ABSTRACT FROM AUTHOR]

Background: National guidelines do not provide recommendations concerning optimal dispatch time for helicopter emergency medical services (HEMS) in the United States.Objectives: This study describes the association between mode of transport (ground vs. helicopter) and survival of patients with penetrating injury across different prehospital time intervals and proposes evidence-based time-related dispatch criteria for HEMS.Methods: A retrospective matched cohort study was conducted using the 2015 National Trauma Data Bank. Adult patients (age ≥ 16 years) with penetrating injuries were included. Patients transported via HEMS were selected and matched (1 to 1) for 17 variables to patients transported by ground ambulance (GEMS). Bivariate analyses were conducted to compare characteristics and outcomes (survival to hospital discharge) of patients across different prehospital time intervals.Results: Each group consisted of 949 patients. Overall survival rate was similar in both groups (90.6% for HEMS vs. 87.9% for GEMS, p = 0.054). Patients transported by HEMS had significantly higher survival compared with those transported by GEMS (92.5% for HEMS vs. 87.0% for GEMS, p = 0.002) in the 0-60-min time interval from dispatch to arrival to hospital, and more specifically, in the 31-60-min interval (92.2% vs. 85.2%, p = 0.001). No difference in survival between the two groups was observed in the shortest (0-30 min) or in the extended prehospital time intervals (>60 min).Conclusion: In adult patients with penetrating trauma, HEMS transport was associated with improved survival in a specific total prehospital time interval (31 to 60 min). This finding can help emergency medicine service administrators develop evidence-based HEMS dispatch criteria. [ABSTRACT FROM AUTHOR]

To characterize burden of migraine in prevention-eligible patients compared with prevention non-eligible patients in the United States (US). Receipt of preventive therapy was also examined among prevention-eligible patients. This retrospective study utilized data from the 2017 US National Health and Wellness Survey linked with medical and pharmacy claims. Patients aged ≥18 years who self-reported experiencing migraine and had confirmed evidence of migraine (≥1 medical or pharmacy claim) were included. Prevention eligibility was based on number of headache days in the past 30 days (prevention-eligible: ≥4 and prevention non-eligible: <4). Descriptive statistics summarized study variables; bivariate and multivariable analyses were conducted to examine the association of prevention-eligibility status with outcomes. Analyses included 450 patients, 291 (65%) prevention-eligible, and of these 56 (19%) received preventive therapy. Overall, patients were 42.98 ± 14.51 years old; 84% were female. Prevention-eligible patients reported significantly more migraine headache days in the past 6 months (29.27 ± 37.96 vs. 8.61 ± 7.88), had lower mental component summary scores (35.80 ± 2.73 vs. 37.90 ± 2.96), and more presenteeism (47.30 ± 2.98% vs. 37.90 ± 2.60%), overall work impairment (46.30 ± 2.87% vs. 37.90 ± 2.55%) and activity days missed due to migraine (8.16 ± 3.05 vs. 3.82 ± 1.58) than prevention non-eligible patients (all p<.001). Prevention-eligible patients receiving preventive therapy reported more migraine headache days during the past month (9.21 ± 7.99 vs. 6.06 ± 7.10; p=.002) and activity days lost due to migraine (18.39 ± 28.08 vs. 10.69 ± 21.43, p=.015) than those not receiving preventive therapy. Prevention-eligible patients experience greater burden due to migraine, including more headache days, worse health-related quality-of-life, and greater work and activity impairment than prevention non-eligible patients. [ABSTRACT FROM AUTHOR]

Empirical research has yet to explore the intersections of victim characteristics on case outcomes (e.g. guilty, not guilty, unsolved) in transgender homicides. Drawing on queer criminological and intersectional frameworks, both theoretically and methodologically, we explore this relationship using data from 105 transgender homicide cases in the United States between 2010 and 2016. Although only an exploratory study due to our small and sparse sample, both bivariate and multivariate analyses reveal that case outcomes are patterned on the intersections between trans homicide victim race, gender identity, and age at death. We find that while Black trans women are the most common group of trans homicide victim, their cases are among the least likely to result in a guilty verdict. We also find that age plays a unique role in the likelihood of conviction creating an eldership advantage for some race and gender identity intersections but serving as a disadvantage for others. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to review recent drug and medical device recalls, categorize recall types based on the free text descriptions posted within the recall announcements, and conduct exploratory analyses for researchers interested in pharmaceutical supply chain challenges.Methods: A cross-sectional study of all current recalls, market withdrawals, and safety alerts published by the United States Food and Drug Administration pertaining to drugs was conducted. A manual review of all the recalls was also conducted to extract additional information including company details, recall type (labeling or quality), and location of failure in the pharmaceutical supply chain (manufacturing or distribution). Descriptive statistics and exploratory bivariate analyses were conducted to test any potential differences between drug and device recalls.Results: Most recalls issued between January 2017 and September 2019 were pharmaceutical drug recalls (85.2%), while 34 (14.8%) medical device recalls were issued for the same period. For drug recalls, 85.1% (166/195) were because of quality, while 14.9% (29/195) were because of labeling issues. Of the quality issues for drug recalls, lack of sterility was the most frequent issue (139/166, 83.7%). There was no difference between drug or device recalls based on recall type (P = 0.16), top 20 pharmaceutical company (P = 0.62), or location of the supply chain failure (P = 0.20).Conclusions: This study provides a process to categorize and evaluate drug and device recalls by recall type and location of the supply chain. By categorizing the free text provided in public recall data it would be easier to monitor trends over time. [ABSTRACT FROM AUTHOR]

While lower educational attainment is associated with worse health status, education may also affect one's ability to identify need for urgent care. Using data from the 2010 Medicare CAHPS survey, we estimated multivariate logistic models to test the relationship between self-reported educational attainment and the perceived need for urgent care, controlling for health status and other factors. As expected, lower educational attainment was associated with greater reported need for urgent care in bivariate analyses because of poorer health. However, lower educational attainment was associated with less perceived need for urgent care after controlling for health status, particularly for those in poor health. These findings suggest the need for interventions to improve the likelihood that people with less education recognize the need for urgent care, particularly those in poor health and in most need of urgent care. [ABSTRACT FROM AUTHOR]

Background: Emergency department thoracotomy (EDT) is done to control life threatening hemorrhage and injuries. Literature examining this topic is limited to relatively small studies from single trauma centers.Objective: This study identifies factors associated with survival to hospital discharge of patients undergoing EDT using the largest U.S. national trauma database.Methods: This retrospective cohort study used the U.S. National Trauma Data Bank 2015. We conducted univariate and bivariate analyses followed by a multivariate analysis that adjusted for confounders to identify factors associated with survival.Results: Two thousand four hundred eighty-six patients who underwent EDT were included. Most patients were 16 to 64 years of age (92.3%) with a male predominance (84.9%) and without any previous comorbidities (62.8%). Penetrating injury was most common (60.2%), mainly as a result of assault (51.0%) by firearm (45.1%). Overall survival to hospital discharge was 38.2%. After adjusting for confounders, factors associated with increased survival were cut/piece injuries, presenting with signs of life, Glasgow Coma Scale score ≥8, systolic blood pressure >90 mm Hg, and transportation to the ED through helicopter/fixed-wing ambulance or public/private vehicle (reference, ground ambulance).Conclusions: Factors associated with survival in patients undergoing EDT were identified. The clinical indication of presence of appropriate resources to continue and repair EDT was validated, along with the contraindications of lack of signs of life and presence of major nonsurvivable injuries. Future studies should focus on validation of all criteria of EDT, namely hemodynamic instability despite appropriate fluid resuscitation, duration of time of cardiopulmonary resuscitation and pulselessness, cardiac rhythm on arrival, and the presence of pericardial tamponade. [ABSTRACT FROM AUTHOR]

This study examined the relative effects of mental illness, substance abuse/dependence, and co-occurring mental disorders and substance abuse/dependence (CODs) on prison misconduct among male inmates (N = 2,065) incarcerated in Taiwan's nine correctional facilities. Both bivariate and multivariate analyses revealed that COD-affected inmates have the highest risk of prison misconduct compared to those with singular drug abuse/dependence disorders or no disorders, similar to the findings of previous studies conducted in the United States. These results highlighted the importance of clinical screenings and assessments for inmates who might have CODs. Integrated treatments may be more appropriate for inmates with CODs, rather than providing separate treatments for mental and drug abuse/dependence disorders. [ABSTRACT FROM AUTHOR]

Non-communicable diseases and chronic conditions such as obesity constitute significant public health issues in the United States (US) and globally. A major proximal determinant of obesity is physical activity, and related behavior. Limited data however exists comparing physical activity levels of US immigrants with those of native-born adults. This study aimed to compare US immigrants and native-born adults regarding associations of physical activity behavior and obesity. We analyzed data from the Health Information National Trends Survey. Outcomes of interest were various indicators of physical activity. Bivariate analyses and multivariate logistic regression models were utilized in describing demographics, weight distribution, and associations between variables of interest. A total of 3,185 individuals participated in the survey. Male to female ratio was 1.6 and 17% of the participants were immigrants. The mean age was 51 years (SD ± 15) for immigrants and 55 years (SD ± 16) for native-born respondents. Among immigrants, the racial distribution was 55.3% Hispanic, 18.9% Asian, 14.7% White, 9.9% Black, and 1.3% other races. Immigrants were less likely than non-immigrants to spend 6 h or more a day on sedentary leisure activities (adjusted OR = 0.64; 95% CI: 0.42–0.97; p = 0.0350). Also, immigrants were more likely than non-immigrants to engage in physical activity of at least moderate intensity, at least once a week (adjusted OR = 1.48; 95% CI: 1.07–2.05; p = 0.0192). Compared to native-born adults, US immigrants appear to have healthier lifestyles regarding physical activity behavior. Strategies to sustain such tendencies among immigrants will promote health and reduce overall risks of obesity and other chronic diseases in the US. Researchers, practitioners and policy makers should develop targeted strategies and focus attention on keeping immigrants in the loop of positive health behavior, while encouraging US adults to engage in more physical activity. Further studies are needed to determine the effects of various socio-economic, demographic and cultural factors that impact proximal determinants of obesity. [ABSTRACT FROM AUTHOR]

Many college students experience intimate partner violence (IPV). Although receiving help from formal and informal sources may ameliorate possible negative impacts of IPV victimization, the outcomes of help-seeking are not always positive. This study used survey data collected at six universities across the United States (U.S.) to examine gender differences in IPV, help-seeking, and its outcomes (n=3,070). Major variables included IPV victimization, IPV consequences, help-seeking, and outcomes. Descriptive and bivariate analyses revealed higher rates of victimization among females as well as poorer health status, higher levels of depression, and more daily routine problems. Females also used more formal help, and reported it as being useful more often than males. Inversely, more males than females reported that informal supports were helpful. Recommendations include social workers providing tailored services both for male and female survivors, service providers developing educational programs that target informal help sources, and social work education providing relevant trainings. [ABSTRACT FROM AUTHOR]

Background: Motor vehicular transport (MVT) is a leading cause of injuries globally. Health care regionalization aims at improving patients' outcomes.Objectives: This study examines the association between trauma center designation levels in the United States and survival of patients with MVT-related injuries.Methods: We used the National Trauma Data Bank 2015 dataset for this retrospective study. We conducted descriptive and bivariate analyses. This was followed by a multivariate analysis to assess the association between trauma center level and survival to hospital discharge.Results: One hundred sixty-eight thousand five hundred twenty-four patients were included in this study. The mean age was 39.9 years (±19.5 years) with a male predominance (63.8%). Most patients were taken to level I (55.7%) and level II (35.9%) centers. The overall survival of patients with MVT injuries was 95.3%. Involved patients were occupant (64.8%), motorcyclist (17.3%), and pedestrian (12.7%). After adjusting for confounders, patients sustaining MVT injuries who were taken to level II and III trauma centers were less likely survive compared with those taken to level I centers (odds ratio = 0.89 [95% confidence interval 0.81-0.97] and odds ratio = 0.70 [95% confidence interval 0.59-0.82], respectively).Conclusions: In this study, we identified a survival benefit for patients with MVT injuries when treated at level I compared with level II and III centers. These findings provide additional evidence for the benefit of health care regionalization in the form of trauma center level designation. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, no national studies have investigated the epidemiology of hereditary hemorrhagic telangiectasia (HHT) in the United States since the incorporation of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10 CM). Objective: Our objective is to analyze the epidemiology of HHT from 2013 to 2017 and to determine the relationships between epistaxis and other associated complications of this rare disease. Methods: We analyzed the epidemiology of HHT between 2013 and 2017 by accessing data of 87 709 738 patients from the Clinformatics Data Mart using ICD-9 CM and ICD-10 CM codes. Variables analyzed included age, gender, region, clinical setting of diagnosis, hospitalizations, and complications. Bivariate analyses using generalized linear models were conducted to determine the likelihood of HHT patients with epistaxis enduring associated life-threatening complications such as cerebral hemorrhage, thrombosis, and pulmonary hemorrhage compared to HHT patients without epistaxis during the study period. Results: The prevalence of HHT increased from 6.1 to 12.1 per 100 000 persons, with patients of ages 18 to 29 years and those older than 60 years seeing the greatest percent increase. The prevalence of HHT in the Southern United States saw a 147% increase. Compared to HHT patients without epistaxis, HHT patients with epistaxis were 3.4 times more likely to experience pulmonary hemorrhage, 3.3 times more likely to have pulmonary emboli, 2.8 times more likely to experience cerebral hemorrhage, and 2.0 times more likely to have thrombosis during the study period. Conclusion: Our national study has provided the first incidence and prevalence rates of HHT in the United States since the incorporation of the ICD-10 CM. HHT patients with epistaxis require prompt multidisciplinary treatment of their condition due to their increased risk of life-threatening complications. [ABSTRACT FROM AUTHOR]

Objectives: Industry, policymakers, researchers, and others have interest in social media, assuming that they influence - or reflect - individual behavior, despite limited supporting research. Electronic nicotine delivery systems (ENDS) emerged in the United States in the past decade alongside strong social media presence, making ENDS relevant for examining this issue. In this study, we examined monthly ENDS-related Twitter activity (tweet volume) in relation to monthly ENDS purchasing among ENDS purchasers. Methods: Data from 2105 Nielsen Consumer Panel households with any ENDS purchases from October 2012 to September 2015 were examined, accounting for ENDS advertising expenditures, state-level tobacco environment, and consumer characteristics. Results: ENDS-related purchases and twitter volume increased over time; advertising expenditures did not increase at the same level. Bivariate analyses indicated that ENDS purchases increased over time (p < .001) and were related to lower designated market area advertising expenditures (p = .025), higher cigarette taxes (p = .015), and older consumer age (p = .001). Among ENDS purchasers, multivariate analyses indicated that purchases correlated positively with tweet volume but negatively with advertising expenditure measures. Conclusions: Social media (eg, Twitter) may offer platforms for monitoring and/or intervening with respect to ENDS use, and potentially the ENDS industry, which engages in social media. [ABSTRACT FROM AUTHOR]

Conflicting data on the microbiology and epidemiology of necrotizing soft tissue infections (NSTIs) appear to stem from the heterogeneity in microbiology observed in regions across the United States. Our goal was to determine current differences in organism prevalence and outcomes for NSTI and non-necrotizing severe soft tissue infections across the United States. We hypothesized that there were geographical differences in organism prevalence that would lead to differences in outcomes. This study was a retrospective multi-institutional trial from centers across the United States and Canada. Demographic, clinical, and outcomes data were collected. Bivariate and multivariable analyses were performed to determine the effects of region and microbiology on outcomes. A total of 622 patients were included in this study. Polymicrobial infections (45%) were the most prevalent infections in all regions. On bivariate analysis, Clostridium and polymicrobial infections had higher mean Laboratory Risk Indicator for Necrotizing Fasciitis scores and American Association for the Surgery of Trauma grades (P < 0.001 for both) than other organisms. Patients in the South were more likely to be uninsured and had worse unadjusted outcomes. In a risk-adjusted model, increasing American Association for the Surgery of Trauma grade was predictive of mortality (OR, 2.3; 95% CI, 1.6–3.1; P < 0.001), as was age ≥ 55 y (OR 2.7, 95% CI 1.3–5.3, P = 0.006), but region and organism type were not associated with mortality. We found important regional differences with respect to organism type and demographics. However, on risk-adjusted models, neither region nor organism type predicted mortality. [ABSTRACT FROM AUTHOR]

Background: Use of the emergency department (ED) for routine or preventative care has been an abiding concern for policy makers and public health practitioners.Objectives: We utilized recent data to examine health-related, socioeconomic, and demographic factors associated with use of the ED for routine or preventative care using a national sample of adults.Methods: Data from the 2017 National Health Interview Survey, a nationally representative sample of 26,742 adults ≥18 years of age was used for this investigation. Bivariate and multivariate analyses were used to assess the association between reported use of EDs as a usual source of preventative care and health-related, socioeconomic, and demographic factors.Results: In 2017, approximately 2 million adults nationwide reported the ED as their usual source of preventative health care. Individuals experiencing ≥2 health care-related barriers were more likely to use the ED as a source of usual preventative care (odds ratio = 2.78 [95% confidence interval 1.64-4.72]). Individuals without insurance had higher odds (odds ratio = 9.52 [95% confidence interval 5.60-16.19]) of using the ED for care compared with those who were privately insured. In addition, those using the ED for preventative care were more likely to be younger, poorer, less educated, to identify as Asian or African American, and to reside in the Northeast United States.Conclusion: This study provides a current perspective into characteristics and factors contributing to use of the ED for preventative care. Overall, our findings suggest that the ED continues to provide crucial safety net services to a small subset of the population experiencing significant barriers to timely medical care. [ABSTRACT FROM AUTHOR]

Context: State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. Method: This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care. Findings: Results show a lack of consistent association between quality of primary care provided by NPs and state SoP restrictions. Conclusion: State regulations restricting NP SoP do not improve the quality of care. [ABSTRACT FROM AUTHOR]

Background: Cardiac arrests are a leading cause of mortality with survival of only 12%. In the United States, cardiac arrests were significantly more likely to occur on Saturdays. Hospitals experience a decrease in staffing on weekends. This study aims to assess the relationship between weekend vs weekday admission and outcomes of patients presenting with out of hospital cardiac arrests (OHCA) in the United States.Methods: This retrospective study utilized the 2014 US National Emergency Department Sample (NEDS) database. Patients who sustained out of hospital cardiac arrests were included using ICD-9-CM codes. Descriptive analysis was conducted, followed by bivariate analysis to compare the collected variables by admission day. Multivariate analysis was done to assess the impact of weekday vs weekend admission on survival of cardiac arrests patients after adjusting for confounders.Results: A total of 145,774 patients with cardiac arrest were included in this study. Mean age was 65.9 years with male predominance of 61.8%. Almost 71% of cardiac arrests took place on a weekday. As an overall outcome, only 5.7% patients survived to hospital discharge. After adjusting for significant confounders, patients presenting on weekends were less likely to survive compared to those admitted on weekdays (OR = 0.833, 95% CI: 0.727-0.954).Conclusion: In this study, patients with OHCA admitted to the ED on weekends had slightly lower survival compared to those admitted on weekdays. Modifiable factors should be identified in future studies to reduce outcome discrepancies and improve survival in this patient population. [ABSTRACT FROM AUTHOR]

This study aimed to compare the characteristics of people obtaining medication and procedural abortions in clinical settings in the United States. We conducted a cross-sectional survey of people obtaining abortions at a sample of 56 US facilities between June 2021 and July 2022. We restricted analyses to patients with pregnancies less than 11 weeks' gestation presenting at 43 clinics offering both medication and procedural abortion. We conducted bivariate analyses and multivariable logistic regression to identify factors associated with obtaining a medication vs procedural abortion. Our analytic sample includes 4717 respondents, 57% of whom obtained a medication abortion. In bivariate analyses, individuals who identified as Asian or White, had no prior births or abortions, or were paying out of pocket were all more likely to have a medication abortion. Non-Hispanic Black individuals, those with incomes at or below the poverty level, and those paying with insurance were more likely to have a procedural abortion. Some 24% of respondents chose the facility because it offered medication abortion, but even after controlling for this proxy for method preference in a logistic regression model, Black respondents and those with poverty-level incomes were less likely to have a medication abortion. The findings of the study suggest that Black individuals and those with low incomes—who often face systemic barriers to care—are less likely to have medication abortions. When medication abortion is the only option available, for example, at a medication-only clinic or from an online source, these groups may be most impacted by the lack of options. To the extent possible, offering both medication and procedural abortion and increasing access to both types are important to meet patients' individual needs and preferences. [ABSTRACT FROM AUTHOR]

Abstract The complex relationship between water quality and river discharge has long been an active area of research. This research applies bivariate statistics to river nitrate concentration and discharge, and develops a procedure for selecting the best bivariate distribution for the chosen models. Nitrate concentration (NO 3) data from five stations on the Lower Illinois River, USA, collected from 1972 to 2012 were used for demonstration of this procedure. To explore the statistical relationship between discharge and nitrate concentration, three copula statistical models were applied to determine optimal bivariate distributions. The generalized Pareto (GPA), generalized extreme value (GEV), and lognormal two- (LN2) and three-parameter (LN3) distributions were used as marginal distributions, and were combined with the Clayton, Frank, and Gumbel copula models. The probability plot correlation coefficient (PPCC) test and the S n statistic were used to select the most suitable copula models. As a result, the GPA distributions for streamflow and nitrate concentration in the Frank copula model were more accurate for representing the data from the two mainstem stations, Havana (D-31) and Valley City (D-32), and those from the Oakford station along the Sangamon River (E-25). However, the Clayton copula model using NL3 for representing streamflow and GPA for representing nitrate concentration was more accurate for stations along the Spoon (DJ-08) and La Moine Rivers (DG-01). This study enabled the development of a procedure for determining an optimal copula for application in the environmental sciences and also provided a case study for applying copula models using discharge and nutrient concentration as hydrologic and water quality variables, respectively. Highlights • The relationship between nitrate concentration and river discharge was investigated. • Hydrologic and water quality data from the Lower Illinois River Basin were assessed. • A procedure for choosing the optimal bivariate distribution was developed. • The Frank copula model was a better fit for the River mainstem. • The Clayton copula model was a more accurate fit for the tributaries. [ABSTRACT FROM AUTHOR]

Purpose: This article examines sociodemographic correlates of initiation and quitting among French and American smokers.Methods: National surveys in France and the United States in 2000, 2005, and 2010 were analyzed of ever smokers, 20-75 years old. Bivariate and multivariate logistic regression analyses were conducted on age of initiation and quitting.Results: Smoking prevalence decreased for Americans each survey year (25.2%, 22.9%, and 17.9%), whereas the comparable figures for the French were 33.9%, 31.5%, and 33.8%. French smokers consumed fewer cigarettes per day (12.9 vs. 14.4 in 2000, 13.5. vs. 16.8 in 2005, and 12.2 vs. 15.1 in 2010), began consuming at a later age, and smoked for a shorter duration. Multiple logistic regression results revealed significant differences in the odds ratios, indicating the relative influence of sociodemographic variables on age of initiation and quitting.Conclusions: Quitting smoking continues to be a major challenge, varying by similar factors, particularly education, in both France and the United States.Policy Implications: Public policy initiatives to promote quitting must be strengthened, including the need to address population-specific inequalities and disparities in tobacco use and consequences. [ABSTRACT FROM AUTHOR]

To determine the agreement of 6 established visual field (VF) progression algorithms in a large dataset of VFs from multiple institutions and to determine predictors of discordance among these algorithms. Retrospective longitudinal cohort study. Visual fields from 5 major eye care institutions in the United States were analyzed, including a subset of eyes with at least 5 Swedish interactive threshold algorithm standard 24-2 VFs that met our reliability criteria. Of a total of 831 240 VFs, a subset of 90 713 VFs from 13 156 eyes of 8499 patients met the inclusion criteria. Six commonly used VF progression algorithms (mean deviation [MD] slope, VF index slope, Advanced Glaucoma Intervention Study, Collaborative Initial Glaucoma Treatment Study, pointwise linear regression, and permutation of pointwise linear regression) were applied to this cohort, and each eye was determined to be stable or progressing using each measure. Agreement between individual algorithms was tested using Cohen's κ coefficient. Bivariate and multivariate analyses were used to determine predictors of discordance (3 algorithms progressing and 3 algorithms stable). Agreement and discordance between algorithms. Individual algorithms showed poor to moderate agreement with each other when compared directly (κ range, 0.12–0.52). Based on at least 4 algorithms, 11.7% of eyes progressed. Major predictors of discordance or lack of agreement among algorithms were more depressed initial MD (P < 0.01) and older age at first available VF (P < 0.01). A greater number of VFs (P < 0.01), more years of follow-up (P < 0.01), and eye care institution (P = 0.03) also were associated with discordance. This extremely large comparative series demonstrated that existing algorithms have limited agreement and that agreement varies with clinical parameters, including institution. These issues underscore the challenges to the clinical use and application of progression algorithms and of applying big-data results to individual practices. [ABSTRACT FROM AUTHOR]

Projections of multivariate climate extremes require methodological approaches that can maintain relationships among variables. Here we apply a piecewise multivariate quantile mapping approach to temperature and humidity projections from a subset of models from the Fifth Coupled Model Intercomparison Project and analyze the resulting climatology of extreme heat days (EHDs) with explicit consideration of the prevailing humidity. The piecewise multivariate bias correction method shows good fidelity in reproducing the frequency of different types of extreme heat events in the historical period. Projections for U.S. regions and individual cities for both the middle and end of the century are characterized by increases in the frequency of EHDs, and especially those characterized by high humidity. For many regions and individual cities, there is no overlap between the frequency of high‐humidity EHDs in general circulation model ensembles from the historical and future periods, indicating that increases in extreme heat are robust. Analysis of 500‐mb height, sea‐level pressure, and low‐level circulation composites for historical and future periods indicates that the Fifth Coupled Model Intercomparison Project models reproduce basic large‐scale circulation features associated with EHDs in U.S. regions and that future changes in extreme heat are related primarily to large‐scale warming rather than enhancement of regional circulation anomalies. Key Points: The frequency of dry and humid temperature extremes varies by location and interannuallyBias‐corrected projections from CMIP5 models indicate a transition toward more extreme heat days, driven largely by more humid extremes [ABSTRACT FROM AUTHOR]

Purpose: Primary and secondary (P&S) syphilis in men who have sex with men (MSM) has been increasing; however, there is a lack of research on geographic factors associated with MSM P&S syphilis.Methods: We used multiple data sources to examine associations between social and environmental factors and MSM P&S syphilis rates at the state- and county-level in 2014 and 2015, separately. General linear models were used for state-level analyses, and hurdle models were used for county-level models. Bivariate analyses (P < .25) were used to select variables for adjusted models.Results: In 2014 and 2015 state models, a higher percentage of impoverished persons (2014 β = 1.24, 95% confidence interval, 0.28-2.20; 2015 β = 1.19; 95% confidence interval, 0.42-1.97) was significantly associated with higher MSM P&S syphilis rates. In the 2015 county model, policies related to sexual orientation (marriage, housing, hate crimes) were significant correlates of MSM P&S syphilis rates (P < .05).Conclusions: Our state-level findings that poverty is associated with MSM P&S syphilis are consistent with research at the individual level across different subpopulations and various sexually transmitted diseases. Our findings also suggest that more research is needed to further evaluate potential associations between policies and sexually transmitted diseases. Geographic-level interventions to address these determinants may help curtail the rising syphilis rates and their sequelae in MSM. [ABSTRACT FROM AUTHOR]

Socioeconomic health disparities in the United States have remained largely unchanged for decades. This remains the case even for preventable illness and disease. Current health behavior theories and interventions rely on the perception of control over one's fate to achieve desired behavior. In low-income and other marginalized populations, however, hopelessness and the perception of having limited control may make interventions less effective. The purpose of this quantitative study was to examine the role of the locus of control (LOC) as defined by the degree to which one believes outcomes are determined by external forces such as chance or authority figures as an adaptive response to poverty. Using cross-sectional survey methodology, 136 U.S. adult participants were recruited through snowball sampling to anonymously complete measures of the Multidimensional Locus of Control, the Health-Promoting Lifestyle Profile II, the Kessler Psychological Distress Scale, and a demographic questionnaire. Hierarchical regression and bivariate analyses were used to test the hypotheses. Study results found that chance LOC mediated the relationship between socioeconomics and health lifestyles, while it was as associated with less healthy lifestyle choices than external authority figures (powerful others). Internal LOC was not found to provide any psychological protection from anxiety and depression for low socioeconomic populations. Recommendations included the need for additional studies to understand the role of LOC as it relates to health beliefs, behavior, and psychological wellbeing of marginalized populations. [ABSTRACT FROM AUTHOR]

Mature weight of beef cows in the United States has been increasing as a correlated response to selection for calf growth. Unfavorable genetic correlations between cow weight and various measures of female fertility, stayability, and lifetime production suggest declining cow productivity might also be expected as a correlated response to growth selection. National cattle evaluations, however, show increasing trends for stayability and sustained fertility. Random regression (RR) models were employed to further examine genetic relationships among cow weight and productivity, and to assess cumulative productivity traits observed throughout cows' productive lives. Records were from 13,707 females born in the Germplasm Evaluation (GPE) project and mated to calve first as 2-yr olds. Weights observed at pregnancy testing (n = 65,086) and calf production from each exposure to breeding (n = 71,583) were included in uni- and bivariate RR analyses. Production following each breeding season was added to previous production to obtain cumulative production records for each season that the female was exposed to breeding. Zero was added if the cow failed to produce after a breeding season. The number of pregnancies, calves born and calves weaned, as well as age and weight of weaned calves, were accumulated. Projected age-specific heritability (h 2) estimates for cumulative production were low (<0.1) at age 2 but increased with age (0.12 to 0.26 at age 6; 0.32 to 0.48 at age 10). Estimated h 2 for cow weight were high, fluctuating between 0.6 and 0.7 from ages 2 through 10. Genetic correlations (r g) were positive among all ages within each trait. Between ages 3 and 9, estimated r g were negative between cumulative weaning productivity and cow weight. The correlations were usually weak enough (<−0.2) that small correlated declines from following yearling weight trends might be overcome by culling females after their first reproductive failure. More noticeable increases might be realized by selection among sires with EBV based on productivity of several daughters. The RR EBV for cow weight and cumulative weight weaned represent major sources of variation in cow costs and income, and can be incorporated into economic selection indexes to project differences in cow profitability and value at any age. The RR approach utilizes all available records, enabling later productivity to be projected from observations on young cows. [ABSTRACT FROM AUTHOR]

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This study analyzes the law enforcement response to prostitution in Houston, Texas, between 1977 and 2010 to examine whether the traditional approach to policing prostitution disproportionately penalizes women. Data included the disposition and sentencing information for 22,916 first-time prostitution arrests in Harris County. Using bivariate and multivariate analyses, we explored gender differences in the likelihood of receiving punishment, the type(s) of punishment received, and the amount of punishment for first-time prostitution offenses. We find that women were disproportionately arrested for prostitution and that women were more likely to receive a jail sentence for involvement in prostitution than men were. In contrast, male arrestees for prostitution were more likely to receive probation sentences and/or fines. This study adds to a robust body of literature suggesting that gender impacts sentencing in the criminal justice system. Yet, it is unclear whether the role of the arrestee—as either a buyer or seller—moderates the effect of gender. This quandary demonstrates the need for more comprehensive data collection about the role of the arrestee in the commercial sexual exchange. [ABSTRACT FROM AUTHOR]

The purpose of the study was to examine the association between women's experience of two types (sexual and physical) of intimate partner violence (IPV) and number of previous abortions among a national sample of 4,586 abortion patients between the ages of 13 and above 38 years in the United States. Using data from the nationally representative Abortion Patients Survey 2008, χ2 tests were conducted to examine the bivariate associations between all independent and dependent variables. Prevalence ratios were calculated to determine the association between IPV, physical and sexual, and number of abortions, controlling for whether the coconceiving partner knew about the pregnancy and the abortion, and demographic factors including age, education, income, poverty rate, race, and type of union. Results indicate that approximately 51% of the sample of women seeking abortion services had never gotten an abortion before. Reports of IPV were low among this sample-5.6% reported physical violence and 2.4% reported sexual violence, while 82.3% of the coconceiving partners knew about the abortion, and 87.1% knew about the pregnancy. Prevalence ratios revealed that physical violence was positively associated with number of abortions (PR = 1.31, p < .001), but sexual violence was negatively associated with number of abortions (PR = 0.74, p < .05) when all control variables were accounted for. Findings suggesting that physical and sexual violence are differentially associated with a history of multiple abortions were unexpected and suggest the need for additional research in this area. Implications for practice, policy, and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Abstract: A large number of models have been developed in the literature to analyze and forecast changes in output dynamics. The objective of this paper was to compare the predictive ability of univariate and bivariate models, in terms of forecasting US gross national product (GNP) growth at different forecasting horizons, with the bivariate models containing information on a measure of economic uncertainty. Based on point and density forecast accuracy measures, as well as on equal predictive ability (EPA) and superior predictive ability (SPA) tests, we evaluate the relative forecasting performance of different model specifications over the quarterly period of 1919:Q2 until 2014:Q4. We find that the economic policy uncertainty (EPU) index should improve the accuracy of US GNP growth forecasts in bivariate models. We also find that the EPU exhibits similar forecasting ability to the term spread and outperforms other uncertainty measures such as the volatility index and geopolitical risk in predicting US recessions. While the Markov switching time‐varying parameter vector autoregressive model yields the lowest values for the root mean squared error in most cases, we observe relatively low values for the log predictive density score, when using the Bayesian vector regression model with stochastic volatility. More importantly, our results highlight the importance of uncertainty in forecasting US GNP growth rates. [ABSTRACT FROM AUTHOR]

Latinos comprised 17.1% of the U.S. population and 33.1% of US prisoners, yet they are underrepresented in the psychopathology literature. Despite higher rates of trauma among incarcerated individuals than in the general population, most of the previous research in this area focused primarily on women samples, and very few studies examined sex differences in PTSD and traumatic experiences. In addition, there is a need for research assessing traumatic experiences and probable PTSD in men and women Latino inmates to inform culturally competent care and sex sensitive care for this vulnerable and underserved population. Our study examined whether men and women Latino inmates with probable Posttraumatic Stress Disorder (PTSD), based on the cut off 40 or more symptoms on the Davidson Trauma Scale (DTS), differed significantly by the number of event types experienced, the type of potentially traumatizing event, and in co-occurring psychiatric conditions. A multi-stage sample design was used to select a probabilistic sample of 1,331 inmates from 26 penal institutions in PR of which 1179 participated in the study. Bivariate associations were calculated for each type of traumatic event and probable PTSD. Mean number of types of potentially traumatizing event experienced was comparable for both sexes (F = 3.83, M = 3.74) yet sex differences were found in the nature of the event. Women with probable PTSD had higher rates of experiencing rape and sexual abuse. Men had higher rates of experiencing combat in war, a life-threatening accident, of witnessing violence, and being threatened with a weapon. Men with significant ADHD symptoms in childhood and with Generalized Anxiety Disorder (GAD) during adulthood were almost 5 and 7 times as likely to score above threshold on the DTS whereas women were >3 times as likely in the presence of ADHD symptoms in childhood or depression during adulthood. This study underscores the need to improve understanding of the clinical manifestations of trauma and co-occurring psychiatric conditions for appropriate sex sensitive interventions targeting Latinos living in prisons. [ABSTRACT FROM AUTHOR]

Abstract: Price volatility complicates price discovery and creates risks for cattle producers. This paper analyzes volatility spillovers in the western Canadian beef cattle supply chain. A modified bivariate VAR‐BEKK‐GARCH model is used to examine spillovers and account for asymmetries associated with rising versus falling markets. The spillovers that are found are unidirectional from input to output markets. Spillovers tended to be stronger when cattle prices are depressed and feed costs are rising. Volatility transmission is also flows from feed barley to feeder cattle markets, but volatility does not flow in the opposite direction nor does it advance by more than one level in the supply chain. La volatilité des prix complique la découverte des prix et crée des risques pour les éleveurs de bétail. Cet article analyse les répercussions de la volatilité au sein de la chaîne d'approvisionnement des bovins d'élevage. Un modèle VAR‐BEKK‐GARCH modifié à deux variables sert à l'examen des répercussions et tient compte des asymétries associées aux marchés à la hausse et à la baisse. Les répercussions décelées sont unidirectionnelles du marché des intrants aux produits. Les répercussions semblent plus fortes lorsque les prix des bovins sont bas, et les coûts de fourrage à la hausse. Le transfert de la volatilité se fait aussi sentir de l'orge de fourrage aux marchés de bovins d'engraissement, mais l'inverse ne survient pas et elle ne progresse pas de plus d'un niveau dans la chaîne d'approvisionnement. [ABSTRACT FROM AUTHOR]