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The United States has embarked on a wide-ranging nuclear modernization program that will ultimately see every nuclear delivery system replaced with newer versions over the coming decades. In this issue of the Nuclear Notebook, we estimate that the United States maintains a stockpile of approximately 3,708 warheads—an unchanged estimate from the previous year. Of these, only about 1,770 warheads are deployed, while approximately 1,938 are held in reserve. Additionally, approximately 1,336 retired warheads are awaiting dismantlement, giving a total inventory of approximately 5,044 nuclear warheads. Of the approximately 1,770 warheads that are deployed, 400 are on land-based intercontinental ballistic missiles, roughly 970 are on submarine-launched ballistic missiles, 300 are at bomber bases in the United States, and approximately 100 tactical bombs are at European bases. The Nuclear Notebook is researched and written by the staff of the Federation of American Scientists' Nuclear Information Project: director Hans M. Kristensen, senior research fellow Matt Korda, research associate Eliana Johns, and program associate Mackenzie Knight. To see all previous Nuclear Notebook columns in the Bulletin of the Atomic Scientists dating back to 1987, go to . [ABSTRACT FROM AUTHOR]

Spiritual healthcare providers (e.g., chaplains) working in healthcare settings across the United States were surveyed with the goals of (1) understanding their awareness of aphasia (a language disorder affecting reading, writing, verbal communication, and auditory comprehension); (2) determining whether they have received any training in aphasia and what type of training has been received; (3) whether they altered their approach to assessing the spiritual well-being of a person with aphasia; and, (4) what tools were used to augment communication. From a convenience sample of 203 respondents, the results indicated that 96% of respondents had previously heard of aphasia and 85% of respondents correctly identified the definition of aphasia. Seventy-three percent of respondents (N = 128) altered their approach to spiritual well-being assessment due to the aphasia diagnosis. Most respondents did not indicate receiving any formal training related to aphasia. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced cancer and family caregivers often use avoidant coping strategies, such as delaying advance care planning discussions, which contribute to deterioration in their quality of life. Mindfulness-based interventions have shown promise in improving quality of life in this population but have rarely been applied to advance care planning. This pilot trial examined the preliminary efficacy of a group-based Mindfulness to Enhance Quality of Life and Support Advance Care Planning (MEANING) intervention for patient-caregiver dyads coping with advanced cancer. Primary outcomes were patient and caregiver quality of life or well-being, and secondary outcomes included patient advanced care planning engagement (self-efficacy and readiness) and other psychological and symptom outcomes. Methods: In this pilot trial, dyads coping with advanced cancer were recruited from five oncology clinics in the midwestern U.S. and randomized to six weekly group sessions of a mindfulness intervention (n = 33 dyads) or usual care (n = 22 dyads). Outcomes were assessed via surveys at baseline, post-intervention, and 1 month post-intervention. All available data were included in the multilevel models assessing intervention efficacy. Results: Patients in the MEANING condition experienced significant increases in existential well-being and self-efficacy for advance care planning across follow-ups, whereas usual care patients did not. Other group differences in outcomes were not statistically significant. These outcomes included other facets of patient well-being, caregiver quality of life, patient readiness for advance care planning, caregiver burden, and patient and caregiver depressive symptoms, anxiety, sleep disturbance, cognitive avoidance, and peaceful acceptance of cancer. However, only MEANING patients showed moderate increases in psychological well-being across follow-ups, and MEANING caregivers showed moderate increases in quality of life at 1-month follow-up. Certain psychological outcomes, such as caregiver burden at 1-month follow-up, also showed moderate improvement in the MEANING condition. Patients in both conditions reported small to moderate increases in readiness to engage in advance care planning. Conclusions: A mindfulness-based intervention showed promise in improving quality-of-life and advance care planning outcomes in patients and caregivers coping with advanced cancer and warrants further testing. Trial Registration: ClinicalTrials.gov NCT03257007. Registered 22 August 2017, https://clinicaltrials.gov/ct2/show/NCT03257007. [ABSTRACT FROM AUTHOR]

Policy PointsThe US health care system faces mounting pressure to reduce greenhouse gas emissions and adapt to the impacts of climate change; motivated institutions and an engaged health care workforce are essential to the development, implementation, and maintenance of a climate‐ready US health care system.Health care workers have numerous profession‐specific and role‐specific opportunities to address the causes and impacts of climate change.Policies must address institutional barriers to change and create incentives aligned with climate readiness goals.Institutions and individuals can support climate readiness by integrating content on the health care implications of climate change into educational curricula. [ABSTRACT FROM AUTHOR]

Mental health conditions including substance use disorder are the leading cause of pregnancy-related deaths in the U.S. Unfortunately, fears of child protective services' involvement interfere with maternal self-disclosure of substance use in pregnancy. Seeking to identify more mothers with substance use disorder in pregnancy or at delivery, and responsive to changes to the federal Child Abuse Prevention and Treatment Act (CAPTA), Connecticut requires hospital personnel to submit a deidentified notification to CPS for all newborns with prenatal substance exposure. However, it is unknown whether this approach aligns with maternal self-report on substance use. For the present study, we compared population parameters derived from CAPTA notifications submitted between March-December 2019 with parameters derived from self-report data on substance use in pregnancy from mothers who gave birth during the same timeframe. Results revealed that three times as many mothers self-reported any alcohol or drug use in pregnancy compared to the rate measured with CAPTA notifications. Compared to mothers who self-reported drug use in the third trimester, CAPTA notifications were made for statistically similar rates of Black mothers but half the self-reported rate of White and Hispanic mothers. This disparity reflects that CAPTA notifications were made for twice as many Black mothers as White or Hispanic. Although CAPTA notifications are not punitive in nature, this disparity reveals that the public health aims of this policy are not yet achieved. Significance: Accurate and equitable identification of infants with prenatal substance exposure and their mothers, coupled with non-stigmatized, non-punitive intervention is central to any public health response.The current study relies on 2019 data from Connecticut to understand accuracy and equity in identification of these infants by comparing hospital-based notifications to self-report substance use in pregnancy. We found that hospital approaches to detecting prenatal substance exposure identified twice as many Black mothers as White or Hispanic mothers. Compared to self-reported substance use in pregnancy, which detected equivalent rates of substance use across race groups, White and Hispanic mothers' substance use in pregnancy was under-identified in hospital settings. [ABSTRACT FROM AUTHOR]

Young women who have had contact with the criminal justice system (justice-involved young women) have an increased risk of being a victim of violence. However, no reviews have synthesized the evidence on interventions to prevent or respond to violence against justice-involved young women. We conducted a scoping review to identify interventions designed to prevent or respond to violence against justice-involved young women. We searched Medline, Criminal Justice Abstracts, Web of Science, and Google Scholar for peer-reviewed and gray literature published in English from January 1, 2000 until March 23, 2021. Consistent with the public health approach to violence, we included primary, secondary, and tertiary interventions. Excluding duplicates, our search returned 5,603 records, 14 of which met our inclusion criteria. We narratively synthesized the included studies, all of which were conducted in the United States. Most included studies examined a tertiary intervention (n = 10), and few examined a primary (n = 2) or secondary (n = 2) intervention. Across the Joanna Briggs Institute Critical Appraisal Tools, the percentage of items met ranged from 0% to 78%. There was some limited evidence that tertiary interventions that included cognitive behavioral therapy reduced the mental health impacts of violence victimization among justice-involved young women. There was little evidence on primary and secondary interventions. Effective and evidence-based interventions to prevent violence victimization and revictimization against justice-involved young women remains a critical gap in knowledge. [ABSTRACT FROM AUTHOR]

Sexual health education experienced by lesbian, gay, and bisexual (LGB) youth varies widely in relevancy and representation. However, associations among sexual orientation, type of sex education, and exposure to affirming or disaffirming content have yet to be examined. Understanding these patterns can help to address gaps in LGB-sensitive sex education. Our goal in this study was to examine the prevalence and associations among abstinence-only until marriage (AOUM) and comprehensive sex education with LGB-affirming and -disaffirming content sought/received before age 18 (from 1999 to 2014) by sexual orientation (completely heterosexual with same-sex contact, completely heterosexual with no same-sex contact, mostly heterosexual, bisexual, gay/lesbian) in a sample of 12,876 US young adults from the Growing Up Today Study. Compared to completely heterosexual referents, LGB participants who received AOUM sex education were more likely to encounter LGB-disaffirming content, and this effect was largest among sexual minority participants. Conversely, exposure to comprehensive sex education was associated with receipt of LGB-affirming information. Overall, participants commonly reported receiving AOUM sex education, which may lead to deficits and potential harm to sexual minorities. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is a major health problem, and the risk of CKD and hypertension in children born low birth weight (LBW) is under-recognized. We hypothesized that children born with LBW would have a higher prevalence of reduced kidney function and hypertension. Methods: Using the National Health and Nutrition Examination Survey (NHANES), we conducted a cross-sectional study to evaluate whether LBW (< 2500 g), very low birth weight (VLBW < 1500 g), and large birth weight (BW) (> 4000 g) were associated with kidney disease using 4 different estimating equations. We used the Counahan–Barratt, updated Schwartz, CKiD-U25, and full age spectrum creatinine-based GFR estimating equations to evaluate associations between a history of LBW/VLBW/large BW and reduced kidney function (eGFR < 90 mL/min/1.73 m2) in children. We also assessed blood pressure (BP) using the old and new pediatric hypertension guidelines. Results: Our analysis included 6336 children (age 12–15 years) in NHANES representing over 13 million US individuals. Using the updated Schwartz, the prevalence of reduced kidney function was 30.1% (25.2–35.6) for children born with LBW compared to 22.4% (20.5–24.3) in children with normal BW. Equations yielded different estimates of prevalence of reduced kidney function in LBW from 21.5% for Counahan–Barratt to 35.4% for CKiD-U25. Compared to those with normal BW, participants with LBW and VLBW had a 7.2 and 10.3% higher prevalence of elevated BP and a 2.4 and 14.6% higher prevalence of hypertension, respectively. Conclusions: Children born with LBW are at higher risk of reduced kidney function and hypertension than previously described. [ABSTRACT FROM AUTHOR]

Harbor porpoises are typically seen in small groups of 1–3 individuals, with aggregations of 20+ individuals treated as rare events. Since the 1990s, the harbor porpoise population in the Salish Sea has seen a significant recovery, and an increased number of observed aggregations that exceed the more usual small group sizes has been observed in recent years. By combining the observational data of United States and Canadian research organizations, community scientists, and whale watch captains or naturalists, we demonstrate that harbor porpoise aggregations appear to be more common than previously known, with 160 aggregations documented in 2022 alone. Behavioral data also indicate that foraging behaviors are common and social behaviors, like mating, are seen more often during these encounters compared to small groups. Other behaviors that are considered to be rare or unknown were also observed during these encounters, including cooperative foraging and vessel approach. These aggregations are likely important foraging and social gatherings for harbor porpoises. This holistic approach integrating data from two countries and multiple sources provides a population level assessment that more effectively reflects the behavior of harbor porpoises in this region, which do not recognize the socio-political boundaries imposed upon the natural world. [ABSTRACT FROM AUTHOR]

During April 30-August 4, 2023, smoke originating from wildfires in Canada affected most of the contiguous United States. CDC used National Syndromic Surveillance Program data to assess numbers and percentages of asthma-associated emergency department (ED) visits on days with wildfire smoke, compared with days without wildfire smoke. Wildfire smoke days were defined as days when concentrations of particulate matter (particles generally ≤2.5 μm in aerodynamic diameter) (PM2.5) triggered an Air Quality Index ≥101, corresponding to the air quality categorization, "Unhealthy for Sensitive Groups." Changes in asthma-associated ED visits were assessed across U.S. Department of Health and Human Services regions and by age. Overall, asthma-associated ED visits were 17% higher than expected during the 19 days with wildfire smoke that occurred during the study period; larger increases were observed in regions that experienced higher numbers of continuous wildfire smoke days and among persons aged 5-17 and 18-64 years. These results can help guide emergency response planning and public health communication strategies, especially in U.S. regions where wildfire smoke exposure was previously uncommon. [ABSTRACT FROM AUTHOR]

The system of oceanic flows constituting the Atlantic Meridional Overturning Circulation (AMOC) moves heat and other properties to the subpolar North Atlantic, controlling regional climate, weather, sea levels, and ecosystems. Climate models suggest a potential AMOC slowdown towards the end of this century due to anthropogenic forcing, accelerating coastal sea level rise along the western boundary and dramatically increasing flood risk. While direct observations of the AMOC are still too short to infer long-term trends, we show here that the AMOC-induced changes in gyre-scale heat content, superimposed on the global mean sea level rise, are already influencing the frequency of floods along the United States southeastern seaboard. We find that ocean heat convergence, being the primary driver for interannual sea level changes in the subtropical North Atlantic, has led to an exceptional gyre-scale warming and associated dynamic sea level rise since 2010, accounting for 30-50% of flood days in 2015-2020. AMOC-induced heat advection controls ocean temperature in the subtropical North Atlantic, drives year-to-year changes of basin-wide and coastal sea level, and accounts for 30-50% of flood days along the South Atlantic Bight and Gulf of Mexico coasts in 2015-2020. [ABSTRACT FROM AUTHOR]

BACKGROUND: When children and youth feel connected to their school, family, and others in their community, they are less likely to engage in risky behaviors and experience negative health. Disruptions to school operations during the COVID‐19 pandemic have led many teachers and school administrators to prioritize finding ways to strengthen and re‐establish a sense of connectedness among students and between students and adults in school. METHODS: We conducted a systematic search of peer‐reviewed literature that reported on US‐based research and were published in English from January 2010 through December 2019 to identify classroom management approaches that have been empirically tied to school connectedness‐related outcomes in K‐12 school settings. FINDINGS: Six categories of classroom management approaches were associated with improved school connectedness among students: (1) teacher caring and support, (2) peer connection and support, (3) student autonomy and empowerment, (4) management of classroom social dynamics, (5) teacher expectations, and (6) behavior management. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Prioritizing classroom management approaches that emphasize positive reinforcement of behavior, restorative discipline and communication, development of strong, trusting relationships, and explicitly emphasize fairness has potential to promote equitable disciplinary practices in schools. CONCLUSIONS: Classroom management approaches most linked to school connectedness are those that foster student autonomy and empowerment, mitigate social hierarchies and power differentials among students, prioritize positive reinforcement of behavior and restorative disciplinary practices, and emphasize equity and fairness. [ABSTRACT FROM AUTHOR]

Since December 2020, COVID-19 vaccines have become increasingly available to populations around the globe. A growing body of research has characterised inequalities in COVID-19 vaccination coverage. This scoping review aims to locate, select and assess research articles that report on within-country inequalities in COVID-19 vaccination coverage, and to provide a preliminary overview of inequality trends for selected dimensions of inequality. We applied a systematic search strategy across electronic databases with no language or date restrictions. Our inclusion criteria specified research articles or reports that analysed inequality in COVID-19 vaccination coverage according to one or more socioeconomic, demographic or geographic dimension of inequality. We developed a data extraction template to compile findings. The scoping review was carried out using the PRISMA-ScR checklist. A total of 167 articles met our inclusion criteria, of which half (n = 83) were conducted in the United States. Articles focused on vaccine initiation, full vaccination and/or receipt of booster. Diverse dimensions of inequality were explored, most frequently relating to age (n = 127 articles), race/ethnicity (n = 117 articles) and sex/gender (n = 103 articles). Preliminary assessments of inequality trends showed higher coverage among older population groups, with mixed findings for sex/gender. Global research efforts should be expanded across settings to understand patterns of inequality and strengthen equity in vaccine policies, planning and implementation. [ABSTRACT FROM AUTHOR]

Objective: Medical podcasts are becoming increasingly available; however, it is unclear how these new resources are being used by trainees or whether they influence clinical practice. This study explores the preferences and experiences of otolaryngology residents with otolaryngology-specific podcasts, and the impact of these podcasts on resident education and clinical practice. Methods: An 18-question survey was distributed anonymously to a representative junior (up to post-graduate year 3) and senior (post-graduate year 4 or greater) otolaryngology residents at most programs across the US. Along with demographic information, the survey was designed to explore the preferences of educational materials, podcast listening habits and motivations, and influence of podcasts on medical practice. Descriptive statistics and student t -tests were used to analyze the results. Results: The survey was distributed to 198 current otolaryngology residents representing 94% of eligible residency programs and was completed by 73 residents (37% response rate). Nearly 3-quarters of respondents reported previous use of otolaryngology podcasts, among which 83% listen at least monthly. Over half of residents changed their overall clinical (53%) and consult (51%) practice based on podcast use. Residents rank-ordered listening to podcasts last among traditional options for asynchronous learning, including reading textbooks and watching online videos. Conclusions: While other asynchronous learning tools remain popular, most residents responding to this survey use podcasts and report that podcasts influence their clinical practice. This study reveals how podcasts are currently used as a supplement to formal otolaryngology education. Results from the survey may inform how medical podcasts could be implemented into resident education in the future. [ABSTRACT FROM AUTHOR]

Perceived racism in school (i.e., a student's report of being treated badly or unfairly because of their race or ethnicity) is an important yet understudied determinant of adolescent health and well-being. Knowing how perceived racism influences adolescent health can help reduce health inequities. CDC's 2021 Adolescent Behaviors and Experiences Survey (ABES), an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9-12 (N = 7,705), was conducted during January--June 2021 to assess student behaviors during the COVID-19 pandemic. CDC analyzed data from ABES to measure perceived racism and the extent to which perceptions of racism are associated with demographic, mental health, and behavioral characteristics. Mental health and behavioral characteristics analyzed included mental health status; virtual connection with others outside of school; serious difficulty concentrating, remembering, or making decisions; and feeling close to persons at school. Demographic characteristics analyzed included sex, race and ethnicity, and grade. Prevalence of perceived racism and associations between perceived racism and demographic, mental health, and behavioral characteristics are reported overall and stratified by race and ethnicity. Approximately one third (35.6%) of U.S. high school students reported perceived racism. Perceived racism was highest among Asian (63.9%), Black (55.2%), and multiracial students (54.5%). Students who reported perceived racism had higher prevalences of poor mental health (38.1%); difficulty concentrating, remembering, or making decisions (44.1%); and not feeling close to persons at school (40.7%). Perceived racism was higher among those students who reported poor mental health than those who did not report poor mental health during the pandemic among Asian (67.9% versus 40.5%), Black (62.1% versus 38.5%), Hispanic (45.7% and 22.9%), and White students (24.5% versus 12.7%). A better understanding of how negative health outcomes are associated with student experiences of racism can guide training for staff and students to promote cultural awareness and antiracist and inclusivity interventions, which are critical for promoting safe school environments for all students. [ABSTRACT FROM AUTHOR]

This study examined how lifetime stress exposure and race are associated with first-birth intendedness, and whether these associations differ based on stress exposure timing. Greater lifetime stress exposure was related to increased first-birth intendedness for black women but was unrelated or even associated with decreased first-birth intendedness for white women, depending on stress exposure timing. These effects were robust while controlling for age, partner status, household income, and education, and they differed based on the timing of participants’ stress exposure. These data thus provide evidence that first-birth intendedness is influenced by both lifetime stress exposure and race in the United States. [ABSTRACT FROM AUTHOR]

Bullying of sexual minorities in the United States is common and often begins in middle and high school, yet research that examines sexual harassment of sexual minorities is limited. This study examines whether sexual minorities are more likely than straight people to (a) report sexual harassment and (b) report sexual harassment as adolescents at middle or high school. We analyzed survey data from a cross-sectional study of sexual harassment and assault, conducted with nationally representative samples of adults in 2019 (N = 2,205). Sexual harassment was categorized as non-physically aggressive sexual harassment only (NPSH; e.g., verbal or cyber harassment), physically aggressive sexual harassment (PSH; e.g., stalking, rubbing up against you; with or without NPSH), sexual assault (SA; i.e., forced sex; with or without NPSH or PSH), or no sexual harassment (none). In total, 6% of female and male respondents identified as a sexual minority. A history of sexual harassment or assault was reported by 95.0% of sexual minority women and 80.3% of straight women (p =.001), and by 77.3% of sexual minority men and 41.3% of straight men (p =.001). Multivariable multinomial models demonstrate that sexual minorities were more likely than straight individuals to report NPSH (Adjusted Odds Ratio [AOR] = 2.88, 95% [Confidence Interval] CI = [1.33, 6.20]), PSH (AOR = 4.15, 95% CI: [1.77, 9.77]), and SA (AOR = 5.48, 95% CI = [2.56, 11.73]; reference group: no harassment), as well as to report PSH (AOR = 2.67, 95% CI = [1.30, 5.47]) at school in middle or high school. These abuses demonstrate increased risk for sexual harassment among sexual minorities, including increased risk for physically aggressive sexual harassment when in middle and high school. [ABSTRACT FROM AUTHOR]

Since its initial conception in 2017, the University of Denver Ethnography Lab (DUEL) has aimed to catalyze collaborations between students, faculty, and community organizations. Inspired by community–campus partnerships implemented in the past across the United States, DUEL seeks to cultivate a community of practice centered on ethnography in action, and to draw on strengths and opportunities specific to our university. In this article, we present the process that channeled the energies and ideas of 30 faculty and students from 10 different departments into the creation of DUEL, we share examples from our experience so far, and we identify challenges and opportunities for DUEL's future. [ABSTRACT FROM AUTHOR]

Objective: To examine neurodevelopment in preschool-aged children with craniofacial microsomia (CFM) relative to unaffected peers. Design: Multisite, longitudinal cohort study. Setting: Tertiary care centers in the United States. Participants: We included 92 children with CFM ("cases") through craniofacial centers and clinics. Seventy-six children without CFM (controls) were included from pediatric practices and community advertisements. This study reports on outcomes assessed when participants were an average age of 38.4 months (SD = 1.9). Main outcome measures: We assessed cognitive and motor skills using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), and language function using subtests from the Clinical Evaluation of Language Fundamentals—Preschool, second edition (CELF-P2). Results: Case–control differences were negligible for Bayley-III cognitive (effect sizes [ES] = −0.06, P =.72) and motor outcomes (ES = −0.19, P =.25). Cases scored lower than controls on most scales of the CELF-P2 (ES = −0.58 to −0.20, P =.01 to.26). Frequency counts for "developmental delay" (ie, one or more scores > 1 SD below the normative mean) were higher for cases (39%) than controls (15%); however, the adjusted odds ratio = 1.73 (P = 0.21) was not significant. Case–control differences were most evident in children with microtia or other combinations of CFM-related facial features. Conclusions: Cognitive and motor scores were similar for preschool-aged children with and without CFM. However, children with CFM scored lower than controls on language measures. We recommend early monitoring of language to identify preschoolers with CFM who could benefit from intervention. [ABSTRACT FROM AUTHOR]

This study was designed to assess racial/ethnic disparities in victimization from sexual harassment and assault by sex in the United States, and to assess racial/ethnic differences in depression/anxiety as a consequence of sexual harassment or assault, among those victimized. In January 2018, the organization Stop Street Harassment led a nationally representative online survey regarding lifetime experiences of sexual harassment and assault with women and men aged 18+ (N = 2,009). We used sex-stratified multinomial logistic regression models to assess racial/ethnic differences in (a) self-reported victimization from these sexual abuses and (b) depression/anxiety due to these abuses among those reporting victimization. Eighty-one percent (81%) of women and 43% of men reported victimization from sexual harassment (27% and 6% indicating sexual assault, for women and men, respectively). Among those reporting harassment or assault, 30.8% of women and 19.8% of men reported depression or anxiety as a consequence. We found no significant racial/ethnic disparities in victimization from sexual harassment or assault among women, although an insignificant trend of increased risk for harassment was seen for Hispanic relative to White women (adjusted odds ratio [AOR] = 1.95, 95% confidence interval (CI) = 0.95, 3.99). Black relative to White men had lower odds of reporting sexual harassment (AOR = 0.53, 95% CI = 0.30, 0.93), and Hispanic relative to White men had higher odds of reporting sexual assault (AOR = 2.17, 95% CI = 1.06, 4.45). No racial/ethnic differences were observed for women or men in likelihood of depression or anxiety as a consequence of this abuse. These findings highlight the ubiquity of sexual harassment and assault, especially for women, with increased risk for Hispanics relative to Whites. In addition, findings demonstrate mental health effects of these types of abuses regardless of sex and race/ethnicity. Broad social change is needed to support prevention and intervention efforts with intersectional and trauma-informed approaches. [ABSTRACT FROM AUTHOR]

Background: There are known associations between mental health symptoms and transgender identity among adults. Whether this relationship extends to early adolescents and to gender domains other than identity is unclear. This study measured dimensions of gender in a large, diverse, sample of youth, and examined associations between diverse gender experiences and mental health. Methods: The ABCD study is an ongoing, longitudinal, US cohort study. Baseline data (release 2.0) include 11,873 youth age 9/10 (48% female); and the 4,951 1‐year follow‐up visits (age 10/11; 48% female) completed prior to data release. A novel gender survey at the 1‐year visit assessed felt‐gender, gender noncontentedness, and gender nonconformity using a 5‐point scale. Mental health measures included youth‐ and parent‐reports. Results: Roughly half a percent of 9/10‐year‐olds (n = 58) responded 'yes' or 'maybe' when asked, 'Are you transgender' at baseline. Recurrent thoughts of death were more prevalent among these youth compared to the rest of the cohort (19.6% vs. 6.4%, χ2 = 16.0, p <.001). At the 1‐year visit, when asked about the three dimensions of gender on a 5‐point scale, 33.2% (n = 1,605) provided responses that were not exclusively and totally aligned with one gender. Significant relationships were observed between mental health symptoms and gender diversity for all dimensions assessed. Conclusions: Similar to adult studies, early adolescents identifying as transgender reported increased mental health symptoms. Results also point to considerable diversity in other dimensions of gender (felt‐gender, gender noncontentedness, gender nonconformity) among 10/11‐year‐olds, and find this diversity to be related to critical mental health symptoms. These findings add to our limited understanding of the relationship between dimensions of gender and wellness for youth. [ABSTRACT FROM AUTHOR]

Lesbian, gay, and bisexual (LGB) youths continue to experience more violence victimization and suicide risk than heterosexual youths; however, few studies have examined whether the proportion of LGB youths affected by these outcomes has varied over time, and no studies have assessed such trends in a nationally representative sample. This report analyzes national trends in violence victimization and suicide risk among high school students by self-reported sexual identity (LGB or heterosexual) and evaluates differences in these trends among LGB students by sex (male or female) and race/ethnicity (non-Hispanic black, non-Hispanic white, or Hispanic). Data for this analysis were derived from the 2015, 2017, and 2019 cycles of CDC's Youth Risk Behavior Survey (YRBS), a cross-sectional, school-based survey conducted biennially since 1991. Logistic regression models assessed linear trends in prevalence of violence victimization and indicators of suicide risk among LGB and heterosexual students during 2015-2019; in subsequent models, sex-stratified (controlling for race/ethnicity and grade) and race/ethnicity-stratified (controlling for sex and grade) linear trends were examined for students self-identifying as LGB during 2015-2019. Results demonstrated that LGB students experienced more violence victimization and reported more suicide risk behaviors than heterosexual youths. Among LGB youths, differences in the proportion reporting violence victimization and suicide risk by sex and race/ethnicity were found. Across analyses, very few linear trends in these outcomes were observed among LGB students. Results highlight the continued need for comprehensive intervention strategies within schools and communities with the express goal of reducing violence victimization and preventing suicide risk behaviors among LGB students. [ABSTRACT FROM AUTHOR]

Background: Gender parity in the workplace—and increased representation of women at work—may reduce workplace sexual harassment, but research on this is unclear. This study assessed the associations between gender parity at work and workplace sexual harassment. Methods : We analyzed data from an online sexual harassment survey conducted with a nationally representative sample of U.S. adults in 2018 (N = 2,009; response rate 29%); current analyses were restricted to employed participants (women n = 610, men n = 690). Data on occupation and industry were each categorized as female-dominant (61%–100% female), male-dominant (0%–39% female), or at parity (40%–60% female). We used sex-stratified logistic regression models to assess associations between gender parity in industry and occupation and workplace sexual harassment. Findings : Our study of employed adults in the U.S. found that 42% women and 15% men had experienced workplace sexual harassment. Logistic regression analyses indicated that women employed in female-dominated industries (adjusted odds ratio [AOR] = 0.52; 95% confidence interval [CI] = [0.33, 0.81]) and men employed in male-dominated occupations (AOR = 0.55; 95% CI = [0.33, 0.91]) were less likely to have experienced workplace sexual harassment. Women in male-dominated occupations were more likely to report harassment or assault by a supervisor (AOR = 2.41, 95% CI = [1.00, 5.80]), and men in male-dominated occupations were less likely to report harassment or assault by a supervisor (AOR = 0.26, 95% CI = [0.08, 0.89]). Conclusion/Application to Practice : Women in female-dominated industries and men in male-dominated occupations, relative to those with workplace gender parity, are at lower risk for harassment. Women in male-dominated occupations are at greater risk for harassment from supervisors. Gender parity at work is not sufficient on its own to address workplace sexual harassment; normative changes are needed. [ABSTRACT FROM AUTHOR]

Congress has abdicated its role at the center of U.S. political life. As a result, the constitutional powers that should be exercised by Congress in both domestic and foreign policy have been progressively appropriated by the executive branch. At times, presidents have seized those powers through exigent circumstances or congressional desuetude and ineffectiveness. Just as frequently, however, Congress has been willing--if not eager--to cede those prerogatives to the president whether for the sake of expediency, emergency, efficiency, electoral maneuvering, or in a deliberate effort to deflect political consequences. This has made the country less democratic, more authoritarian, and decreasingly likely to solve complex problems that require a broad range of perspectives and thoughtful deliberation. The article explores how this abdication has occurred throughout U.S. history in a variety of areas, including U.S. foreign relations, the constitutional war powers, national emergencies, and delegations of power. This article is a revised and expanded version of the author's presidential address at 2019 annual meeting of the Pacific Coast Branch of the American Historical Association, delivered August 1, 2019, at the University of Nevada, Las Vegas. [ABSTRACT FROM AUTHOR]

Discusses literacy materials for hearing impaired persons and lists four Canadian and four American support services for such persons. (DF)

Lists associations and other resources that provide materials and services for the visually impaired. (HOD)

Background Many individuals access and share health information on social networking sites. Previous studies have analyzed the social media site Twitter to discern public opinion related to health phenomena such as antibiotics, concussions, and flu. Physical therapy-related online discussions have not been studied. Objective The aim of this study was to explore content, participants, and structure of physical therapy-related discussions on Twitter. Design This study was observational. Methods Over 12 weeks, more than 30,000 physical therapy-related tweets were collected. A random sample of 100 tweets underwent preliminary analysis to determine broad categories including tweet author, tone, and theme. A second random sample of 100 tweets was analyzed to confirm categories. Once categories were established, a new sample of 1000 tweets was randomly selected for analysis and categorization. All study investigators categorized a shared collection of tweets to establish inter- and intrarater agreement. Twitter conversations were visualized using NodeXL. Results Intrarater and interrater agreement for tweet categorization was 95% and 89%, respectively. The distribution of the intended audience was 35.5% professional, 35.5% broad reach, and 29% public. The gross distribution of tweet tone was 63.1% neutral, 31.4% positive, and 5.6% negative. Twenty-eight percent of tweets were authored by physical therapists/physical therapist assistants and nearly one-half were categorized as "marketing." Tweets tended to be "isolated," not within a conversation, or consist of conversation within "tight crowds." Limitations This study was purely observational. Social media content can be highly influenced by temporal events, which limits the generalization of specific findings. Conclusions Study results indicate that the reach of physical therapy-related tweets may not be as broad as intended by the author. Physical therapy professionals and the hospitals/clinics that employ them may need to implement strategies to be more intentional in reaching a broader audience with online messages. [ABSTRACT FROM AUTHOR]

After decades of broad, bipartisan support for global economic integration, US politics has been shaken by a backlash against global economic governance. The promise of internationally derived gains no longer suffices to smooth over domestic distributional consequences. The Trump administration has turned inward, shunning multilateral governance and raising the following question: If the US and other protectionist governments step back from global economic governance, what will step forward? We contend that weakened global governance is unlikely to cause economic integration itself to unravel. Powerful business interests that benefit from the global economy can use private governance to set their own regulatory agendas using their market power. By stepping away from global governance, states weaken their own bargaining power vis-à-vis powerful domestic groups and curtail the influence of civil society groups. Paradoxically, the Trump administration's step back from global governance would leave power in the hands of firms that predominantly benefit from the status quo. [ABSTRACT FROM AUTHOR]

Youths identifying as lesbian, gay, bisexual, or another nonheterosexual identity (sexual minority youths) report more violence victimization, substance use, and suicide risk than do heterosexual youths (1). These disparities are generally attributed to minority stress (the process through which stigma directed toward sexual minorities influences health outcomes) (2,3). Sexual minority youths might experience negative outcomes associated with minority stress differently across sexual identities, but to date, no nationally representative study has examined differences in victimization, substance use, and suicide risk within sexual minority youth. Using pooled data from the 2015 and 2017 national Youth Risk Behavior Surveys (YRBS), relationships between sexual identity groups and victimization, substance use, and suicide risk were evaluated with sex-stratified logistic regression models. Compared with heterosexual students, bisexual females and all sexual minority males reported more victimization; lesbian and bisexual females reported more use of alcohol, cigarettes, and marijuana; and all sexual minority youths reported elevated high-risk substance use and suicide risk. Programmatic efforts to reduce and prevent victimization, substance use, and suicide risk among sexual minority youths might benefit from consideration of issues within group differences. [ABSTRACT FROM AUTHOR]

The Trump administration has undertaken an assault on the Environmental Protection Agency (EPA), an agency critical to environmental health. This assault has precedents in the administrations of Ronald Reagan and George W. Bush. The early Reagan administration (1981-1983) launched an overt attack on the EPA, combining deregulation with budget and staff cuts, whereas the George W. Bush administration (2001-2008) adopted a subtler approach, undermining science-based policy. The current administration combines both these strategies and operates in a political context more favorable to its designs on the EPA. The Republican Party has shifted right and now controls the executive branch and both chambers of Congress. Wealthy donors, think tanks, and fossil fuel and chemical industries have become more influential in pushing deregulation. Among the public, political polarization has increased, the environment has become a partisan issue, and science and the mainstream media are distrusted. For these reasons, the effects of today's ongoing regulatory delays, rollbacks, and staff cuts may well surpass those of the administrations of Reagan and Bush, whose impacts on environmental health were considerable. [ABSTRACT FROM AUTHOR]

The article discusses factors that contribute to the achievement gap between African Americans and White Americans children and provides recommendation for educators, administrators and policy makers to help equalize educational opportunities. Topics discussed include creating unique ways to learn language depending on experiences in their language communities, importance of interpersonal relationships to provide consistent physical care, social guidance and emotional support in children.

Background: A number of phenols and parabens are added to consumer products for a variety of functions, and have been found at detectable levels in the majority of the U.S. population. Among other functions, thyroid hormones are essential in fetal neurodevelopment, and could be impacted by the endocrine disrupting effects of phenols and parabens. The present study investigated the association between ten maternal urinary phenol and paraben biomarkers (bisphenol S, triclosan, triclocarban, benzophenone-3, 2,4-dichlorophenol, 2,5-dichlorophenol, and ethyl, butyl, methyl and propyl paraben) and four plasma thyroid hormones in 439 pregnant women in a case–control sample nested within a cohort study based in Boston, MA. Methods: Urine and blood samples were collected from up to four visits during pregnancy (median weeks of gestation at each visit: Visit 1: 9.64, Visit 2: 17.9, Visit 3: 26.0, Visit 4: 35.1). Linear mixed models were constructed to take into account the repeated measures jointly, followed by multivariate linear regression models stratified by gestational age to explore potential windows of susceptibility. Results: We observed decreased total triiodothyronine (T3) in relation to an IQR increase in benzophenone-3 (percent change [%Δ] = −2.07; 95% confidence interval [CI] = −4.16, 0.01), butyl paraben (%Δ = −2.76; 95% CI = −5.25, −0.26) and triclosan (%Δ = −2.53; 95% CI = −4.75, −0.30), and triclocarban at levels above the LOD (%Δ = −5.71; 95% CI = −10.45, −0.97). A 2.41% increase in T3 was associated with an IQR increase in methyl paraben (95% CI = 0.58, 4.24). We also detected a negative association between free thyroxine (FT4) and propyl paraben (%Δ = −3.14; 95% CI = −6.12, −0.06), and a suggestive positive association between total thyroxine (T4) and methyl paraben (%Δ = 1.19; 95% CI = −0.10, 2.47). Gestational age-specific multivariate regression analyses showed that the magnitude and direction of some of the observed associations were dependent on the timing of exposure. Conclusion: Certain phenols and parabens were associated with altered thyroid hormone levels during pregnancy, and the timing of exposure influenced the association between phenol and paraben, and hormone concentrations. These changes may contribute to downstream maternal and fetal health outcomes. Additional research is required to replicate the associations, and determine the potential biological mechanisms underlying the observed associations. [ABSTRACT FROM AUTHOR]

BACKGROUND: The educational identification (ED-ID) of students with traumatic brain injury (TBI) has been legislated in numerous states, and TBI has become its own special education category. Questions abound as to whether these changes will lead to more readily identifying these students to provide appropriate special education supports. OBJECTIVE: Elucidate one state’s response to legislative changes around ED-ID of TBI. METHODS: This is a phenomenological case study of nine school districts in one state. Researchers conducted focus groups as well as individual interviews with various special education staff. On-going analysis of the focus group and interview data occurred, until themes were finalized. RESULTS: Reactions of staff comprised two opposing viewpoints: those supporting and carrying out ED-ID (“Toward ED-ID”) and those describing processes and attitudes that stand in the way (“Barriers”). Themes that were supportive of ED-ID include Credible History, Personnel, Targeted Intervention, Effective Communication, and Education. Themes aligned with the barrier viewpoint include Concussion Protocols, Medical Nature, Misidentification, Stigma, and Communication Breakdown. CONCLUSION: While many districts reported success with ED-ID for TBI, responses to the ED-ID legislation and TBI category were mixed, with enough barriers identified to cause concern over whether the legislative and policy changes have been overall beneficial. [ABSTRACT FROM AUTHOR]

Introduction: Sexual minority youth often experience increased social stress due to prejudice, discrimination, harassment, and victimization. Increased stress may help explain the disproportionate use of substances like tobacco, alcohol, marijuana, and other illicit drug use by sexual minority youth. This study examined the effect of social stress on substance use disparities by sexual orientation among U.S. high school students.Methods: In 2016, data from the national 2015 Youth Risk Behavior Survey, conducted among a nationally representative sample of 15,624 U.S. high school students, were analyzed to examine the effect of school-related (threatened/injured at school, bullied at school, bullied electronically, felt unsafe at school) and non-school-related (forced sexual intercourse, early sexual debut) social stress on substance use disparities by sexual orientation, by comparing unadjusted prevalence ratios (PRs) and adjusted (for social stressors, age, sex, and race/ethnicity) prevalence ratios (APRs).Results: Unadjusted PRs reflected significantly (p<0.05 or 95% CI did not include 1.0) greater substance use among students who identified as lesbian/gay or bisexual than students who identified as heterosexual. APRs for injection drug use decreased substantially among lesbian/gay (PR=12.02 vs APR=2.14) and bisexual (PR=2.62 vs APR=1.18) students; the APR for bisexual students became nonsignificant. In addition, APRs among both lesbian/gay and bisexual students decreased substantially and were no longer statistically significant for cocaine, methamphetamine, and heroin use.Conclusions: School-based substance use prevention programs might appropriately include strategies to reduce social stress, including policies and practices designed to provide a safe school environment and improved access to social and mental health services. [ABSTRACT FROM AUTHOR]