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Hailstorms are analyzed across the United States using explicit hailstone size calculations from convection-permitting regional climate simulations for historical, mid-century, and end of twenty-first-century epochs. Near-surface hailstones <4 cm are found to decrease in frequency by an average of 25%, whereas the largest stones are found to increase by 15–75% depending on the greenhouse gas emissions pathway. Decreases in the frequency of near-surface severe hail days are expected across the U.S. High Plains, with 2–4 fewer days projected—primarily in summer. Column-maximum severe hail days are projected to increase robustly in most locations outside of the southern Plains, a distribution that closely mimics projections of thunderstorm days. Primary mechanisms for the changes in hailstone size are linked to future environments supportive of greater instability opposed by thicker melting layers. This results in a future hailstone size dichotomy, whereby stronger updrafts promote more of the largest hailstones, but significant decreases occur for a majority of smaller diameters due to increased melting. [ABSTRACT FROM AUTHOR]

This research seeks to understand simulated supercell precipitation characteristics across the conterminous United States (CONUS) using high‐resolution, convection‐permitting, dynamically downscaled simulations for three 15‐year epochs. Epochs include a historical end‐of‐20th‐century period (1990–2005) and two end‐of‐21st‐century (2085–2100) scenarios for intermediate and pessimistic greenhouse gas concentration trajectories. Simulated updraft helicity, which measures the corkscrew flow within a storm's updraft, is used as a proxy for supercells. An algorithm tracks and catalogues updraft helicity swaths that, when buffered, are used to acquire simulated precipitation from supercells. The historical epoch provides a baseline climatology of supercell precipitation for a contemporary climate, which is then compared against the two future epochs to assess how supercell precipitation may change during the 21st century. Despite their relatively small size, supercells provide critical precipitation to the Wheat and Corn Belts, large expanses of CONUS pasture and rangeland, regional aquifers and several large river basins. Many areas in the central CONUS receive upwards of 3%–6% of their annual and 5%–8% of their warm‐season precipitation from these storms. Results suggest that precipitation contribution from supercells will decrease in the future across most of the High Plains and Central and Northern Great Plains with robust increases likely across the south‐central and Southeast regions. Supercell precipitation rates are expected to increase for large portions of the CONUS by the end‐of‐the‐21st‐century, suggesting a growing threat for flash floods from these storms as they become more efficient precipitation producers. This research provides an initial perspective on the magnitude of supercell precipitation and potential changes to this important hydrologic input to assist water‐sensitive industries, private and public insurance markets, agriculture entities, as well as inform plans to mitigate and build resilience to rapid environmental and societal change. [ABSTRACT FROM AUTHOR]

Explicit representation of finer‐scale processes can affect the sign and magnitude of the precipitation response to climate change between convection‐permitting and convection‐parameterizing models. We compare precipitation across two 15‐year epochs, a historical (HIST) and an end‐of‐21st‐century (EoC85), between a set of dynamically downscaled regional climate simulations at 3.75 km grid spacing (WRF) and bias‐corrected Community Earth System Model (CESM) output used to initialize and force the lateral boundaries of the downscaled simulations. In the historical climate, the downscaled simulations demonstrate less overall error than CESM when compared to observations for most portions of the conterminous United States. Both sets of simulations overestimate the incidence of environments with moderate to high precipitable water while CESM generally simulates rainfall that is too frequent but less intense. Within both sets of simulations, EoC85 rainfall amounts decrease in low‐moisture environments due to reduced rainfall frequency and intensity while rainfall amounts increase in high‐moisture environments as they occur more often. Overall, reductions in rainfall are stronger in WRF than in CESM, particularly during the warm season. This reduced drying in CESM is attributed to relatively higher rainfall frequency in environments with high concentrations of precipitable water and weak vertical motion. As a result, an increase in the occurrence of high moisture environments in EoC85 naturally favors more rainfall in CESM than WRF. Our results present an in‐depth examination of the characteristics of changes in overall accumulated precipitation and highlight an extra dimension of uncertainty when comparing convection‐permitting models against convection‐parameterizing models. Plain Language Summary: Model resolution determines what features can be explicitly resolved within a model and what features must be parameterized. In cases where precipitation is convective or interacts with fine‐scale geographic features such as mountains, coarser model resolutions employed by most global climate models may misrepresent the end‐of‐21st century precipitation response to climate change. An examination of this precipitation response for the conterminous United States is examined for a coarse resolution global climate model and a dynamically downscaled regional climate model at 3.75 km resolution. Using a decomposition approach, it is shown that the downscaled model better captures precipitation and its characteristics against observations for most portions of the United States. In western portions of the United States, over the northern Rockies and the Northwest, the downscaled simulation produces the right precipitation but for the wrong reasons and overestimates the frequency of high‐moisture environments. Within the end‐of‐21st‐century response, reductions in rainfall during the summer months are generally more pronounced in the downscaled simulations than in the global climate model. This reduced drying at coarser scales is due to the higher overall frequency of precipitation, particularly in environments with weak upward motion. A discussion diagnosing potential causes for this response within the convective parameterization and future avenues of work is given. Key Points: We compare the end‐of‐21st‐century precipitation response between a global climate model and a dynamically downscaled regional climate modelCompared to observations, the downscaled model best captures the amount, frequency, and intensity of precipitationProjections show stronger warm‐season drying in the downscaled simulation due to relatively lower precipitation frequencies [ABSTRACT FROM AUTHOR]

A supercell is a distinct type of intense, long-lived thunderstorm that is defined by its quasi-steady, rotating updraft. Supercells are responsible for most damaging hail and deadly tornadoes, causing billions of dollars in losses and hundreds of casualties annually. This research uses high-resolution, convection-permitting climate simulations across 15-yr epochs that span the twenty-first century to assess how supercells may change across the United States. Specifically, the study explores how late-twentieth-century supercell populations compare with their late-twenty-first-century counterparts for two—intermediate and pessimistic—anthropogenic climate change trajectories. An algorithm identifies, segments, and tracks supercells in the simulation output using updraft helicity, which measures the magnitude of corkscrew flow through a storm's updraft and is a common proxy for supercells. Results reveal that supercells will be more frequent and intense in future climates, with robust spatiotemporal shifts in their populations. Supercells are projected to become more numerous in regions of the eastern United States, while decreasing in frequency in portions of the Great Plains. Supercell risk is expected to escalate outside of the traditional severe storm season, with supercells and their perils likely to increase in late winter and early spring months under both emissions scenarios. Conversely, the latter part of the severe storm season may be curtailed, with supercells expected to decrease midsummer through early fall. These results suggest the potential for more significant tornadoes, hail, and extreme rainfall that, when combined with an increasingly vulnerable society, may produce disastrous consequences. [ABSTRACT FROM AUTHOR]

This research quantifies the spatiotemporal statistics of composite radar reflectivity in the vicinity of severe thunderstorm reports. By using over 20 years (1996–2017) of data and 500,000 severe thunderstorm reports, this study presents the most comprehensive analysis of the mesoscale presentation of radar reflectivity composites during severe weather events to date. We first present probability matched mean composites of approximately 5,000 radar images centred on tornado reports that contain one of three types of manually‐labelled convective storm modes—namely, (a) quasi‐linear convective system (QLCS); (b) cellular; or (c) tropical system. Next, we generate composites for tornado report data stratified by EF‐scale and for four temporal periods during which notable severe weather events took place. The data are then stratified by hazard, region, season, and time of day. The results show marked spatiotemporal and intra‐hazard variability in radar presentation. In general, cellular convection is favoured in the Great Plains of the United States, whereas QLCS convection is favoured in the Southeast United States. Night and cool‐season subsets showed a preference for QLCS convection, whereas day and warm‐season subsets showed a preference for cellular convection. These results agree well with the existing literature and suggest that the data extraction and organization approach is sound. Because of this, these data will be useful for future image classification studies in climate and atmospheric sciences—particularly those involving storm mode classification. [ABSTRACT FROM AUTHOR]

This research uses image classification and machine learning methods on radar reflectivity mosaics to segment, classify, and track quasi-linear convective systems (QLCSs) in the United States for a 22-yr period. An algorithm is trained and validated using radar-derived spatial and intensity information from thousands of manually labeled QLCS and non-QLCS event slices. The algorithm is then used to automate the identification and tracking of over 3000 QLCSs with high accuracy, affording the first, systematic, long-term climatology of QLCSs. Convective regions determined by the procedure to be QLCSs are used as foci for spatiotemporal filtering of observed severe thunderstorm reports; this permits an estimation of the number of severe storm hazards due to this morphology. Results reveal that nearly 32% of MCSs are classified as QLCSs. On average, 139 QLCSs occur annually, with most of these events clustered from April through August in the eastern Great Plains and central/lower Mississippi and Ohio River Valleys. QLCSs are responsible for a spatiotemporally variable proportion of severe hazard reports, with a maximum in QLCS-report attribution (30%-42%) in the western Ohio and central Mississippi River Valleys. Over 21% of tornadoes, 28% of severe winds, and 10% of severe hail reports are due to QLCSs across the central and eastern United States. The proportion of QLCS-affiliated tornado and severe wind reports maximize during the overnight and cool season, with more than 50% of tornadoes and wind reports in some locations due to QLCSs. This research illustrates the utility of automated storm-mode classification systems in generating extensive, systematic climatologies of phenomena, reducing the need for time-consuming and spatiotemporal-limiting methods where investigators manually assign morphological classifications. [ABSTRACT FROM AUTHOR]

Intro. Both discrimination and harassment directly impact mental and physical health. Further, workplace discrimination degrades workplace culture and negatively impacts health behaviors, job-related outcomes, and family dynamics. Women represent a small proportion of the fire service and are often the targets of discrimination/harassment, yet little research documents the impact of such experiences. The purpose of this study was to evaluate the relationship between chronic work discrimination and/or harassment and women firefighters' (FFs) physical and mental health, substance abuse, and job efficacy, stress, and satisfaction. Methods. Snowball sampling was used to solicit participation from women career FFs. Participants completed an online survey regarding physical and mental health, health behavior, job efficacy/stress/satisfaction, and family well-being. Logistic regression examined the impact of work discrimination-harassment severity on dichotomous variables. Results. 1,773 had complete data on their experiences with work-related discrimination and harassment. Women reported experiencing verbal (37.5%) and written (12.9%) harassment, hazing (16.9%), sexual advances (37.4%), and assaults (5.1%) in the fire service. FFs in the highest tertile of work discrimination-harassment severity reported over 40% more poor health days in the last 30 days (OR=1.42; 95%CI=1.33-1.51; p<0.001). Women who experienced moderate and severe discrimination/harassment had negative mental health outcomes including higher prevalence of depressive symptoms, anxiety, and PTSD symptoms. Those who experienced high rates of discrimination and/or harassment also were more likely to report issues with alcohol consumption. Conclusion. The impact of discrimination and harassment, related negative physical and mental outcomes, low levels of job satisfaction, and negative impact of these experiences on family/home stress likely take a significant toll on women in the fire service. Findings confirm and extend previous work suggesting there is a need to improve the mental and physical health of women FFs. Future work should examine the prospective relationship between discrimination/harassment and poor health outcomes and potential policies/practices to reduce these negative behaviors. [ABSTRACT FROM AUTHOR]

This research applies an automated mesoscale convective system (MCS) segmentation, classification, and tracking approach to composite radar reflectivity mosaic images that cover the contiguous United States (CONUS) and span a relatively long study period of 22 years (1996–2017). These data afford a novel assessment of the seasonal and interannual variability of MCSs. Additionally, hourly precipitation data from 16 of those years (2002–17) are used to systematically examine rainfall associated with radar-derived MCS events. The attributes and occurrence of MCSs that pass over portions of the CONUS east of the Continental Divide (ECONUS), as well as five author-defined subregions—North Plains, High Plains, Corn Belt, Northeast, and Mid-South—are also examined. The results illustrate two preferred regions for MCS activity in the ECONUS: 1) the Mid-South and Gulf Coast and 2) the Central Plains and Midwest. MCS occurrence and MCS rainfall display a marked seasonal cycle, with most of the regions experiencing these events primarily during the warm season (May–August). Additionally, MCS rainfall was responsible for over 50% of annual and seasonal rainfall for many locations in the ECONUS. Of particular importance, the majority of warm-season rainfall for regions with high agricultural land use (Corn Belt) and important aquifer recharge properties (High Plains) is attributable to MCSs. These results reaffirm that MCSs are a significant aspect of the ECONUS hydroclimate. [ABSTRACT FROM AUTHOR]

Objectives Despite increasing attention to the occupational impact of firefighting, little is known specific to the health of women firefighters. In particular, quantitative data is lacking on the impact firefighting has on maternal and child health for women who become pregnant while working as firefighters. Methods A total of 1821 women firefighters responded to requests to complete a self-report survey of questions about pregnancy. Women answered questions about their departments’ policies and practices and their own experiences of pregnancy. Those participants who reported a pregnancy while serving as a firefighter were asked detailed questions about their pregnancy and outcomes. Results Female firefighters reported that nearly a quarter of their first pregnancies while in the fire service ended in miscarriage and that increased to a third of pregnancies by the fourth. Rates of pre-term delivery also were high among this population. Conclusions Findings have important implications for policy and practice among women who become pregnant while actively serving in the fire service. [ABSTRACT FROM AUTHOR]

Introduction: Prevalence rates of smokeless tobacco (SLT) use and late initiation among firefighters (ie, starting use as an adult after joining the fire service) are remarkably high, 10.5% and 26.0%, respectively. The purpose of this study is to examine characteristics associated with late SLT initiation in a sample comprised of male career firefighters from two large cohort studies.Methods: We examined correlates of late SLT initiation in a secondary analysis of data combining the baseline evaluations of two published firefighter health studies with 1474 male career firefighters in the United States.Results: Fourteen percent of participants were current SLT users. Among this group, the unadjusted rate of firefighters who initiated SLT use after joining the fire service was 15.9%, while the age-standardized rate was 38.2%; this is substantially higher than the national adjusted late initiation rate among adult males (0.8%). In addition, firefighters demonstrated higher rates of late SLT initiation (15.9% unadjusted; 18.4% age-standardized) when compared to males in the military overall (13.8%).Conclusions: The exceptionally high prevalence of SLT use overall and late initiation in the fire service suggest that joining the fire service in the United States is a risk factor for SLT use. There is a need to develop interventions aimed at reducing SLT use in the fire service that are specifically tailored for this occupational group.Implications: The high prevalence of late SLT initiation (ie, starting use as an adult after joining the fire service) among firefighters should be addressed by both researchers and fire service organizations given the significant health risks associated with SLT and its impact on occupational readiness. There is a need for developing intervention programs aimed at reducing SLT use in the fire service. Interventions would need to be specifically tailored for this occupational group and their unique culture, given that joining the fire service appears to be a risk factor for SLT initiation among firefighters who did not use tobacco prior to joining the fire service. [ABSTRACT FROM AUTHOR]

It is a common belief in the fire service that the divorce rate for firefighters is higher than that in the general population. However, no data exists to substantiate this concern. We conducted surveys in 31 U.S. fire departments to assess relationship status, history of divorce, and key health outcomes. Prevalence of divorce among male firefighters was similar to the general population. In contrast, age-standardized prevalence of current divorce among female fighters (32.1%) was more than three times that for females in the general population (10.4%). Prevalence of ever divorce was substantially higher among female (40.0%) compared with male firefighters (24.4%). Married firefighters were less likely to report heavy alcohol use or depression, whereas single firefighters had more favorable body composition. These findings suggest that the rate of divorce among male firefighters is similar to that found in the general public. In contrast, female firefighters report high rates of divorce. [ABSTRACT FROM AUTHOR]

General, or private and non-commercial, aviation accidents produce more fatalities than any other aviation category within the United States. Despite advances in scientific understanding and technology since the early 1900s, weather causes concern for aviation safety, and little is known about the characteristics of fatal weather-related general aviation accidents. We provide a comprehensive spatiotemporal analysis of fatal weather-related general aviation accidents from 1982 through 2013 using data culled from the United States National Transportation Safety Board (NTSB). Weather was a cause or contributing factor in 35% of fatal general aviation accidents, of which 60% occurred while instrument meteorological conditions were present. Fatal weather-related general aviation accidents occur most frequently between October and April, on weekends, in early morning and evening periods, and along the West Coast, Colorado Rockies, Appalachian Mountains, and the Northeast. There has been a long-term reduction in weather-related general aviation accidents and fatalities since the 1980s; nonetheless, these accidents are still responsible for nearly 100 fatalities/year in the United States. This study provides pilots, academics, the Federal Aviation Administration, the NTSB, and other aviation organizations with information to advance mitigation efforts aimed at reducing future aviation-related accidents in the United States. [ABSTRACT FROM PUBLISHER]

Background: Obesity compromises firefighter safety, yet more than 70% of firefighters are overweight. Though healthcare professionals are encouraged to counsel overweight patients, the effectiveness of weight counseling is not consistent across studies.Objective: Examine longitudinal changes in cardiovascular risk factors and determine the role of healthcare professional weight loss advice on six-month weight changes among a national sample of male, overweight and obese firefighters.Methods: This study included baseline and six-month assessments of 757 firefighters. Medical and demographic data were collected using questionnaires. Investigators collected height, weight, percent body fat, waist circumference, blood pressure, and fasting serum samples (total cholesterol, high-density lipoprotein, low-density lipoprotein, glucose). Multilevel linear regression assessed the association between weight advice and outcomes.Results: Participants lost an average of 0.55 kg (95%CI: 0.17-0.93), and experienced significant improvements in systolic blood pressure (mean: 3.75 mm Hg; 95% CI: 2.35-5.14) and non-significant improvements in other clinical outcomes. Healthcare professional weight advice was not significantly associated with weight loss or other outcomes.Conclusion: Similar to other studies, results show little benefit of low intensity weight loss counseling. Additional research is needed to identify effective and feasible weight management strategies to address firefighter obesity. [ABSTRACT FROM AUTHOR]

Tobacco use prevalence is unacceptably high in the U.S. military, and the Department of Defense and service branches have implemented tobacco control policies and cessation programs. To explore aspects of programs regarded as exemplary by their services, we visited four installations, nominated by their service's health promotion leaders, and conducted interviews, observations, and focus groups. Installations included Naval Hospital Guam, Tripler Army Medical Center, MacDill Air Force Base, and the Naval Hospital at Marine Corps Air Ground Combat Center Twentynine Palms. The tobacco control managers (TCMs) at the programs studied were all civilian employees, highly motivated and enthusiastic, and had remained in their positions for approximately a decade. Other commonalities included support from command, a "culture" of health, and location in warm climates. Programs varied in their involvement in establishing designated tobacco use areas, and length and requirement of attending cessation classes; however, no evaluation of cessation programs is currently underway. TCMs should be more engaged in policy discussions for the larger installations they serve. A strong policy framework and command support for TCMs will be necessary to achieve the goal of a tobacco-free military. [ABSTRACT FROM AUTHOR]

BACKGROUND: Firefighters must be ready to respond to a broad range of emergencies every duty day. In the course of many of these emergencies, firefighters witness events which have the potential to induce emotional trauma, such as badly injured people, deceased children, and individuals who are highly distraught. Previous research suggests that repeated exposure to these traumas (RET) may have negative impacts on the emotional and mental health of fire service personnel. Research on the mental health of firefighters has been limited to small surveys reporting the prevalence of specific mental health problems such as depression and post-traumatic stress disorder among firefighters. OBJECTIVE: Despite the likelihood that RET leads to negative outcomes in firefighters, data is lacking on how exposure impacts fire service personnel. The current study examines the experiences of firefighters related to RET. METHODS: Using formative research methods, we examined the beliefs and experiences of firefighters and administrators from across the United States regarding the impact of RET on firefighter health. RESULTS: Study findings highlight the cumulative psychological toll of repeated exposure to traumatic events including desensitization, flashbacks, and irritability. CONCLUSION: Results of the current study suggest that RET is a significant concern for emergency responders that warrants additional research and attention. It is likely that the long term consequences of RET are closely intertwined with other mental health outcomes and general well-being of this important occupational group. [ABSTRACT FROM AUTHOR]

Accessible summary In the Western world, many people who have mental health problems experience poor physical health. Research suggests that those with mental illness often have difficulties in accessing health care services, reporting that when they do, their physical health needs are often overlooked., Nurses are expected to deliver safe and effective care that meets the needs of service users. In order to help mental health nurses address physical health care needs, changes to nurse education, supported by government policy, have been made in the United Kingdom. Despite these changes, mental health nurses still feel less confident and prepared to address physical health needs of service users. However, this same problem is also reported by nurses throughout Europe and in other Western countries, who have undergone different training and education programmes., This paper discusses important factors affecting the mental health nurses' ability to deliver physical care and how they impact on confidence and competence., The paper concludes by highlighting the role of the mental health nurse being key in addressing the physical health needs of those in their care, and how this will only be realized when education and practice provide sufficient opportunity for them to develop and maintain their knowledge and skills., Abstract In the Western world, there is increasing concern regarding the ability of health care professionals to meet the physical health care needs of those diagnosed with mental illness. This discussion paper seeks to explore some of the issues facing mental health nurses in delivering care to those who have both mental and physical illness. Criticism of the National Health Service for failing to meet the physical health needs of people with serious mental illness has generated a number of political strategies aimed at addressing inequalities between mental and physical health care, a consequence being a change in pre-registration nurse education. It is envisaged that such changes will enable all nurses to deliver safe, effective care to service users, with adult and mental health nurses being more adept at meeting both the mental and physical health needs of those in their care. The impact of three key areas identified within the literature will be considered: the impact of co-existing physical and mental illness; the role of mental health nurses and perceptions of service users re physical health care; and education, training and learning from others in the Western world. In conclusion, the complexities of delivering such care will be addressed. [ABSTRACT FROM AUTHOR]

Background The military has had a long pro-tobacco tradition. Despite official policy discouraging smoking, tobacco still is widely seen as part of military culture. While active smoking has presented a particular challenge for the military, in recent years there also has been increasing concern with secondhand smoke. This is especially true in closed environments and submarines may be deployed for months at a time. The current case study describes the successful implementation by the Navy of a comprehensive ban on smoking aboard submarines. Methods The authors searched documents on the internet, popular media, military-based news outlets and the scientific literature. We also conducted interviews with Navy officers who were instrumental in policy implementation. Findings Data demonstrating substantial exposure of non-smokers to tobacco smoke aboard submarines had major impact on successful adoption of the policy. A systematic and extended roll out of the ban included establishing a working group, soliciting input and active engagement from submarine personnel, and offering cessation assistance. Support was enlisted from Chief Petty Officers who could have been strongly opposed but who became strong proponents. Fewer problems were encountered than had been expected. In contrast to a previous unsuccessful attempt by a Navy captain to ban smoking on his ship, the ban was adopted without apparent tobacco industry interference. Conclusions Lessons learned included the importance of strong empirical support, effective framing of the issue, setting a realistic timeline, soliciting support from key personnel and providing appropriate resources. These lessons have implications for those considering further tobacco policy changes in the military and elsewhere. [ABSTRACT FROM AUTHOR]

The article discusses the assessment of the increase in the billion dollar events in the U.S. due to weather hazards such as tornadoes and hurricanes, along with exploring the increase in population and rural-to-urban migration. Topics include the fatalities and damage caused by tornadoes in the country such the Enhanced Fujita 5 (EF5) in Joplin, Missouri, the death of people and damage caused by the Hurricane Katrina, and the use of bull's-eye effect in determining disaster frequency.

The article discusses research on vehicular fatalities in the U.S. from 1994 to 2011 caused by atmospheric conditions such as fog, smoke and dust events. These weather-related visibility hazards have caused impaired motor vehicle driver visibility that lead to chain reaction road crashes. According to the author, an understanding of the characteristics of these hazards can be used to prevent future accidents by focusing on reducing visibility-related hazard impacts on roads.

Objectives. We conducted a longitudinal assessment of tobacco pricing in military retail outlets, including trends within each service branch. Methods. We determined the price of a single pack of Marlboro Red cigarettes at military retail stores located in the continental United States, Alaska, and Hawaii and at their nearest Walmarts in spring 2011 and 2013 (n = 128 for pairs available at both assessments). Results. The average difference between cigarettes sold in military retail outlets and Walmarts decreased from 24.5% in 2011 to 12.5% in 2013. The decrease was partially attributable to significant price decreases at Walmarts. The largest increases in cigarette prices occurred on naval installations. Potential savings at stores on several installations remained substantial in 2013; the largest approached $6 per pack. Stores on 17 military installations decreased cigarette prices during the study period. Conclusions. Tobacco can be purchased in military retail stores at substantial savings over civilian stores. If tobacco pricing is to cease to be an incentive for use among personnel, a revised military tobacco pricing policy is needed. [ABSTRACT FROM AUTHOR]

Little is known about smokeless tobacco (SLT) use in the fire service, whose personnel need to maintain high levels of health and fitness given the rigorous physical and mental job requirements. We examined the relationships among variables associated with SLT use and dual tobacco use (SLT and smoking) among 353 male career firefighters. Around 13% of male career fire fighters reported being current exclusive SLT users, and 2.6% used both cigarettes and SLT. Age-adjusted models revealed that race, binge drinking, and dietary fat consumption were positively associated with exclusive SLT use when compared to nontobacco users. SLT users were much more likely to binge drink (OR = 3.98, P < .01) and consume high fat foods (OR = 1.94, P < .05). Only high dietary fat consumption was a strong correlate (OR = 8.41, P < .05) of dual use when compared to nontobacco users. SLT and dual tobacco use are associated with significant health risks. Detailed information on the predictors of SLT use among fire fighters will aid in developing more effective tobacco prevention and cessation intervention in fire service. [ABSTRACT FROM AUTHOR]

Introduction: Firefighters currently have substantially lower smoking rates than similar occupational groups and the general U.S. population. In contrast, firefighters have very high rates of smokeless tobacco (SLT). The reasons for this paradox have not been explored; thus, the current study examined firefighters’ perspectives on tobacco use. Methods: Key informant interviews and focus groups were conducted in a national, cross-sectional purposively sampled group of 332 career firefighters. Results: Firefighters suggested several reasons for the decline in smoking in the fire service including changes in the fire service culture, concerns about the impact of smoking on their ability to perform their job, regulations aimed at reducing smoking in departments, and the costs of smoking. In contrast, they felt that the greater use of SLT was primarily due to increasing restrictions on smoking. Conclusions: The primary reasons cited for decreased smoking rates by firefighters in our study were policy implementation at the state and local levels that prohibit tobacco use as a condition of employment and related presumption laws. However, reasons beyond policy mandates such as witnessing the end results of tobacco use, fitness, greater education about the negative health effects of smoking, and awareness about increased risk of exposure to toxic products of combustions also were noted. The primary reason cited for increased SLT use was the greater restrictions on smoking. [ABSTRACT FROM PUBLISHER]

Background: Cigarette prices at military exchanges historically have been discounted. DoD Instruction 1330.9 has mandated that prices be within 5% of the price offered in the local community since 2001. Because minorities are highly represented in the military, we determined whether menthol cigarette prices, the leading choice of African Americans, were compliant with the instruction. Methods: We collected, via telephone, menthol cigarette price data from 48 randomly selected US military installation exchanges and matched local area Walmarts. We collected prices after taxes to determine the cost to consumer. Newport was selected as the index brand for menthol cigarettes because it is the leading and second leading brand smoked by African Americans and by Hispanics, respectively and has the second overall highest market share in the US. Results: Smokers purchasing menthols at exchanges would realize average savings of 22.78%. There were no significant differences in savings based on military service (F = 1.850, p = 0.152) or US Census Division (F = 1.226, p = 0.311: data not shown). In addition, not a single exchange price was compliant with the DoD instruction. Conclusions: Newport menthol cigarettes at military exchanges cost substantially less than the nearest Walmart, with an average savings of 23%. Our findings demonstrate that menthol cigarettes are substantially discounted on military installations, in a manner similar to other cigarette prices, and that DoD Instruction 1330.09 is not enforced. [ABSTRACT FROM AUTHOR]

Reported avalanche fatalities in the United States increased markedly through the latter half of the twentieth century, a result of the increasing popularity of winter sports. Despite this increase, the literature concerning US avalanche fatalities is sparse. This paper presents a comparison of three US databases containing avalanche fatality information: Storm Data, the West Wide Avalanche Network (WWAN) dataset, and the National Avalanche Database (NAD). The frequency of avalanche fatalities, their temporal trends, spatial distributions, and the demographic characteristics of the victims were analyzed in each database for the years 1998-2009 for the US mountainous west. The data were then pooled to arrive at an estimate of avalanche fatality frequency in the United States for the study period. While the results indicate a considerable amount of overlap between the datasets, Storm Data reports fewer avalanche fatalities than both the WWAN and NAD datasets. All three datasets report a maximum of fatalities in January and display three spatial maxima: the Rocky Mountains of west-central Colorado, the intermountain region from central Utah through Idaho to west-central Montana, and the northern Cascade Ranges of Washington; however, a large void appears in the Storm Data records in the vicinity of the Montana maximum. These maxima result from a juxtaposition of avalanche hazard in these mountainous environments with a high concentration of winter sports activities. [ABSTRACT FROM AUTHOR]

There are still hundreds of casualties produced by thunderstorm hazards each year in the United States despite the many recent advances in prediction and mitigation of the effects of convective storms. Of the four most common thunderstorm hazards (wind, hail, flooding, and lightning), convective winds (tornadic and nontornadic) remain one of the most dangerous threats to life and property. Using thunderstorm fatality and Weather Surveillance Radar-1988 Doppler (WSR-88D) data, this research illustrates a spatial and temporal analysis of the storm morphological characteristics, or convective mode, of all fatal tornadic and nontornadic convective wind events from 1998 to 2007. The investigation employs a radar-based morphology classification system that delineates storm type based on an organizational continuum, including unorganized cellular, quasi-organized cellular (either a cluster of cells or a broken line of cells), organized cellular (supercells and supercells embedded in an organized linear system), and organized linear (either squall lines or bow echoes). Results illustrate that over 90%% of the 634 recorded tornado deaths were associated with supercells, with 78%% of the deaths due to isolated tornadic supercells and 12%% linked to tornadic supercells embedded within an organized linear convective system. The morphologies responsible for the 191 nontornadic convective wind fatalities vary substantially, with bow echoes (24%%), squall lines (19%%), and clusters of cells (19%%) the most prominent convective modes producing fatalities. Unorganized and quasi-organized convection accounted for nearly half (45%%) of all nontornadic convective wind fatalities. Over half of all fatal tornadoes (53%%) occurred between 0000 and 0600 UTC, and most (59%%) fatalities from nontornadic convective winds occurred in the afternoon between 1800 and 0000 UTC. Two corridors of nontornadic convective wind fatalities were present: the lower Great Lakes region and the mid-South. Tornado fatalities were greatest in a zone extending from southeastern Missouri, through western Tennessee, northeastern Arkansas, Mississippi, Alabama, and Georgia. The methods employed and results found in this study are directly applicable in the further development of storm classification schemes and provide forecasters and emergency managers with information to assist in the creation and implementation of new convective wind mitigation strategies. [ABSTRACT FROM AUTHOR]

Despite progress in policy changes, tobacco use rates are still high in the military. Little is known about the views of those who create and implement tobacco control policies within the Department of Defense. These individuals determine what policy initiatives will be developed, prioritized, and implemented. We conducted key informant interviews with 16 service-level policy leaders (PLs) and 36 installation-level tobacco control managers (TCMs). PLs and TCMs believed that line leadership view tobacco control as a low priority that has minimal impact on successful mission completion. They also identified cultural factors that perpetuate tobacco use, such as low cost and easy accessibility to tobacco, smoke breaks, and uneven or unknown enforcement of current tobacco policies. [ABSTRACT FROM AUTHOR]

Introduction:: Rates of tobacco use in the U.S. military have traditionally been higher than in the general U.S. population. While the military has experienced decreases in tobacco use over the past two decades, recent surveys suggest a trend of increased use. Given the negative impact of tobacco on both the readiness and the long-term health of military members, it is important to understand what factors may be related to the increased use rates. It has been suggested that there is a culture that supports tobacco use in the military. [ABSTRACT FROM PUBLISHER]

Lightning is a unique weather hazard when compared to other perils such as tornadoes, flash floods, and hurricanes since lightning itself does not constitute a criterion for a severe event according to National Weather Service guidelines. Indeed, the mitigation of lightning casualties is complex since lightning is often preceded by no formal warning and little informal warning, because of the unpredictability and random nature of a lightning strike. This investigation tallies and assesses the fatalities produced by lightning in the United States from 1959 to 2006 in order to reevaluate the specific vulnerabilities and impacts associated with this deadly hazard. The study is the first to assemble a comprehensive lightning fatality dataset for the United States using both governmental and nongovernmental data sources. As with previous studies that have examined data discrepancies at the state level, the comparisons between traditional data sources such as Storm Data and other alternative data sources reveal significant differences in fatality tallies for the years when analyses overlap. Mortality data are gridded and mapped at a much finer resolution than previous studies in order to reveal the distinctive spatial distributions of lightning fatalities, which are a combination of both risk and human vulnerability. Although lightning is not a criterion for either tornado or severe thunderstorm warnings, we assess whether lightning fatalities during the 1994-2004 period occurred in conjunction with these types of warnings. These warning data, in addition to radar analyses from 1998 to 2006, illustrate that unorganized, nonsevere thunderstorms are the most likely storm morphology yielding killer lightning events. [ABSTRACT FROM AUTHOR]

Smoking during deployments is a growing problem, particularly among junior-enlisted personnel, who have the highest smoking rates in the military. Few studies have examined reasons for smoking initiation among never smokers, relapse among former smokers, or increased smoking frequency among current smokers, We conducted 24 focus groups at four Air Force and two Army installations (N = 189) to examine the extent of smoking during deployment and to elucidate factors thought to contribute to new initiation, relapse, and increased smoking in a sample of junior enlisted personnel and their supervisors. Important reasons for smoking included: (1) managing stress, boredom, anxiety, and sleep deprivation; (2) lack of alternate activities and privileges: (3) the perception that dangers in the field trumps the health impact of smoking: and (4) the role of the military environment in encouraging smoking. In addition, the phenomenon of new initiation and relapse to smoking in the field was discussed. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates the synoptic and mesoscale environments associated with flooding events in the U.S. from 1996 to 2005. A manual classification scheme is used to determine the primary ascent mechanisms and storm types producing fatal flood cases. The said classification scheme includes analyses of surface charts, 500 hPa maps, and composite radar data. It is mentioned that the two most dominant ascent mechanisms were the frontal boundaries and tropical systems. Findings exemplify that mesoscale convective systems were responsible for 36 percent of the total number of flood fatalities over the period.

Smoking prevalence among junior enlisted members of the United States armed forces significantly exceeds that of civilians. Furthermore, nearly 40% of junior enlisted who smoke reported they initiated smoking after joining the military. Although the tobacco industry has attempted to develop messages that encourage military members to use tobacco, no research has examined messages that would counteract industry messages and effectively discourage military members from using tobacco. This study conducted 24 focus groups on four Air Force and two Army installations (N = 189 personnel) to discover effective messages that discourage tobacco use among junior enlisted personnel. Four message themes were identified that hold promise for tobacco control efforts in the military: (a) smoking harms one's ability to positively influence others, (b) smoking increases the chance a military member will be discharged from the military prematurely, (c) smoking lowers readiness to fight and win wars, and (d) smokers are not as productive as other military personnel. In contrast, messages focusing on manipulation by the tobacco industry and the health effects of tobacco use were not strongly supported by military personnel. [ABSTRACT FROM AUTHOR]

A database was compiled for the period 1980–2005 to assess the threat to life in the conterminous United States from nonconvective high-wind events. This study reveals the number of fatalities from these wind storms, their cause, and their unique spatial distributions. While tornadoes continue to cause the most wind-related fatalities per year, nonconvective high winds (defined as phenomena such as downslope and gap winds, gradient winds, dust storms, and winds associated with midlatitude cyclones) have the potential to fatally injure more people than thunderstorm or hurricane winds. Nonconvective wind fatalities occur more frequently in vehicles or while boating. Fatalities are most common along the West Coast and Northeast in association with passing extratropical cyclones, with fewer fatalities observed in the central United States despite this region’s susceptibility for high-wind gusts. A combination of physical and social vulnerabilities is suggested as the cause for the unique fatality distribution found. More than 83% of all nonconvective wind fatalities are associated with the passage of extratropical cyclones. [ABSTRACT FROM AUTHOR]

A dataset of killer tornadoes is compiled and analyzed spatially in order to assess region-specific vulnerabilities in the United States from 1880 to 2005. Results reveal that most tornado fatalities occur in the lower–Arkansas, Tennessee, and lower–Mississippi River valleys of the southeastern United States—a region outside of traditional “tornado alley.” Analysis of variables including tornado frequency, land cover, mobile home density, population density, and nocturnal tornado probabilities demonstrates that the relative maximum of fatalities in the Deep South and minimum in the Great Plains may be due to the unique juxtaposition of both physical and social vulnerabilities. The spatial distribution of these killer tornadoes suggests that the above the national average mobile home density in the Southeast may be a key reason for the fatality maximum found in this area. A demographic analysis of fatalities during the latter part of the database record illustrates that the middle aged and elderly are at a much greater risk than are younger people during these events. Data issues discovered during this investigation reveal the need for a concerted effort to obtain critical information about how and where all casualties occur during future tornado and hazardous weather events. These new, enhanced data, combined with results of spatially explicit studies exploring the human sociology and psychology of these hazardous events, could be utilized to improve future warning dissemination and mitigation techniques. [ABSTRACT FROM AUTHOR]

A multi‐scale analysis is presented on widespread and long‐lived convectively generated windstorms, known as derechos. Analyses of the derecho‐producing environments during 15 May–30 June 1998 indicate that this exceptional episode of derechos and derecho groupings (or series) was supported by ingredients (i.e. moisture, instability, and wind shear) that were supplied by the large‐scale setting. In particular, the semi‐stagnant subtropical ridge and associated capping inversion across the southern tier of the U.S. were important in supplying amplified moisture and instability to derecho‐genesis regions through an underrunning process. Regions of preferred derecho formation appeared to correspond to shifts in the overall strength and position of the ridge, illustrating the importance of the ridge in focusing successive organized convection. Initiating mechanisms varied widely and were not restricted to warm‐air advection regimes along quasi‐stationary boundaries that forecasters often associate with warm‐season derecho environments. In several cases, derecho‐producing convective systems were generated by tropospheric features not consistent with common conceptual models of derecho environments such as closed lows and strong vorticity maxima. Further, three distinct series types were identified and classified based on their initiating mechanisms. Copyright © 2007 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

Background: The proportion of injury deaths with unspecified external cause codes has been used as an indicator of the level of comprehensiveness and specificity of information on death certificates provided by certifiers. Objective: To compare the proportion of unspecified external cause codes across countries. Methods: Multiple-cause-of-death mortality data for people who died in 2001 due to external causes in Australia, Sweden, Taiwan and the USA were used for this international comparison study. The proportion of injury deaths coded as due to an unspecified external cause (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, ICD-10, chapter XX) to all injury deaths in each block was calculated. Results: Sweden (33%) had the highest proportion of use of the least specific code (lCD-10 code X59 exposure to unspecified factor), followed by Australia (17%), Taiwan (13%) and the USA (7%). More than two-thirds of the deceased for whom an lCD-10 code X59 was assigned in Sweden and Australia were those aged ⩾65 years, and more than half of them had femoral fractures. The percentage of use of the unspecified codes within specific groups of external causes was relatively high for falls and unintentional drowning. Conclusions: Caution should be used in examining the compensatory effects of the unspecified external event code (lCD-10 code X59) on specific external causes (especially falls) when making international comparisons. Efforts are needed to educate certifiers to report sufficient information for specific coding so as to provide more useful information for injury prevention. [ABSTRACT FROM AUTHOR]

Background: Single item questions about self ratings of overall health status are widely used in both military and civilian surveys. Limited information is available to date that examines what relationships exist between self-rated health, health status and health related behaviors among relatively young, healthy individuals. Methods: The current study uses the population of active duty United States Air Force recruits (N = 31,108). Participants completed surveys that asked about health behaviors and health states and were rated their health on a continuum from poor to excellent. Results: Ratings of health were consistently lower for those who used tobacco (F = 241.7, p < .001), reported binge drinking (F = 69.0, p < .001), reported drinking and driving (F = 19.4, p < .001), reported taking health risks (F = 109.4, p < .001), were depressed (F = 256.1, p < .001) and were overweight (F = 39.5, p < .001). Conclusion: Given the consistent relationship between self-rated overall health and factors important to military health and fitness, self-rated health appears to be a valid measure of health status among young military troops. [ABSTRACT FROM AUTHOR]

Convectively generated wind-storms occur over broad temporal and spatial scales; however, the more widespread and longer lived of these windstorms have been given the name “derecho.” Utilizing an integrated derecho database, including 377 events from 1986 to 2003, this investigation reveals the amount of insured property losses, fatalities, and injuries associated with these windstorms in the United States. Individual derechos have been responsible for up to 8 fatalities, 204 injuries, forest blow-downs affecting over 3,000 km2 of timber, and estimated insured losses of nearly a $500 million. Findings illustrate that derecho fatalities occur more frequently in vehicles or while boating, while injuries are more likely to happen in vehicles or mobile homes. Both fatalities and injuries are most common outside the region with the highest derecho frequency. An underlying synthesis of both physical and social vulnerabilities is suggested as the cause of the unexpected casualty distribution. In addition, casualty statistics and damage estimates from hurricanes and tornadoes are contrasted with those from derechos to emphasize that derechos can be as hazardous as many tornadoes and hurricanes. [ABSTRACT FROM AUTHOR]

Utilizes results from each of the mesoscale convective complex (MCC) summaries compiled between 1978 and 1999 for the U.S. in order to develop a more complete climatology, or description of long-term means and interannual variation, of these storms. Indication that during the warm season, significant portions of the Great Plains receive, on average, between 8 percent and 18 percent of their total precipitation from MCC rainfall.

Examines the legislations pertaining to dietary supplements in the United States. Uses of dietary supplements; Significance of the Dietary Supplement Health and Education Act of 1994 and the Food and Drug Modernization Act of 1997; Impact of the legislations on the quality, safety, and use of dietary supplements; Limitations in the dietary supplement regulations.

Context: Obesity is increasing at an alarming rate. During the past decade, the overall prevalence of obesity in the United States increased over 30%, with more than one third of the adult population meeting the definition of being overweight.Objective: We review current and emerging therapies, present outcome data from a large clinical practice, and discuss challenges for physicians and researchers involved in obesity treatment.Summary: Because obesity is a risk factor for numerous medical disorders and excess mortality, it is imperative that effective treatments be developed. While the current conservative therapies produce short-term weight losses, they are ineffective in the long term. Some obesity treatments are controversial, most notably the increasing use of anorexiant medications. For example, the Food and Drug Administration (FDA) recently requested the withdrawal of two widely used medications because of concerns about side effects. Currently, therapies that combine psychosocial interventions, drugs, and extended maintenance appear to have the most promising long-term benefits.Conclusions: Long-term treatment, including extended pharmacotherapy, may be necessary for many obese patients. Broader definitions of treatment outcome and success, including improvements in comorbid conditions, physical activity, and quality of life are needed. [ABSTRACT FROM AUTHOR]

Objective: To examine occupational injuries among career women firefighters (FFs). Methods: A national cross-sectional survey assessed injury prevalence, types, frequencies, and predictors. Results: A total of 3012 women career FFs were enrolled in the study. Almost a third (31.7%) reported at least one occupational injury in the past 12 months. The most common injuries were dislocations, sprains, or strains (59.3%). Racial minority status, self-rated health, body composition, exercise habits, substance use, mental health, and job dissatisfaction were all significant injury correlates. Nearly 43% of injuries resulted in missed workdays. Additionally, 25% reported incurring chronic injuries. Conclusions: Women FFs reported a high prevalence of occupational injury and a significant percentage reported chronic injuries. These data can inform initiatives to curtail injuries in the fire service and better protect women FFs. [ABSTRACT FROM AUTHOR]

Convectively generated windstorms occur over broad temporal and spatial scales; however, one of the larger‐scale and most intense of these windstorms has been given the name ‘derecho’. This study illustrates the tendency for derecho‐producing mesoscale convective systems to group together across the United States—forming a derecho series. The derecho series is recognized as any succession of derechos that develop within a similar synoptic environment with no more than 72 h separating individual events. A derecho dataset for the period 1994–2003 was assembled to investigate the groupings of these extremely damaging convective wind events. Results indicate that over 62% of the derechos in the dataset were members of a derecho series. On average, nearly six series affected the United States annually. Most derecho series consisted of two or three events; though, 14 series during the period of record contained four or more events. Two separate series involved nine derechos within a period of nine days. Analyses reveal that derecho series largely frequent regions of the Midwest, Ohio Valley, and the south–central Great Plains during May, June, and July. Results suggest that once a derecho occurred during May, June, or July, there was a 58% chance that this event was the first of a series of two or more, and about a 46% chance that this was the first of a derecho series consisting of three or more events. The derecho series climatology reveals that forecasters in regions frequented by derechos should be prepared for the probable regeneration of a derecho‐producing convective system after an initial event occurs. Copyright © 2005 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

Objective: Both media reports and preliminary research suggest that problem drinking is a concern in the U.S. fire service. However, no national epidemiological research has been conducted. This study presents the first national data on alcohol consumption patterns among firefighters. Method: Data are from 954 male firefighters at 20 career fire departments. The departments covered 14 U.S. states, commonwealths, and/or territories and each of the four major U.S. Census Bureau Regions. Alcohol use was assessed through both surveys and, in a subsample, 24-hour dietary recall interviews from an off-duty day. Results: More than 85% of participants consumed alcohol, nearly half reported excessive drinking, and approximately one third reported episodic heavy use when off duty. Firefighters (in comparison with officers or chiefs) and those with fewer years of service had particularly high levels of alcohol intake. Among firefighters who drank, the energy derived from alcohol averaged 539 kcals, or nearly 18% of total energy. Twenty-five percent of firefighters consumed more than 770 kcals from alcohol in a single day. Conclusions: Given the high prevalence of excessive and episodic heavy drinking and the impact of alcohol on energy intake in this population, national surveillance programs and targeted prevention interventions for problem drinking in the U.S. fire service are critically needed. [ABSTRACT FROM AUTHOR]

Military and Veterans Service Organizations (MVSOs) have a unique opportunity to influence legislation and advocate for the interests of their members. However, little is known about what legislative priorities MVSOs see as important. Understanding the legislative priorities of MVSOs can inform efforts by health scientists to promote policy and laws designed to improve the health of our nation's veterans. Using a mixed methods approach, we conducted a thematic analysis of legislative priorities MVSOs promote with their legislative agendas. Most commonly, MVSOs addressed issues related to disability evaluations and ratings with the Veterans Administration and access to Veterans Administration services. Other common themes identified as priorities include benefits such as retirement, education, housing assistance for veterans, and TRICARE benefits. Findings highlight the broad range of topics MVSOs identify as legislative priorities as well as some health issues that receive relatively limited attention. [ABSTRACT FROM AUTHOR]

Tobacco use is the leading cause of preventable death in the United States and has been shown to significantly harm the combat readiness of military personnel. Unfortunately, recent research showed that cigarettes are sold at substantial discounts in military retail outlets. In fact, the military is the only retailer that consistently loses money on tobacco. Cheap tobacco prices have been identified by enlisted personnel and Department of Defense health policy experts as promoting a culture of tobacco use in the U.S. Military. This article provides an analysis of why current military tobacco pricing policy has failed to eliminate cheap tobacco prices as an incentive for use. A rationale for increasing tobacco prices also is presented along with recommendations for improved military tobacco control policy. [ABSTRACT FROM AUTHOR]

Abstract: Objective : The detrimental health effects of tobacco use have long been documented and accepted. Recent research has begun to explore the financial strain that tobacco places on those who use it (e.g. Mokdad, A.H., Marks, J.S., Stroup, D.F., Gerberding, J.L., 2004. Actual causes of death in the United States, 2000. J. Am. Med. Assoc. 291, 1239–1245). The issue of this financial burden is particularly salient for young enlisted in the military who often struggle with financial issues and who continue to use tobacco at relatively high rates. Methods : Using the 2002 Department of Defense Survey of Health Related Behaviors among Military Personnel, the current study examines the percentage of income young military members spend on tobacco given varying levels of consumption. In addition, a representative sample of junior enlisted (E1–E4) from all four military branches were surveyed about their tobacco use and their experiences of financial strain and experienced stress from financial problems. Results : Adjusted logistic models demonstrated that smokers reported substantially higher amounts of both financial strain and stress from financial problems then those who did not smoke. Conclusions : This study suggests there is a relationship between financial stress and tobacco use among junior military members. [Copyright &y& Elsevier]