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Abstract Introduction Mass incarceration has mental health consequences on those directly affected; some studies have also shown spillover effects on the physical health of the surrounding population. There is a dearth of research on the spillover mental health consequences of mass incarceration. This study aimed to quantify a consequence of mass incarceration which may adversely affect the population’s health and widen health disparities. Methods Using data from the Vera Institute’s Incarceration Trends 2.2 and the Robert Wood Johnson County Health Rankings, the association between county-level (n = 2823) counts of jail incarceration and reported number of poor mental health days within the past 30 days in the United States in 2018 was examined. To conduct the analysis, a negative binomial regression model was fit, adjusting for State and key demographic covariates. Results A change in jail incarceration rate from the first to the second and third tertiles was associated with 10.14% and 14.52% increases, respectively. For every 1% increase in the rate of mass incarceration, there was a statistically significant 15% increase in the average number of reported poor mental health days over the past 30 days. Discussion Mass incarceration is a threat to mental health as well as the well-being of the surrounding population. This can be attributed to the spillover effects that extend beyond those who are directly affected by mass incarceration. Interventions to reduce jail incarceration as well as address the mental health needs of those living in high-incarceration rate areas should be prioritized in order to reduce health inequities and augment health outcomes for all residents of the United States.

`Since 2014, the Community Eligibility Provision (CEP) school meal funding option has enabled high-poverty schools nationwide to serve universal free breakfast and lunch. Evidence suggests that CEP has benefits for student meal participation, behavior, and academic performance. This qualitative study explores perspectives among food service staff (n=28) in CEP-participating school districts in Maryland on (1) implementation barriers, (2) implementation best practices, and (3) impacts on students, school operations, and the broader food system. Perceived benefits of CEP include increased meal participation, reduced student stigma and financial stress among parents, and improved staff morale. Most participants did not report any change in wasted food or relationships with local or regional farms associated with CEP adoption. Implementation barriers, including concerns regarding CEP’s impact on federal, state, and grant education funding, provide insight into potential policy interventions that may promote uptake. Best practices, including strong communication with parents and creative strategies to boost student meal participation, can be adopted by other districts.

Abstract Background A key mechanism through which globalization has impacted health is the liberalization of trade and investment, yet relatively few studies to date have used quantitative methods to investigate the impacts of global trade and investment policies on non-communicable diseases and risk factors. Recent reviews of this literature have found heterogeneity in results and a range of quality across studies, which may be in part attributable to a lack of conceptual clarity and methodological inconsistencies. Methods This study is a critical review of methodological approaches used in the quantitative literature on global trade and investment and diet, tobacco, alcohol, and related health outcomes, with the objective of developing recommendations and providing resources to guide future robust, policy relevant research. A review of reviews, expert review, and reference tracing were employed to identify relevant studies, which were evaluated using a novel quality assessment tool designed for this research. Results Eight review articles and 34 quantitative studies were identified for inclusion. Important ways to improve this literature were identified and discussed: clearly defining exposures of interest and not conflating trade and investment; exploring mechanisms of broader relationships; increasing the use of individual-level data; ensuring consensus and consistency in key confounding variables; utilizing more sector-specific versus economy-wide trade and investment indicators; testing and adequately adjusting for autocorrelation and endogeneity when using longitudinal data; and presenting results from alternative statistical models and sensitivity analyses. To guide the development of future analyses, recommendations for international data sources for selected trade and investment indicators, as well as key gaps in the literature, are presented. Conclusion More methodologically rigorous and consistent approaches in future quantitative studies on the impacts of global trade and investment policies on non-communicable diseases and risk factors can help to resolve inconsistencies of existing research and generate useful information to guide policy decisions.

Abstract Background This study evaluated the efficacy of a fire department proactive risk management program aimed at reducing firefighter injuries and their associated costs. Methods Injury data were collected for the intervention fire department and a contemporary control department. Workers’ compensation claim frequency and costs were analyzed for the intervention fire department only. Total, exercise, patient transport, and fireground operations injury rates were calculated for both fire departments. Results There was a post-intervention average annual reduction in injuries (13%), workers’ compensation injury claims (30%) and claims costs (21%). Median monthly injury rates comparing the post-intervention to the pre-intervention period did not show statistically significant changes in either the intervention or control fire department. Conclusions Reduced workers’ compensation claims and costs were observed following the risk management intervention, but changes in injury rates were not statistically significant.

Abstract Background Emergency service vehicle crashes (ESVCs) are a leading cause of death in the United States fire service. Risk management (RM) is a proactive process for identifying occupational risks and reducing hazards and unwanted events through an iterative process of scoping hazards, risk assessment, and implementing controls. We describe the process, outputs, and lessons learned from the application of a proactive RM process to reduce ESVCs in US fire departments. Methods Three fire departments representative of urban, suburban, and rural geographies, participated in a facilitated RM process delivered through focus groups and stakeholder discussion. Crash reports from department databases were reviewed to characterize the context, circumstances, hazards and risks of ESVCs. Identified risks were ranked using a risk matrix that considered risk likelihood and severity. Department-specific control measures were selected based on group consensus. Interviews, and focus groups were used to assess acceptability and utility of the RM process and perceived facilitators and barriers of implementation. Results Three to six RM meetings were conducted at each fire department. There were 7.4 crashes per 100 personnel in the urban department and 10.5 per 100 personnel in the suburban department; the rural department experienced zero crashes. All departments identified emergency response, backing, on scene struck by, driver distraction, vehicle/road visibility, and driver training as high or medium concerns. Additional high priority risks varied by department; the urban department prioritized turning and rear ending crashes; the suburban firefighters prioritized inclement weather/road environment and low visibility related crashes; and the rural volunteer fire department prioritized exiting station, vehicle failure, and inclement weather/road environment related incidents. Selected controls included new policies and standard operating procedures to reduce emergency response, cameras to enhance driver visibility while backing, and increased training frequency and enhanced training. The RM process was generally acceptable to department participants and considered useful. All departments reported that the focused and systematic analysis of crashes was particularly helpful. Implementation of controls was a commonly cited challenge. Conclusions Proactive RM of ESVCs in three US fire departments was positively received and supported the establishment of interventions tailored to each department’s needs and priorities.

News media have been blamed for sensationalizing Ebola in the United States, causing unnecessary alarm. To investigate this issue, we analyzed US-focused news stories about Ebola virus disease during July 1–November 30, 2014. We found frequent use of risk-elevating messages, which may have contributed to increased public concern.

OBJECTIVES/SPECIFIC AIMS: To examine maternal morbidity and its related social determinants among women experiencing homelessness during pregnancy. METHODS/STUDY POPULATION: This study will use an exploratory sequential mixed method design to explore and examine the structural, interpersonal and individual factors contributing to maternal morbidity among a convenience sample of 150 English speaking women experiencing homelessness during a pregnancy within the last 3 years in Baltimore. In the qualitative phase of the study, we will conduct semi-structured interviews with 15 women purposively sampled to refine the relationships between resilience, social determinants of health and multilevel factors that impact maternal morbidities. Factors of interest include prenatal care received, barriers and facilitators to receiving prenatal care, maternal morbidities, social support, and strategies used to manage their condition during this time. Using the findings from the qualitative phase, a quantitative survey will be developed to gather data on topics that emerged in the interviews. In addition, the Housing Instability Index will be used to measure the degree of homelessness as defined by the degree of housing instability in a 6-month period. Using the 25-item Connor-Davidson Resilience Scale, resilience levels among women in the sample will be assessed as a moderating factor in the examination of the relationship between a pregnant woman’s homeless status and maternal morbidity. Descriptive statistics and logistical regression tests will be used to analyze these relationships while controlling for other structural, interpersonal, and individual factors that may be associated with maternal morbidity. RESULTS/ANTICIPATED RESULTS: Qualitatively we expect to gain insight into the relationship between the extrinsic and intrinsic factors impacting maternal morbidities and the health behaviors and practices used by women to manage their pregnancy while homeless. These findings will inform the quantitative survey development and help generalize the quantitative findings. We expect to identify the common morbidities in this population we anticipate that there will be differences in maternal morbidity among the different types of homelessness. Maternal morbidity will be higher among women with a greater degree of homelessness. Resilience will have a moderating effect on the relationship between homelessness and maternal morbidity. DISCUSSION/SIGNIFICANCE OF IMPACT: This study, to our knowledge, is the first to look at maternal morbidity in this population. Additionally, this study seeks to move current research from examining infant outcomes at birth among mothers experiencing homelessness to understanding the maternal morbidities during this period. Long term, good maternal health has significant implications for the health of a mother’s future pregnancies and a risk reduction of adverse chronic conditions. Study results will provide the preliminary knowledge needed to guide further research leading to clinical approaches that promote better maternal health in this population. Lastly, the study findings will inform policy by characterizing the quality and strength of evidence of the adverse maternal health effects associated with the experience of homelessness.

Food policy councils (FPCs) have become a popular way to organize various food system stakeholders at the local, municipal, and state levels. FPCs typically build partnerships with stakeholders; examine current policies, regulations, and ordinances related to food; and support or create programs that address food system issues. While FPCs have the potential to affect policy change and often include policy-related goals in their missions, the literature on how FPCs engage in the policy process, what policies FPCs address, and the policy impacts of their work are very limited. We conducted an electronic survey of FPC leaders to describe FPCs, their level of engagement in policy processes, and the scope of their policy activities. We invited all U.S. FPCs that were included in an FPC database (N =92) to participate. Of the 56 FPCs that completed the survey (64 percent response rate), 52 percent had been in existence for at least 3 years and 85 percent were engaged in policy activities at the time of the survey. Most FPCs engage in policy work in multiple venues (88 percent) and on multiple topics (79 percent). Many FPCs reported participating in the policy process through problem identification (95 percent) and education (78 percent); few mentioned evaluating their policy work. Those not engaged in policy most often cited lack of resources and technical expertise as barriers. These results suggest that while most FPCs are engaging in policy, why and how they engage varies greatly. Since FPCs are frequently cited as an effective way to address local and state food system issues, there is a need for more rigorous evaluation of the processes, outcomes, and impacts of their work.

Correction After publication of the article [1], it has been brought to our attention that the second author’s name was published incorrectly. Previously included as “Keshia P. Porter”, the full and correct name should be “Keshia Pollack Porter”. This has now been corrected in the original version of the article.

Objective To investigate the relationship between joining the World Trade Organization (WTO) and the availability of several commodities with both harmful and protective effects for the development of noncommunicable diseases. Methods We used a natural experiment design to compare trends in the domestic supply of tobacco, alcohol and seven food groups, between 1980 and 2013, in 21 countries or territories joining WTO after 1995 and 26 non-member countries, using propensity score weights. We applied a comparative interrupted time-series framework, by using multivariate random-effects linear models, adjusted for gross domestic product per capita, the percentages of urban population and female labour force participation. In the tobacco model, we controlled for Member States that had ratified the Framework Convention on Tobacco Control and in the alcohol model, the percentage of the population identifying themselves as Muslim. Findings Following accession to WTO, member states experienced immediate increases in the domestic supply of fruits and vegetables of 55 g per person per day on average, compared to non-member countries. The analysis showed gradual increases in the geometric mean of the supply of tobacco and alcohol of 6.2% and 3.6% per year, respectively. We did not detect any significant changes in the availability of red meats and animal fats; seafood; nuts, seeds and legumes; starches; or edible oils; and results for sugars were inconsistent across model variations. Conclusion The results suggest that WTO membership may lead to increases in both harmful and protective factors for noncommunicable disease, but further exploration of country-specific variation is warranted. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of a youth-led nutrition intervention on youth-leaders themselves., Design: Mixed methods, including: in-depth interviews and a quasi-experimental quantitative study comparing youth-leaders and nonparticipant comparison youth., Analysis: Qualitative analysis using direct content analysis. Difference-in-differences analyses assessing quantitative program impact., Results: Youth-leaders perceived that the intervention impacted themselves, the youth-participants, and their respective social networks. Youth-leaders experienced greater increases in intentions to eat healthfully (p=0.04), and greater decreases in support for healthy eating from their friends (p=0.01), than the comparison group., Conclusions/implications: Youth-leaders reported multiple levels of intervention impact, and increased intentions for healthy eating; however, additional research is needed to enhance impact on behavioral outcomes., Competing Interests: Conflict of Interest Statement: The authors declare that they have no conflict of interest..

We conducted a legal mapping study of state bills related to racial/ethnic health disparities in all 50 states between 2002 and 2011. Forty-five states introduced at least 1 bill that specifically targeted racial/ethnic health disparities; we analyzed 607 total bills. Of these 607 bills, 330 were passed into law (54.4%). These bills approached eliminating racial/ethnic health disparities by developing governmental infrastructure, providing appropriations, and focusing on specific diseases and data collection. In addition, states tackled emerging topics that were previously lacking laws, particularly Hispanic health. Legislation is an important policy tool for states to advance the elimination of racial/ethnic health disparities.