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Retirement plans can create strong financial incentives that have important labor market implications, and many states have adopted alternative plan designs that significantly change these incentives. The authors use longitudinal data to investigate the impact of Washington State's 1996 introduction of a hybrid retirement plan on late-career attrition. The unique setup of Washington's plans allows them to provide empirical evidence on the influence of financial incentives created by statutory retirement eligibility thresholds. Findings show that despite facing very different financial incentives, teachers enrolled in the hybrid and traditional plans respond similarly to reaching a key retirement eligibility threshold. The authors hypothesize that teachers are anchoring to the eligibility thresholds, muting the influence of the financial incentives. They also provide evidence that, in the presence of bright-line eligibility thresholds that can anchor workers' separation behavior, commonly used structural models may overpredict workers' responsiveness to the financial incentives embedded in retirement plans. [ABSTRACT FROM AUTHOR]

Background: The Developmental Origins of Health and Disease Hypothesis (DOHaD) suggests prenatal alcohol exposure (PAE) should have implications for adult physical and mental health. Since the health profile of older adults with PAE and diagnoses of fetal alcohol spectrum disorder (FASD) is unknown, the current study evaluates self‐reported health problems of midlife adults with and without a history of PAE to describe these outcomes. Methods: Participants (N = 357) recruited from longitudinal cohorts in Atlanta, GA and Seattle, WA completed a health survey assessing a range of physical conditions. Initial analysis compared the frequency of conditions between alcohol‐exposed and nonexposed groups. To identify patterns within groups, 10 problem areas were subjected to latent class analysis (LCA). Finally, the direct effect of PAE on health outcomes was evaluated using multilevel modeling, controlling for effects of other factors. Results: Compared with unexposed controls, individuals with PAE reported significantly higher frequencies of problems with hearing, dentition, heart, cancer, gastritis, kidney stones, bladder, diabetes, thyroid, skin, and seizures. LCA found that controls yielded two classes, with 45% reporting sleep and vision problems and 55% reporting sleep, vision, cardiovascular, endocrine, immune, and dental problems. The PAE group yielded three classes, with 13% endorsing few health problems, 43% reporting sleep, vision, immune, and dental problems, and 43% reporting sleep, vision, cardiovascular, urinary, endocrine, skin, immune, dental, and gastrointestinal problems. With multivariate analysis, controlling for other influences, PAE was associated directly with hearing, urinary, dental, and gastrointestinal problems. A similar pattern was found for alcohol‐exposed individuals who did and did not meet criteria for fetal alcohol syndrome (FAS). Discussion: Patients affected by alcohol may report greater frequency and range of health adversity. That PAE was only uniquely associated with a limited set of problems suggests that many health outcomes in midlife result from an initial vulnerability potentiated by postnatal stress resulting from other associated factors. [ABSTRACT FROM AUTHOR]

Systemic reform is needed to address racism as a root cause of mental health inequities, such as understanding how community mental health (CMH) agencies' practices and policies may impact care provided to racially minoritized populations. This study described and examined associations between CMH clinicians' multicultural knowledge and awareness and agency practices and policies to improve care for Clients of Color. CMH clinicians (N = 119) across Washington State reported on their multicultural competence and agencies' practices and policies in an online survey. Multicultural competence was assessed with the Multicultural Counseling Knowledge and Awareness Scale (MCKAS), which assesses respondents' knowledge of multicultural counseling frameworks and awareness of multicultural counseling issues. Agency policies were examined with an adapted version of the Multiculturally Competent Service System (MCSS) Assessment Guide, which asked respondents to endorse the degree to which their agencies had taken specific steps to better serve racially and ethnically minoritized populations across 11 domains, including policies, linguistic diversity in services, and quality monitoring and improvement. Multicultural knowledge and awareness were generally high across the sample. Clinicians commonly endorsed that their agencies had mission statements that were committed to cultural competence. Endorsement of concrete steps to improve services for non-English speaking clients was associated with greater multicultural knowledge and awareness, and practices to monitor and improve care provided to Clients of Color were associated with lower scores. Addressing mental health inequities requires multifaceted solutions. Results highlight the potential of examining agency practices and policies as one solution to improve care for Clients of Color. [ABSTRACT FROM AUTHOR]

Objective: To understand rural older farmers' perspectives and attitudes toward skin cancer risk and prevention. Design and sample: This study used a grounded theory approach and semi‐structured interviews with 12 rural older farmers (farm owners, farmworkers ages 50 years or older) in Washington. Participants' perspectives were explored relative to Health Belief Model constructs. Inductive and deductive analyses were used to generate relevant themes. COREQ guidelines were followed. Results: The findings fit well and extended the Health Belief Model, which was used to arrange key themes identified in relation to skin cancer risk and prevention, specifically participants' perceived barriers to accessing primary care and protection when outdoors, perceived benefits of sun‐protective behaviors, perceived hereditary susceptibility to skin cancer, perceived severity of the increased skin cancer risk, and cues to action for skin checks. A new construct of hope was identified to emphasize the importance of establishing emotional, instrumental, and informational support systems for promoting skin cancer prevention. Participants also indicated their hope of raising awareness of skin cancer prevention among all ages. Conclusions: Findings highlighted the importance of integrating skin cancer prevention services for rural older farmers and across the lifespan. Public health approaches are needed to enhance the awareness of and access to preventive care in these underserved populations. [ABSTRACT FROM AUTHOR]

BACKGROUND: We aimed to better understand the impact of statewide legislation removing personal belief exemptions (PBEs) for the measles, mumps, and rubella (MMR) school immunization requirement and factors associated with resulting health‐seeking behaviors. METHODS: We used chi‐squared tests and logistic regression models to determine individual‐ and school‐level characteristics associated with holding a MMR PBE and with post‐law MMR immunization status among students linked to the Washington State Immunization Information System. RESULTS: Of students with a MMR PBE pre‐law change, 43.0% completed the MMR vaccine series and 40.4% sought another exemption type. Religious exemptions made up most new MMR exemptions signed (71.8%), followed by medical exemptions (18.5%), and religious membership exemptions (9.7%). Students were more likely to complete the vaccine series post‐law change if they attended a school with a low school‐level MMR exemption rate, a public school, or held a lower number of school‐required immunization exemptions. CONCLUSIONS: This study confirms previous concerns that parents might replace their PBE with another exemption type; however, nearly half the students in the cohort completed the MMR vaccine series. Our findings suggest that targeted immunization policies can increase MMR coverage 1‐year post‐law change but must account for a replacement effect when exemption categories are eliminated. [ABSTRACT FROM AUTHOR]

Objectives. To examine trends in young adult self-reported driving under the influence of alcohol (DUI-A), cannabis (DUI-C), and simultaneous alcohol and cannabis use (DUI-AC) in a state with legalized nonmedical cannabis use from before to during the COVID-19 pandemic. Methods. We used logistic regression and annual statewide data from the Washington Young Adult Health Survey to assess DUI behaviors from 2016 to 2021. Results. Both prepandemic yearly changes in prevalence and deviations from those trends during the pandemic years were small and not statistically significant. However, prevalence estimates were alarming: 12.0% of participants reported DUI-A, 12.5% reported DUI-C, and 2.7% reported DUI-AC. Exploratory moderation analyses indicated a relative increase in DUI-A during 2020 among 4-year college students relative to young adults not attending 4-year colleges. Conclusions. Young adults in Washington State continued to engage in risky DUI behaviors during the pandemic. College students may have increased their likelihood of DUI-A during COVID-19. Public Health Implications. Young adults, for whom vehicle crashes remain a leading cause of death, showed little change in DUI behaviors during the COVID-19 pandemic. There is continued need for young adult DUI prevention efforts. (Am J Public Health. 2024;114(S8):S698–S701. https://doi.org/10.2105/AJPH.2024.307767) [ABSTRACT FROM AUTHOR]

Background: Practice facilitation (PF) is an evidence-based multicomponent in-person implementation strategy. COVID-19-related lockdowns caused many implementation initiatives to rapidly shift to virtual settings, but there is limited evidence on PF deployed exclusively using virtual meeting platforms. Our objective was to assess the feasibility and acceptability of virtual PF used in a primary care setting to implement interdisciplinary opioid safety committees (OSCs) to improve care for patients using opioid medicines for persistent pain and reduce high-dose opioid prescribing. We also describe alignment of virtual PF with the core functions of PF and fidelity of participating clinics to the OSC intervention. Methods: We applied qualitative and quantitative methods to evaluate virtual PF used to implement a quality improvement project at Kaiser Permanente Washington, an integrated health system in Washington State. We established interdisciplinary OSCs in primary care clinics using virtual PF. OSCs were tasked with promoting opioid safety and high-quality pain care through population management and chart reviews. We used administrative data to calculate feasibility measures including attendance and retention. Acceptability data came from interviews with OSC members conducted by evaluators. Measures of fidelity to the OSC intervention were abstracted from meeting notes and administrative data. We used qualitative methods to assess the adherence of virtual PF to the core functions of PF. Results: Facilitators carried out a comprehensive PF approach virtually and demonstrated adherence to the core functions of PF. We established OSCs in eight clinics and conducted an average of 17.5 virtual PF meetings over eight months of PF for each clinic. Average attendance was 75% and we had 84% retention. OSC members were highly satisfied with virtual PF. Facilitators effectively supported teams through implementation and technical challenges and OSC members gained skills through virtual PF. We implemented OSCs with high fidelity, suggesting virtual PF is an effective implementation strategy. Conclusions: We found virtual PF is a feasible and acceptable implementation strategy for this intervention and identified strategies to support care teams through challenges. Our findings can help inform future implementation efforts, especially those hoping to engage geographically dispersed clinics or remote clinical staff. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

The Centers for Medicare and Medicaid Innovation (CMMI) gave rise to the State Innovation Models (SIMs). Medicaid Integrated Purchasing for Physical and Behavioral Health, referred to as Payment Model 1 (PM1), was a core payment redesign area of the Washington State SIM project under which our research team was contracted to provide an evaluation. In doing so, we leveraged an open systems conceptual model to assess qualitatively Early Adopter stakeholders' perceived effects of implementation. Between 2017 and 2019, we conducted three rounds of interviews, examining themes of care coordination, common facilitators and barriers to integration, and potential concerns for sustaining the initiative into the future. Further, we noted the initiative's complexity may require the establishment of enduring partnerships, secure funding sources, and committed regional leadership to ensure longer-term success. [ABSTRACT FROM AUTHOR]

This study assesses the impacts of the COVID-19 pandemic on healthcare access for Washington State Home Care Aides (HCAs). Analyzing 62 months of medical claims data from over 35,000 HCAs, the research reveals significant healthcare disruptions during the early pandemic, especially in outpatient settings. However, healthcare utilization rebounded swiftly, surpassing pre-COVID levels as new variants emerged. Furthermore, the analysis indicated significant decreases in healthcare utilization for respiratory conditions in later stages of the pandemic, suggesting that the implementation of non-pharmaceutical and pharmaceutical interventions played a crucial role in preventing the transmission of respiratory diseases. Notably, behavioral health-related utilization among HCAs increased significantly throughout most pandemic phases, underscoring the importance of enhancing behavioral health support during public health crises. This research represents the first comprehensive study unveiling the effects of the COVID-19 pandemic on HCAs' healthcare access and opening avenues for further research and policy development to support this essential workforce. [ABSTRACT FROM AUTHOR]

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a quality improvement project focused on increasing the use of continuous glucose monitoring among emerging adults with type 1 diabetes enrolled in a health care transition program in the state of Washington. [ABSTRACT FROM AUTHOR]

The Washington State Department of Health developed an equitable funding allocation methodology incorporating quantitative and qualitative decision-making components. We describe the methodology and an implementation evaluation performed by an external evaluation team using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation framework. The evaluation team concluded that the methodology was developed in a way that used a racial equity lens and prioritized intersectionalities in the communities that the funding was intended to serve. (Am J Public Health. 2024;114(S7):S575–S579. https://doi.org/10.2105/AJPH.2024.307833) [ABSTRACT FROM AUTHOR]

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11–17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06–1.13) and completion (APR:1.16, 95%CI:1.08–1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01–1.07) and completion (APR:1.12, 95%CI:1.05–1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage. [ABSTRACT FROM AUTHOR]

Purpose: To characterize distance traveled for breast cancer screening and to sites of service for breast cancer treatment, among rural and urban women served by a Washington State healthcare network. Methods: Data for this study came from one of the largest not-for-profit integrated healthcare delivery systems in Washington State. Generalized linear mixed models with gamma log link function were used to examine the associations between travel distance and sociodemographic and contextual characteristics of patients. Results: Median travel distance for breast cancer screening facilities, hematologist/oncologists, radiation oncologists, or surgeons was 11, 19, 23, or 11 miles, respectively. Travel distance to breast cancer screening or referral facilities was longer in non-core metropolitan ZIP codes compared to metropolitan ZIP codes. AI/AN and Hispanic women travelled longer distances to reach referral facilities compared to other racial and ethnic groups. Conclusion: Disparities exist in travel distance to breast cancer screening and treatment. Further research is needed to describe sociodemographic and system level characteristics that contribute to such disparities and to discover novel approaches to alleviate this burden. [ABSTRACT FROM AUTHOR]

Purpose: To understand the communicative participation experiences of transgender people through a qualitative inquiry, and to address similarities and differences in experiences across genders. Method: This study was a secondary analysis of interview data gathered for modifying the Communicative Participation Item Bank for use with transgender populations. Fourteen transgender participants attended individual qualitative interviews. During the interview, participants shared their communication experiences in various situations and the availability of social supports related to communication. Qualitative content analysis was used to develop themes and subthemes from the data. Result: Three themes emerged from the data: the participants' priorities for comfort, safety, and authenticity; the use of an internal "checklist" to optimise their communication; and changes in attitudes towards communication over time. Across themes, participants shared core communication experiences regardless of gender identities. Conclusion: The findings support prior research on voice-related communication experiences of transgender people. A key finding is the notion that communication success is influenced by sociocultural contexts and the physical environment beyond their communication presentation. To achieve targeted comfort and satisfaction in communication, healthcare professionals need to consider the transgender client's communication contexts, and incorporate a life-participation approach to gender-affirming voice and communication training. [ABSTRACT FROM AUTHOR]

Background and Objectives: Previous studies have found that falls among community-dwelling older people with dementia negatively impact the health and well-being of their relative/friend care partners. Limited studies have explored the challenges care partners experience because of older people's falls (including fall incidents and fall risks). We sought to investigate care partners' experiences of these challenges and how care partners responded. Methods: We conducted an inductive thematic analysis of 48 dementia care partner interviews (age range: 33–86, mean: 61, 70.8% women; 58.3% adult children; 29.2% spouse; 62.5% completed college; 25% people of color), conducted after a health crisis of older people with dementia from three local university-affiliated hospitals in the United States. Findings: Care partners reported that falls in older people with dementia can intensify overall care demands and lead to self-sacrificing behaviors, dissatisfaction with healthcare providers, conflicts with care recipients, and intense emotions. Care partners described several adaptations to mitigate these impacts, including practicing acceptance, approaching falls as an opportunity for learning, facilitating collaborations within formal/informal care networks, collaborating with older people with dementia to balance autonomy and safety, and modifying the physical environment. Discussions and Implications: Falls among older people with dementia are a significant stressor and an important activation stimulus for their care partners. Our findings suggest that care partners are "second clients" and "competent collaborators." As they provide important insights about fall prevention, care partners should be engaged to co-design new multi-level interventions to facilitate collaborations among care networks, older people with dementia, and service providers. [ABSTRACT FROM AUTHOR]

The purpose of the present study is to determine if state-level mask mandates significantly reduced COVID-19 fatality rates. Using weekly data for the period 22 January 2020 to 1 February 2022 and a synthetic control method, results indicated that mask mandates were associated with reductions in COVID-19 fatalities. In both California and Washington, mask mandates were associated with a reduction in COVID-19 fatality rates, especially after COVID-19 vaccines became readily available in April of 2021. In Oregon, there was no statistically significant relationship between mask mandates and COVID-19 fatality rates. To test the robustness of these results, a random effects model was also estimated, and it was also found that mask mandates were associated with a significant reduction in COVID-19 fatality rates. Findings also indicated that states with larger elderly populations and larger populations of African-Americans had significantly higher COVID-19 fatality rates. [ABSTRACT FROM AUTHOR]

Prior to the 2022 midterm elections, we conducted large-scale randomized controlled trials in Iowa and Washington aimed at increasing voter turnout among newly enfranchised individuals with past felony convictions. Alongside national and grassroots partners, we designed and implemented experiments to ascertain the effectiveness of alternative outreach mechanisms, including targeted mailers and digital ads. We did not detect statistically significant or economically meaningful effects on voter registration or turnout; most observed effects were precise nulls. The absence of measured impact is likely attributed to low digital engagement with our online ads as well as extensive voter outreach already conducted by our local partners prior to the study. Our evidence highlights the importance of context in voter outreach efforts, as the political and legal environment in Iowa and Washington differed significantly from other regions where similar interventions had previously shown success. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate occupational factors associated with burnout among a sample of 9-1-1 public safety telecommunicators (PSTs). Methods: An online survey measuring organizational factors (ie, perceived visibility and inclusion in the agency, respectful culture, leadership support, perceived gratitude, and coworker conflict); job characteristics (ie, work-life integration, overtime, salary satisfaction, and jobmeaningfulness); and burnout, demographic, and call center characteristics was emailed to a sample of PSTs. Analysis: Descriptive, bivariate, and multiple linear regression analyses were used to characterize the sample and investigate relationships among variables. Results: PSTs (N = 324) completed the survey. Multivariate analysis showed that poor work-life integration and coworker conflict were associated with greater PST burnout, while job meaningfulness and perceptions of greater visibility and inclusion were linked to decreased levels of burnout Conclusion: Occupational factors were associated with burnout among PSTs. [ABSTRACT FROM AUTHOR]

Appropriate training and continuing education for mental health professionals are designed to ensure that clinicians provide effective and ethical care. Mental health consumers may depend upon these credentials to judge the level of a professional's competence, but whether these activities and credentials provide a valid indicator of knowledge and skills is subject to debate. The present study was designed to examine preferences for mental health clinicians among potential consumers and factors that may inform these preferences, specifically comparing preferences for doctoral-level mental health clinicians and masters-level clinicians with and without specialty certification for treating anxiety symptoms. Cross-sectional assessment with self-report surveys (clinician preferences, prior mental health diagnosis and treatment, demographic characteristics, generalized anxiety symptoms, mental health literacy, and mental health stigma) was administered in two samples: a college student sample (N = 224; 71.9% female; Mage = 19.1, SD = 1.5) and a sample of adults with chronic pain (N = 116; 74.1% female; Mage = 43.8, SD = 13.8). The present study found that across both samples, therapists with a specialty certification were preferred over those without such credentials within each profession, and that certification status trumped professional standing such that certified masters-level clinicians were rated more highly than noncertified PhD-level clinicians. These findings are indicative of a schism between how the field of clinical psychology conceptualizes itself and how it is seen by its consumers. Implications of our findings for mental health consumers, clinicians, and professional organizations are discussed. Public Significance Statement: This study found evidence that specialty certification status influences consumer preference for mental health providers in the treatment of anxiety. There is no research supporting an association between certification status and functional expertise for the treatment of anxiety disorders; thus, it appears that a "certification" designation holds undeserved yet substantial influence on consumer preference. This finding provides a call for action to address this issue for professional organizations tasked with developing practice guidelines and ethical standards and for the protection of consumers making mental health decisions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this exploratory study was to (a) construct a virtual reality (VR) test environment to measure speech recognition in noise (SIN) and localization, and (b) use the VR test environment to establish degree of binaural hearing benefit among a small number of adults with single-sided deafness (SSD) using a cochlear implant (CI). Method: This pilot study included five adults implanted for SSD. The test environment was composed of an eight-speaker array that delivered restaurant noise and Institute of Electrical and Electronics Engineers sentences. VR head-mounted display goggles delivered a video recording of a busy restaurant. Participants completed SIN and localization in two conditions: (a) normal-hearing ear and a CI on the contralateral SSD side (CI-ON) and (b) normal-hearing ear and unaided on the contralateral SSD side (CI-OFF). Results: Overall, CI benefits for SIN and localization within the VR test environment were improved for some participants, although not all. CI benefit for SIN and localization was dependent on speaker location. Conclusions: VR test environments present new opportunities for studying SIN and localization abilities in participants with CIs. This pilot study shows that, within a VR test environment, degree of CI benefit among SSD participants for SIN and localization varies across speaker location and across participants. [ABSTRACT FROM AUTHOR]

Objective: AIDS Drug Assistance Programs (ADAPs) are state-administered programs that pay for medical care and medication for people living with HIV (PLWH) in the United States. In October 2021, the federal policy requiring that clients recertify for the program every 6 months was repealed, giving states the authority to set their own recertification policies. However, little data exist on the costs and health effects of alternative recertification schedules. We assessed the cost of changing the legacy 6-month recertification to a 12-month schedule in Washington State to inform policy decisions on recertification. Methods: We used a Markov model to simulate the population of PLWH in Washington State who are eligible or enrolled in ADAP. We obtained model inputs and validation data from the Washington State Ryan White database. We estimated the cost of 12-month and 6-month criteria over a 5-year time horizon. Model outputs included annual program costs, population sizes, and number of people virally suppressed, by scenario. Results: Under a continuation of the legacy 6-month recertification criteria, the annual cost of Washington ADAP would be $37 663 000 (95% CI, $34 570 000-$41 686 000) during the next 5 years, with a per-client cost of $7966 (95% CI, $7478-$8494). Under 12-month criteria, the annual cost would be $40 217 000 (95% CI, $36 243 000-$44 401 000) and the per-client cost would be $7543 (95% CI, $7084-$8042). Under the 12-month scenario, 245 more people will have been virally suppressed by the end of 2025. Conclusions: Switching to a less frequent recertification process may improve health outcomes at a modest increase in cost in Washington State. [ABSTRACT FROM AUTHOR]

Interprofessional (IP) education is imperative to foster collaboration within and between healthcare professions to improve healthcare delivery and outcomes. Increasing the capacity of health professions faculty to effectively deliver learning about IP knowledge and skills fosters sustainability of IP care in health systems. This short report describes a series of three virtual IP faculty development workshops during 2020–2021 that used a Train-the-Trainer approach and adopted flexible and context-specific teaching methods to enhance learning. The collaboration involved interprofessional researchers from the University of Washington Center for Health Sciences Interprofessional Education, Research, and Practice and Kenyan health professions faculty and was supported by a global health grant. Learners were drawn from multiple health professions and healthcare institutions in Kenya. Content was packaged in lectures, videos, pictures, and session notes. Teaching methods adopted included lecturing, discussing, playing videos, interpretation of pictures, and reading text notes. The Train-the-Trainer approach helped ensure that workshop content and plans were relevant to participants. Workshop participants shared positive feedback about the trainings and showed a good grasp of the concepts and skills. In-built feedback mechanisms in training were key in supporting the programme and ensured continuous improvement within and between sessions. This collaboration offers an innovative example of a global partnership to support IP faculty development and mainstreaming of IPE in training and in practice. [ABSTRACT FROM AUTHOR]

Purpose: Native Americans and Latinos have higher COVID‐19 infection and mortality rates and may have limited access to diagnostic testing. Home‐based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID‐19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington. Methods: A two‐arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID‐19 test kit registration and virtual swabbing support. The passive arm participants received standard‐of‐care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis. Findings: Overall, 63% of participants (n = 268) completed COVID‐19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60 years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home‐based testing. Conclusions: CHW support led to higher COVID‐19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues. [ABSTRACT FROM AUTHOR]

The Produce Safety Alliance was founded to provide standardized training on the Produce Safety Rule. An assessment of knowledge gained from Produce Safety Alliance grower trainings was conducted to identify topics needing additional educational support for the Washington State produce industry. Knowledge gain was assessed through a 25-question pretest (n = 152) and posttest (n = 138) conducted at 10 trainings in 2022. Overall, a significant 15.6% (four-point) improvement in knowledge was observed from the pre- to posttest. Module-specific changes varied from 1.4 to 22.3%. Despite significant knowledge gain, posttest correct response rates for the Wildlife, Domesticated Animals, and Land Use and How to Develop a Farm Food Safety Plan modules were below 75%, highlighting the need for targeted resources. Knowledge changes for the 25 questions ranged from -2.7 to 49.6%, revealing that specific topics lack adequate understanding, despite satisfactory overall module knowledge. Recommendations include the development of tailored materials for the produce industry (e.g., fact sheets), as well as resources to help educators facilitate learning (e.g., hands-on activities). A thorough review of the pre- and posttests is crucial to ensure that the current assessment accurately gauges training effectiveness. Continuous assessment of food safety education programs is essential for guiding current and future educational initiatives. [ABSTRACT FROM AUTHOR]

Recognizing the inequities in developmental screening and services for children in immigrant families, a pediatric primary care clinic in partnership with a community-based early childhood program co-created a bicultural, bilingual early childhood developmental (ECD) family navigator program in Seattle, Washington. The primary aim of this study is to explore caregivers' perspectives about this program. Twenty-seven caregivers of young children participated in semi-structured interviews that were thematically analyzed. Three key themes were identified: 1) sharing language and culture, 2) facilitating accessibility, and 3) promoting development. Caregivers valued linguistic and cultural concordance between the navigator and the family, the navigator's approach to screening to improve accessibility and reduce barriers, and the focus on supporting early childhood development. Understanding caregivers' experience with the ECD family navigator development program and the aspects they value, informs clinic-based approaches to ensure families of diverse language and cultural backgrounds have accessible development screening and connection to services. [ABSTRACT FROM AUTHOR]

This study aims to explore the financial status of Medicaid Home Care Aides (HCAs) working in Washington State (WA). This study importantly covers both economic and psychological components of financial insecurity, a comprehensive approach that may help advance policy development for HCAs' financial security. An online survey was conducted from April to May 2019 among employed WA HCAs. The descriptive analyses were conducted using Stata. About two-thirds earned less than $30,000 annually (62%) from all their jobs combined, including non-caregiving work. Over 1 in 4 reported having over $40 k in long-term debt (28%). More than 3 in 4 reported they could only cover housing and basic living expenses using savings for less than 2 months (76%), showing likely unreadiness for sudden financial shocks (financial vulnerability). Nearly 3 in 4 HCAs (73%) experienced at least one material hardship that include housing hardship, utilities hardship, medical hardship, and food insecurity. One in 4 expressed their financial stress was severe. More WA HCAs experienced material hardships (73%) than U.S. low-income families (64.2%). In 2021, the median annual wage for WA HCAs was about 20% higher than the national one; however, their wages still remain below the living wage. In conclusion, although WA HCAs' wages are comparable to national averages, they still experience financial vulnerability and material hardships. Therefore, achieving living wages is necessary for WA HCAs. [ABSTRACT FROM AUTHOR]

Introduction While retail sales and retailer inspection studies generally indicate high compliance with state sales restrictions on Nicotine Vaping Products (NVPs) within the restricted area, studies using survey data generally indicate that most users could readily continue gaining access to restricted NVPs. Our study bridges a gap in the current literature and investigates the potential role of cross-state border purchases to evade state emergency NVP sales restrictions in 2019. Aims and Methods The study sample was restricted to NVP sales from the states neighboring Massachusetts, Rhode Island, and Washington, three states that implemented all NVP or flavored NVP sales restrictions in 2019. Among these neighboring states, the 2019 weekly county-level NVP sales by flavors (tobacco, mint/menthol, and other flavors) were compiled using Nielsen Scanner data. A quasi-experimental, comparison group pre–post study design was used to study the impacts of NVP sales restrictions on cross-state border NVP purchases. Results Weekly NVP sales for border counties significantly increased in response to the MA, RI, and WA bans for tobacco flavored (56%, 45%, 14%, respectively), menthol/mint flavored (51%, 2%, 41%, respectively), and other flavored (79%, 3%, 4%, respectively) products, compared to sales for non-border counties (all p -values <.01). Conclusions Our study identified significant cross-state border NVP purchases in all studied states to circumvent NVP emergency sales restrictions in response to the EVALI outbreak. Policymakers should factor in these purchasing behaviors to evade sales restrictions when evaluating any future potential policies at the state or local levels. Implications While retail sales data and retailer inspections indicate high compliance with Nicotine Vaping Product (NVP) flavor sales restrictions from major retail outlets, survey data obtain mixed findings on the effects of sales restrictions on vaping behaviors. Our study identified a significant increase in cross-state border NVP purchases to circumvent NVP sales restrictions in 2019, consistent across all three settings of Massachusetts, Rhode Island, and Washington. Policymakers should factor in these cross-state border NVP purchases in response to sales restrictions when evaluating any future potential NVP sales restrictions. [ABSTRACT FROM AUTHOR]

Large wood is an integral part of many rivers, often defining river‐corridor morphology and habitat, but its occurrence, magnitude, and evolution in a river system are much less well understood than the sedimentary and hydraulic components, and due to methodological limitations, have seldom previously been mapped in substantial detail. We present a new method for this, representing a substantial advance in automated deep‐learning‐based image segmentation. From these maps, we measured large wood and sediment deposits from high‐resolution orthoimages to explore the dynamics of large wood in two reaches of the Elwha River, Washington, USA, between 2012 and 2017 as it adjusted to upstream dam removals. The data set consists of a time series of orthoimages (12.5‐cm resolution) constructed using Structure‐from‐Motion photogrammetry on imagery from 14 aerial surveys. Model training was optimized to yield maximum accuracy for estimated wood areas, compared to manually digitized wood, therefore model development and intended application were coupled. These fully reproducible methods and model resulted in a maximum of 15% error between observed and estimated total wood areas and wood deposit size‐distributions over the full spatio‐temporal extent of the data. Areal extent of wood in the channel margin approximately doubled in the years following dam removal, with greatest increases in large wood in wider, lower‐gradient sections. Large‐wood deposition increased between the start of dam removal (2011) and winter 2013, then plateaued. Sediment bars continued to grow up until 2016/17, assisted by a partially static wood framework deposited predominantly during the period up to winter 2013. Plain Language Summary: We measure the large wood in the Elwha River, Washington, USA, during and after dam removal. The presence of two dams had previously limited the movement of sediment and wood through the system. The removal of those dams liberated large amounts of sediment and wood from the former reservoir bottoms, which traveled downstream and deposited in the river channel. We develop an Artificial Intelligence (AI) model to measure all wood and sediment in the Elwha River corridor downstream of the two former dams, from a time‐series of high‐resolution imagery collected from aircraft. These measurements, accurate to within 15% of true values, provide a unique opportunity to understand how large wood occurs and behaves over multiple years and tens of kilometers. We found that the deposition of large wood on bars was coincident with and promoted the growth of sediment bars. The AI model we made could be powerful enough to find large wood in other places and images for similar purposes. Our data sets and models are made available to stimulate further studies of changes in river form resulting from interactions between water flow, wood, sediment, and vegetation. Key Points: We develop automated methods for detection and mapping of large wood, sediment, vegetation, and water from a time‐series of orthoimageryHigh‐resolution, reach‐wide measurements reveal wood dynamics in two Elwha River reaches adjusting to upstream dam removals over 5.5 yearsLarge wood deposition increased after dam removal, then plateaued, and bars continued to grow assisted by a partially static wood framework [ABSTRACT FROM AUTHOR]

We examined how a two-staged approach to recentering statistics courses in scientist–practitioner psychology (PhD) programs led to changes in course evaluations. Because course evaluations (up to three per student) were nested within the individual, we evaluated three dimensions of course evaluations (i.e., perceived value to the student, traditional pedagogy, socially responsive pedagogy) with multilevel models. In the first stage, the transition from SPSS to R (a shift from fee-based to zero-cost, open-source, software) negatively impacted students' perceived value of the course (B = −0.40, p =.001) and evaluation of traditional pedagogy (B = −0.56, p <.001). Explicit recentering positively impacted evaluation of traditional (B = 0.37, p <.001) and socially responsive (B = 0.24, p =.003) pedagogies. Post hoc, multilevel correlations supported the notion that after the initial decline associated with the transition to R, course evaluations improved with the subsequent number of "times taught." Qualitative findings indicated that most students recognized and appreciated the strategies used in the recentering. Some worried that the recentering efforts would not be sustained, a few responses noted resistance or the potential for harm. The recentering process requires continuous evaluation and revision. Tools such as the "liberate your syllabus" section of the Council of Chairs of Training Councils 2020: Social Responsiveness in Health Service Psychology Education and Training Toolkit can be useful to faculty who are working toward a socially responsive pedagogy. Public Significance Statement: As psychology programs seek to be more socially responsive, statistics courses can be overlooked. Our research article reports on strategies for "recentering" statistics courses through open-access software, open resource materials, assignment options that meet the needs/interests of the students, and justice-oriented research vignettes. Our investigation of these efforts highlighted their positive and negative impacts to course evaluations. [ABSTRACT FROM AUTHOR]

States have turned to novel Medicaid financing to pay for community health worker (CHW) programs, often through fee-for-service or capitated payments. We sought to estimate Medicaid payment rates to ensure CHW program sustainability. A microsimulation model was constructed to estimate CHW salaries, equipment, transportation, space, and benefits costs across the U.S. Fee-for-service rates per 30-min CHW visit (code 98960) and capitated rates were calculated for financial sustainability. The mean CHW hourly wage was $23.51, varying from $15.90 in Puerto Rico to $31.61 in Rhode Island. Overhead per work hour averaged $43.65 nationwide, and was highest for transportation among other overhead categories (65.1% of overhead). The minimum fee-for-service rate for a 30-min visit was $53.24 (95% CI $24.80, $91.11), varying from $40.44 in South Dakota to $70.89 in Washington D.C. The minimum capitated rate was $140.18 per member per month (95% CI $105.94, $260.90), varying from $113.55 in South Dakota to $176.58 in Washington D.C. Rates varied minimally by metro status but more by panel size. Higher Medicaid fee-for-service and capitated rates than currently used may be needed to support financial viability of CHW programs. A revised payment estimation approach may help state officials, health systems and plans discussing CHW program sustainability. [ABSTRACT FROM AUTHOR]

This study explored the effectiveness of various employer-based travel demand management strategies in promoting multimodality and mode substitution among employees in Washington state using a mixed multinomial logit model. The study found that employee transportation coordinators played an important role in encouraging the use of sustainable travel modes. Spatial analysis revealed that individuals who lived and worked in proximity were more likely to adopt multimodal transportation. The study also highlighted the convenience of driving alone and the lack of information on sustainable alternatives as two major barriers to the adoption of sustainable transportation modes and recommended educational campaigns to increase awareness. To inform practice, this study identified transit subsidies, parking pricing, and work schedule flexibility as the most effective TDM strategies to promote multimodality and mode substitution, followed by compressed workweeks, and providing easy access to transit and amenities. [ABSTRACT FROM AUTHOR]

There is growing interest in working with beavers (Castor canadensis and Castor fiber) to restore and maintain ecosystem function, improve hydrologic conditions and build climate resiliency in freshwater ecosystems. Beaver translocation into historically occupied but degraded systems has been increasingly applied as a restoration practice over the last two decades. Knowledge of beaver distributions on the landscape is critical to understanding where and when beaver translocations may be effective. However, current understanding of beaver occupancy and translocation success is limited by uncertainty, subjectivity and inefficiency associated with available monitoring methods. We evaluated the efficacy and spatial inference associated with environmental DNA (eDNA) techniques for detecting beaver presence in natural wetland and stream systems in the Cascade mountains of Washington State. We conducted eDNA sampling paired with radio‐tracking of translocated beavers at four relocation sites from October 2020 through October 2022 to elucidate spatial patterns of site use, eDNA detection probability and eDNA quantity. We found that eDNA techniques detected beaver rapidly over long distances – up to 2.9 km from known locations within the first week after release – and reliably detected beavers when they were upstream, with positive detections in 92.4% of downstream eDNA samples collected 1–3 months after release. We also found that eDNA quantity decreased with increasing distance from beaver and increased with the amount of upstream beaver activity. Our study suggests that eDNA is a sensitive tool for monitoring translocated beaver and can provide spatial information on beaver location and site use within a stream system. Hence, eDNA methods could be a valuable tool for rapid inventory and assessment of beaver occupancy and our findings highlight important implications for using eDNA to monitor other semi‐aquatic mammal species that share similar life histories. [ABSTRACT FROM AUTHOR]

Background: Despite curative treatment options since 2014, only 12% of individuals in Washington State diagnosed with Hepatitis C (HCV) received treatment in 2018. Washington State agencies launched an elimination plan in 2019 to promote access to and delivery of HCV screening and treatment. The purpose of this study is to evaluate provider and health system barriers to successful implementation of HCV screening and treatment across Washington State. Methods: This is a cross-sectional online survey of 547 physicians, nurse practitioners, physician assistants, and clinical pharmacists who provide care to adult patients in Washington State conducted in 2022. Providers were eligible if they worked in a primary care, infectious disease, gastroenterology, or community health settings. Questions assessed HCV screening and treating practices, implementation barriers, provider knowledge, observed stigma, and willingness to co-manage HCV and substance use disorder. Chi-squared or fishers exact tests compared characteristics of those who did and did not screen or treat. Results: Provider adoption of screening for HCV was high across the state (96%), with minimal barriers identified. Fewer providers reported treating HCV themselves (28%); most (71%) referred their patients to another provider. Barriers identified by those not treating HCV included knowledge deficit (64%) and lack of organizational support (24%). The barrier most identified in those treating HCV was a lack of treating clinicians (18%). There were few (< 10%) reports of observed stigma in settings of HCV treatment. Most clinicians (95%) were willing to prescribe medication for substance use disorders to those that were using drugs including alcohol. Conclusion: Despite widespread screening efforts, there remain barriers to implementing HCV treatment in Washington State. Lack of treating clinicians and clinician knowledge deficit were the most frequently identified barriers to treating HCV. To achieve elimination of HCV by 2030, there is a need to grow and educate the clinician workforce treating HCV. [ABSTRACT FROM AUTHOR]

Background: Health systems have long been interested in the best practices for staffing in the acute care setting. Studies on staffing often focus on registered nurses and nurse-to-patient staffing ratios. There were fewer studies on the relationship between interprofessional team members or contextual factors such as hospital and community characteristics and patient outcomes. This qualitative study aimed to refine an explanatory model by soliciting hospital personnel feedback on staffing and patient outcomes. Methods: We conducted a qualitative study using semi-structured interviews and thematic analysis to understand hospital personnel's perspectives and experiences of factors that affect acute care inpatient outcomes. Interviews were conducted in 2022 with 38 hospital personnel representing 19 hospitals across Washington state in the United States of America. Results: Findings support a model of characteristics impacting patient outcomes to include the complex and interconnected relationships between community, hospital, patient, and staffing characteristics. Within the model, patient characteristics were positioned into hospital characteristics, and in turn these were positioned within community characteristics to highlight the importance of setting and context when evaluating outcomes. Together, these factors influenced both staff characteristics and patient outcomes, but these two categories also share a direct relationship. Conclusion: Findings can be applied to hospitals and health systems in a variety of contexts to examine how external factors such as community resource availability impact care delivery. Future research should expand on this work with specific attention to how staffing changes and interprofessional team composition can improve patient outcomes. [ABSTRACT FROM AUTHOR]

The broadnose sevengill shark (Notorynchus cepedianus) is a large, apex predator found in temperate waters around the world. Yet data on their distribution are limited, with reports of species occurrence typically restricted to specific bays or estuaries where they have been historically observed in high seasonal abundances. The Puget Sound is located in the southern portion of the Salish Sea, a large estuary spanning the border between northwestern Washington state, USA and southwestern British Columbia, Canada, and serves as an economic, cultural, and ecological hub. Until recently, there was only one verified record of broadnose sevengill sharks in the Salish Sea and none in the Puget Sound. However, our recent multi-agency collaborative effort revealed the presence of adult and sub-adult broadnose sevengill sharks in South Puget Sound, extending their previously known range hundreds of kilometers and into a new ecosystem. This work represents the first evidence of a significant presence of these apex sharks within the Salish Sea. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion We describe the experiences and preferences of women who switched from clinic‐administered intramuscular depot medroxyprogesterone acetate (DMPA‐IM) to self‐administered subcutaneous DMPA (DMPA‐SC) in the context of the COVID‐19 pandemic.We conducted interviews with women in California and Washington about their experiences with self‐administered DMPA‐SC. We interviewed women after their first or second self‐administered DMPA‐SC injection and conducted follow‐up interviews after their third or fourth injection. We performed both thematic and descriptive content analyses.We completed 29 interviews with 15 women. Most participants (n = 10) were between the ages of 20 and 39 and the majority (n = 12) used DMPA primarily for contraception. Most (n = 13) described self‐administered DMPA‐SC as “very easy” or “somewhat easy” to use and reported greater convenience, decreased pain, fewer logistical and financial challenges, increased privacy, and improved comfort with injection compared to DMPA‐IM. Participants identified difficulties obtaining DMPA‐SC from pharmacies and safe needle disposal as barriers. Most (n = 13) would recommend DMPA‐SC to a friend and desired to continue self‐administration beyond the COVID‐19 pandemic. Participants recommended counseling all patients about this option alongside other contraceptive methods, and offering clinician supervision, if desired.Women who switched from in‐clinic DMPA‐IM to self‐administered DMPA‐SC during the COVID‐19 pandemic preferred the latter and intended to continue self‐administration. Self‐administration of DMPA‐SC should be routinely offered and easily accessible to patients. [ABSTRACT FROM AUTHOR]

From July 2019 through April 2021, the Latino Center for Health, a bicultural population health research center at the University of Washington, partnered with community stakeholders to generate evidence to inform elected officials about the need to increase the diversity of the state's physician workforce and ultimately improve Latina/o health in Washington state. Legislative efforts resulted in legislation creating goals for the state's medical schools to admit students representative of the state's population diversity and the creation of a new residency pathway for international medical graduates. (Am J Public Health. 2024;114(S6):S467–S471. https://doi.org/10.2105/AJPH.2024.307627) [ABSTRACT FROM AUTHOR]

Introduction: Neighborhoods are often overlooked as a determinant of health. Among recent research, the focus on "place‐based effects," due to prolonged residential environmental exposure, has been of particular interest. These studies' purpose is to identify and examine how a healthy neighborhood is intentionally created to describe a transferable process‐driven theory. Method: A classic grounded theory approach was used in these studies. Data sources include individual in‐depth interviews, historical documents, and a member‐checking focus group, collected over 3‐years. Results: Analysis generated the Four Stages of Neighborhood Trust Model, which is nested within the context of perceived neighborhood safety. The theory outlines a social process of four stages of neighborhood trust: (a) rules‐based agreements, (b) shared values, (c) cooperation, and (d) neighborhood belonging. Conclusions: We present the development of a process‐driven theory that may be useful for public health nurses as they engage neighborhoods in health promotion activities. The stage of trust development will aid the nurse in identifying what is needed to move to the next stage in a healthy neighborhood process. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the relationship between hypertensive (HTN) disorders and severe maternal morbidity (SMM). To understand whether there is differential prevalence of HTN disorders by race and whether the relationship between HTN disorders and SMM is modified by race and ethnicity. Methods: We performed a retrospective cohort study using patient-level rates of SMM for pregnancies at all 61 non-military hospitals in Washington State from 10/2015 to 9/2016. Data were obtained from the Washington State Comprehensive Hospital Abstract Reporting System. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate the association of HTN disorders and SMM (with and without transfusion) overall and by race. The population-attributable fraction of HTN disorders on SMM within each racial/ethnic group was calculated. Results: Of 76,965 deliveries, 864 (1.1%) had any SMM diagnosis or procedure. All racial and ethnic minorities, except white and Asian, were disproportionally affected by preeclampsia with severe features (SF) and SMM. Overall, and within each racial/ethnic group, the SMM rate was higher among pregnancies with any HTN disorder compared to no HTN disorder (2.8 vs. 0.9%, OR 3.1, 95% CI 2.7–3.6). Race and ethnicity significantly modified the association. Overall and within each racial/ethnic group, there was a dose-response relationship between the type of HTN disorder and SMM, with more severe HTN disorders leading to a greater risk of SMM. The population-attributable fraction of HTN disorders on SMM was 20.6% for Black individuals versus 17.5% overall. The findings were similar when reclassifying transfusion-only SMM as no SMM. Conclusions: In Washington, HTN disorders are associated with SMM in a dose-dependent fashion with the greatest impact among Black individuals. Significance: What is already known on this subject?: Hypertensive disorders are a risk factor for SMM and hypertensive disorders and SMM occur disproportionately among marginalized populations. What does this study add to what is already known?: This study highlights that severe hypertensive disorders, especially preeclampsia with SF, disproportionately affect marginalized groups, and SMM appears to be disproportionately attributable to hypertensive disorders among people who identify as Black. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and social distancing measures elevated stress levels globally, exacerbating mental health challenges for people with HIV (PWH). We examined the effect of COVID-19-related stress on mental health among PWH in western Washington, exploring whether social support and coping self-efficacy were protective. Data on COVID-19-related stress, mental health, social support, and coping self-efficacy were collected using online surveys during the pandemic. Pre-COVID-19 mental health data were available for a subset of participants and were linked with the survey data. In the total sample (N = 373), COVID-19-stress was associated with elevated depression (PHQ-8, β = 0.21, 95%CI [0.10, 0.32]) and anxiety (GAD-7, β = 0.28, 95%CI [0.17, 0.39]). Among the subset of respondents with pre-pandemic mental health data (N = 103), COVID-19-related stress was associated with elevated PHQ-8 scores (β = 0.35, 95%CI [0.15, 0.56]) and GAD-7 scores (β = 0.35, 95%CI [0.16, 0.54]), adjusted for baseline mental health and other confounders. Coping self-efficacy was negatively associated with GAD-7 scores (β = −0.01, 95%CI [−0.01, 0.00]), while social support was negatively associated with PHQ-8 scores (β = −0.06, 95%CI [−0.12, −0.01]). Viral suppression before and during the pandemic did not differ among participants with available data. While COVID-19-related stress predicted elevated depression and anxiety symptoms among PWH, social support and coping self-efficacy were protective. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) have been linked to numerous negative health outcomes in adulthood and have been recognized as a hurdle to participating in HIV care. However, few studies have examined the cumulative impact that different types of childhood trauma have on HIV care engagement and HIV outcomes. This study characterized the relationship between ACEs, viral suppression, and health-related quality of life (HRQOL) among persons living with HIV (PLWH). We used HIV surveillance data and self-reported information on ACEs and HRQOL from PLWH in Washington State from 2018–2020. Logistic regression was used to assess the relationship between the quantity and type of ACEs and viral suppression. We used Poisson regression to examine the relationship between ACEs and HRQOL as measured by unhealthy days. The majority of PLWH experienced ≥1 ACE (86.8%). ACEs were not significantly associated with the likelihood of viral suppression (OR ≥4 vs 0 ACEs: 0.49, 95% CI: 0.12–2.09), but ACEs were associated with more unhealthy days experienced in a 30-day period (RR ≥4 vs 0 ACEs: 3.19, 95% CI: 1.59–6.40). These findings provide support that trauma is common among PLWH, and efforts to address the impact of childhood trauma may work to improve quality of life. [ABSTRACT FROM AUTHOR]

The purpose of this study was to understand the experiences of agricultural workers during periods of heat and wildfire smoke exposure and to support the development and implementation of protective workplace interventions. Using community-engaged research and the Center for Disease Control (CDC) framework for policy evaluation, a qualitative descriptive study was conducted with current and former agricultural workers in Central Washington (WA). Twelve participants answered semi-structured questions via interviews or by attending a focus group. Interviews and focus groups were conducted in Spanish, recorded, transcribed, and translated into English; one interview was conducted in English. Using Braun and Clarke's Reflexive Thematic Analysis, five themes were identified among workers from various worksites: 1) Extreme weather and working conditions are becoming increasingly hazardous to worker health, 2) Employers and supervisors lack training and education on current labor laws, and health and safety rules, 3) Employers and supervisors use intimidation and retaliation to ensure productivity and to evoke feelings of replaceability among workers, 4) Workers do not trust regulatory agencies to enforce rules or hold employers accountable, 5) Solutions to climate-driven problems in the agricultural industry need to value worker health and safety, not just productivity. Participants reported experiencing adverse health symptoms related to heat and smoke exposure at work. Workers proposed solutions including improving education, training, and communication, and increased enforcement of existing and forthcoming occupational health and safety rules. The agricultural workforce is essential for ensuring a robust food supply and is facing extreme weather events due to climate change. Western states impacted by wildfires and heat are working to develop and implement occupational health and safety rules. Developing effective policies and interventions inclusive of worker perspectives is critical to adapt to a changing climate, retain a stable workforce and promote optimal health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Following the removal of lead from gasoline, paint and pipes were thought to be the main sources of lead exposure in the United States. However, consumer products, such as certain spices, ceramic and metal cookware, traditional health remedies, and cultural powders, are increasingly recognized as important sources of lead exposure across the United States. OBJECTIVE: This paper reviews data from four US jurisdictions that conduct in-home investigations for children with elevated blood lead levels (BLLs) to examine the prevalence of lead exposures associated with consumer products, in comparison with housing-related sources. METHODS: Authors reviewed investigation data (2010–2021) provided by California, Oregon, New York City, and King County, Washington, and compared the extent of lead exposures associated with housing-related vs. consumer products–related sources. DISCUSSION: The proportion of investigations identifying consumer products–related sources of lead exposure varied by jurisdiction (range: 15%– 38%). A review of US CDC and US FDA alerts and New York City data indicates that these types of lead-containing products are often sourced internationally, with many hand carried into the United States during travel. Based on surveillance data, we believe that US immigrant and refugee communities are at an increased risk for lead exposures associated with these products. To engage health authorities, there is a need for evidentiary data. We recommend implementing a national product surveillance database systematically tracking data on consumer products tested by childhood lead poisoning prevention programs. The data repository should be centralized and accessible to all global stakeholders, including researchers and governmental and nongovernmental agencies, who can use these data to inform investigations. Effectively identifying and addressing the availability of lead-containing consumer products at their source can focus resources on primary prevention, reducing lead exposures for users abroad and in the United States. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate changes in monthly buprenorphine dispensation associated with federal prescribing policies in Washington State from 2012 to 2022. Methods. We conducted an interrupted time series analysis comparing monthly buprenorphine prescriptions dispensed per 1000 population after the Comprehensive Addiction and Recovery Act (CARA), Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT), and new prescribing rules during the COVID-19 pandemic. Buprenorphine formulated for opioid use disorder was included from the Washington State Prescription Monitoring Program. A log-linear autoregressive model measured linear trend changes. Results. Physician prescribing increased by 1.63% (95% confidence interval [CI] = 1.41%, 1.85%) per month after CARA with sustained declines after SUPPORT. Nurse practitioner (NP) prescribing increased by 19.48% (95% CI = 18.8%, 20.16%) per month after CARA with physician assistants (PAs) showing similar trends. Following the implementation of SUPPORT, NP and PA trends continued to increase at a reduced growth rate of 3.96% (95% CI = 2.01%, 5.94%) and 1.87% (95% CI = 0.56%, 3.19%), respectively. No prescribers experienced increases during the COVID-19 pandemic. Conclusions. CARA nearly tripled the buprenorphine prescribing rate. The SUPPORT Act initiated sustained declines for physician prescribing, and the COVID-19 period reversed gains for PAs and NPs. The current opioid crisis requires expanded efforts in Washington State. (Am J Public Health. 2024;114(7):696–704. https://doi.org/10.2105/AJPH.2024.307649) [ABSTRACT FROM AUTHOR]

An important public concern about the impact of recreational cannabis legalization is how it may affect adolescent cannabis use. Prior research on this issue has primarily focused on the implications of medical cannabis legalization for adolescents and used data that cover a relatively short post-legalization period. This study extends this line of research by examining the relationship between recreational cannabis legalization and adolescent cannabis use in Washington State, using the National Survey of Drug Use and Health (NSDHU) data from 2005 to 2019. Based on a quasi-experimental research design, this study found some evidence suggesting a positive effect of recreational legalization on the prevalence of adolescent cannabis use and cannabis initiation. Findings suggest the need to create a cannabis regulatory environment that minimizes adolescent access to this drug. [ABSTRACT FROM AUTHOR]