Alcohol-involved motor vehicle crashes and the size and duration of random breath testing checkpoints.

OBJECTIVE: Sobriety checkpoints have strong empirical and theoretical support as an intervention to reduce alcohol-involved motor vehicle crashes. The purpose of this study was to examine whether checkpoint size (the number of police officers) and checkpoint duration (the amount of time in operation) affect associations between individual checkpoints and subsequent alcohol-related crash incidence. METHOD: Queensland Police Service provided latitude-longitude coordinates and date and time data for all breath tests that occurred in Brisbane, Australia, from January 2012 to June 2018. We applied hierarchical cluster analysis to the latitude-longitude coordinates for breath tests, identifying checkpoints as clusters of ≥25 breath tests conducted by ≥3 breath testing devices over a duration of 3 to 8 hours. Generalized linear autoregressive moving average (GLARMA) models related counts of alcohol-involved motor vehicle crashes to the number of checkpoints conducted per week, as well as 1 week prior and 2 weeks prior. RESULTS: A total of 3420 alcohol-related crashes occurred and 2069 checkpoints were conducted in Brisbane over the 6.5-year (339-week) study period. On average, checkpoints included a mean of 266.0 breath tests (SD = 216.3), 16.4 devices (SD = 13.7), and were 286.3 minutes in duration (SD = 104.2). Each 10 additional checkpoints were associated with a 12% decrease in crash incidence at a lag of 1 week (IRR = 0.88; 95%CI: 0.80, 0.97). We detected no differential associations according to checkpoint size or duration. CONCLUSIONS: Sobriety checkpoints are associated with fewer alcohol-related motor vehicle crashes for around 1 week. Checkpoint size and duration do not appear to affect this relationship.

Assaults on Days of Campaign Rallies During the 2016 US Presidential Election.

BACKGROUND: This study investigates whether assault frequency increased on days and in cities where candidates Donald Trump and Hillary Clinton held campaign rallies prior to the 2016 US Presidential election. METHODS: We calculated city-level counts of police-reported assaults for 31 rallies for Donald Trump and 38 rallies for Hillary Clinton. Negative binomial models estimated the assault incidence on rally days (day 0) relative to that on eight control days for the same city (days -28, -21, -14, -7, +7, +14, +21, and +28). RESULTS: Cities experienced an increase in assaults (incidence rate ratio [IRR] = 1.12, 95% CI: 1.03-1.22) on the days of Donald Trump's rallies, and no change in assaults on the days of Hillary Clinton's rallies (IRR = 1.00; 95% CI: 0.94-1.06). CONCLUSION: Assaults increased on days when cities hosted Donald Trump's rallies during the 2016 Presidential election campaign.

Neighborhood social environment and patterns of adherence to oral hypoglycemic agents among patients with type 2 diabetes mellitus.

This study examined whether neighborhood social environment was related to patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus. Residents in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage, compared to residents in neighborhoods with one or no high features present, were significantly more likely to have an adherent pattern compared to a nonadherent pattern. Neighborhood social environment may influence patterns of adherence. Reliance on a multilevel contextual framework, extending beyond the individual, to promote diabetic self-management activities may be essential for notable public health improvements.

Neighborhood Social Environment and Patterns of Depressive Symptoms Among Patients with Type 2 Diabetes Mellitus.

This study sought to examine whether neighborhood social environment was related to patterns of depressive symptoms among primary care patients with type 2 diabetes mellitus (DM). Neighborhood social environment was assessed in 179 patients with type 2 DM. Individual patient residential data at baseline was geo-coded at the tract level and was merged with measures of neighborhood social environment. Depressive symptoms at baseline and at 12-week follow up were assessed using the nine-item Patient Health Questionnaire (PHQ-9). Patients in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage were much less likely to have a persistent pattern of depressive symptoms compared to a pattern of few or no depressive symptoms (adjusted odds ratio (OR) = 0.06, 95 % confidence interval (CI) [0.01, 0.36]). Detrimental neighborhood influences may amplify risk for persistent depressive symptoms.

A review of legislation restricting the intersection of firearms and alcohol in the U.S.

OBJECTIVES: In the United States, injury is a leading cause of alcohol-related death, and alcohol use is the leading risk factor for injury. We reviewed state and federal legislation regulating the intersection of alcohol and firearms. METHODS: We examined the current criminal codes of all 50 states and the District of Columbia using the databases Westlaw and LexisNexis to review restrictions on firearm use while intoxicated. RESULTS: We found three types of laws in 26 states that restrict firearm use by intoxicated people: sales or transfers are restricted in six states, carrying of concealed weapons is restricted in four states, and possession or discharge of a firearm while intoxicated is restricted in 20 states. CONCLUSIONS: Regulation of the carrying and use of firearms by acutely intoxicated individuals may represent a public health opportunity to reduce firearm-related injury.

Sobriety Checkpoints and Alcohol-Involved Motor Vehicle Crashes at Different Temporal Scales.

INTRODUCTION: Roadside sobriety checkpoints are an intervention in which law enforcement officers stop passing vehicles to check whether drivers are impaired. There is clear evidence that a program of roadside sobriety checkpoints is an effective approach to reducing alcohol-involved motor vehicle crashes, likely because of general deterrent effects across the entire population of drivers. The aim of this study is to assess the duration of time over which individual roadside sobriety checkpoints are associated with alcohol-involved motor vehicle crashes, within the context of a broader checkpoint program. METHODS: In August 2018, the authors accessed incident-level data for alcohol-involved motor vehicle crashes and roadside sobriety checkpoints for the City of Los Angeles, California, 2013-2017. Counts of crashes and checkpoints were computed within three different temporal units: days (n=1,826), weeks (n=260), and months (n=60). The number of checkpoints were then calculated at different lagged periods (up to 7 days, up to 4 weeks, and up to 3 months). Autoregressive integrated moving average analyses related counts of checkpoints over these lagged periods to subsequent crashes. RESULTS: Fewer alcohol-involved motor vehicle crashes occurred when there were more roadside sobriety checkpoints over the previous 4 days, 5 days, 6 days, 7 days, and 1 week. CONCLUSIONS: Individual roadside sobriety checkpoints affected alcohol-involved motor vehicle crashes in Los Angeles, California for approximately 1 week. The temporal configuration of individual checkpoints is an important consideration when designing an overall roadside sobriety checkpoint program.

Intergenerational effects of witnessing domestic violence: Health of the witnesses and their children.

Studies that explore intergenerational effects of witnessing domestic violence during childhood ("witnessing") are lacking. We examined effects of witnessing on general health status for adults who witnessed domestic violence during childhood and their children. Cross-sectional data from population-based phone interviews conducted in Philadelphia during 2012-2013 provided health information for 329 parents and children, and parent's witnessing exposure. We used propensity scores to predict parent's witnessing status using childhood confounders; response models included inverse probability of treatment weighting and population weights for standardization. Separate standardized multivariate logistic regression models provided average treatment effects and 95% CIs for associations between childhood witnessing and below average health for: 1) adults who witnessed and 2) their children. Sensitivity analyses guided interpretation. Standardized models showed no differences in average treatment effects for below average adult health for witnesses vs. non-witnesses [0.04 (-0.12, 0.19)]. Conversely, children whose parents witnessed had considerably higher probability of having below average health than children whose parents did not witness [0.15 (0.02, 0.28)]. An unmeasured confounder would need 3.0-fold associations with both exposure and outcome to completely remove observed effects, indicating a moderate relationship. However, the lower confidence bound could cross 1.0 in the presence of a weaker unmeasured confounder having 1.2-fold associations with both exposure and outcome, while controlling for our same measured confounders. Witnessing during childhood did not affect adult health in our population, but we found moderate evidence supporting harmful intergenerational effects of witnessing on health, with parent's witnessing exposure affecting their child's health.

Describing Total Population Health: A Review and Critique of Existing Units.

Total population health is a key tenet of health care reform efforts, evident in initiatives such as the National Quality Strategy, shifts toward population-based payments, and community benefit requirements for tax-exempt hospitals. Representing total population health in a way that guides best practices and establishes shared accountability for geographic communities, however, remains a challenge in part because of differences in how stakeholders define populations. To better understand the landscape of potential denominators for population health, this study examined a selection of relevant geographic units. The approach included a comprehensive review of health services and public health research literature as well as recent pertinent health policy documents. Units were characterized based on whether they: exhibit "breadth" of coverage across the whole US population; are "accurate" or grounded in health care utilization patterns; are "actionable" with mechanisms for implementing funding and regulation; and promote "synergism" or effective coordination of public health and health care activities. Although other key components of a total population health unit may exist and no single identified unit possesses all of the aforementioned features, several promising candidates were identified. Specifically, healthcare coalitions link health care and public health domains to care for a geographic community, but their connection to utilization is not empiric and limited funding exists at the coalition level. Although Accountable Care Organizations do not uniformly incorporate public health or facilitate coordination across all payers or providers, they represent an effective mechanism to increase collaboration within health care systems and represent a potential building block to influence total population health.

Reducing firearm violence: a research agenda.

In the United States, firearms are involved in tens of thousands of deaths and injuries each year. The magnitude of this problem prompted the National Academy of Sciences (NAS) to issue a report in 2004 detailing the strengths and limitations of existing research on the relationship between firearms and violence. In response, a multidisciplinary group of experts in the field of firearms and violence formed the National Research Collaborative on Firearm Violence. The Collaborative met for 2 days in June 2005 to (1) critically review the main findings of the NAS report and (2) define a research agenda that could fill research and data gaps and inform policy that reduces gun-related crime, deaths and injuries. This article summarizes the Collaborative's conclusions and identifies priorities for research and funding.