A Proportionate Mortality Study of Mississippi's Agricultural Industry, 2017-2021.

OBJECTIVES: Individuals employed in the agricultural industry encounter hazards in their work that could lead to injury or illness. Furthermore, the mental stress of being involved in the agricultural industry could lead to negative health-related outcomes for workers. This study evaluates the causes of deaths among employees in Mississippi's agricultural industry from 2017 to 2021. METHODS: Data are provided by the Mississippi Department of Health. Proportionate mortality ratios (PMRs) are calculated to determine if agricultural industry employees show an elevated mortality in comparison to the general population for any cause of death. RESULTS: Agricultural industry employees show a statistically significant elevated mortality for circulatory disease (PMR 107, 95% confidence interval [CI] 103-110) and coronavirus disease 2019 (PMR 122, 95% CI 111-134). They also show a significant excess mortality for deaths caused by transport accidents (PMR 117, 95% CI 101-136) and exposure to inanimate mechanical forces (PMR 274, 95% CI 183-396). CONCLUSIONS: The causes of death for which agricultural employees show an excess mortality can be explained by the hazards associated with working in the agricultural industry. These findings can be used to create targeted future public health programs for individuals who are employed in agriculture.

Epidemiologic Assessment of Craniosynostosis in Mississippi's Pediatric Population from 2015 to 2020.

OBJECTIVES: This study aimed to report geographic and demographic patterns of patients with craniosynostosis (CS) treated at Children's of Mississippi, the state's only American Cleft Palate-Craniofacial Association-approved craniofacial team. METHODS: Patients with CS were treated at a tertiary pediatric hospital cared for by craniofacial surgeons and neurosurgeons from 2015 to 2020. Demographic, geographic, and CS diagnosis details, including sex, gestational age, race, ethnicity, insurance status, and affected cranial suture type(s), number, and associated syndromic diagnosis were collected, including birth county and total live births from state data. Significant differences between prevalence of CS in four regions of Mississippi were examined using two-tailed t tests (P < 0.05). RESULTS: Among 222,819 live births in Mississippi between 2015 and 2020, 79 pediatric patients presented to Children's of Mississippi with CS, with an overall incidence of 0.355/1000 live births. Most cases were nonsyndromic CS (82%, n = 65) affecting a single major cranial suture (81%, n = 64). The overall incidence of CS was higher in the coastal and central regions compared with northeast Mississippi, at 0.333 and 0.527 vs 0.132/1000 live births (P = 0.012 and P = 0.004), respectively. CONCLUSIONS: Results from this study suggest regional patterns of CS in Mississippi, which may reflect actual incidence patterns or proximity to Children's of Mississippi. Further study could reveal regional differences in risk factors underlying CS incidence or access to specialized CS care for different regions in the state. This will lead to opportunities for institutional outreach to decrease the burden of CS care in Mississippi.

A multi-tiered approach to assess fecal pollution in an urban watershed: Bacterial and viral indicators and sediment microbial communities.

Development of effective pollution mitigation strategies require an understanding of the pollution sources and factors influencing fecal pollution loading. Fecal contamination of Turkey Creek in Gulfport, Mississippi, one of the nation's most endangered creeks, was studied through a multi-tiered approach. Over a period of approximately two years, four stations across the watershed were analyzed for nutrients, enumeration of E. coli, male-specific coliphages and bioinformatic analysis of sediment microbial communities. The results demonstrated that two stations, one adjacent to a lift station and one just upstream from the wastewater-treatment plant, were the most impacted. The station adjacent to land containing a few livestock was the least impaired. While genotyping of male-specific coliphage viruses generally revealed a mixed viral signature (human and other animals), fecal contamination at the station near the wastewater treatment plant exhibited predominant impact by municipal sewage. Fecal indicator loadings were positively associated with antecedent rainfall for three of four stations. No associations were noted between fecal indicator loadings and any of the nutrients. Taxonomic signatures of creek sediment were unique to each sample station, but the sediment microbial community did overlap somewhat following major rain events. No presence of Escherichia coli (E. coli) or enterococci were found in the sediment. At some of the stations it was evident that rainfall was not always the primary driver of fecal transport. Repeated monitoring and analysis of a variety of parameters presented in this study determined that point and non-point sources of fecal pollution varied spatially in association with treated and/or untreated sewage.

Fire season matters for midstory hardwood control: Impacts of fire season and firing technique on plant communities.

In the southeastern USA, lack of historical fire regimes often leads to hardwood encroachment into early successional plant communities and managed pine stands, reducing wildlife value and timber yields. Land managers lack information on how firing technique interacts with fire season to influence plant communities. We designed an experiment to quantify these interactions in east-central Mississippi with pairs of 4 m × 8 m plots randomly assigned a backing and heading fire in each of three seasons: February (Feb), May-June (May/Jun), and September-October (Sep/Oct). We used thermocouples to monitor fire temperature and tagged midstory trees to monitor response. We lit heading fires with an 18-25 kph wind generated by a backpack blower and backing fires into the ambient wind. Despite backing fires producing longer residence times than heading fires and raising temperature above the lethal threshold of 60 °C an average of 54 s longer, firing technique did not influence midstory response one growing season post-fire. Backing and heading fires produced similar maximum temperatures. For both firing techniques, May/Jun resulted in the highest midstory mortality rates which were 3-fold greater than Sep/Oct and 4-fold greater than Feb. Among all three fire seasons, trees with a 2.5 cm diameter at breast height (DBH) had approximately a 75% chance of top-kill which decreased to <20% as trees approached 6.5 cm DBH. We found no effects of fire season on fire temperature, rate of spread, flame height, or percent crown scorch. We found no significant interactions between fire season and firing technique. Understory analysis revealed Sep/Oct produced the greatest increase in forb coverage, May/Jun resulted in the most grass coverage, and Feb produced the most brambles (Rubus spp.). On sites with similar species, weather, and fuel conditions to ours, land managers should emphasize fire season over firing technique for midstory control and understory manipulation. Where midstory hardwood control with fire is a priority, fire return intervals should be frequent enough to prevent trees from exceeding 2.5 cm DBH to avoid trees escaping fire's reach. These data can help managers reduce midstory competition with crop trees and promote understory development for wildlife.

Resurgent Maternal and Congenital Syphilis in Mississippi-Pathways for Prevention.

This Viewpoint discusses Mississippi's public health challenges particularly as they relate to resurgent maternal and congenital syphilis.

Effectiveness and residual activity of four common insecticides used in the Mississippi Delta to control tarnished plant bugs in cotton.

The tarnished plant bug, (TPB) Lygus lineolaris Palisot de Beauvois (Hemiptera: Miridae) is a key pest of cotton in the midsouth region and some areas of the eastern United States. Its control methods have been solely based on chemical insecticides which has contributed to insecticidal resistance and shortened residual periods for control of this insect pest. This study was conducted over a two-year period and examined the efficacy and residual effect of four commercial insecticides including lambda-cyhalothrin (pyrethroid), acephate (organophosphate), imidacloprid (neonicotinoid), and sulfoxaflor (sulfoxamine). The effectiveness and residual effects of these insecticides were determined by application on cotton field plots on four different dates during each season using three different concentrations (high: highest labeled commercial dose (CD), medium: 1/10 of the CD, low: 1/100 of the CD) on field cotton plots. Four groups of cotton leaves were randomly pulled from each treated plot and control 0-, 2-, 4-, 7-, and 9-days post treatment (DPT) and exposed to a lab colony of TPB adults. One extra leaf sample/ plot/ spray /DPT interval (0-2-4-7-9-11) during 2016 was randomly collected from the high concentration plots and sent to Mississippi State Chemical Laboratory for residual analysis. Mortality of TPB adults was greatest for those placed on leaves sprayed with the organophosphate insecticide with mortalities (%) of 81.7±23.4 and 63.3±28.8 (SE) 1-day after exposure (DAE) on leaves 0-DPT with the high concentration for 2016 and 2017, respectively, reaching 94.5±9.5 and 95.4±7.6 6-DAE each year. Mortality to all insecticides continued until 9 and 4-DPT for high and medium concentrations, respectively. However, organophosphate (39.4±28.6) and pyrethroid (24.4±9.9) exhibited higher mortality than sulfoxamine (10.6±6.6) and the neonicotinoid (4.0±1.5) 7-DAE on 9-DPT leaves with the high concentration. Based on our results using the current assay procedure, TPB adults were significantly more susceptible to contact than systemic insecticides and due to its residual effect, organophosphate could kill over 80% of the TPB population 7-DPT.

Plastic Surgery Outreach Clinics Expand Access to Cleft and Craniofacial Care in Mississippi.

ABSTRACT: Accessing treatment at ACPA (American Cleft Palate-Craniofacial Association)-approved centers is challenging for individuals in rural communities. This study aims to assess how pediatric plastic surgery outreach clinics impact access for patients with orofacial cleft and craniosynostosis in Mississippi. An isochrone map was used to determine mean travel times from Mississippi counties to the sole pediatric hospital and the only ACPA-approved team in the state. This analysis was done before and after the establishment of two outreach clinics to assess differences in travel times and cost of travel to specialized plastic surgery care. Two sample t-tests were used for analysis.The addition of outreach clinics in North and South Mississippi led to a significant reduction in mean travel times for patients with cleft and craniofacial diagnoses across the state's counties (1.81 hours vs 1.46 hours, P < 0.001). Noteworthy travel cost savings were observed after the introduction of outreach clinics when considering both the pandemic gas prices ($15.27 vs $9.80, P < 0.001) and post-pandemic prices ($36.52 vs $23.43, P < 0.001).The addition of outreach clinics in Mississippi has expanded access to specialized healthcare for patients with cleft and craniofacial differences resulting in reduced travel time and cost savings for these patients. Establishing specialty outreach clinics in other rural states across the United States may contribute significantly to reducing burden of care for patients with clefts and craniofacial differences. Future studies can further investigate whether the inclusion of outreach clinics improves follow-up rates and surgical outcomes for these patients.

Epidemiologic Trends of Cleft Lip and Palate in a Southern State: A 30-Year Follow-Up.

OBJECTIVES: Children's of Mississippi at the University of Mississippi Medical Center serves as the state's only American Cleft Palate-Craniofacial Association-approved cleft team at the only pediatric hospital in the state. The goal of this study is to report geographic and demographic patterns of patients with orofacial cleft (OFC) treated at Children's of Mississippi, which are lacking. METHODS: Patients with OFC treated at Children's of Mississippi from 2015 to 2020 were included. Demographic data were collected, including birth county and total live births from state data. Significant differences between incidence of OFC among public health regions of Mississippi were examined using analysis of variance (P < 0.05). Cases were compared with historical data from 1980 to 1989. RESULTS: There were 184 patients who presented with OFC, with a statewide incidence of 0.83 per 1000 live births among 222,819 live births in the state across 6 years. The incidence of OFC was 0.83/1000 for Whites and 0.82/1000 for non-Whites versus a historical rate of 1.36 and 0.54, respectively. Significantly fewer children in the northern region (0.25/1000) were born with OFC than in central (1.21; P < 0.001) and southern (0.86; P < 0.001) regions. CONCLUSIONS: Results from this study suggest changing regional patterns of OFC in Mississippi. Although rates increased among non-White infants, the overall incidence of OFC has decreased compared with historical data. The findings may reflect actual incidence patterns in the state or the proximity of certain regions to Children's of Mississippi. Further study may reveal regional differences in risk factors underlying OFC incidence, and/or issues with access to cleft care for different regions in the state.

Association Between Dietary Intake of Phosphorus and Measures of Obesity in the Jackson Heart Study.

BACKGROUND: The relation between phosphorus (P) intake and obesity is equivocal, with hypotheses in both directions. OBJECTIVES: We investigated the relationship between P intake, assessed from a current database, and calculated bioavailable P intake and obesity among African-American adults. METHODS: We examined associations between original and bioavailable P (total, added, and natural) and BMI and waist circumference (WC) in a cross-sectional study of 5306 African-American adults (21-84 y) from the Jackson Heart Study. A total of 3300 participants had complete interviews, valid dietary data, and normal kidney function. Diet was assessed by food frequency questionnaire. A novel algorithm was used to estimate P bioavailability. BMI or WC was regressed on each P variable, adjusting for total energy intake and potential confounders. RESULTS: After adjusting for covariates, original P (total and added) and bioavailable P (total and added) intakes (expressed/100 mg) were associated with BMI (ß: 0.11, 0.67, 0.31, and 0.71, respectively; all P < 0.0001). Neither original nor bioavailable natural P was significantly associated (ß: -0.03 and 0.09, respectively; both P > 0.05). When added and natural P were included in the same model, added P (original and bioavailable) intakes remained strongly associated with BMI (0.70 and 0.73, respectively; both P < 0.0001). Similar results were seen for WC. Intake of original added P tended to be more strongly associated with BMI, in females (ß: 0.72; P < 0.0001) than in males (ß: 0.56; P = 0.003) (P-interaction = 0.06). CONCLUSIONS: We found that greater intake of added, not natural, which may be a proxy for intake of processed foods was associated with higher BMI and WC. These were somewhat stronger when bioavailability was considered and for women than for men. Further investigation is needed to fully understand the mechanisms driving these associations.

Social vulnerability index and age-adjusted mortality from all causes by county: Mississippi 2016-2020.

BACKGROUND: Social variables are correlates of mortality. A number of social variables were used by the Centers for Disease Control and Prevention (CDC) to create a Social Vulnerability Index (SVI). SVI has been used as a correlate of health status. Age-adjusted mortality rates have been higher in Mississippi than in other states. Within Mississippi, the Delta region has had higher mortality. To test the hypothesis that social vulnerability was associated with mortality rate within the state, we examined SVI of counties in Mississippi as related to mortality from all causes in 2016-2020. METHODS: The CDC/ATSDR SVI ranks each census tract on 16 social factors, including poverty, lack of vehicle access, and crowded housing, and groups them into four related themes. Using CDC Wonder, we gathered data analyzing age-adjusted rate of death from all causes (AAR) in Mississippi Counties from 2016 to 2020, combined (reporting the death rate per 100,000 persons). Descriptive statistics were computed for each variable. Pearson correlation analysis, bivariable and multivariable regression analysis was done using Microsoft Excel version 16.77. The dependent variable was AAR and independent variables were for themes from the SVI. RESULTS: AAR varied greatly amongst counties in Mississippi. Higher AAR was seen in northwestern areas of Mississippi. The county with the lowest AAR (730 per 100,000 persons) had only half the AAR of the county with the highest AAR (1313.3 per 100,000 persons). The association of SVI THEME 1 (socioeconomic status) with AAR in Mississippi was positive. Linear regression analysis showed a coefficient of 203.5, 95 % CI 111.9-295.0, p = 0. 0.0000305. R square was 0.20. The addition of the following themes added little to the variation in AAR explained: SVI THEME 2 (household characteristics), SVI THEME 3 (racial and ethnic minority status), and SVI THEME 4 (housing type/transportation). CONCLUSION: Socioeconomic status explained a fifth of the variation in AAR among Mississippi counties in 2016-2020.

Feasibility of Remote Blood Pressure Monitoring for Detection and Management of Maternal Hypertension in a predominantly Black, Rural and Medicaid Population in Mississippi.

Background: Remote patient monitoring (RPM) has potential in hypertension management, but limited studies have focused on maternal hypertension, especially among vulnerable populations. The objective of this study was to integrate RPM into perinatal care for pregnant patients at elevated risk of hypertensive disorders to show feasibility, acceptability, and safety. Methods: A prospective pilot cohort study was conducted at the University of Mississippi Medical Center 2021-2023. Participants' blood pressure readings were remotely captured and monitored until 8-week postpartum, with timely assessment and intervention. Results: Out of 98 enrollees, 77 utilized RPM, and no maternal or neonatal deaths occurred within 60-day postpartum. High program satisfaction was reported at discharge. Conclusion: This study demonstrates the feasibility and acceptability of RPM for perinatal care in a vulnerable population. Positive outcomes were observed, including high patient satisfaction and no maternal or neonatal deaths. Further research should address patient engagement barriers and develop tailored protocols for improved clinical outcomes.

Vegetation dieback in the Mississippi River Delta triggered by acute drought and chronic relative sea-level rise.

Vegetation dieback and recovery may be dependent on the interplay between infrequent acute disturbances and underlying chronic stresses. Coastal wetlands are vulnerable to the chronic stress of sea-level rise, which may affect their susceptibility to acute disturbance events. Here, we show that a large-scale vegetation dieback in the Mississippi River Delta was precipitated by salt-water incursion during an extreme drought in the summer of 2012 and was most severe in areas exposed to greater flooding. Using 16 years of data (2007-2022) from a coastwide network of monitoring stations, we show that the impacts of the dieback lasted five years and that recovery was only partial in areas exposed to greater inundation. Dieback marshes experienced an increase in percent time flooded from 43% in 2007 to 75% in 2022 and a decline in vegetation cover and species richness over the same period. Thus, while drought-induced high salinities and soil saturation triggered a significant dieback event, the chronic increase in inundation is causing a longer-term decline in cover, more widespread losses, and reduced capacity to recover from acute stressors. Overall, our findings point to the importance of mitigating the underlying stresses to foster resilience to both acute and persistent causes of vegetation loss.

Implications of the Mississippi v. Tennessee Supreme Court Decision for Interstate Groundwater Management.

Groundwater allocation is rapidly becoming a contentious water resource management problem around the world. It is anticipated that the effects of climate change would further aggravate this problem. Conflicts over the distribution of freshwater are expected to increase as stakeholders want to access more groundwater to meet their growing demands. In the United States, water conflicts are settled through a litigation process. Water litigations can be expensive, protracted, and fraught with complex legal and technical difficulties. A landmark groundwater case involving Tennessee (TN) and Mississippi (MS) was recently litigated in the Supreme Court of the United States (SCOTUS). In this case, MS sued TN for stealing their groundwater and SCOTUS unanimously ruled that the water contained in the aquifer that naturally crosses the border between TN and MS is subject to equitable apportionment. This decision has significant ramifications for groundwater management as it established a precedent for resolving future interstate groundwater litigations. Although the Court has previously applied the legal doctrine of equitable apportionment to settle disputes involving surface water use, this is the first instance in which the doctrine has been applied to resolve an interstate groundwater dispute. Therefore, currently, there are little or no guidelines available for equitably distributing groundwater resources between two states. The objective of this article is to examine this historic legal dispute to fully understand the scientific justification for the judicial stances taken by the plaintiff and defendants, and the legal reasoning for the final verdict. We also discuss the challenges this ruling presents for managing interstate groundwater resources.

Telemental Health Services Usage and Association with Health Care Utilization and Expenditures Among Vulnerable Medicare Beneficiaries in 2019: A Comparative Study Using Propensity Score Matching.

Background: Telemental health (TMH) offers a promising approach to managing major depressive disorder (MDD). The objective of our work was to evaluate TMH usage among a vulnerable population of MDD Medicare beneficiaries and its association with health care utilization and expenditures. Methods: This cohort study analyzed 2019 Mississippi Medicare fee-for-service data for adult beneficiaries with MDD. Subjects were matched by the use of TMH following 1:1 propensity score matching. Comparisons between TMH and non-TMH cohorts were made on health care utilization and expenditure outcomes, adjusting for provider types postmatching. Results: Among 7,673 identified beneficiaries, 551 used TMH and 7,122 did not. Prematching, TMH cohort showed greater proportions of dual beneficiaries, rural residents, subjects with income below $40,000, those with disability entitlement, and higher Charlson comorbidity index scores, compared to the non-TMH cohort (all p < 0.001). Moreover, the TMH cohort had fewer outpatient visits, but more inpatient admissions, emergency department (ED) visits, and higher medical, pharmacy, and total expenditures (all p < 0.001). Postmatching, TMH was associated with a 25% reduction in outpatient visits (p < 0.001) and a 20% reduction in pharmacy expenditures (p = 0.01), with no significant effect on inpatient admissions, ED visits, medical expenditures, or total expenditures. Conclusions: These results underscore the potential of TMH in enhancing accessible health care services for vulnerable populations and affordable services for Medicare. Our results provide a robust baseline for future policy discussions concerning TMH. Future studies should consider identifying barriers to TMH use among vulnerable populations and ensuring equitable and high-quality patient care.

Autochthonous Ascariasis, Mississippi, USA.

We describe a case of a 2-year-old child who expelled a single adult female Ascaris lumbricoides worm. The patient is from a rural county in Mississippi, USA, with no reported travel outside of the United States. The caregivers in the home practice good sanitation. Exposure to domestic pigs is the likely source of infection.

Phenotypic virulence characterization of avian pathogenic Escherichia coli (APEC) isolates from broiler breeders with colibacillosis in Mississippi.

AIMS: In this study, we evaluated the phenotypic virulence characteristics of avian pathogenic Escherichia coli (APEC) isolates from broiler breeders with colibacillosis in Mississippi. Also, the relationship between phenotypic and genotypic virulence patterns was determined. METHODS AND RESULTS: Twenty-eight APEC isolated from lesions of broiler breeders diagnosed with colibacillosis were used for embryo lethality assay and chick challenge study. The percentage of embryo mortality following embryo lethality assay and pathogenicity score following the chick challenge study were used to categorize the isolates based on virulence. Pearson correlation analysis was performed to determine the relationship between embryo mortality, chick pathogenicity, and the presence of virulence-associated genes in the isolates. Overall, 39.3% of the isolates were highly virulent and 3.5% were avirulent, following both assays. There existed a positive correlation between embryo mortality and chick pathogenicity (r = 0.73, P < .01), as well as percentage embryo mortality and pathogenicity score with the presence of some virulence genes. CONCLUSIONS: Even though all the APEC were isolated from lesions of diseased breeders, the virulence potential varied from being avirulent to highly virulent. Further, we identified a positive relationship between phenotypic virulence and the frequency of virulence-associated genes.

Risk Factors for Severe Maternal Morbidity Among Women Enrolled in Mississippi Medicaid.

Importance: Mississippi has one of the highest rates of severe maternal morbidity (SMM) in the US, and SMMs have been reported to be more frequent among Medicaid-insured women. A substantial proportion of pregnant women in Mississippi are covered by Medicaid; hence, there is a need to identify potential risk factors for SMM in this population. Objective: To examine the associations of health care access and clinical and sociodemographic characteristics with SMM events among Mississippi Medicaid-enrolled women who had a live birth. Design, Setting, and Participants: A nested case-control study was conducted using 2018 to 2021 Mississippi Medicaid administrative claims database. The study included Medicaid beneficiaries aged 12 to 55 years who had a live birth and were continuously enrolled throughout their pregnancy period and 12 months after delivery. Individuals in the case group had SMM events and were matched to controls on their delivery date using incidence density sampling. Data analysis was performed from June to September 2022. Exposure: Risk factors examined in the study included sociodemographic factors (age and race), health care access (distance from delivery center, social vulnerability index, and level of maternity care), and clinical factors (maternal comorbidity index, first-trimester pregnancy-related visits, and postpartum care). Main Outcomes and Measures: The main outcome of the study was an SMM event. Adjusted odds ratio (aORs) and 95% CIs were calculated using conditional logistic regression. Results: Among 13 485 Mississippi Medicaid-enrolled women (mean [SD] age, 25.0 [5.6] years; 8601 [63.8%] Black; 4419 [32.8%] White; 465 [3.4%] other race [American Indian, Asian, Hispanic, multiracial, and unknown]) who had a live birth, 410 (3.0%) were in the case group (mean [SD] age, 26.8 [6.4] years; 289 [70.5%] Black; 112 [27.3%] White; 9 [2.2%] other race) and 820 were in the matched control group (mean [SD] age, 24.9 [5.7] years; 518 [63.2%] Black; 282 [34.4%] White; 20 [2.4%] other race). Black individuals (aOR, 1.44; 95% CI, 1.08-1.93) and those with higher maternal comorbidity index (aOR, 1.27; 95% CI, 1.16-1.40) had higher odds of experiencing SMM compared with White individuals and those with lower maternal comorbidity index, respectively. Likewise, an increase of 100 miles (160 km) in distance between beneficiaries' residence to the delivery center was associated with higher odds of experiencing SMM (aOR, 1.14; 95% CI, 1.07-1.20). Conclusions and Relevance: The study findings hold substantial implications for identifying high-risk individuals within Medicaid programs and call for the development of targeted multicomponent, multilevel interventions for improving maternal health outcomes in this highly vulnerable population.

Long-term trajectory of ozone impact on maize and soybean yields in the United States: A 40-year spatial-temporal analysis.

Understanding the long-term change trends of ozone-induced yield losses is crucial for formulating strategies to alleviate ozone damaging effects, aiming towards achieving the Zero Hunger Sustainable Development Goal. Despite a wealth of experimental research indicating that ozone's influence on agricultural production exhibits marked fluctuations and differs significantly across various geographical locations, previous studies using global statistical models often failed to capture this spatial-temporal variability, leading to uncertainties in ozone impact estimation. To address this issue, we conducted a comprehensive assessment of the spatial-temporal variability of ozone impacts on maize and soybean yields in the United States (1981-2021) using a geographically and temporally weighted regression (GTWR) model. Our results revealed that over the past four decades, ozone pollution has led to average yield losses of -3.5% for maize and -6.1% for soybean, translating into an annual economic loss of approximately $2.6 billion. Interestingly, despite an overall downward trend in ozone impacts on crop yields following the implementation of stringent ozone emission control measures in 1997, our study identified distinct peaks of abnormally high yield reduction rates in drought years. Significant spatial heterogeneity was detected in ozone impacts across the study area, with ozone damage hotspots located in the Southeast Region and the Mississippi River Basin for maize and soybean, respectively. Furthermore, we discovered that hydrothermal factors modulate crop responses to ozone, with maize showing an inverted U-shaped yield loss trend with temperature increases, while soybean demonstrated an upward trend. Both crops experienced amplified ozone-induced yield losses with rising precipitation. Overall, our study highlights the necessity of incorporating spatiotemporal variability into assessments of crop yield losses attributable to ozone pollution. The insights garnered from our findings can contribute to the formulation of region-specific pollutant emission policies, based on the distinct profiles of ozone-induced agricultural damage across different regions.

Disparities in access to appointments for contraceptive services among Black, Hispanic, White, and recently incarcerated women in Alabama, Louisiana, and Mississippi.

OBJECTIVE: To measure differences in access to contraceptive services based on history of incarceration and its intersections with race/ethnicity and insurance status. DATA SOURCES AND STUDY SETTING: Primary data were collected from telephone calls to physician offices in Alabama, Louisiana, and Mississippi in 2021. STUDY DESIGN: We deployed a field experiment. The outcome variables were appointment offers, wait days, and questions asked of the caller. The independent variables were callers' incarceration history, race/ethnicity, and insurance. DATA COLLECTION METHODS: Using standardized scripts, Black, Hispanic, and White female research assistants called actively licensed primary care physicians and Obstetrician/Gynecologists asking for the next available appointment for a contraception prescription. Physicians were randomly selected and randomly assigned to callers. In half of calls, callers mentioned recent incarceration. We also varied insurance status. PRINCIPAL FINDINGS: Appointment offer rates were five percentage points lower (95% CI: -0.10 to 0.01) for patients with a history of incarceration and 11 percentage points lower (95% CI: -0.15 to -0.06) for those with Medicaid. We did not find significant differences in appointment offer rates or wait days when incarceration status was interacted with race or insurance. Schedulers asked questions about insurance significantly more often to recently incarcerated Black patients and recently incarcerated patients who had Medicaid. CONCLUSIONS: Women with a history of incarceration have less access to medical appointments; this access did not vary by race or insurance status among women with a history of incarceration.