Cohort Study of Downgraded Misdemeanor Convictions and Subsequent Violent Crime: Differences by Defendant Race and Ethnicity.

Introduction: Criminal convictions may be imperfect markers of criminalized behavior, in part because of criminal legal system processes (e.g., plea bargaining). In this retrospective cohort study of individuals convicted of misdemeanors, authors compared the risk of subsequent criminal charges for a violent crime among those initially charged with a felony with that among those initially charged with only misdemeanors, overall and by defendant race and ethnicity. Methods: The study population included individuals aged ≥18 years who were convicted of a misdemeanor in Washington Superior Courts from January 1, 2015 to December 31, 2019. Those with and without initial felony charges were age/gender matched in a 4:1 ratio. The primary outcome was the first subsequent violent crime charge in Washington Superior Courts through December 31, 2020. Data were analyzed with Fine-Gray hazard models from June 2022 to November 2023. Results: There were 3,841 individuals with initial felony charges and 956 with initial misdemeanor charges only. Median follow-up was 2.4 years for both groups. During follow-up, there were 166 new violent crime charges. In multivariable models, White defendants with initial felony charges had a greater risk of subsequent violent crime charges (subdistribution hazard ratio=2.58; 95% CI=1.24, 5.36) than White defendants with initial misdemeanor charges only. Among Black and Hispanic/Latinx defendants, initial felony versus misdemeanor charges were not associated with subsequent violent crime charges (subdistribution hazard ratio=0.93; 95% CI=0.44, 1.97 among Black defendants; subdistribution hazard ratio=0.49; 95% CI=0.15, 1.57 among Hispanic/Latinx defendants). Conclusions: Findings suggest differential associations between downgrading of felony charges to misdemeanor convictions and future violent crime charges by defendant race and ethnicity, with implications for inequitable collateral consequences of criminal convictions.

Low antibody levels associated with significantly increased rate of SARS-CoV-2 infection in a highly vaccinated population from the US National Basketball Association.

SARS-CoV-2 antibody levels may serve as a correlate for immunity and could inform optimal booster timing. The relationship between antibody levels and protection from infection was evaluated in vaccinated individuals from the US National Basketball Association who had antibody levels measured at a single time point from September 12, 2021, to December 31, 2021. Cox proportional hazards models were used to estimate the risk of infection within 90 days of serologic testing by antibody level (<250, 250-800, and >800 AU/mL1 ), adjusting for age, time since last vaccine dose, and history of SARS-CoV-2 infection. Individuals were censored on date of booster receipt. The analytic cohort comprised 2323 individuals and was 78.2% male, 68.1% aged ≤40 years, and 56.4% vaccinated (primary series) with the Pfizer-BioNTech mRNA vaccine. Among the 2248 (96.8%) individuals not yet boosted at antibody testing, 77% completed their primary vaccine series 4-6 months before testing and the median (interquartile range) antibody level was 293.5 (interquartile range: 121.0-740.5) AU/mL. Those with levels <250 AU/mL (adj hazard ratio [HR]: 2.4; 95% confidence interval [CI]: 1.5-3.7) and 250-800 AU/mL (adj HR: 1.5; 95% CI: 0.98-2.4) had greater infection risk compared to those with levels >800 AU/mL. Antibody levels could inform individual COVID-19 risk and booster scheduling.

Characterizing Female Firearm Suicide Circumstances: A Natural Language Processing and Machine Learning Approach.

INTRODUCTION: Since 2005, female firearm suicide rates increased by 34%, outpacing the rise in male firearm suicide rates over the same period. The objective of this study was to develop and evaluate a natural language processing pipeline to identify a select set of common and important circumstances preceding female firearm suicide from coroner/medical examiner and law enforcement narratives. METHODS: Unstructured information from coroner/medical examiner and law enforcement narratives were manually coded for 1,462 randomly selected cases from the National Violent Death Reporting System. Decedents were included from 40 states and Puerto Rico from 2014 to 2018. Naive Bayes, Random Forest, Support Vector Machine, and Gradient Boosting classifier models were tuned using 5-fold cross-validation. Model performance was assessed using sensitivity, specificity, positive predictive value, F1, and other metrics. Analyses were conducted from February to November 2022. RESULTS: The natural language processing pipeline performed well in identifying recent interpersonal disputes, problems with intimate partners, acute/chronic pain, and intimate partners and immediate family at the scene. For example, the Support Vector Machine model had a mean of 98.1% specificity and 90.5% positive predictive value in classifying a recent interpersonal dispute before suicide. The Gradient Boosting model had a mean of 98.7% specificity and 93.2% positive predictive value in classifying a recent interpersonal dispute before suicide. CONCLUSIONS: This study developed a natural language processing pipeline to classify 5 female firearm suicide antecedents using narrative reports from the National Violent Death Reporting System, which may improve the examination of these circumstances. Practitioners and researchers should weigh the efficiency of natural language processing pipeline development against conventional text mining and manual review.

Long-Term Prescription Opioid Use After Injury in Washington State 2015-2018.

BACKGROUND: Patients with injury may be at high risk of long-term opioid use due to the specific features of injury (e.g., injury severity), as well as patient, treatment, and provider characteristics that may influence their injury-related pain management. OBJECTIVES: Inform prescribing practices and identify high-risk populations through studying chronic prescription opioid use in the trauma population. METHODS: Using the Washington State All-Payer Claims Database (WA-APCD) data, we included adults aged 18-65 years with an incident injury from October 1, 2015-December 31, 2017. We compared patient, injury, treatment, and provider characteristics by whether or not the patients had long-term (≥ 90 days continuous prescription opioid use), or no opioid use after injury. RESULTS: We identified 191,130 patients who met eligibility criteria and were included in our cohort; 5822 met criteria for long-term use. Most had minor injuries, with a median Injury Severity Score = 1, with no difference between groups. Almost all patients with long-term opioid use had filled an opioid prescription in the year prior to their injury (95.3%), vs. 31.3% in the no-use group (p < 0.001). Comorbidities associated with chronic pain, mental health, and substance use conditions were more common in the long-term than the no-use group. CONCLUSION: Across this large cohort of multiple, mostly minor, injury types, long-term opioid use was relatively uncommon, but almost all patients with chronic use post injury had preinjury opioid use. Long-term opioid use after injury may be more closely tied to preinjury chronic pain and pain management than acute care pain management.

Prevalence of a loaded firearm in the home among birth parents experiencing symptoms of postpartum depression.

Firearm access increases the risk of suicide among all household members. The prevalence of loaded firearms in the home among those experiencing symptoms of postpartum depression (PPD) is unknown. We conducted a cross-sectional study using Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2019. We included participants from the nine jurisdictions that asked about loaded firearms in the home and who screened positive for PPD. We excluded participants whose infants were not alive at time of survey completion and who did not respond to the firearm question, resulting in an analytic sample of 4986 participants. Using PRAMS analytic weights, we estimated the prevalence of a loaded firearm in the home and the prevalence of screening for PPD based on having a loaded firearm in the home. Among PRAMS participants experiencing symptoms of PPD, 8.8% (95% CI: 7.6%, 10.1%) reported there was a loaded firearm in their home. Participants with a loaded firearm in their home were more likely to be White (81.3% vs. 60.6%) and live in a rural area (57.9% vs. 27.5%) than those without. Among participants who reported attending a postpartum checkup, 78.6% (95% CI: 67.0%, 90.2%) of those with a loaded firearm in their home reported having been asked by a provider if they were feeling depressed, compared to 88.7% (95% CI: 85.3%, 92.0%) of those without. About 1 in 11 birth parents experiencing symptoms of PPD report a loaded firearm in their home. Further screening for firearm access in this population may need to be considered.

A Pilot Randomized Controlled Trial of a Fitbit- and Facebook-Based Physical Activity Intervention for Young Adult Cancer Survivors.

Purpose: Most young adult cancer survivors (YACS) do not meet physical activity (PA) guidelines. Although PA can improve health and quality of life (QOL), few randomized controlled trials (RCTs) of PA interventions for YACS exist. We conducted a pilot RCT to test feasibility of a PA intervention among YACS. Methods: We recruited 18-39-year-olds (≥1 and <5 years postcancer therapy) from Seattle Cancer Care Alliance. The 12-week intervention involved a wrist-worn PA-tracking device (Fitbit), a peer-based Facebook support group, step count goal setting, and a self-selected support "buddy." Controls received Fitbit only. Baseline assessments occurred before randomization; follow-up assessments occurred during intervention weeks 10-12. Feasibility criteria are listed below. Exploratory outcomes included PA, sedentary time (ST), QOL measures (e.g., fatigue), and self-determination theory (SDT) construct measures. Results: All feasibility criteria were met: We recruited 50 YACS, intervention participants wore the Fitbit on the majority of intervention days (82.9%), ≥75% of participants completed questionnaires at baseline (100%) and follow-up (93.9%). Exploratory analyses, adjusted for wave, accelerometer wear time, race, and income, showed significant group differences for change in ST (-52.4 vs. 2.5 minutes/day; p = 0.002) but no change in moderate-to-vigorous intensity PA (0.0 vs. -0.2 minutes/day; p = 0.40), comparing intervention participants to controls. The intervention (vs. control) group had a greater increase in fatigue interference (p = 0.03). No other significant differences in SDT or QOL measures were found. Conclusion: This Fitbit and Facebook-based PA intervention was feasible to YACS, with promising effects on reducing ST, and warrants a fully powered RCT. Clinical Trial Registration no.: NCT03233581.

Understanding the Process, Context, and Characteristics of Extreme Risk Protection Orders: A Statewide Study.

Research summary. Extreme risk protection orders (ERPOs) allow police, family, and household members to file an order to temporarily remove firearms or prevent purchasing among individuals at high risk for harming themselves or others. Using inductive qualitative content analysis, we examined 241 ERPOs filed December 8, 2016 through May 10, 2019 in Washington State. Focusing on recurring themes, we explored the circumstances and behaviors that led to an ERPO filing. Extreme risk protection orders were filed over concerns for domestic violence, mass shooting threats, direct threats to oneself or others, and other concerning behavior with a firearm. Factors at all levels of the social-ecological model were found to play a role in the dangerous behaviors of respondents that led to an ERPO petition. Policy implications. Extreme risk protection orders can serve an important role in both protecting people and facilitating the provision of care for substance use, mental illness, and assistance to vulnerable individuals.

Impact of Walking School Bus Programs on Self-Efficacy and Outcome Expectations.

BACKGROUND: A walking school bus (WSB) consists of students and adults walking to and from school and promotes active commuting to school. Self-efficacy (SE) and outcome expectations (OE) are behavioral constructs associated with active commuting to school. The authors sought to assess the impact of a WSB program on child SE, and parent SE, and OE. METHODS: The authors conducted a cluster randomized controlled trial of a WSB intervention from 2012 to 2016 among 22 elementary schools serving racially diverse, low-income populations in Houston, TX and Seattle, WA. Surveys collected data from third- to fifth-grade students and their parents, (n = 418) child-parent dyads, before school randomization and at the school year's end. Child surveys included 16 SE items, while parent surveys included 15 SE items and 14 OE items. Scores were averaged from responses ranging from 1 to 3. The authors compared changes in SE and OE between groups over time and accounted for clustering using linear mixed-effects models. RESULTS: The intervention group had increases in child SE of 0.12 points (P = .03), parent SE of 0.11 points (P = .048), and parent OE of 0.09 points (P = .02) compared to controls over time. CONCLUSIONS: As hypothesized, the WSB improved child SE, parent SE, and parent OE related to active commuting to school.

Perspectives of Parents and Providers on Reasons for Mental Health Readmissions: A Content Analysis Study.

Pediatric hospitalizations for mental health conditions are rapidly increasing, with readmission rates for mental health conditions surpassing those for non-mental health conditions. The objective of this study was to identify reasons for pediatric mental health readmissions from the perspectives of parents and providers. We performed a retrospective content analysis of surveys administered to parents and providers of patients with a 14-day readmission to an inpatient pediatric psychiatry unit between 5/2017 and 8/2018. Open-ended survey items assessed parent and provider perceptions of readmission reasons. We used deductive coding to categorize survey responses into an a priori coding scheme based on prior research. We used inductive coding to identify and categorize responses that did not fit into the a priori coding scheme. All data were recoded using the revised schema and reliability of the coding process was assessed using kappa statistics and consensus building. We had completed survey responses from 89 (64%) of 138 readmission encounters (56 parent surveys; 61 provider surveys). The top three readmission reasons that we identified from parent responses were: discordant inpatient stay expectations with providers (41%), discharge hesitancy (34%), and treatment plan failure (13%). Among providers, the top readmission reasons that we identified were: access to outpatient care (30%), treatment adherence (13%), and a challenging home (11%) and social environment (11%). We identified inpatient stay expectations, discharge hesitancy, and suboptimal access to outpatient care as the most prominent reasons for mental health readmissions, which provide targets for future quality improvement efforts.

Assessment of county-level proxy variables for household firearm ownership.

Our objective in this study was to evaluate how well proxy variables for firearm ownership used in county-level studies measure firearm ownership. We applied Bayesian spatial smoothing methods to calculate county-level estimates of household firearm ownership using Behavioral Risk Factor Surveillance System (BRFSS) data (2013-2018). We compared these estimates to four proxies for county-level firearm ownership: the proportion of suicides that were firearm suicides, the average of the proportion of suicides that were firearm suicides and the proportion of homicides that were firearm homicides, gun shops per capita, and federal firearm licenses per capita. U.S. counties for which BRFSS data on household firearm ownership were collected and available for release (n = 304) were included. The median (interquartile range) prevalence of household firearm ownership was 46.6% (37.2%, 56.4%). The per capita rate of federal firearm licenses was most strongly correlated with household firearm ownership (r = 0.70; 95% CI: 0.63, 0.75) followed by the proportion of suicides that were firearm suicides (r = 0.45; 95% CI: 0.36, 0.54). These correlations were stronger among counties with populations of ≥250,000 people. The per capita rate of federal firearm licenses was the best proxy variable for firearm ownership at the county level, however, a better proxy should be identified.

Adverse psychosocial factors in pregnancy and preterm delivery.

BACKGROUND: Mental health symptoms, stress, and low psychosocial resources are associated with preterm delivery. It is unknown if there are groups of women who experience similar patterns of these adverse psychosocial factors during pregnancy and if the risk of preterm delivery differs among these groups. OBJECTIVE: To identify groups of women with similar patterns of adverse psychosocial factors during pregnancy and determine whether the risk of preterm delivery differs among these groups. METHODS: Spontaneous Prematurity and Epigenetics of the Cervix (SPEC) is a prospective cohort study of pregnant women, aged 18 and older. In this analysis, we included women who enrolled after 24 August 2014 and delivered by 20 January 2019. As women could enrol more than once, our cohort included 774 women with 787 pregnancies. We conducted a latent class analysis to identify groups of women with similar patterns of adverse psychosocial factors during pregnancy based on their responses to measures assessing depression, perceived stress, anxiety (pregnancy-related and generalised), stressful life events, resilience, and social support (partner and friend/family). After identifying the latent classes, we used log-binomial regression to compare the incidence of preterm delivery among the classes. RESULTS: The median age among participants was 33.2 years (interquartile range 30.3-36.3), and the majority were non-Hispanic white (56.9%). We identified three classes of adverse psychosocial factors (few, some, and many factors). In total, 63 (8.0%) pregnancies resulted in a preterm delivery. Compared to participants with few factors, the risk of preterm delivery was no different among participants with some (RR 1.23, 95% CI 0.68, 2.25) and many adverse factors (RR 1.62, 95% CI 0.73, 3.62). CONCLUSIONS: We identified three groups of pregnant women with similar patterns of adverse psychosocial factors. We did not observe a difference in the risk of preterm delivery among the classes.

Evaluation of Postpartum Pelvic Floor Physical Therapy on Obstetrical Anal Sphincter Injury: A Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to evaluate a short course of postpartum pelvic floor physical therapy (PFPT) on symptoms and quality of life after obstetrical anal sphincter injuries (OASIS). METHODS: This was a multicenter, randomized controlled trial. Adult women were eligible if they had a vaginal delivery complicated by OASIS and did not have a prior vaginal delivery after 24 weeks' gestation. Participants were randomized to standard care plus PFPT or standard care alone. The primary outcome was change in the Pelvic Floor Distress Inventory (PFDI-20) at 12 weeks postpartum. Secondary outcomes included other validated questionnaires assessing pelvic floor symptoms and bother. RESULTS: We approached 89 eligible women; 50 were enrolled and randomized. We excluded 6 participants in the PFPT group and 1 in the standard care group who withdrew before study initiation or did not provide baseline data at 2 weeks postpartum. Thus, we analyzed 19 in the PFPT group and 24 in the standard care group. The groups were similar with regard to most baseline characteristics.The PFPT group reported significant improvement in pelvic floor symptoms and bother compared with the standard care group, reflected by a decrease of 29.2 (interquartile range = -58.3 to -4.2) compared with 0.0 (interquartile range = -14.6 to 20.8) on the PFDI-20 from 2 to 12 weeks postpartum (P = 0.002). Significant differences also were observed for all PFDI-20 subscales (all P ≤ 0.02). CONCLUSIONS: At 12 weeks postpartum, the PFPT group reported a significant improvement in pelvic floor symptoms and bother compared with the standard care group.

Age, period and cohort effects in firearm homicide and suicide in the USA, 1983-2017.

BACKGROUND: Rates of firearm homicide and suicide have varied over time. These variations are due to a number of factors including temporal trends, age, birth year and gender. We sought to conduct an age-period-cohort analysis to understand the intersection of these factors with firearm homicide and suicide. METHODS: We used data on firearm homicide and suicide for the years 1983-2017 from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System for this analysis. We restricted our analysis on firearm homicide to persons aged 10-44 years and our analysis on firearm suicide to persons aged 50-84 years, as these age groups are most at risk of each outcome. We calculated annual incidence rates for both outcomes per 100 000 population, overall and by gender. RESULTS: Across all age groups, rates of firearm homicide increased dramatically in the late 1980s and early 1990s. The peak age for firearm homicide varied across cohorts, although it was generally between ages 15 and 29 years. Rates of firearm homicide were substantially higher among men than women, regardless of age, period or cohort. Firearm suicide rates varied significantly by gender. Among men, older cohorts had higher firearm suicide rates, although the rate of firearm suicide increased with age across all cohorts. Among women, firearm suicide rates were also highest among older cohorts; however, firearm suicide rates decreased or remained relatively constant with age. CONCLUSION: There are important differences in rates of firearm homicide and suicide with respect to gender, age, period and cohort.

Psychotropic medication use during pregnancy and gestational age at delivery.

PURPOSE: The purpose of this study was to evaluate the association between psychotropic medication use during pregnancy and gestational age at delivery, after adjusting for depressive symptom and perceived stress severity. METHODS: We analyzed data on singleton live births from 2914 female Pregnancy Study Online participants, aged 21 to 45, with a reported conception from 6/2013 to 6/2018. Women reported psychotropic medication use at 8 to 12 weeks' and ~32 weeks' gestation. We measured depressive symptoms using the Major Depressive Inventory and perceived stress using the 10-item Perceived Stress Scale. Data on gestational age at delivery were based on self-reports and/or birth certificates. We used restricted mean survival time models, stratifying by severity of depressive symptoms (Major Depression Inventory <25 vs. ≥25) and perceived stress (Perceived Stress Scale <20 vs. ≥20). RESULTS: Two hundred and ten (7.2%) participants reported using psychotropic medications during pregnancy. Mean gestational age at delivery among women who never used psychotropic medications was 38.2 weeks (95% confidence interval: 37.7, 38.7), whereas it was 37.3 weeks (95% confidence interval: 36.7, 37.9) among women who used psychotropic medications during pregnancy. Results were similar across strata of depressive symptoms and perceived stress. CONCLUSIONS: Our data indicate that the association between psychotropic medication use and gestational age at delivery is not confounded by indication.

Relation of Driving Under the Influence Laws to Access to Firearms Across US States.

Objectives. To determine differences among US states in how driving under the influence of alcohol (DUI) laws activate federal firearm possession and purchase prohibitions.Methods. We performed primary legislative research to characterize DUI laws in each state. The primary outcome was the number of DUI convictions an individual must be convicted of in each state to activate the federal firearm possession and purchase prohibition. We also determined the time interval in which previous DUI convictions count for future proceedings.Results. Forty-seven states had DUI laws that activated the federal prohibition of firearm possession and purchase for a threshold number of repeated DUIs. Variation exists among states in the number of convictions (1-4) and length of liability period (5 years-lifetime) required to prohibit firearm possession and purchase.Conclusions. Variation in state laws on DUI results in differences in determining who is federally prohibited from possessing and purchasing firearms. Future research should explore whether these federal prohibitions arising from DUI convictions are enforced and whether an association exists between stricter DUI policies and reduction in firearm crimes, injuries, and deaths.

Firearm purchasing and storage during the COVID-19 pandemic.

To better understand motivations behind purchase and storage of firearms during the COVID-19 pandemic, we used Amazon Mechanical Turk to conduct an online survey of individuals who did and did not purchase a firearm since 1 January 2020 in response to COVID-19. The survey was fielded between 1 and 5 May 2020. We asked about motivations for purchase, changes in storage practices and concern for themselves or others due to COVID-19. There were 1105 survey respondents. Most people who purchased a firearm did so to protect themselves from people. Among respondents who had purchased a firearm in response to COVID-19 without prior household firearm ownership, 39.7% reported at least one firearm was stored unlocked. Public health efforts to improve firearm-related safety during COVID-19 should consider increasing access to training and framing messages around the concerns motivating new firearm purchase.