Injury Prevention Activities in US Schools, School Health Policies and Practices Survey 2014.

BACKGROUND: Exposure to injury and violence early in life increases the risk of experiencing injury and violence later in life. In 2019, the top 3 leading causes of death among 15- to 18-year-olds in the United States were unintentional injury, suicide, and homicide. This study examines the extent to which schools promote injury and violence prevention. METHODS: This study examined injury- and violence-related school policies and practices using nationally representative data from the 2014 School Health Policies and Practices Study. The social ecological model served as the theoretical framework to identify level of impact. RESULTS: For many injury-related topics, more than 75% of schools nationwide had relevant policies and practices to address those topics. However, this study showed differences in schools' injury-related policies and practices by urbanicity. CONCLUSIONS: Understanding and identifying gaps in school policies and practices is essential for reducing and preventing the injury and violence children experience. Collecting data on school policies and practices allows for better monitoring and evaluation to determine which are efficacious and aligned with the best available evidence.

Mental Health Among Parents of Children Aged <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic - United States, December 2020 and February-⁠March 2021.

Early during the COVID-19 pandemic, nearly two thirds of unpaid caregivers of adults reported adverse mental or behavioral health symptoms, compared with approximately one third of noncaregivers† (1). In addition, 27% of parents of children aged <18 years reported that their mental health had worsened during the pandemic (2). To examine mental health during the COVID-19 pandemic among U.S. adults on the basis of their classification as having a parenting role (i.e., unpaid persons caring for children and adolescents aged <18 years, referred to as children in this report) or being an unpaid caregiver of adults (i.e., persons caring for adults aged ≥18 years),§ CDC analyzed data from cross-sectional surveys that were administered during December 2020 and February-March 2021 for The COVID-19 Outbreak Public Evaluation (COPE) Initiative.¶ Respondents were categorized as parents only, caregivers of adults only, parents-caregivers (persons in both roles), or nonparents/noncaregivers (persons in neither role). Adjusted odds ratios (aORs) for any adverse mental health symptoms, particularly suicidal ideation, were higher among all respondents who were parents, caregivers of adults, or both compared with respondents who were nonparents/noncaregivers and were highest among persons in both roles (parents-caregivers) (any adverse mental health symptoms: aOR = 5.1, 95% confidence interval [CI] = 4.1-6.2; serious suicidal ideation: aOR = 8.2, 95% CI = 6.5-10.4). These findings highlight that parents and caregivers, especially those balancing roles both as parents and caregivers, experienced higher levels of adverse mental health symptoms during the COVID-19 pandemic than adults without these responsibilities. Caregivers who had someone to rely on for support had lower odds of experiencing any adverse mental health symptoms. Additional measures are needed to improve mental health among parents, caregivers, and parents-caregivers.

Costs of Nonfatal Traumatic Brain Injury in the United States, 2016.

BACKGROUND: Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, TBIs substantially contribute to health care costs, which vary by severity. This is important to consider given the variability in recovery time by severity. RESEARCH DESIGN: This study quantifies the annual incremental health care costs of nonfatal TBI in 2016 for the US population covered by a private health insurance, Medicaid, or Medicare health plan. This study uses MarketScan and defines severity with the abbreviated injury scale for the head and neck region. Nonfatal health care costs were compared by severity. RESULTS: The estimated 2016 overall health care cost attributable to nonfatal TBI among MarketScan enrollees was $40.6 billion. Total estimated annual health care cost attributable to TBI for low severity TBIs during the first year postinjury were substantially higher than costs for middle and high severity TBIs among those with private health insurance and Medicaid. CONCLUSIONS: This study presents economic burden estimates for TBI that underscore the importance of developing strategies to prevent TBIs, regardless of severity. Although middle and high severity TBIs were more costly at the individual level, low severity TBIs, and head injuries diagnosed as "head injury unspecified" resulted in higher total estimated annual health care costs attributable to TBI.

Assessment of HEADS UP online training as an educational intervention for sports officials/athletic trainers.

BACKGROUND: Sports- and recreation-related concussions are a common injury among children. Sports officials (SOs) and athletic trainers (ATs) are integral to setting the stage for safe play and managing concussions when they occur, and significant numbers of both groups have completed the Centers for Disease Control and Prevention's HEADS UP online concussion training course. However, the utility of the course for these audiences has not been assessed. We hypothesized that sports officials' and athletic trainers' concussion-related knowledge, attitudes, and behavioral intentions will improve from pre- and post-test after completing CDC's HEADS UP online concussion training course. METHOD: Respondents' concussion-related knowledge, attitudes, and behavioral intentions were assessed both before and after taking the training course. Differences between pre- and post-test scores were calculated based on the Wilcoxon Signed Rank Test Z-score or McNemar's test. Effect sizes were interpreted. RESULTS: The SOs and ATs who participated in the HEADS UP online training had a high level of concussion knowledge before taking the course: 90% or more of respondents could identify the correct response for at least seven of the 13 knowledge questions in the pre-test. Still, the course was effective at improving the respondents' knowledge about return-to-play protocols and concussion reporting. Further, SOs and ATs demonstrated improvement in their concussion-related attitudes and behavioral intentions between the pre- and post-test. CONCLUSION: SOs' and ATs' concussion knowledge, attitudes, and behavioral intentions improved immediately following completion of the CDC HEADS UP online training. Future research could also focus on the long-term retention of this type of training. Practical Applications: This study provides insight into how to better focus concussion-related educational programs to fit SOs' and ATs' needs.

Exploring gender norms, agency and intimate partner violence among displaced Colombian women: A qualitative assessment.

Women displaced by conflict are often exposed to many factors associated with a risk of intimate partner violence (IPV) such as high levels of community violence and the breakdown of social support systems. Previous research found that Colombian women perceived IPV to increase after displacement. This study explored how the experience of displacement altered gendered roles in ways that influenced the risk of IPV. Thirty-three qualitative interviews were conducted with displaced partnered Colombian women. Women disclosed that couples often held patriarchal gender norms; however, the roles of each partner necessitated by conditions of displacement were often in conflict with these norms. Men's underemployment and women's employment outside the home were viewed as gender transgressive within some partnerships and increased relationship conflict. Economic resources intended to empower displaced women, notably women's earnings and home ownership, had unintended negative consequences for women's agency. These consequences included a corresponding decrease in partner financial contributions and reduced mobility. Women's ability to obtain support or leave violent relationships was hindered by interpersonal, social and structural barriers. For women to have agency to leave violent relationships, power relationships at all levels from the interpersonal to societal must be recognised and addressed.

Excessive drinking among African American men: individual and contextual correlates.

In this article, the authors explored associations of multiple domains with regular drinking and getting drunk among adult African American men. Questionnaire-based, computer-assisted interviews were conducted with 484 men in Atlanta, Georgia. Data analysis involved multivariate logistic regression analyses. Findings show that being older increased the odds of both drinking behaviors. Sensation seeking increased the odds of regular drinking, and having experienced childhood sexual and physical abuse increased the odds of getting drunk. Having health insurance reduced the odds of both outcomes. Insurance coverage and the heterogeneity among adult African American men must be considered in risk reduction efforts.

College graduation reduces vulnerability to STIs/HIV among African-American young adult women.

African-American women are disproportionately affected by sexually transmitted infections (STIs), including HIV. The Theory of Gender and Power (TGP) posits that socioeconomic exposures, including educational attainment, place women at increased risk for STIs/HIV. This study examined the association between educational attainment and vulnerability to STIs/HIV, as well as potential TGP-driven mediators of this association, among African-American women. Baseline data were assessed from an STI/HIV prevention intervention for African-American women (n = 848) aged 18 to 29 recruited from three Kaiser Permanente Centers in Atlanta, Georgia. Data collection included a survey of demographic, psychosocial, and behavioral measures and self-collected, laboratory-confirmed vaginal swabs for STIs (trichomoniasis, chlamydia, gonorrhea, and human papillomavirus). Multiple regression analyses and multivariate mediation analyses were used to examine the association between educational attainment with a laboratory-confirmed STI and potential TGP mediators. Controlling for age and receipt of public assistance, the odds of an STI diagnosis were 73% lower among participants with a college degree or greater compared with participants who had not completed high school. There were also significant associations between educational attainment and multiple TGP mediators from the sexual division of power and the structure of cathexis. TGP constructs did not mediate the association between educational attainment and laboratory-confirmed STI. The current study suggests that graduating from college may lead to a beneficial reduction in vulnerability to STIs/HIV among African-American women. Findings from this study support expanding structural-level interventions, emphasizing both high school and college graduation, as a means of reducing vulnerability to STIs/HIV among African-American women.

Beyond Sexual Partnerships: The Lack of Condom Use during Vaginal Sex with Steady Partners.

PURPOSE: The purpose of this paper is to identify independent correlates of the lack of condom use when engaging in vaginal sex with steady partners among HIV-negative African American adults. The conceptual model includes proximal as well as more distal domains. METHODS: Cross-sectional data were collected between May 2009 and August 2011. Recruitment involved active and passive recruitment strategies. Computer-assisted, individual interviews were conducted with 1,050 African American adults. Multivariate logistic regression was used to identify independent predictors of a lack of condom use with steady partners in the past 30 days. RESULTS: In multivariate analysis, being older than 35, being partnered, perceiving having a steady partner as important, and ever having been homeless were associated positively with the odds of a lack of condom use during vaginal sex with steady partners in the past 30 days. On the other hand, reporting more than one steady partner in the past 30 days, having health insurance during the past 12 months, and perceived neighborhood social cohesion were negatively associated. CONCLUSIONS: These findings highlight the need for HIV risk-reduction prevention and intervention efforts that consider distal as well as proximal domains. Such a perspective allows for a broader sociological inquiry into health disparities that moves beyond epidemiological factors that commonly guide public health research.

The assessment of complementary and alternative medicine use among individuals with HIV: a systematic review and recommendations for future research.

OBJECTIVES: The use of complementary and alternative medicine (CAM), a group of health care practices and products that are not considered part of conventional medicine, has increased in recent years, particularly among individuals with human immune deficiency virus (HIV). Assessing the prevalence and predictors of CAM use among HIV-positive populations is important because some CAM therapies may adversely affect the efficacy of conventional HIV medications. Unfortunately, CAM use is not comprehensively or systematically assessed among HIV-positive populations. Therefore, the aim of the present study was to evaluate the quality of the instruments employed in observational studies assessing CAM use among HIV-positive populations by examining the degree to which these studies (1) evaluated the psychometric properties of their CAM instruments and (2) assessed the multidimensional nature of CAM use. DESIGN: A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. Specifically, articles were included that were published in English and in a peer-reviewed journal between 1997 and 2007, recruited HIV-positive study participants, and assessed CAM use. Thirty-two (32) studies met these inclusion criteria. RESULTS: Results suggest that CAM assessment among HIV-positive populations continues to be problematic. For example, approximately 20% of the studies assessed the reliability and 3% assessed the validity of the CAM instrument employed. CONCLUSIONS: CAM assessment--regardless of the specific study population--is a complex and challenging task. However, CAM instruments will not become more refined over time in the absence of rigorous psychometric evaluation. Future research must assess reliability and validity and report these data in a clear and nuanced manner.

A day in the life of women with a serious mental illness: a qualitative investigation.

PURPOSE: Few studies have taken a holistic perspective to the lives of women with a serious mental illness (SMI). This qualitative study of women with an SMI describes and interprets women's experiences and provides a new understanding about the nature and needs of these women. METHODS: A convenience sample of 30 poor, urban, predominantly African-American women with a diagnosis of an SMI was recruited from an ongoing National Institutes of Mental Health study. Data collection involved face-to-face, in-depth interviews. The interviews were audio-recorded and transcribed verbatim. Data analysis occurred concurrently with data collection using a modified constant comparative method. RESULTS: The majority of the women self-identified as African American, single, having completed high school, and at the time of the interview were either unemployed or on disability. The most common SMI was major depression. A common topic in the women's reflections on their lives was that of social disadvantage both before being diagnosed as well as after to their diagnosis with an SMI. Salient themes of their stories included social isolation, experiencing loss, and having a lack of control over one's own life decisions. CONCLUSION: The findings from this study revealed varied experiences among these women as well as the complexity of their situation. The enhanced understanding of women's situation will allow mental health professionals to improve the quality of life for women with an SMI by taking a contextual approach to the treatment of their mental illness.