Prediction of the mechanism of suicide among Minnesota residents using data from the Minnesota violent death reporting system (MNVDRS).

BACKGROUND: Suicide remains a major public health problem, and firearms are used in approximately half of all such incidents. This study sought to predict the occurrence of suicide specifically by firearm, as opposed to any other means of suicide, in order to help inform possible life-saving interventions. METHODS: This study involved data from the Minnesota Violent Death Reporting System. Models evaluated whether data beyond basic demographics generated increased prediction accuracy. Models were built using random forests, logistic regression and data imputation. Models were evaluated for prediction accuracy using the area under the curve analysis and for proper calibration. RESULTS: Results showed that models constructed with social determinants and personal history data led to increased prediction accuracy in comparison to models constructed with basic demographic information only. The study identified an optimised 'top 20' variables model with a 73% chance of correctly discerning relative incident risk for a pair of individuals. Age, height/weight, employment industry/occupation, sex and education level were found to be most highly predictive of firearm suicide in the study's 'top 20' model. CONCLUSIONS: The study demonstrated that the use of a firearm in a death by suicide, as opposed to any other means of suicide, can be reasonably well predicted when an individual's social determinants and personal history are considered. These predictive models could help inform many prevention strategies, such as safe storage practices, background checks for firearm purchases or red flag laws.

Opioid-related Mortality in United States Death Certificate Data: A Quantitative Bias Analysis With Expert Elicitation of Bias Parameters.

BACKGROUND: Opioid-related mortality is an important public health problem in the United States. Incidence estimates rely on death certificate data generated by health care providers and medical examiners. Opioid overdoses may be underreported when other causes of death appear plausible. We applied physician-elicited death certificate bias parameters to quantitative bias analyses assessing potential age-related differential misclassification in US opioid-related mortality estimates. METHODS: We obtained cause-of-death data (US, 2017) from the National Center for Health Statistics and calculated crude opioid-related outpatient death counts by age category (25-54, 55-64, 65+). We elicited beliefs from 10 primary care physicians on sensitivity of opioid-related death classification from death certificates. We summarized elicited sensitivity estimates, calculated plausible specificity values, and applied resulting parameters in a probabilistic bias analysis. RESULTS: Physicians estimated wide sensitivity ranges for classification of opioid-related mortality by death certificates, with lower estimated sensitivities among older age groups. Probabilistic bias analyses adjusting for physician-estimated misclassification indicated 3.1 times more (95% uncertainty interval: 1.2-23.5) opioid-related deaths than the observed death count in the 65+ age group. All age groups had substantial increases in bias-adjusted death counts. CONCLUSIONS: We developed and implemented a feasible method of eliciting physician expert opinion on bias parameters for sensitivity of a medical record-based death indicator and applied findings in quantitative bias analyses adjusting for differential misclassification. Our findings are consistent with the hypothesis that opioid-related mortality rates may be substantially underestimated, particularly among older adults, due to misclassification in cause-of-death data from death certificates.

Barriers and Facilitators to the Online Delivery of a School-Based Intervention to Reduce Racial Trauma.

Students of color face disproportionate rates of adverse childhood experiences, including racial discrimination in school settings. Effective interventions strategies are needed to address school-based racial trauma. Link for Equity was designed to be a culturally-responsive trauma-informed intervention that includes universal cultural humility training for teachers. As a result of the COVID-19 pandemic, the in-person trauma-informed cultural humility training was adapted for online delivery. The purpose of this study was to assess barriers and facilitators that impacted online delivery of the training. We conducted semi-structured interviews with 25 high school teachers from three public school districts in the Midwestern United States who participated in the online training. Interview transcripts were coded by two team members, and thematic analysis was utilized. Barriers and facilitators to online delivery were identified across five domains: receptivity, logistics, engagement, comfort, and application. The implications of these barriers and facilitators are discussed and tailored recommendations for the virtual delivery of culturally-responsive trauma-informed interventions to reduce racial discrimination in schools are provided.

Violence in the Great Recession.

Substantial evidence suggests that economic hardship causes violence. However, a large majority of this research relies on observational studies that use traditional violence surveillance systems that suffer from selection bias and over-represent vulnerable populations, such as people of color. To overcome limitations of prior work, we employed a quasi-experimental design to assess the impact of the Great Recession on explicit violence diagnoses (injuries identified to be caused by a violent event) and proxy violence diagnoses (injuries highly correlated with violence) for child maltreatment, intimate partner violence, elder abuse, and their combination. We used Minnesota hospital data (2004-2014), conducting a difference-in-differences analysis at the county level (n = 86) using linear regression to compare changes in violence rates from before the recession (2004-2007) to after the recession (2008-2014) in counties most affected by the recession, versus changes over the same time period in counties less affected by the recession. The findings suggested that the Great Recession had little or no impact on explicitly identified violence; however, it affected proxy-identified violence. Counties that were more highly affected by the Great Recession saw a greater increase in the average rate of proxy-identified child abuse, elder abuse, intimate partner violence, and combined violence when compared with less-affected counties.

A serial cross-sectional study of trends and predictors of prescription controlled substance-related traumatic injury.

Pre-injury drug use is a key contributor to traumatic injury. However, limited research has examined trends and predictors of controlled substance-related trauma. The present study aims to provide better clarity on the specific role of prescription-controlled substances (PCS) in traumatic injury events. The data source was the American College of Surgeons National Trauma Data Bank. Trends by injury mechanism and intent for patients with PCS and no-confirmed substances were compared from 2007 to 2014. Logistic regression models were also performed to examine the association between substance use and injury mechanism and intent for data across the study period. Of 405,334 trauma patients, 328,623 (81.1%) had no-confirmed substances and 76,711 (18.9%) had PCS detected. The majority of events in the PCS and no-confirmed substance groups were classified as unintentional. Motor vehicle traffic (MVT), falls, other transport, and cut/pierce injuries accounted for approximately 80% of all injuries. From 2007 to 2014, the proportion of injuries with PCS increased for all injury mechanisms and injury intents. The injury mechanisms of fire/burn, firearm, machinery, poisoning, and other transport were significantly more likely to have PCS relative to MVT injuries. For injury intent, self-harm was more likely to have a toxicology test positive for PCS, while assault was less likely to have a toxicology test positive for PCS compared to unintentional injuries. PCS-related traumatic injuries increased significantly over time and across injury mechanisms and intents. These findings can be used to inform prescribing and understand risk factors to reduce the likelihood of PCS-related traumatic injury.

Approach to analysing correlated contextual factors: an application for studies on violence.

BACKGROUND: Numerous public health studies, especially in the area of violence, examine the effects of contextual or group-level factors on health outcomes. Often, these contextual factors exhibit strong pairwise correlations, which pose a challenge when these factors are included as covariates in a statistical model. Such models may be characterised by inflated standard errors and unstable parameter estimates that may fluctuate drastically from sample to sample, where the excessive estimation variability is reflected by inflated standard errors. METHODS: We propose a three-stage approach for analysing correlated contextual factors that proceeds as follows: (1) a principal components analysis (PCA) is performed on the original set of correlated variables, (2) the primary generated principal components are included in a multilevel multivariable model and (3) the estimated parameters for these components are transformed into estimates for each of the original contextual factors. Using school violence data, we examined the associations between school crime and correlated contextual school factors (ie, English proficiency, academic performance, pupil to teacher ratio, average class size and children on free and reduced meals). RESULTS: From models ignoring correlations, school crime was not reliably associated with any of the contextual school factors. When models were fit with principal components, school crime was found to be positively associated with a school's student to teacher ratio, average classroom size and academic performance but negatively associated with the proportion of children who were on free and reduced meals. CONCLUSION: Our multistep approach is one way to address multicollinearity encountered in social epidemiological studies of violence.

Workplace violence victimization in young workers: An analysis of the US National Crime Victimization Survey, 2008 to 2012.

BACKGROUND: The aim of this study was to measure the frequency of workplace violence (WPV) victimization in 16 to 24-year olds in the United States and compare rates by occupation and demographics. METHODS: As an open cohort, participants 12 years or older in the National Crime Victimization Survey were interviewed at 6-month intervals over a 3-year period from 2008 to 2012. WPV victimization rates were calculated. Weighted, multilevel Poisson regression was used to compare WPV victimization rates by occupation and demographics. RESULTS: The rate of WPV victimization was 1.11 incidents per 1000 employed person-months (95% confidence interval: 0.95-1.27). The highest rates of WPV were in protective service occupations (5.24/1000 person-months), transportation (3.04/1000 person-months), and retail sales (2.29/1000 person-months). Compared with their respective counterparts, lower rates of WPV victimization were found among younger, black, and rural/suburban workers. CONCLUSIONS: Findings identify occupations and target populations in need of future research and evidence-based interventions to improve the working conditions for young workers.

A GIS-based Matched Case-control Study of Road Characteristics in Farm Vehicle Crashes.

BACKGROUND: Farm vehicle-related crashes (crashes) are hazardous for farm and non-farm vehicle users; however, most studies examine risk factors of injury given a crash, and shed little light on risk factors of crashes. We evaluated the association of road sinuosity and gradient with crashes in nine Midwestern States from 2005 to 2010. METHODS: We collected crash data from the state departments of transportation, and road segment data from the Environmental Sciences Research Institute. We measured gradient and sinuosity of road segments using ArcGIS. A road segment with a crash was defined as a case (n = 6,848), and that without a crash was defined as a control. Controls were matched to cases by ZIP code, road type, and length in 1:1 (controls = 6,808) matching scheme. In addition, a 1:many control matched scheme was employed such that all road segments adjacent to the case would serve as controls (n = 24,390). We computed odds ratios (OR) and 95% confidence intervals (CIs) using multivariable conditional logistic regression. RESULTS: The adjusted OR of a crash on a road segment with 6%-10% gradient was 0.60 (95% CI: 0.49, 0.75) as compared with a leveled (<1% gradient) road segment. Compared with a straight (<1% sinuosity) road segment, the adjusted OR of a crash on a road segment with 6%-10% sinuosity was 0.38 (95% CI: 0.29, 0.52). CONCLUSIONS: Roads with increased gradient and sinuosity had fewer farm crashes. These associations may be due to cautious driving behaviors on curvy or steep roads and road side signage alerting drivers of impending curve or grade.

Does Implementation Matter? Associations Between Implementation of Maine's Anti- Bullying Law and Bullying Victimization Among High School Youth.

PURPOSE: To characterize the relationship between implementation of an antibullying law and bullying rates among high school youth. METHODS: School staff (administrators, counselors, and teachers) from public high schools in Maine completed a survey assessing: (1) the frequency with which they implemented 17 components of their district's antibullying policy as mandated by state law; and (2) confidence in implementing the law. Their responses were linked to data on bullying victimization among high school respondents to the Maine Integrated Youth Health Survey, which created a population-based dataset of 84 high schools with 29,818 student responses. RESULTS: Students in schools where administrators (adjusted odds ratio = 0.93; 95% CI: 0.89, 0.97) and counselors (adjusted odds ratio = 0.86; 95% CI: 0.81, 0.92) reported implementing more mandated components of the law experienced notable reductions in the odds of bullying, controlling for student-level characteristics (sex, race, grade) and for school-level bullying rates assessed prior to the passage of the law. With respect to specific implementation components, bullying was most consistently reduced in schools where staff reported increased referrals for counseling and other supports for targets of bullying and in schools where counselors and teachers were interviewed as part of bullying investigations. Students in schools where teachers reported increased confidence in implementing the antibullying law also had reduced odds of bullying. DISCUSSION: These data provide some of the first evidence that the efficacy of a state's antibullying law depends in part on the extent to which school personnel implement the law.

Ambient air pollution and the risk of violence in primary and secondary school settings: a cross-sectional study.

BACKGROUND: Individual and social characteristics are attributed to violent behavior in schools, yet environmental hazards may play an understudied role. Ambient air pollution has been linked to neurological dysfunction that inhibits decision-making and may result in violent behavior in adult populations. However, little is known on how air pollution may be associated with violent behaviors in children. METHODS: A cross-sectional ecologic study was designed to estimate the associations between air pollution (fine particulate matter, carbon monoxide, and nitrogen dioxide) with the occurrence of violent incidents and incidents involving a weapon among a cohort of children in Minnesota schools (2008-2012). Differences by urban and rural status of schools were also explored. Negative binomial regression models were developed to estimate incidence rate ratios (IRR) and incidence rate differences (IRD) to describe associations between air pollution and violent incidents in school settings. RESULTS: Our results indicate that the highest levels of carbon monoxide, nitrogen dioxide and fine particulate matter concentrations were associated with increased violent disciplinary incidents. Among the total student population, the 4th quartile of carbon monoxide exposure was associated with an IRD of 775.62 (95% CI 543.2, 1008.05) violent incidents per 100,000 students per school year compared to schools in the lowest quartile of exposure. Comparing the 4th to the 1st quartiles of exposure, nitrogen dioxide and fine particulate matter had an IRD of 629.16 (95% CI 384.87, 873.46), and 510.49 (95% CI 274.92, 746.05) violent incidents per 100,000 students per school year respectively. Schools in urban settings shared a larger burden of violent incidents associated with air pollution compared to rural schools. CONCLUSIONS: Modifying environmental pollutants surrounding school environments, particularly for high exposure communities, may be a novel tool for reducing violence and subsequent injuries in schools.

Economic Hardship and Violence: A Comparison of County-Level Economic Measures in the Prediction of Violence-Related Injury.

Economic hardship may lead to a wide range of negative outcomes, including violence. However, existing literature on economic hardship and violence is limited by reliance on official reports of violence and conflation of different measures of economic hardship. The goals of this study are to measure how violence-related injuries are associated with five measures of county-level economic shocks: unemployment rate, male mass layoffs, female mass layoffs, foreclosure rate, and unemployment rate change, measured cross-sectionally and by a 1-year lag. This study measures three subtypes of violence outcomes (child abuse, elder abuse, and intimate partner violence). Yearly county-level data were obtained on violence-related injuries and economic measures from 2005 to 2012 for all 87 counties in Minnesota. Negative binomial models were run regressing the case counts of each violence outcome at the county-year level on each economic indicator modeled individually, with population denominator offsets to yield incidence rate ratios. Crude models were run first, then county-level socio-demographic variables and year were added to each model, and finally fully-adjusted models were run including all socio-demographic variables plus all economic indicators simultaneously. In the fully-adjusted models, a county's higher foreclosure rate is the strongest and most consistently associated with an increase in all violence subtypes. Unemployment rate is the second strongest and most consistent economic risk factor for all violence subtypes. Lastly, there appears to be an impact of gender specific to economic impacts on child abuse; specifically, male mass-lay-offs were associated with increased rates while female mass-lay-offs were associated with decreased rates. Understanding the associations of different types of economic hardship with a range of violence outcomes can aid in developing more holistic prevention and intervention efforts.

Impacts of COVID-19 on Stress in Middle School Teachers and Staff in Minnesota: An Exploratory Study Using Random Forest Analysis.

While the COVID-19 pandemic has negatively impacted many occupations, teachers and school staff have faced unique challenges related to remote and hybrid teaching, less contact with students, and general uncertainty. This study aimed to measure the associations between specific impacts of the COVID-19 pandemic and stress levels in Minnesota educators. A total of 296 teachers and staff members from eight middle schools completed online surveys between May and July of 2020. The Epidemic Pandemic Impacts Inventory (EPII) measured the effects of the COVID-19 pandemic according to nine domains (i.e., Economic, Home Life). The Kessler-6 scale measured non-specific stress (range: 0-24), with higher scores indicating greater levels of stress. Random forest analysis determined which items of the EPII were predictive of stress. The average Kessler-6 score was 6.8, indicating moderate stress. Three EPII items explained the largest amount of variation in the Kessler-6 score: increase in mental health problems or symptoms, hard time making the transition to working from home, and increase in sleep problems or poor sleep quality. These findings indicate potential areas for intervention to reduce employee stress in the event of future disruptions to in-person teaching or other major transitions during dynamic times.

Development of a Checklist to Identify Injury Hazards on Row Crop Farms in the Midwestern United States.

Agriculture is among the most dangerous industries in the U.S., yet routine surveillance of injury hazards is not currently being conducted on a national level. The objectives of this study were to describe a new tool, called the Hazard Assessment Checklist (HAC), to identify and characterize farm hazards that increase injury risk to farmers and farm workers, and (2) report the inter-rater reliability of the new tool when administered on row-crop farms in Iowa. Based on a literature review and a consensus of expert opinion, the HAC included hazards related to self-propelled vehicles, powered portable implements, fixed machinery and equipment, farm buildings and structures, fall risks, and portable equipment associated with fall risk. A scoring metric indicating the extent of compliance with recommended safety guidelines and standards was developed for each item of the HAC, which included compliant, minimal improvement needed, substantial improvement needed, and not compliant. Inter-rater reliability was assessed from data collected by research staff on 52 row crop farms in Iowa. Cohen's weighted Kappa values demonstrated high inter-rater reliability, ranging between 0.86 and 0.94, for all HAC sections. The HAC can be completed in 1.5-2 hours on each farm and requires about three hours of training, two hours of which are spent in field training. The ability to monitor injury-related hazards over time using an empirically driven tool will contribute significantly to injury prevention efforts in an industry with consistently high rates of fatal and nonfatal injury.

Building A Comprehensive, Longitudinal Dataset to Advance Research on the Efficacy of State-Level Anti-bullying Legislation: 1999 to 2017.

Bullying is one of the most common forms of youth violence and is associated with myriad adverse consequences over the life course. There has been increasing interest in examining whether anti-bullying legislation is effective in preventing bullying victimization and its negative effects. However, a lack of data structures that comprehensively and longitudinally assess anti-bullying legislation and its provisions has hampered this effort. We provide 18 years of data (1999-2017) on anti-bullying legislation and amendments across 50 U.S. states and the District of Columbia, which we are making publicly available at LawAtlas.org. This article describes how the legal content analysis was conducted, provides information on the reliability of the coding, and details provisions of the legislation that were coded, such as funding provisions and enumerated groups (a total of 122 individual codes are provided). Over 90% of states had at least one amendment to their legislation during this 18-year period (range: 0-22; Mean = 6.1), highlighting both the evolving content of anti-bullying statutes and the importance of tracking these changes with longitudinal data. Additionally, we offer illustrative examples of the kinds of research questions that might be pursued with these new data. For instance, using survival analyses, we show that a variety of state characteristics (e.g., political leaning of state legislatures) predict time to adoption of key provisions of anti-bullying legislation (e.g., the comprehensiveness of legal provisions). Finally, we end with a discussion of how the dataset might be used in future research on the efficacy of anti-bullying legislation.

Link for Equity, a community-engaged waitlist randomized controlled trial of a culturally responsive trauma-informed care program for BIPOC students: Design features and characteristics of baseline sample.

BACKGROUND: Link for Equity is a multi-tiered, school-based program of trauma-informed care and cultural humility designed to reduce the impact of Adverse Child Experiences among Black Indigenous and other children of color (BIPOC). This report describes the program, its trial design, and the study participants' baseline characteristics. METHODS: We designed a nested waitlist-controlled trial to evaluate Link for Equity's effectiveness in reducing school violence among BIPOC students. Three pairs of school districts, matched on suspension rates and enrollment of Black/African American, Hispanic/Latinx, and American Indian/Alaska Native children, were randomized into either an intervention or delayed intervention (waitlist control) group. A community-engaged approach guided the development of protocols. Within intervention sites, BIPOC students who screened positive for ACEs or posttraumatic stress were also randomized into an immediate and waitlist control group to receive additional one-on-one support from trained school staff. RESULTS: The trial was implemented from 2019 to 2021, which overlapped with the pandemic and civil unrest in Minnesota. At baseline, 444 staff and 188 students enrolled in the study. Over a quarter of American Indian/Alaska Native students, 18% of multiple race, 12% of Black/African American, 14% of Hispanic/Latinx students reported 4+ ACEs. Between 44 and 53% of all the BIPOC students in the study were symptomatic for PTSD. Of the enrolled students, 78.7% qualified for one-on-one Link support. CONCLUSION: We implemented a multilevel waitlist-controlled trial of Link for Equity using community-engaged methods. Despite school closures during the pandemic, the study persisted with its methods now being employed in an expanded cohort of middle schools. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04026477, NCT04026490).

School-Based Diversity Education Activities and Bias-Based Bullying Among Secondary School Students.

Bias-based bullying (e.g., bullying related to race, weight, sexual orientation) is a common experience among youth, yet few school-based prevention programs explicitly address this type of bullying. This study explores whether schools that offer diversity education activities have lower rates of bias-based bullying among students compared to schools that do not offer these activities. Data came from two sources: the 2018 CDC School Profiles Survey (N = 216 schools) and the 2019 Minnesota Student Survey (N = 64,510 students). Multilevel logistic regression tested associations between diversity education activities (diversity clubs, lessons, or special events) and eight types of bias-based bullying among students, with attention to effect modification by relevant demographic characteristics. Students attending schools that offer a wider variety of diversity education opportunities had significantly lower odds of bullying about race, ethnicity, or national origin among boys of color (OR = 0.89, CI: 0.80, 1.00), about sexual orientation for gay, bisexual, and questioning boys (OR = 0.81, CI: 0.67, 0.97), and about disability for boys with a physical health problem (OR = 0.86, CI: 0.76, 0.99). Attending a school with more types of diversity education activities may protect vulnerable students against specific types of bias-based bullying and advance health equity. A diversity education is recommended as a key component of antibullying efforts and policy.

Cognitive factors influenced physical distancing adherence during the COVID-19 pandemic in a population-specific way.

Even early in the COVID-19 pandemic, adherence to physical distancing measures was variable, exposing some communities to elevated risk. While cognitive factors from the Health Belief Model (HBM) and resilience correlate with compliance with physical distancing, external conditions may preclude full compliance with physical distancing guidelines. Our objective was to identify HBM and resilience constructs that could be used to improve adherence to physical distancing even when full compliance is not possible. We examined adherence as expressed through 7-day non-work, non-household contact rates in two cohorts: 1) adults in households with children from Minnesota and Iowa; and 2) adults ≥50 years-old from Minnesota, one-third of whom had Parkinson's disease. We identified multiple cognitive factors associated with physical distancing adherence, specifically perceived severity, benefits, self-efficacy, and barriers. However, the magnitude, and occasionally the direction, of these associations was population-dependent. In Cohort 1, perceived self-efficacy for remaining 6-feet from others was associated with a 29% lower contact rate (RR 0.71; 95% CI 0.65, 0.77). This finding was consistent across all race/ethnicity and income groups we examined. The barriers to adherence of having a child in childcare and having financial concerns had the largest effects among individuals from marginalized racial and ethnic groups and high-income households. In Cohort 2, self-efficacy to quarantine/isolate was associated with a 23% decrease in contacts (RR 0.77; 95% CI 0.66, 0.89), but upon stratification by education level, the association was only present for those with at least a Bachelor's degree. Education also modified the effect of the barrier to adherence leaving home for work, increasing contacts among those with a Bachelor's degree and reducing contacts among those without. Our findings suggest that public health messaging tailored to the identified cognitive factors has the potential to improve physical distancing adherence, but population-specific needs must be considered to maximize effectiveness.

A cross sectional study of non-medical use of prescription opioids and suicidal behaviors among adolescents.

BACKGROUND: Non-medical use of prescription opioids (NMUPO), defined as taking an opioid in a manner or dose other than prescribed, taking someone else's, or for the feelings that it produces, has been reported by 5 to 20% of adolescents, and is associated with a two fold increase in suicidal behaviors among adolescents. Adolescents with long-term health problems (LTHP) have poorer mental health and may seek NMUPO for pain relief that is not obtained through standard care. For this study, we measured the association between NMUPO and suicidal behaviors, and further assessed effect modification by LTHP hypothesizing the association between NMUPO and suicidal behaviors was stronger for adolescents with LTHP. FINDINGS: For students with LTHP, 13.5% reported suicide ideation, while 8.0% of students without LTHP reported suicide ideation. For suicide attempt, 4.4% of students with LTHP reported a suicide attempt, while 2.1% of students without LTHP reported a suicide attempt. The proportion of students who reported suicide ideation and attempts increased with higher occasions of NMUPO. Adjusted logistic regression models found increased odds of suicide ideation (OR (95% CI): 1-5 occasions: 2.3 (2.0-2.6); > 6 occasions: 2.7 (2.2-3.8)) and suicide attempts (OR (95% CI): 1-5 occasions: 3.2 (2.7-3.7); > 6 occasions: 4.1 (3.1-5.3)) for students who reported NMUPO. An interaction term for NMUPO and LTHP was then added to the models. Effect modification was not present on the multiplicative scale. On the additive scale, evidence of effect modification was observed: higher risk was indicated for students with LTHP versus no LTHP for both suicide ideation (Predicted risk (95%CI): > 6 occasions NMUPO, LTHP: 0.24 (0.18-0.29); No LTHP: 0.16 (0.13-0.18)) and attempt (Predicted risk (95%CI): 1-5 occasions NMUPO, LTHP: 0.08 (0.07-0.10); No LTHP: 0.05 (0.05-0.06); > 6 occasions NMUPO, LTHP: 0.11 (0.07-0.15); No LTHP: 0.06 (0.05-0.08)). CONCLUSIONS: The results affirmed that NMUPO is associated with suicidal behaviors among adolescents. A pattern also emerged of higher risk of suicidal behaviors for those with LTHP who reported NMUPO. Areas of further inquiry should explore chronic medical or pain conditions as possible modifying pathways that could exacerbate the effects of NMUPO on suicidal behaviors specific to an adolescent population.

Cost, Severity and Prevalence of Agricultural-Related Injury Workers' Compensation Claims in Farming Operations from 14 U.S. States.

(1) Background: There is no national surveillance of agricultural injuries, despite agricultural occupations being among the most hazardous in the U.S. This effort uses workers' compensation (WC) data to estimate the burden of agricultural injuries and the likelihood of experiencing an injury by body part involved, cause, and nature in farming operations. (2) Methods: WC data from 2010 to 2016 provided by a large insurance company covering small to medium-sized farm operations from 14 U.S. states was used. We investigated the associations between injury characteristics and WC costs and the risk of having a more severe versus a less severe claim. The proportion of costs attributable to specific claim types was calculated. (3) Results: Of a total 1000 claims, 67% were medical only. The total cost incurred by WC payable claims (n = 866) was USD 21.5 million. Of this, 96% was attributable to more severe claims resulting in disabilities or death. The most common body part injured was the distal upper extremity. Falling or flying objects and collisions were the most expensive and common causes of injury. (4) Conclusions: Characterizing the cost and severity of agricultural injury by key injury characteristics may be useful when prioritizing prevention efforts in partnership with insurance companies and agricultural operations.

Examining the Association Between Age and Tractor Driving Performance Measures Using a High-Fidelity Tractor Driving Simulator.

HIGHLIGHTS This study uses a new tractor driving simulator to examine the impact of age on perception response time in an emergency braking situation. The results demonstrate increased risk for crash among older farm equipment operators. ABSTRACT. Transportation-related incidents are the leading cause of occupational fatalities for all industries in the U.S. In the agriculture industry, where tractor-related incidents are the leading cause of occupational fatality, fatal crashes occur more frequently among senior farm equipment operators (FEOs) than younger FEOs. This study examined the association between age and driving performance among FEOs using a simulated driving environment. We demonstrated that older FEOs have longer perception response times when encountering an incurring semi-truck during a simulated drive than younger FEOs. These results persisted when adjusted for selected medical diagnoses and medications, tractor generation, and tractor horsepower. However, due to the small sample size and limitations of the tractor driving simulator, its use for event perception response time research is questionable. The tractor driving simulator used in this study may be better suited for distracted driving studies and studies comparing the ways in which FEOs drive passenger vehicles compared to tractors.