Did the COVID-19 experience change U.S. parents' attitudes towards HPV vaccination? Results from a national survey.

BACKGROUND: In the U.S., uptake of the HPV vaccine remains below coverage goals. There is concern that negative reactions to emergency initiatives during the COVID-19 pandemic, including vaccination, may have increased some parents' hesitancy towards all vaccines, including HPV. Understanding how different parent populations view routine vaccination post-pandemic is key to strategic efforts to maintaining and increasing uptake of HPV vaccine. METHODS: In early 2022, we recruited an online panel of English-speaking U.S. parents and caregivers, who used the social media platform Twitter and had HPV vaccine-eligible but unvaccinated children age 9-14 years. Respondents completed a 20-minute survey measuring knowledge, attitudes and intentions regarding HPV vaccination for their child, as well as background socio-demographics and health information-seeking practices. Questions regarding experiences during the COVID-19 pandemic included changes in access to preventive care, and perceptions of whether pandemic experiences had positively or negatively affected their attitudes about routine vaccination, with open text capturing reasons for this change. RESULTS: Among 557 respondents, 81 % were definitely or likely to vaccinate their child against HPV, with 12 % being uncertain, and 7 % unlikely to vaccinate. Regarding routine vaccination, most (70 %) felt their attitudes had not changed, while 26 % felt more positively, and only 4 % felt more negatively. Reasons for positive attitude change included increased appreciation for vaccines overall, and motivation to proactively seek preventive care for their child. Negative attitude changes stemmed from distrust of COVID-19 public health efforts including vaccine development, and disillusionment with vaccines' ability to prevent disease. In multivariable models, intention to vaccinate was greater among parents reporting greater education, Democratic affiliation, greater religiosity, and urban residence. Negative attitude change due to the pandemic independently predicted reduced HPV vaccination intention, while positive attitude change predicted positive intention. CONCLUSIONS: Post-pandemic, most U.S. parents remain committed to vaccinating their children against HPV. However, addressing residual COVID-19 concerns could improve uptake among vaccine-hesitant parents.

Social Media, Public Health Research, and Vulnerability: Considerations to Advance Ethical Guidelines and Strengthen Future Research.

The purpose of this article is to build upon prior work in social media research and ethics by highlighting an important and as yet underdeveloped research consideration: how should we consider vulnerability when conducting public health research in the social media environment? The use of social media in public health, both platforms and their data, has advanced the field dramatically over the past 2 decades. Applied public health research in the social media space has led to more robust surveillance tools and analytic strategies, more targeted recruitment activities, and more tailored health education. Ethical guidelines when using social media for public health research must also expand alongside these increasing capabilities and uses. Privacy, consent, and confidentiality have been hallmarks for ethical frameworks both in public health and social media research. To date, public health ethics scholarship has focused largely on practical guidelines and considerations for writing and reviewing social media research protocols. Such ethical guidelines have included collecting public data, reporting anonymized or aggregate results, and obtaining informed consent virtually. Our pursuit of the question related to vulnerability and public health research in the social media environment extends this foundational work in ethical guidelines and seeks to advance research in this field and to provide a solid ethical footing on which future research can thrive.

"We adjusted for race": now what? A systematic review of utilization and reporting of race in American Journal of Epidemiology and Epidemiology, 2020-2021.

Race is a social construct, commonly used in epidemiologic research to adjust for confounding. However, adjustment of race may mask racial disparities, thereby perpetuating structural racism. We conducted a systematic review of articles published in Epidemiology and American Journal of Epidemiology between 2020 and 2021 to (1) understand how race, ethnicity, and similar social constructs were operationalized, used, and reported; and (2) characterize good and poor practices of utilization and reporting of race data on the basis of the extent to which they reveal or mask systemic racism. Original research articles were considered for full review and data extraction if race data were used in the study analysis. We extracted how race was categorized, used-as a descriptor, confounder, or for effect measure modification (EMM)-and reported if the authors discussed racial disparities and systemic bias-related mechanisms responsible for perpetuating the disparities. Of the 561 articles, 299 had race data available and 192 (34.2%) used race data in analyses. Among the 160 US-based studies, 81 different racial categorizations were used. Race was most often used as a confounder (52%), followed by effect measure modifier (33%), and descriptive variable (12%). Fewer than 1 in 4 articles (22.9%) exhibited good practices (EMM along with discussing disparities and mechanisms), 63.5% of the articles exhibited poor practices (confounding only or not discussing mechanisms), and 13.5% were considered neither poor nor good practices. We discuss implications and provide 13 recommendations for operationalization, utilization, and reporting of race in epidemiologic and public health research.

EMERG-ing data: Multi-city surveillance of workplace violence against EMS responders.

PROBLEM: Between 1980 and 2021, emergency medical services (EMS) calls experienced a 421% increase, while calls for fires declined by 55%. The more exposure, the more the opportunity for workplace violence (WPV). Due to the non- existence of a reporting system that captures physical and verbal violence, it has been difficult to quantify the degree of WPV experienced by the U.S. fire and rescue service. METHODS: To describe WPV in three large metropolitan fire departments, an existing data system was modified. The EMERG platform was selected because it is one of the most confidential data systems available to collect exposures. RESULTS: In a one-year pilot of EMERG, 126 events were reported. Verbal violence was present in 81% of all reports, with physical violence only at 19%. Patients were the most frequently reported assailant (73%).The most frequently reported injury was emotional stress (70%). Six percent of all injuries reported moderate-to-major physical injury severity, and 30% reported moderate-to-major mental injury severity. DISCUSSION: Verbal violence as a contributor to first responder stress is often underestimated. This pilot shows that it can and should be captured. That mental injury severity was consistently rated higher than physical injury severity across all injuries is not surprising given the prevalence of verbal violence reported and because physical violence has emotional sequela. SUMMARY: Data from the EMERG reporting system give us evidence, on a larger scale than has ever existed for the fire and rescue service, that verbal and physical violence, and the resultant emotional stress and mental injury severity, is an issue that needs further attention and resources. PRACTICAL APPLICATIONS: In order to ensure robust surveillance, it remains likely that triangulation of multiple data sources will still be required to approximate the true burden.

Random Walk Particle Tracking to Model Dispersion in Steady Laminar and Turbulent Pipe Flow.

To accurately model a two-dimensional solute transport in drinking water pipes and determine the effective dispersion coefficients for one-dimensional water quality models of water distribution systems, a random walk particle tracking approach was developed to analyze the advection and dispersion processes in circular pipes. The approach considers a solute particle's two-dimensional random movement caused by molecular or turbulent diffusion and associated velocity profile, and can simulate any mixing time and accurately model the longitudinal distribution of the solute concentration. For long mixing times, the simulation results agreed with a previous analytically derived solution. For turbulent flow conditions, simulations showed that the longitudinal dispersion of the solute is very sensitive to the utilized cross-sectional velocity profiles. This approach is easy to implement programmatically and unconditionally stable. It can predict the mixing characteristics of a pipe under various initial and boundary conditions.

Relative Water Age in Premise Plumbing Systems Using an Agent-Based Modeling Framework.

Tools used to predict hydraulics and water quality within premise plumbing systems have gained recent interest. An open-source Python-based tool-PPMtools-for modeling and analyzing premise plumbing systems with WNTR or EPANET is presented. A relative water age-the time water has spent in a home-study using three real-world single-family homes was used to demonstrate PPMtools. Results showed that increased use-more people or higher flow fixtures-led to a general decrease in relative water ages. However, even with more use, one user could still experience water for a drinking activity with a relative water age equal to, or longer than, the duration of the longest stagnant period (sleeping or absence from home). Simulations also showed that the general relative water ages increased if the homes were plumbed with larger diameter piping [19.1 mm (3/4 in.) versus 12.7 mm (1/2 in.)]. Hot water heaters were found to have the largest impact on relative water age. Smaller volume uses generally had more variability in relative water ages, while larger volume uses (e.g., showering) resulted in generally low relative water ages with less variability because larger uses fully replaced water in the home with water from the main. This study highlights the potential for using PPMtools to explore more complex water quality modeling within premise plumbing systems.

Assessing the Mental Health Impact of the COVID-19 Pandemic on US Fire-Based Emergency Medical Services Responders: A Tale of Two Samples (The RAPID Study I).

OBJECTIVE: This study aimed to examine the COVID-19 pandemic's impact on fire service safety culture, behavior and morale, levers of well-being, and well-being outcomes. METHODS: Two samples (Stress and Violence against fire-based EMS Responders [SAVER], consisting of 3 metropolitan departments, and Fire service Organizational Culture of Safety [FOCUS], a geographically stratified random sample of 17 departments) were assessed monthly from May to October 2020. Fire department-specific and pooled scores were calculated. Linear regression was used to model trends. RESULTS: We observed concerningly low and decreasing scores on management commitment to safety, leadership communication, supervisor sensegiving, and decision-making. We observed increasing and concerning scores for burnout, intent to leave the profession, and percentage at high risk for anxiety and depression. CONCLUSIONS: Our findings suggest that organizational attributes remained generally stable but low during the pandemic and impacted well-being outcomes, job satisfaction, and engagement. Improving safety culture can address the mental health burden of this work.

Responding to Ontario's Overdose Crisis in the Context of the COVID-19 Pandemic.

The COVID-19 pandemic has exacerbated the overdose crisis in Canada. Using data from ICES and the Office of the Chief Coroner of Ontario, the authors characterized changing patterns of medication use and health services utilization during the pandemic. This analysis suggests that responses to the overdose crisis must confront the rapidly changing unregulated drug supply with a tailored response that addresses varied population needs, expands accessible treatment and harm reduction services and responds to the missed opportunities for engagement and support within various healthcare settings.

Near real-time event detection for watershed monitoring with CANARY.

Illicit discharges in surface waters are a major concern in urban environments and can impact ecosystem and human health by introducing pollutants (e.g., petroleum-based chemicals, metals, nutrients) into natural water bodies. Early detection of pollutants, especially those with regulatory limits, could aid in timely management of sources or other responses. Various monitoring techniques (e.g., sensor-based, automated sampling) could help alert decision makers about illicit discharges. In this study, a multi-parameter sensor-driven environmental monitoring effort to detect or identify suspected illicit spills or dumping events in an urban watershed was supported with a real-time event detection software, CANARY. CANARY was selected because it is able to automatically analyze data and detect events from a range of sensors and sensor types. The objective of the monitoring project was to detect illicit events in baseline flow. CANARY was compared to a manual illicit event identification method, where CANARY found > 90% of the manually identified illicit events but also found additional unidentified events that matched manual event identification criteria. Rainfall events were automatically filtered out to reduce false alarms. Further, CANARY results were used to trigger an automatic sampler for more thorough analyses. CANARY was found to reduce the burden of manually monitoring these watersheds and offer near real-time event detection data that could support automated sampling, making it a valuable component of the monitoring effort.

Identifying the changing age distribution of opioid-related mortality with high-frequency data.

BACKGROUND: Opioid-related mortality continues to rise across North America, and mortality rates have been further exacerbated by the COVID-19 pandemic. This study sought to provide an updated picture of trends of opioid-related mortality for Ontario, Canada between January 2003 and December 2020, in relation to age and sex. METHODS: Using mortality data from the Office of the Chief Coroner for Ontario, we applied Bayesian Poisson regression to model age/sex mortality per 100,000 person-years, including random walks to flexibly capture age and time effects. Models were also used to explore how trends might continue into 2022, considering both pre- and post-COVID-19 courses. RESULTS: From 2003 to 2020, there were 11,633 opioid-related deaths in Ontario. A shift in the age distribution of mortality was observed, with the greatest mortality rates now among younger individuals. In 2003, mortality rates reached maximums at 5.5 deaths per 100,000 person-years (95% credible interval: 4.0-7.6) for males around age 44 and 2.2 deaths per 100,000 person-years (95% CI: 1.5-3.2) for females around age 51. As of 2020, rates have reached maximums at 67.2 deaths per 100,000 person-years (95% CI: 55.3-81.5) for males around age 35 and 16.8 deaths per 100,000 person-years (95% CI: 12.8-22.0) for females around age 37. Our models estimate that opioid-related mortality among the younger population will continue to grow, and that current conditions could lead to male mortality rates that are more than quadruple those of pre-pandemic estimations. CONCLUSIONS: This analysis may inform a refocusing of public health strategy for reducing rising rates of opioid-related mortality, including effectively reaching both older and younger males, as well as young females, with health and social supports such as treatment and harm reduction measures.

Model Policies to Protect U.S. Fire-Based EMS Responders From Workplace Stress and Violence.

The stress and violence to fire-based emergency medical service responders (SAVER) Systems-Level Checklist is an organizational-level intervention to address stress and violence in emergency medical service (EMS), focused on the development of policy and training. Fire and EMS leadership, first responders, dispatchers, and labor union representatives participated in the SAVER Model Policy Collaborative to develop model policies that resulted from the most feasible checklist items. ThinkLets technology was employed to achieve consensus on the model policies, and an Action SWOT analysis was then conducted to assess facilitators and barriers to policy implementation. The resultant model policies are a systems-level workplace violence intervention for the U.S. fire and rescue service that is ready for implementation. Expected improvements to organizational outcomes such as burnout, job engagement, and job satisfaction are anticipated, as are decreasing assaults and injuries. The SAVER Model Policies have the potential to inform national standards and regulations on workplace violence in EMS.

The Use of Cremation Data for Timely Mortality Surveillance During the COVID-19 Pandemic in Ontario, Canada: Validation Study.

BACKGROUND: Early estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province. OBJECTIVE: This study aimed to validate the use of cremation data as a timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality. METHODS: Cremation records from January 2020 until April 2021 were compared to the historical records from 2017 to 2019, grouped according to week, age, sex, and whether COVID-19 was the cause of death. Cremation data were compared to Ontario's provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 accounted for the entirety of the excess mortality. RESULTS: Between 2017 and 2019, cremations were performed for 67.4% (95% CI 67.3%-67.5%) of deaths. The proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within 3 weeks of the date of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI 14.6%-19.3%) in all-cause mortality, a finding that was confirmed several months later with cremation data. CONCLUSIONS: The percentage of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies.

Trends in Hospitalizations for Serious Infections Among People With Opioid Use Disorder in Ontario, Canada.

OBJECTIVES: Opioid use among people who inject drugs can lead to serious complications, including infections. We sought to study trends in rates of these complications among people with an opioid use disorder (OUD) and the sequelae of those hospitalizations. METHODS: We analyzed all inpatient hospitalizations for serious infections (infective endocarditis [IE], spinal infections, nonvertebral bone infections, and skin or soft tissue infections) among people with OUD in Ontario between 2013 and 2019. We reported the population adjusted rate of hospitalizations for serious infections annually, stratified by type of infection and prevalence of prior opioid agonist therapy and hydromorphone prescribing. We reported characteristics of hospitalizations and 30-day mortality in the most recent 2 years. RESULTS: Among people with OUD there was a 167% increase in rates of IE (7.7-20.6 per million residents; P < 0.01), a 394% increase in rates of spinal infections (3.4-16.8 per million residents; P < 0.01), a 191% increase in rates of nonvertebral bone infections (8.9 to 25.9 per million residents; P < 0.01), and a 147% increase in infections of the skin or soft tissue (32.1-79.4 per million residents; P < 0.01) over 7 years in Ontario. Death in-hospital and within 30 days of discharge was highest among those with IE (11.5% and 15.9%, respectively), and lower among those with other infections (<5%). CONCLUSIONS: Rates of serious infections among people with OUD are rising, placing a significant burden on patients. These findings suggest that early intervention and treatment of infections in this population are needed to prevent downstream harm.

Performance and Resilience Analysis of a New York Drinking Water System to Localized and System-Wide Emergencies.

Drinking water utilities are vulnerable to both human-caused and natural disasters that can impact the system infrastructure and the delivery of potable water to consumers. Analyzing system performance and resilience can help utilities identify areas of high risk or concern, understand the impacts on consumers, and evaluate response actions during disasters. In this case study, the Water Network Tool for Resilience (WNTR) was used to investigate the performance and resilience of a drinking water system in New York during increased demands due to firefighting, pipe damage, and loss of the source water emergencies. This case study introduced a new combined performance index (CPI) resilience metric, which served to quantify system resilience as a ratio of system performance during an emergency to normal operations. The results revealed that this drinking water system was able to maintain service to most of the consumers during these emergencies due to high redundancy within the system, and conservation efforts extended water service for an additional 20 h. The analysis in this paper can be used by other drinking water utilities to understand their vulnerabilities and evaluate resilience-improving actions in similar disaster scenarios.

Development of Personas to Communicate Narrative-Based Information About the HPV Vaccine on Twitter.

Introduction: Personas are based on real-life typologies of people that can be used to create characters and messages to communicate important health information through relatable narrative storylines. Persona development is data-driven and can involve multiple phases of formative research and evaluation; however, personas are largely underutilized in digital health research. The purpose of this study was to create and document persona development to deliver narrative-focused health education for parents on Twitter with the goal of increasing uptake of HPV vaccination among adolescents. Methods: Leveraging data from a mixed-method study conducted in the U.S. with a diverse population of parents with adolescents ages 9-14, we used both qualitative and quantitative data (e.g., the National Immunization Survey-Teen, focus groups, and social media) to create personas. These data sources were used to identify and develop key characteristics for personas to reflect a range of parents and their diverse understandings and experiences related to HPV vaccination. A parent advisory board provided insight and helped refine persona development. Results: Four personas emerged and were characterized as the (1) Informed Altruist, (2) Real Talker, (3) Information Gatherer, and (4) Supporter. Characteristics differed across personas and provided insights into targeted narrative strategies. Described attributes included demographics, psychographics, communication style, vaccine goals and aspirations, vaccine challenges and frustrations, and vaccine hesitancy. Discussion: This work demonstrates how multiple data sources can be used to create personas to deliver social media messages that can address the diverse preferences and needs of parents for HPV vaccine information. With increasing usage of social media for health information among parents, it is important for researchers to consider marketing and design thinking to create health communication messages that resonate with audiences.

Lagrangian Method to Model Advection-Dispersion-Reaction Transport in Drinking Water Pipe Networks.

A Lagrangian method to simulate the advection, dispersion, and reaction of a single chemical, biological, or physical constituent within drinking water pipe networks is presented. This Lagrangian approach removes the need for fixed computational grids typically required in Eulerian and Eulerian-Lagrangian methods and allows for nonuniform computational segments. This makes the method fully compatible with the advection-reaction water quality engine currently used in EPANET. An operator splitting approach is used, in which the advection-reaction process is modeled before the dispersion process for each water quality step. The dispersion equation is discretized using a segment-centered finite-difference scheme, and flux continuity boundary conditions are applied at network junctions. A staged approach is implemented to solve the dispersion equation for interconnected pipe networks. First, a linear relationship between the boundary and internal concentrations is established for every pipe. Second, a symmetric and positive definite linear system of equations is constructed to calculate the concentrations at network junctions. Last, pipe internal concentrations are updated based on the junction concentrations. The solution generates exact results when the analytical solutions are available and leads to more accurate water quality simulations than advection-reaction-only water quality models, especially in the areas where dispersion dominates advection.

Evaluating Manual Sampling Locations for Regulatory and Emergency Response.

Drinking water systems commonly use manual or grab sampling to monitor water quality, identify or confirm issues, and verify that corrective or emergency response actions have been effective. In this paper, the effectiveness of regulatory sampling locations for emergency response is explored. An optimization formulation based on the literature was used to identify manual sampling locations to maximize overall nodal coverage of the system. Results showed that sampling locations could be effective in confirming incidents for which they were not designed. When evaluating sampling locations optimized for emergency response against regulatory scenarios, the average performance was reduced by 3%-4%, while using optimized regulatory sampling locations for emergency response reduced performance by 7%-10%. Secondary constraints were also included in the formulation to ensure geographical and water age diversity with minimal impact on the performance. This work highlighted that regulatory sampling locations provide value in responding to an emergency for these networks.

Meeting science meets public health: Results from the "Stress and Violence in fire-based EMS Responders (SAVER)" Systems Checklist Consensus Conference (SC3).

INTRODUCTION: In order to implement a systems-level Emergency Medical Services (EMS) workplace violence intervention, input from end users was critically needed. We convened the two-day Stress and Violence in fire-based EMS Responders (SAVER)" Systems Checklist Consensus Conference (SC3) using methods from meeting science (i.e., ThinkLets) to comprehensively and efficiently gather feedback from stakeholders on the completeness and utility of the draft checklist that would comprise the intervention. METHODS: ThinkLets, a codified facilitation technique was used to aid brainstorming, convergence, organization, evaluation, and consensus building activities on the SAVER Systems Checklist among 41 national stakeholders during a two-day conference. A qualitative and quantitative process evaluation was conducted to measure the effectiveness of conference procedures. To verify checklist feasibility results from the conference, a second feasibility assessment was conducted with the four implementation sites. CONCLUSIONS: The quantitative conference evaluation results indicated most participants viewed the conference process favorably. Emergent themes reflecting on conference effectiveness and suggestions for improvements are described. The re-evaluation of the checklist's feasibility completed by the SAVER study sites confirmed prior feasibility findings. SAVER study sites cast 45.5% of votes on checklist items to be most feasible, 34.9% as less feasible, and 19.6% as extremely difficult. Practical Applications: Multidisciplinary collaboration between public health, occupational health psychology, and meeting science led to the development of the SAVER Systems Checklist. The checklist underscores important needs for EMS policy and training development critical to responder safety as identified and supported by over 41 diverse subject matter experts. The incorporation of a widely used meeting science method, ThinkLets, into public health intervention design proved an effective and well-received approach to bring assessment, evaluation, and consensus to the SAVER Systems Checklist. These methods may hold benefit for other industries and disciplines that may not be familiar with such facilitation and consensus-building techniques.

Framework for Modeling Lead in Premise Plumbing Systems Using EPANET.

The lead contamination of drinking water in homes and buildings remains an important public health concern. In order to assess strategies to measure and reduce exposure to lead from drinking water, models are needed that incorporate the multiple factors affecting lead concentrations in premise plumbing systems (PPS). In this study, the use of EPANET, a commonly used hydraulic and water quality model for water distribution systems, was assessed for its ability to predict lead concentrations in PPS. The model was calibrated and validated against data collected from multiple experiments in the EPA's Home Plumbing Simulator that contained a lead service line and other lead sources. The EPANET's first-order saturation kinetics model was used to simulate the dissolution of lead in the lead service line. A version of EPANET was developed to include one-dimensional mass dispersion. Modeling results were compared to experimental data, and recommendations were made to improve the EPANET-based modeling framework for predicting lead concentrations in PPS.