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Restrictive housing for control purposes (RHCP, a form of solitary confinement) is used in prisons in response to disruptive behaviors, including violence. North Carolina prisons introduced the rehabilitative diversion unit (RDU) in 2016 as an alternative to and step-down from RHCP. We compared rates of psychiatric treatment and self-injury among men enrolled in the RDU and men eligible for the RDU but placed in RHCP. We used Poisson regression to calculate rate ratios (RRs) and 95% confidence intervals (CIs) for these outcomes, using inverse probability of treatment weights to adjust for confounders. The cohort included 1,225 men in the RDU group and 3,059 in the RHCP group. In RHCP, the adjusted psychiatric treatment rate was 2.6 times (95% CI: 1.8, 3.8) and the adjusted self-injury incident rate was 1.2 times (95% CI: 0.6, 2.8) that in RDU. Nearly all self-injury incidents in RDU occurred during "non-participating time" (i.e., in a restrictive housing setting and not actively participating in RDU). After excluding non-participating time from the RDU group's person time, the adjusted RR for self-injury incidents was 23.5 (95% CI: 8.6, 64.2). These results further knowledge of potential benefits of diversion from restrictive housing. Continued development, implementation, and evaluation is needed.
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BACKGROUND: Vision Zero aims to eliminate serious and fatal road injuries using a Safe System approach. Safe System principles establish that safety is a shared responsibility; this involves both multisector partners and community engagement. This descriptive study explored multisector partners and community engagement in the development of municipal Vision Zero plans. METHODS: We reviewed all first edition Vision Zero plans published by US municipalities from 2014 to 2022. Using a structured coding tool, we abstracted partner involvement and community engagement strategies used in the development of Vision Zero plans. RESULTS: We identified, reviewed and abstracted 64 plans. The average number of partner groups per plan was 11.5 (12.0 for municipalities with a population ≥150 000; 10.1 for municipalities <150 000) and was higher for later plans (11.9 for plans published 2019-2022; 10.0 for plans published 2014-2018). Common partner groups engaged in the plan were law enforcement (85.9% of plans), local transportation planning (78.3%), mayor/city council/city manager (78.1%), engineering/public works (78.1%) and schools (73.4%). Community engagement strategies were reported in 71.9% of the plans and were more frequent among municipalities with a population ≥150 000 (76.1%) compared with a population <150 000 (61.1%), and in those with more recent plans (82.1%) versus earlier ones (56.0%). The most common community engagement strategies were public meetings, online surveys and map mark-ups. CONCLUSIONS: These findings highlight the extent to which Vision Zero plans were aligned with core Safe System tenets regarding diverse partner involvement and community engagement. Plan developers should consider the translation of Safe System principles in Vision Zero plan development.
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CONTEXT: Vision Zero (VZ) aims to reduce fatalities and serious injuries from road traffic crashes to zero through multidisciplinary coordination. While public health officials are often recognized as critical to VZ, their involvement in VZ across the United States has not been quantified. OBJECTIVE: To explore how United States public health officials were involved in VZ development and implementation. DESIGN: We used a mixed-method design including a quantitative assessment of VZ plans and in-depth interviewing with VZ coordinators. SETTING: United States. PARTICIPANTS: Twenty-two in-depth interviews with municipal (n = 12) and regional (n = 10) VZ coordinators and 43 VZ plans were reviewed. MAIN OUTCOME MEASURE: Public health involvement in VZ development and implementation. RESULTS: In the United States, 64 municipalities and 21 regional entities had first-time VZ plans published between 2014 and 2022. We abstracted a sample of municipal (n = 22) and all (n = 21) regional plans. Most plans described key groups involved in plan development (municipal 81.8%, regional 100%). About two-thirds (67.4%; 59.1% municipal, 76.2% regional) of the plans noted public health officials in the plan development. Most plans described the principles forming the foundation of their plan (83.7%), but few mentioned public health as part of the plan principles (22.7% municipal, 14.3% regional). Public health officials were involved in engaging the community (9.1% municipal, 33.3% regional) and providing data (22.7% municipal, 52.4% regional) for plan development, as documented in the plans. For proposed implementation, public health officials were identified as involved in: community engagement (31.8% municipal, 42.9% regional), sharing/analyzing data (40.9% municipal, 33.3% regional), and identifying/providing funding sources (13.6% municipal, 4.8% regional). The in-depth interviews provided further context and a more detailed understanding of public health involvement in VZ. CONCLUSIONS: Evidence from the VZ plans and interviews provided examples of how public health officials engaged in the development and implementation of VZ initiatives.
Subject(s)
Public Health , Humans , United States , Public Health/methods , Public Health/statistics & numerical data , Public Health/trends , Accidents, Traffic/statistics & numerical data , Accidents, Traffic/prevention & control , Accidents, Traffic/trends , Qualitative Research , Interviews as Topic/methodsABSTRACT
OBJECTIVE: Rates of death due to homicide, suicide and overdose during pregnancy and the first year postpartum have increased substantially in the USA in recent years. The aims of this study were to use 2018-2019 data on deaths identified for review by the North Carolina Maternal Mortality Review Committee (NC-MMRC), data from the North Carolina Violent Death Reporting System (NC-VDRS) and data from the Statewide Unintentional Drug Overdose Reporting System (NC-SUDORS) to examine homicide, suicide and unintentional opioid-involved overdose deaths during pregnancy and the first year postpartum. METHODS: We linked data from the 2018-2019 NC-MMRC to suicide and homicide deaths among women ages 10-50 years from the 2018-2019 NC-VDRS and to unintentional opioid-involved overdose deaths among women ages 10-50 years from the 2018-2019 NC-SUDORS. We conducted descriptive analyses to examine the prevalence of demographic characteristics and the circumstances surrounding each cause of death. RESULTS: From 2018 to 2019 in North Carolina, there were 23 homicides, nine suicides and 36 unintentional opioid-involved overdose deaths (9.7, 3.8 and 15.1 per 100 000 live births, respectively) during pregnancy and the first year postpartum. Most homicide deaths (87.0%) were by firearm, and more than half (52.5%) were related to intimate partner violence. More than two-thirds of women who died by suicide had a current mental health problem (77.8%). Less than one-fourth (22.2%) of those who died by unintentional opioid-involved overdose had a known history of substance use disorder treatment. CONCLUSION: Our approach to quantifying and describing these causes of pregnancy-associated death can serve as a framework for other states to inform data-driven prevention.
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BACKGROUND/PURPOSE: License suspensions are a strategy to address alcohol-impaired driving behavior and recidivism following an alcohol driving while impaired (alcohol-DWI) conviction. Little is known about the specific impacts of conviction-related suspensions on safety outcomes and given recent fluctuations in alcohol-impaired driving behavior, crashes, and suspension trends, updated and focused assessments of this intervention are necessary. This study aimed to 1) examine the association between type of recent alcohol-DWI suspension and having a secondary alcohol-related license outcome and/or future crash event in North Carolina (NC) between 2007 and 2016; and 2) assess potential modification of these associations by race/ethnicity. METHODS: We used linked NC licensing data, NC crash data, and county-level contextual data from a variety of data sources. We compared individuals ages 21 to 64 who sustained initial (1-year) versus repeat (4-year) suspensions for alcohol-related license and crash involvement outcomes. We estimated unadjusted and adjusted hazard ratios (aHRs) using Cox proportional hazards models and produced Kaplan-Meier (KM) survival curves using a three-year follow-up period. After observing statistically significant modification by race/ethnicity, we calculated stratified aHRs for each outcome (Black and White subgroups only, as other subgroups had low numbers of outcomes). RESULTS: 122,002 individuals sustained at least one alcohol-DWI conviction suspension (117,244 initial, 4,758 repeat). Adjusted KM survival curves indicated that within three years of the index suspension, the predicted risks of having a license outcome and crash outcome were about 8 % and 15 %, respectively, among individuals with an initial suspension and 5 % and 10 %, respectively, among individuals with a repeat suspension. After adjusting for potential confounding, we found that compared to those with an initial suspension, those with repeat suspensions had a lower incidence of future license (aHR: 0.49; 95 % CI: 0.42, 0.57) and crash outcomes (aHR: 0.67; 95 % CI: 0.60, 0.75). Among Black individuals, license outcome incidence was 162 % lower among repeat versus initial index suspension groups (aHR: 0.38; 95 % CI: 0.26, 0.55), while for White individuals, the incidence was 87 % lower (aHR: 0.54; 95 % CI: 0.45, 0.64). Similarly, crash incidence for repeat versus initial suspensions among Black individuals was 56 % lower (aHR: 0.64; 95 % CI: 0.50, 0.83), while only 39 % lower among White individuals (aHR: 0.72; 95 % CI: 0.63, 0.81). CONCLUSIONS: Decreased incidence of both license and crash outcomes were observed among repeat versus initial index suspensions. The magnitude of these differences varied by race/ethnicity, with larger decreases in incidence among Black compared to White individuals. Future research should examine the underlying mechanisms leading to alcohol-impaired driving behavior, convictions, recidivism, and crashes from a holistic social-ecological perspective so that interventions are designed to both improve road safety and maximize other critical public health outcomes, such as access to essential needs and services (e.g., healthcare and employment).
Subject(s)
Accidents, Traffic , Automobile Driving , Humans , Accidents, Traffic/prevention & control , North Carolina/epidemiology , Ethanol , Motor VehiclesABSTRACT
INTRODUCTION: Food insecurity is associated with the development of substance misuse and use disorders (SUD). This study sought to estimate associations between state Supplemental Nutrition Assistance Program (SNAP) eligibility policies and substance-related outcomes. METHODS: 2014-2017 SNAP Policy Database and 2015-2019 National Survey on Drug Use and Health state-level estimates were used to estimate associations between state SNAP eligibility policies and alcohol use disorder (AUD), opioid misuse, illicit drug use disorder (IDUD), SUD, and needing but not receiving SUD treatment. State SNAP policies included those that (1) do not disqualify individuals with a felony drug conviction from SNAP and/or (2) expand SNAP eligibility by increasing the income limit or removing the asset test. Analyses were conducted January-May 2023. RESULTS: States that adopted both SNAP eligibility policies had reduced rates of AUD (adjusted rate ratio (aRR): 0.92; 95% CI 0.86, 0.99), opioid misuse (aRR: 0.94; 95% CI 0.89, 0.98), IDUD (aRR: 0.91; 95% CI 0.85, 0.98), SUD (aRR: 0.91; 95% CI 0.85, 0.97), and needing but not receiving SUD treatment (aRR: 0.92; 95% CI 0.87, 0.98) compared to states with neither policy. Among states that did not adopt increases to the income limit or removal of the asset test, those that removed the felony drug disqualification had lower rates of IDUD, SUD, and needing but not receiving SUD treatment, compared to those that maintained a disqualification. CONCLUSIONS: Expanded SNAP eligibility could help reduce rates of substance misuse and SUD. Opting out of the federal disqualification on SNAP participation for those with felony drug convictions may be particularly beneficial.
Subject(s)
Alcoholism , Food Assistance , Opioid-Related Disorders , Humans , United States/epidemiology , Poverty , Income , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/prevention & controlABSTRACT
Long-term impacts of the COVID-19 pandemic on racial and ethnic disparities in motor vehicle crash (MVC) injuries and death are poorly understood. This study aimed to characterize trends and investigate the heterogeneity of MVC-related disparities in North Carolina across several data sources. Crash reports, emergency department visit records, and death certificates from 2018 to 2021 were used to calculate monthly population-rates of MVC-related public health outcomes. We estimated trendlines using joinpoint regression and compared outcomes across racial and ethnic classifications. MVC and MVC-related injury rates declined in conjunction with NC's stay-at-home order, while rates of severe outcomes remained unimpacted. By December 2021 rates of MVC-related outcomes met or exceeded pre-pandemic levels, with the highest rates observed among non-Hispanic Black individuals. Racial and ethnic disparities in MVC-related outcomes remained prevalent throughout the COVID-19 pandemic. These results highlight the importance of a holistic approach to traffic injury surveillance when assessing the impact of MVCs.
Subject(s)
COVID-19 , Pandemics , Humans , North Carolina/epidemiology , COVID-19/epidemiology , Accidents, Traffic/prevention & control , Motor VehiclesABSTRACT
Economic stress, broadly defined, is associated with an increased likelihood of multiple forms of violence. Food insecurity is a distinct economic stressor and material hardship that is amenable to programmatic and policy intervention. To inform intervention and identify gaps in the current evidence base, we conducted a systematic review to synthesize and critically evaluate the existing literature regarding the association between food insecurity and five forms of interpersonal and self-directed violence: intimate partner violence (IPV), suicidality, peer violence and bullying, youth dating violence, and child maltreatment, in high-income countries. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and searched six electronic databases from their start date through February of 2022. We included studies that examined food insecurity as the exposure and an outcome measure of IPV, suicide, suicidality, peer violence, bullying, youth dating violence, or child maltreatment; were peer-reviewed and published in English; reported quantitative data; and took place in a high-income country. We identified 20 relevant studies. Nineteen studies found that food insecurity was associated with an increased likelihood of these forms of violence. Results highlight the potential for programs and policies that address food insecurity to function as primary prevention strategies for multiple forms of violence and underscore the importance of trauma-informed approaches in organizations providing food assistance. Additional theory-driven research with validated measures of food insecurity and clearly established temporality between measures of food insecurity and violence is needed to strengthen the existing evidence base.
Subject(s)
Bullying , Child Abuse , Intimate Partner Violence , Adolescent , Child , Humans , Violence , Intimate Partner Violence/prevention & control , Food InsecurityABSTRACT
BACKGROUND: State expansion of Supplemental Nutrition Assistance Program (SNAP) eligibility under broad-based categorical eligibility (BBCE) is associated with decreases in household poverty and food insecurity, child protective services investigations, and mental health and substance use disorders among adults, key contributors to foster care entry. OBJECTIVE: To examine the association of state expansion of SNAP eligibility under BBCE with rates of foster care entries. PARTICIPANTS: Foster care entries among children ages <18 years. METHODS: We used 2005-2019 data from the SNAP Policy Database and the Adoption and Foster Care Analysis and Reporting System (AFCARS). We conducted difference-in-differences analyses and generated event study plots adjusting for state economic conditions (percent population unemployed, median household income) and policies (minimum wage, refundable Earned Income Tax Credits, maximum Temporary Assistance for Needy Families benefit for a family of 3). RESULTS: On average, there were 1.8 fewer foster care entries (95 % confidence interval (CI) -2.8, -0.8) per 1000 children per year in states that expanded SNAP eligibility than there would have been if they had not expanded eligibility. Average decreases in foster care entries were similar among young (-1.7 per 1000 children per year, 95 % -3.1, -0.3) and school-age (-1.8 per 1000 children per year, 95 % CI -2.7, -0.8) children and larger among Black non-Hispanic (-5.6 per 1000 children per year, 95 % CI -9.1, -2.0) than among White non-Hispanic (-1.4 per 1000 children per year, 95 % CI -2.2, -0.6) children. The magnitude of these decreases increased with greater time since policy adoption. CONCLUSIONS: Results add to growing evidence that programs and policies that support and stabilize household economic and material conditions may contribute to reductions in foster care entries at the population-level.
Subject(s)
Food Assistance , Child , Humans , Ethnicity , Income , Poverty , United States/epidemiology , Black or African American , White , Foster Home CareABSTRACT
BACKGROUND: Individuals who commit acts of violence in prisons are often placed in highly controlled environments called restrictive housing (i.e., solitary confinement), which can have severe physical and mental health consequences and does not reduce violence. As such, North Carolina prisons have introduced the rehabilitative diversion unit (RDU) to reduce the use of restrictive housing and reduce violence in prison. METHODS: We evaluated the effect of the RDU on prison infractions. We compared rates of infractions by type (including violent infractions) among men enrolled in the RDU and men who were eligible for the RDU but placed in restrictive housing for control purposes (RHCP). We also evaluated sustained program impacts by comparing the hazard of first infraction among these same two groups of men after program completion, when they had returned to the general prison population. Finally, we compared the hazard of first promotion to a less restrictive custody level (medium custody) when these men had returned to the general prison population. RESULTS: The primary analytic cohort was made up of 3128 men contributing 897,822 person-days. Adjusted rates of violent infractions were lower in the RDU than in RHCP (adjusted rate ratio: 0.6; 95% CI: 0.4, 1.1). All other categories of infractions, including drug-related infractions, occurred at higher rates during RDU, as compared to RHCP. In analyses of sustained program impacts, for most categories of infractions, there were no differences in the hazard of first infraction post-RDU and post-RHCP. However, the hazard of violent infraction post-RDU was higher (adjusted hazard ratio: 2.1; 95% CI: 1.1, 4.0) than post-RHCP. The hazard of promotion to a less restrictive custody level was higher post-RDU (adjusted hazard ratio: 17.4; 95% CI: 7.2, 42.2) than post-RHCP. CONCLUSIONS: We found the RDU program may be effective in reducing violence for men enrolled in the program, but that these benefits were not sustained. Continued programming may be a useful tool to transition men from the programmatically intensive environment of the RDU to the general prison population. Additionally, we recommend the expansion of evidence-based treatment for substance use disorder.
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BACKGROUND: To provide insight into the longitudinal dynamics of opioid use throughout the overdose crisis, this study estimated the separate influences of age, period and cohort on prescription opioid use during 1999-2018 in the USA. METHODS: Data from 10 cycles of the cross-sectional National Health and Nutrition Examination Survey were used to conduct an age-period-cohort analysis of the prevalence of prescription opioid use (n=63 500 across 1999-2018). Temporal trends were graphically visualised. The median polish approach was used to estimate age, period and cohort-related effects on prescription opioid use. RESULTS: Prescription opioid use broadly increased across the lifespan, with steeper prevalence increases observed from young adulthood to mid-adulthood. Period-related variation was consistent with recognised nationwide declines in opioid prescribing. While there was no evidence of systematic cohort effects, compared with individuals born in 1951-1954, those born during 1963-1966 had greater prescription opioid use (prevalence ratio (PR)=1.23, 95% CI: 1.05 to 1.43), whereas the 1991-1994 and 1999-2002 cohorts had lower prescription opioid use (PR91-94=0.70, 95% CI: 0.50 to 0.98; PR99-02=0.72, 95% CI: 0.63 to 0.81). CONCLUSION: In the USA, longitudinal trends in prescription opioid use during 1999-2018 were predominantly driven by age and period influences. The cohort of youngest baby boomers experienced greater prescription opioid use, whereas recent-born cohorts have had lower use. As the overdose crisis continues evolving, such population-level characterisations of age, period and cohort dynamics are instrumental in understanding opioid use and can inform prevention and intervention approaches by identifying population groups more likely to use opioids who, thus, may also experience related outcomes.
Subject(s)
Drug Overdose , Opioid-Related Disorders , Humans , United States/epidemiology , Aged , Young Adult , Adult , Analgesics, Opioid/therapeutic use , Cross-Sectional Studies , Nutrition Surveys , Practice Patterns, Physicians' , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/drug therapy , Prescriptions , Drug Overdose/epidemiologyABSTRACT
PURPOSE: To examine racial and ethnic differences and COVID-19 pandemic-related changes in key characteristics of drug overdose deaths in North Carolina. METHODS: We used North Carolina State Unintentional Drug Overdose Reporting System data to describe specific drug-involvement, bystander presence, and naloxone administration for drug overdose deaths by race and ethnicity during pre-COVID-19 (May 2019-February 2020) and COVID-19 periods (March 2020-December 2020). RESULTS: For all racial and ethnic groups, drug overdose death rates and the percentage with fentanyl and alcohol involvement increased from the pre-COVID-19 to COVID-19 period, with fentanyl involvement highest among American Indian and Alaska Native (82.2%) and Hispanic (81.4%) individuals and alcohol involvement highest among Hispanic individuals (41.2%) during the COVID-19 period. Cocaine involvement remained high among Black non-Hispanic individuals (60.2%) and increased among American Indian and Alaska Native individuals (50.6%). There was an increase in the percentage of deaths with a bystander present from the pre-COVID-19 to COVID-19 period for all racial and ethnic groups, with more than half having a bystander present during the COVID-19 period. There was a decrease in the percentage of naloxone administered for most racial and ethnic groups, with the lowest percentage among Black non-Hispanic individuals (22.7%). CONCLUSIONS: Efforts to address increasing inequities in drug overdose deaths, including expanded community naloxone access, are needed.
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Importance: Food insecurity is associated with an increased likelihood of poor mental health and suicidality. The Supplemental Nutrition Assistance Program (SNAP) is the largest program addressing food insecurity in the US; under broad-based categorical eligibility (BBCE), states have the option to expand SNAP eligibility to a greater number of households by eliminating the asset test or increasing the income limit for eligibility. Objectives: To examine the association of state elimination of the asset test and increases in the income limit for SNAP eligibility with rates of mental health and suicidality outcomes among adults. Design, Setting, and Participants: This ecological cross-sectional study used 2014 to 2017 data on US adults from the National Vital Statistics System and 2015 to 2019 data on US adults from the National Survey on Drug Use and Health (NSDUH) State-Level Small Area Estimates. Analyses were conducted between September and November 2022. Exposures: State elimination of the asset test only and state adoption of both SNAP eligibility policies (ie, state elimination of the asset test and increases in the income limit) for 2014 to 2017 from the SNAP Policy Database. Main Outcomes and Measures: Number of adults with a past-year major depressive disorder, mental illness, serious mental illness, or suicidal ideation and number of adults who died by suicide. Results: Analyses included 407â¯391 adult NSDUH participants and 173â¯085 adults who died by suicide. State elimination of the asset test only was associated with decreased rates of past-year major depressive episodes (rate ratio [RR], 0.92; 95% CI, 0.87-0.98) and mental illness (RR, 0.91; 95% CI, 0.87-0.97) among adults. State adoption of both SNAP eligibility policies (ie, state elimination of the asset test and increases in the income limit) was associated with decreased rates of past-year major depressive episodes (RR, 0.92; 95% CI, 0.86-0.99), mental illness (RR, 0.92; 95% CI, 0.87-0.98), serious mental illness (RR, 0.91; 95% CI, 0.84-0.99), and suicidal ideation (RR, 0.89; 95% CI, 0.82-0.96). Results suggested a decreased rate of suicide death (RR, 0.93; 95% CI, 0.84-1.02) in states with both policies compared with states with neither policy, although this result was not statistically significant. Conclusions and Relevance: State adoption of policies that expand SNAP eligibility may contribute to decreased rates of multiple mental health and suicidality outcomes at the population level.
Subject(s)
Depressive Disorder, Major , Food Assistance , Suicide , Humans , Adult , Suicidal Ideation , Poverty , Mental Health , Cross-Sectional Studies , Depressive Disorder, Major/epidemiologyABSTRACT
INTRODUCTION: Growth of e-commerce has caused a vast increase in parcel delivery, which raises concern for safety of drivers and other road users as more deliveries take place. METHODS: This project analyzes injury/illness and fatality trends among workers with delivery-related NAICS codes using three major sources of occupational hazard data in the United States: the Survey of Occupational Illnesses and Injuries, the Census of Fatal Occupational Injuries, and the Industrial Tracking Application. Descriptive statistics were employed to illustrate trends over time as well as to highlight opportunities for improved data collection and dissemination. RESULTS: The number of injuries to drivers has risen sharply over the past decade. Some of this increase appears due to growth of this industry, but increasing overall rates suggest the industry is becoming more hazardous. While nonfatal injuries were typically caused by continuous workplace exposures (e.g., repetitive strain, contact with object/equipment), fatalities were almost exclusively caused by transportation incidents. Additionally, crucial aspects of these trends are difficult or impossible to analyze given the current data landscape. CONCLUSIONS: Observed trends reinforce earlier calls for additional scrutiny of working conditions that threaten drivers. Injuries caused by transportation incidents are likely more severe than others and highlight the danger the transportation system poses to drivers and others. Current data collection and dissemination processes offer room to improve in terms of understanding how to prevent future injuries.
Subject(s)
Occupational Diseases , Occupational Injuries , Humans , United States/epidemiology , Accidents, Occupational , Occupational Injuries/epidemiology , Workplace , IndustryABSTRACT
Vision Zero (VZ) aims to reduce fatalities and serious injuries from road traffic crashes to zero through a Safe Systems approach. Little is known about the extent of uptake of VZ in the United States (US), or the attributes and functioning of the initiatives. Using a mixed-methods design, our objectives were to describe the status of VZ implementation and characteristics of those initiatives among US municipalities. Websites of all US municipalities with a population of at least 50,000 (n = 788) were searched to identify involvement in VZ. When initiatives were identified, we abstracted information from their website and other published documents, using a comprehensive framework of best practice VZ components. From the VZ initiatives identified, we interviewed representatives from 12 municipalities with diversity by region of the country, population size, and VZ implementation. Interviews were recorded, transcribed, and coded for themes. Through systematic web-based searching, we identified 86 of 788 (10.9%) municipalities with a VZ initiative. Among 314 larger municipalities (population >=100,000), 68 (21.7%) were identified. Among 476 medium-size municipalities (population of 50,000-99,999), 18 (3.8%) were identified. VZ initiatives began as early as 2014, starting with larger municipalities, and followed in 2015 with medium-size municipalities. Among the VZ initiatives, 58 (67.4%) recorded a vision statement, with 51 (59.3%) setting a target year to reach zero deaths. Thirty-nine (45.3%) had published VZ plans, with another 22 (25.6%) working towards a plan. Twenty-five initiatives (29.1%) shared resources across stakeholder groups, such as funding or staff. Forty-six initiatives (53.5%) had an established coalition, and 18 (20.9%) proposed or were developing a coalition. Twenty-six initiatives (30.2%) provided regular updates or evaluation on progress towards performance metrics, but only 4 (4.7%) had implemented a performance management system to regularly track progress on VZ-related actions. The interviews provided further context and a more detailed understanding of results. Documenting the characteristics of VZ initiatives among US municipalities can contribute to an understanding of current practice, potential opportunities to support ongoing initiatives, and information to assist new initiatives. Ultimately, the impact of municipal-level VZ efforts should be evaluated with regards to traffic-related serious injuries and fatalities.
Subject(s)
Accidents, Traffic , Benchmarking , Humans , United States , Accidents, Traffic/prevention & control , CitiesABSTRACT
Importance: States in the US have the option to eliminate the asset test and/or increase the income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility under a policy called broad-based categorical eligibility (BBCE). Given associations of economic hardships, including food insecurity, with child protective services (CPS) involvement, state adoption of these policies may be associated with changes in rates of CPS-investigated reports. Objective: To examine the association of state elimination of the asset test and increases in the income limit for SNAP eligibility under BBCE with rates of CPS-investigated reports. Design, Setting, and Participants: This cross-sectional ecologic study used data from 2006 to 2019 obtained from the SNAP Policy Database and the National Child Abuse and Neglect Data System Child Files and difference-in-differences analyses. The data were analyzed from March to September 2022. The study used CPS-investigated reports for suspected child abuse and neglect from 37 US states to examine elimination of the asset test, from 36 states to examine increases in the income limit, and from 26 states to examine adoption of both policies. Exposures: State elimination of the asset test, increases in the income limit, and adoption of both policies to expand SNAP eligibility. Main Outcomes and Measures: Number of CPS-investigated reports, overall and specifically for neglect and physical abuse, per 1000 child population. Results: From 2006 to 2019 for all 50 states and the District of Columbia, there were a total of 29â¯213â¯245 CPS-investigated reports. By race and ethnicity, 19.8% of CPS-investigated reports were among non-Hispanic Black children and 45.7% among non-Hispanic White children (hereafter referred to as Black and White children). On average, there were 8.2 fewer CPS-investigated reports (95% CI, -12.6 to -4.0) per 1000 child population per year in states that eliminated the asset test, 5.0 fewer CPS-investigated reports (95% CI, -10.8 to 0.7) per 1000 child population per year in states that increased the income limit, and 9.3 fewer CPS-investigated reports (95% CI, -15.6 to -3.1) per 1000 child population per year in states that adopted both SNAP policies than there would have been if these states had not adopted these policies. There were decreases in CPS-investigated reports for neglect in states that adopted either or both policies, and small decreases in CPS-investigated reports for physical abuse in states that increased the income limit or adopted both policies. There were decreases in CPS-investigated reports among both Black and White children. For example, there were 6.5 fewer CPS-investigated reports among Black children (95% CI, -14.6 to 1.6) and 8.7 fewer CPS-investigated reports among White children (95% CI, -15.8 to -1.6) in states that adopted both SNAP policies than there would have been if these states had not adopted these policies. Conclusions and Relevance: Results from this cross-sectional study suggest that state expansion of SNAP eligibility through elimination of the asset test and increases in the income limit may contribute to decreases in rates of CPS-investigated reports. These results can inform ongoing debates regarding SNAP policy options, specifically BBCE, and prevention efforts for child abuse and neglect.
Subject(s)
Food Assistance , Humans , Child , United States , Cross-Sectional Studies , Child Protective Services , Income , EthnicityABSTRACT
Introduction: In 2020, the COVID-19 pandemic prompted community officials to initiate local level environmental and policy changes to slow the spread of infection and provide more opportunities for outdoor recreation. Changes in both regards could positively or negatively impact walking and bicycling. Using a mixed methods approach, the purpose of this United States-based study was to systematically describe municipal response to the pandemic at the community level through environmental and policy changes that may have impacted walking and bicycling. Methods: Websites of all United States' municipalities with a residential population of at least 100,000 (n = 314) were searched to identify environmental and policy changes that might impact walking/bicycling as a result of the pandemic. When actions were identified, we systematically abstracted information from the websites. To provide more contextual information, we interviewed representatives from 12 municipalities about changes made at the municipal level as a result of the pandemic that could impact walking and bicycling. Interviews were recorded, transcribed, and coded for themes. Results: For the 314 municipalities, we identified 353 actions resulting from the COVID-19 pandemic that may impact walking and bicycling. Approximately double the number of actions were identified in large-size municipalities (234 actions in 157 municipalities with population≥165,000) compared to mid-size municipalities (119 actions among 157 municipalities with population 100,000 to 164,999). Generally, fewer actions that might suppress walking and bicycling (n = 59) were identified in comparison to actions that would likely facilitate walking and bicycling (n = 294). In-depth interviews provided further context and insight into these results. Conclusion: This mixed-method assessment provides an overview of the environmental and policy changes which may impact walking and bicycling that municipalities implemented in 2020 due to the pandemic. A next step in this line of inquiry is to quantify the impact of these changes on population levels of walking and bicycling and related health and safety outcomes.
ABSTRACT
BACKGROUND: There are complex associations between insomnia symptoms and misuse of prescription drugs. The aim of this study was to examine prospective associations between insomnia symptoms and prescription opioid and benzodiazepine misuse among a nationally representative sample of adults. METHODS: Utilizing data from the National Longitudinal Study of Adolescent to Adult Health (N = 10,685), we conducted log-binomial regression to examine associations of insomnia symptoms at Wave IV (2008-2009; 24-32 years) with prescription opioid and benzodiazepine misuse at Wave V (2016-2018; 33-43 years). We adjusted analyses for prior insomnia symptoms and substance misuse, as well as potential demographic and health-related confounders. RESULTS: Each unit increase in insomnia symptoms at Wave IV was associated with a small increase in the likelihood of prescription opioid (RR = 1.08, 95 % CI 1.01, 1.15) but not benzodiazepine (RR = 1.09, 95 % CI 0.99, 1.21) use at Wave V. Both prescription opioid (ß = 0.20, 95 % CI 0.09, 0.031) and benzodiazepine (ß = 0.21, 95 % CI 0.10, 0.33) misuse at Wave IV had small associations with elevated insomnia symptoms at Wave V. CONCLUSIONS: Results support associations between prescription opioid and benzodiazepine misuse and later insomnia symptoms. There was a small association between insomnia symptoms and later prescription opioid misuse worthy of future study. These results fit within a broad line of research suggesting that insomnia symptoms are associated with future substance use and vice versa. Future research is needed explore mechanisms (e.g., mental health, pain) underlying these associations.