Deployment to Military Bases With Open Burn Pits and Respiratory and Cardiovascular Disease.

Importance: Many veterans who served in Afghanistan and Iraq during Operations Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) were deployed to military bases with open burn pits and exposed to their emissions, with limited understanding of the long-term health consequences. Objective: To determine the association between deployment to military bases where open burn pits were used for waste disposal and the subsequent risk of developing respiratory and cardiovascular diseases. Design, Setting, and Participants: This retrospective observational cohort study used Veterans Health Administration medical records and declassified deployment records from the Department of Defense to assess Army and Air Force veterans who were deployed between 2001 and 2011 and subsequently received health care from the Veterans Health Administration, with follow-up through December 2020. Data were analyzed from January 2023 through February 2024. Exposure: Duration of deployment to military bases with open burn pits. Main Outcomes and Measures: Diagnosis of asthma, chronic obstructive pulmonary disease, interstitial lung disease, hypertension, myocardial infarction, congestive heart failure, ischemic stroke, and hemorrhagic stroke. Results: The study population included 459 381 OEF and OIF veterans (mean [SD] age, 31.6 [8.7] years; 399 754 [87.0%] male). Median (IQR) follow-up from end of deployment was 10.9 (9.4-12.7) years. For every 100 days of deployment to bases with burn pits, veterans experienced increased adjusted odds for asthma (adjusted odds ratio [aOR], 1.01; 95% CI, 1.01-1.02), chronic obstructive pulmonary disease (aOR, 1.04; 95% CI, 1.02-1.07), hypertension (aOR, 1.02; 95% CI, 1.02-1.03), and ischemic stroke (aOR, 1.06; 95% CI, 0.97-1.14). Odds of interstitial lung disease, myocardial infarction, congestive heart failure, or hemorrhagic stroke were not increased. Results based on tertiles of duration of burn pit exposures were consistent with those from the continuous exposure measures. Conclusions and Relevance: In this cohort study, prolonged deployment to military bases with open burn pits was associated with increased risk of developing asthma, COPD, and hypertension. The results also point to a possible increased risk in ischemic stroke. The novel ability to use integrated data on deployment and health outcomes provides a model for additional studies of the health impact of environmental exposures during military service.

The Impact of ABAWD Time Limit Reinstatement on SNAP Participation and Employment.

OBJECTIVE: Estimate the impact of the Supplemental Nutrition Assistance Program (SNAP) time limit for able-bodied adults without dependents (ABAWD) on SNAP participation, employment, and earnings. DESIGN: A quasi-experimental study using state administrative SNAP and earnings data to compare outcomes for SNAP participants before and after the time limit went into effect. PARTICIPANTS: Supplemental Nutrition Assistance Program participants in the study cohorts in Colorado, Missouri, and Pennsylvania (N = 153,599). MAIN OUTCOME MEASURES: Monthly SNAP participation, quarterly employment, annual earnings. ANALYSIS: Logistic and ordinary least squares multivariate regression models. RESULTS: Time limit reinstatement reduced SNAP participation by 7 to 32 percentage points in the 12th month of time limit reinstatement but did not generate evidence of improved employment or annual earnings (1 year after time limit reinstatement, employment decreased by 2 to 7 percentage points and annual earnings decreased by $247 to $1,230). CONCLUSIONS AND IMPLICATIONS: The ABAWD time limit reduced SNAP participation but did not improve employment and earnings. SNAP may provide helpful support to participants as they seek to enter or re-enter employment, and removing this support may be detrimental to their employment prospects. These findings can inform decisions about requesting waivers or pursuing changes to ABAWD legislation or regulations.

Benefits of Multiple Sclerosis Adult Day Program Participation for People with Multiple Sclerosis: A Qualitative Study.

BACKGROUND: Multiple sclerosis adult day programs (MSADPs) are nonmedical service programs that provide care and support to people with multiple sclerosis (MS) experiencing levels of impairment that interfere with employment and activities of daily living. The purpose of this study was to identify how program participants think MSADPs benefit them. METHODS: We conducted in-depth interviews with 95 people with MS who were MSADP participants. Interviews occurred as part of site visits to ten programs across the country. We supplemented participant interviews with interviews of program staff and ethnographic observation of activities at each site over 1 to 3 days. RESULTS: Participants reported several benefits from participating in an MSADP. Almost universally, participants explained that receiving and giving social support were the most important benefits. Other positive outcomes described included increased emotional well-being, better understanding and acceptance of MS, practical know-how for accomplishing ordinary tasks, and increased mobility and improved motor functioning. CONCLUSIONS: Participants believe that MSADPs have a profound influence on their psychosocial health, much of which they attribute to membership in a socially cohesive community. Clinicians and policy makers should consider recommending these programs for people with MS who have unmet psychosocial needs and experience functional impairments.

Multiple Sclerosis Adult Day Programs and Health-Related Quality of Life of Persons with Multiple Sclerosis and Informal Caregivers.

BACKGROUND: Multiple sclerosis adult day programs (MSADPs) offer life-enhancing services for individuals and informal caregivers affected by multiple sclerosis (MS), including medical care, rehabilitation therapies, nutrition therapy, cognitive training, tailored education, exercise programs, and social interaction. The purpose of this study was to examine the effects of MSADPs on health-related quality of life (HRQOL) and health care utilization of persons with MS and HRQOL and well-being of informal caregivers. METHODS: Using a quasi-experimental design, outcomes between baseline and 1-year follow-up in persons with MS and informal caregivers who used MSADP services and a comparison group of similar persons with MS and caregivers who did not use MSADP services were compared. For persons with MS, outcomes included standardized measures of physical and mental HRQOL and health care utilization. For caregivers, outcomes included physical and mental HRQOL and well-being. Changes in outcomes between baseline and follow-up were examined using propensity score-weighted difference-in-differences regression analysis. RESULTS: For persons with MS, MSADP use had a significant positive effect on 12-Item Short Form Health Survey physical component scores, although the difference was not clinically meaningful. Use of MSADPs did not have effects on any other outcomes for persons with MS or caregivers. CONCLUSIONS: Use of MSADPs did not show a clinically meaningful effect on HRQOL for persons with MS or informal caregivers. The MSADPs do not seem to offer sustained benefits to persons with MS or caregivers, but the possibility of initial short-term benefits cannot be ruled out.

Genomic Analysis Identifies Novel Pseudomonas aeruginosa Resistance Genes under Selection during Inhaled Aztreonam Therapy In Vivo.

Inhaled aztreonam is increasingly used for chronic Pseudomonas aeruginosa suppression in patients with cystic fibrosis (CF), but the potential for that organism to evolve aztreonam resistance remains incompletely explored. Here, we performed genomic analysis of clonally related pre- and posttreatment CF clinical isolate pairs to identify genes that are under positive selection during aztreonam therapy in vivo We identified 16 frequently mutated genes associated with aztreonam resistance, the most prevalent being ftsI and ampC, and 13 of which increased aztreonam resistance when introduced as single gene transposon mutants. Several previously implicated aztreonam resistance genes were found to be under positive selection in clinical isolates even in the absence of inhaled aztreonam exposure, indicating that other selective pressures in the cystic fibrosis airway can promote aztreonam resistance. Given its potential to confer plasmid-mediated resistance, we further characterized mutant ampC alleles and performed artificial evolution of ampC for maximal activity against aztreonam. We found that naturally occurring ampC mutants conferred variably increased resistance to aztreonam (2- to 64-fold) and other ß-lactam agents but that its maximal evolutionary capacity for hydrolyzing aztreonam was considerably higher (512- to 1,024-fold increases) and was achieved while maintaining or increasing resistance to other drugs. These studies implicate novel chromosomal aztreonam resistance determinants while highlighting that different mutations are favored during selection in vivo and in vitro, show that ampC has a high maximal potential to hydrolyze aztreonam, and provide an approach to disambiguate mutations promoting specific resistance phenotypes from those more generally increasing bacterial fitness in vivo.

Burn Pit Emissions Exposure and Respiratory and Cardiovascular Conditions Among Airborne Hazards and Open Burn Pit Registry Participants.

OBJECTIVE: The aim of this study was to determine how burn pit emissions exposure is associated with the incidence of respiratory and cardiovascular conditions. METHODS: We examined the associations between assumed geographic and self-reported burn pit emissions exposure and respiratory and cardiovascular outcomes in participants of the Airborne Hazards and Open Burn Pit Registry. RESULTS: We found significant dose-response associations for higher risk of self-reported emphysema, chronic bronchitis, or chronic obstructive pulmonary disease with increased days of deployment within 2 miles of selected burn pits (P-trend = 0.01) and self-reported burn pit smoke exposure (P-trend = 0.0005). CONCLUSIONS: We found associations between burn pit emissions exposure and higher incidence of post-deployment self-reported respiratory and cardiovascular conditions, but these findings should be interpreted with caution because the surrogate measurements of burn pit emissions exposure in this analysis may not reflect individual exposure levels.

Switching Schools: Reconsidering the Relationship Between School Mobility and High School Dropout.

Youth who switch schools are more likely to demonstrate a wide array of negative behavioral and educational outcomes, including dropping out of high school. However, whether switching schools actually puts youth at risk for dropout is uncertain, since youth who switch schools are similar to dropouts in their levels of prior school achievement and engagement, which suggests that switching schools may be part of the same long-term developmental process of disengagement that leads to dropping out. Using data from the National Longitudinal Survey of Youth 1997, this study uses propensity score matching to pair youth who switched high schools with similar youth who stayed in the same school. We find that while over half the association between switching schools and dropout is explained by observed characteristics prior to 9th grade, switching schools is still associated with dropout. Moreover, the relationship between switching schools and dropout varies depending on a youth's propensity for switching schools.

The relationship between school engagement and delinquency in late childhood and early adolescence.

Engagement in school is crucial for academic success and school completion. Surprisingly little research has focused on the relationship between student engagement and delinquency. This study examines whether engagement predicts subsequent school and general misconduct among 4,890 inner-city Chicago elementary school students (mean age: 11 years and 4 months; 43.3% boys; 66.5% black; 28.8% Latino). To improve upon prior research in this area, we distinguish three types of engagement (emotional, behavioral, and cognitive), examine whether the relationship between engagement and misconduct is bidirectional (misconduct also impairs engagement), and control for possible common causes of low engagement and misconduct, including peer and family relationships and relatively stable indicators of risk-proneness. Emotional and behavioral engagement predict decreases in school and general delinquency. However, cognitive engagement is associated with increases in these outcomes. School and general delinquency predict decreased engagement only in the cognitive domain. Suggestions for future research and implications for policy are discussed.