Examining media reports of pediatric unintentional firearm injury deaths for prevention messaging concerning secured storage of firearms: U.S., 2021-2022.

BACKGROUND: Media outlets that report on firearm injuries and deaths may provide an important role in emphasizing safe storage practices, particularly when unintentional firearm injuries and deaths occur among young children. There has been a scarcity of research on aspects of media reports on injuries, particularly concerning prevention messaging. The objective of the present study was to examine prevention messaging on the safe storage of firearms among media outlets when reporting on unintentional firearm injury deaths among children aged 0-11. METHODS: The Gun Violence Archive collects information from media sources regarding firearm injuries and deaths. We analyzed data from 2021 to 2022 to analyze prevention messaging incorporated into the media reports. We then examined if media reporting of events that occurred in States with child access prevention (CAP) laws had a higher likelihood of including prevention messaging compared to those events occurring in States without CAP laws. RESULTS: There were 223 deaths reported that were attributed to unintentional firearm discharge among children aged 0-11. Prevention messages were delivered in 61 of the 223 incidents. Specific messages which included the word "lock" when referring to firearm storage were included in 21.9% of all incidents. An analysis examining State CAP laws and the presence of any prevention message per event did not yield any discernable relationship. CONCLUSION: Inclusion of prevention messaging stating that firearms should be stored locked and unloaded when reporting on unintentional firearm injury deaths among children is lacking. When specific prevention messaging was included, the source was often law enforcement. Public health officials may play an important role in educating the journalistic and law enforcement communities about the inclusion of safe storage messages when reporting on firearm deaths.

Pediatric Poisonings Associated With Ingestion of Marijuana Products.

BACKGROUND: Rapid changes in marijuana legislation have resulted in a wider array of products containing tetrahydrocannabinol (THC) to be legally manufactured and sold, such as edibles in the form of gummy candies and cookies. These products may be enticing to young children who mistake them for typical snack foods. OBJECTIVE: Our aim was to describe emergency department (ED) visits due to unintentional ingestion of cannabis products among children aged birth to 11 years old in the United States. METHODS: Using the 2019-2020 National Electronic Injury Surveillance System, U.S. ED records for poisoning events related to ingestion of THC were examined. Descriptive epidemiologic analyses were conducted to provide national estimates of the pediatric visits. RESULTS: An estimated 1245 pediatric patient visits related to unintentional marijuana poisoning occurred. Most poisonings involved edible marijuana products and most patients were admitted to the hospital. CONCLUSIONS: Cannabis edibles present a challenge with regard to prevention of poisonings among the pediatric population. Legislation or company policies pertaining to packaging and manufacturing are needed to limit the attraction of toddlers and young children, as well reliance on parents and caregivers for safe storage of the products. Continued and expanded public health education campaigns are warranted.

Stair-related falls in the USA: traumatic brain injury and the role of alcohol intoxication.

INTRODUCTION: Falls are a leading cause of head injury in the USA. Stair-related fall injuries are common and often more serious than same level falls. Alcohol is a known contributor to unintentional injuries, and often associated with fall-related injuries, specifically falls occurring on stairs. The objective was to examine the association between alcohol use and head injuries (traumatic brain injuries (TBIs) or craniomaxillofacial (CMF) injuries) among persons aged 15-64 presenting to an emergency department (ED) with an injury resulting from a fall on stairs. METHODS: Using the 2019 National Electronic Injury Surveillance System, US ED records were examined. Injuries due to falling on stairs were retrieved, with the role of alcohol in the outcome of TBI and CMF injuries examined. Prevalence ratios (PR), adjusted for covariates (blood alcohol level screening, patient demographics, drug use, disposition) were obtained from average marginal predictions derived from logistic regression models. RESULTS: An estimated 687 902 patient visits related to falls on stairs occurred during the study period. Patients who presented with alcohol intoxication had a higher prevalence of TBI (PR 2.7 95% CI 2.3 to 3.1) and CMF injuries (PR 2.5; 95% CI 2.3 to 2.8). PRs were more pronounced among patients with blood alcohol concentration ≥0.1, as was hospital admission. CONCLUSIONS: Stair-related falls represent a common cause of ED visits for falls in the USA. Alcohol intoxication had a detrimental effect on the prevalence of TBI and CMF. A multimodal treatment approach may be beneficial given the complex interrelationship between the injury type and alcohol.

Bicycle Injuries Associated With Drug Use in the United States, 2019-2020.

OBJECTIVE: The purpose of this study was to analyze the descriptive epidemiology of bicycle-related injuries associated with substances of abuse other than alcohol and to examine types of drugs involved and injury diagnoses. METHOD: We used data from the 2019-2020 National Electronic Injury Surveillance System (NEISS) among persons seeking treatment in emergency departments in the United States. RESULTS: There were 11,314 bicycle injuries related to drug use. The most common drug reported was methamphetamine, followed by marijuana and opioids. The majority of injuries were fractures or internal organ injuries. Alcohol was involved in 22.3% of these incidents, and 32.3% of those injured were admitted to the hospital. CONCLUSIONS: Drug-related bicycle injuries are a significant public health issue. Prevention and control of these injuries is needed, but will likely prove to be difficult because of the variety of circumstances involved but will be aided by the expansion of quality surveillance data and further research examining the circumstances surrounding the injuries.

Using the PRAPARE Tool to Examine Those Tested and Testing Positive for COVID-19 at a Community Health Center.

The PRAPARE (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences) tool is an instrument that has been used to assess social determinants of health within community health centers in the US. We sought to examine the association between PRAPARE scores and getting tested for and testing positive with the SARS-CoV-2 virus. We used medical record data collected from a community health center in the US between March-August 2020. Employing logistic regression analyzes, we explored the association between demographic factors, history of screening positive for depression, and PRAPARE scores and patients' odds of getting tested and testing positive for COVID-19. While variables such as ethnicity mirrored similar findings from other sources, we found the PRAPARE score to be associated with increased odds of being tested for COVID-19; however, it was not significantly associated with testing positive. These findings can help health care workers and health educators craft messages to explain screening protocols for communicable diseases, such as COVID-19, to best reach vulnerable populations.

Driving after marijuana use among U.S. adolescents: Prevalence profiles and related behaviors.

OBJECTIVES: The interplay between marijuana legislation, perceptions of risks associated with marijuana use, and marijuana-related risk behaviors is an ever changing and complex issue. Marijuana impaired driving is of concern as legalization continues to expand in the United States. While driving after using marijuana has been shown to be prevalent among adults, little research has examined the behavior in adolescents. The aim of the present study was to examine the prevalence of driving after using marijuana among U.S. adolescents, with an examination of the relationship to age of marijuana initiation and marijuana usage patterns. METHODS: We analyzed data from the 2017 Youth Risk Behavior Survey, a nationally representative sample of high schools students in the U.S. The sample was current marijuana users, defined as past 30 day use. Driving after using marijuana was the main outcome variable, with analyses examining the association between the outcome and age of initiation and patterns of use. Prevalence ratios were obtained by modeling Poisson regression to examine factors associated with driving under the influence of marijuana. RESULTS: Nearly half of all marijuana users reported driving after use during the past 30 days, and did not differ between males and females. Prevalence of driving after using marijuana was significantly higher among heavy users (PR = 2.8; 95% CI 2.1-3.6). A higher prevalence of driving after drinking alcohol (PR = 1.7; 95% CI 1.5-1.9) was also found among those who had driven after using marijuana. CONCLUSIONS: Among adolescent marijuana users, the prevalence of driving after using marijuana was high. Enhanced surveillance, prevention, and control measures are necessary to mitigate the negative impacts of marijuana consumption and related behaviors.

Hand injuries associated with reaching into a snow blower to clear clogged snow.

INTRODUCTION: Hand injuries represent the most common and potentially serious injuries associated with the use of snow blowers. Little research has been conducted on a national scale to examine these types of injuries. Therefore, the purpose of the study was to examine hand injuries among patients treated in an emergency department (ED) related to attempting to clear snow out of a clogged snow blower. METHODS: Data were obtained from the National Electronic Injury Surveillance System for the years 2009-2017. National estimates of ED visits for hand injuries associated with the use of a snow blower were analyzed by nature of injury, age, and disposition. Trends in age adjusted rates were also obtained. RESULTS: During the 10 year period, there were 27,826 hand injuries treated in emergency departments associated with the use of snow blowers. The majority of the injuries were fractures and lacerations, with an additional 22% being amputations. The majority (95%) were among males and most occurred among middle aged adults. Overall, hand injuries associated with the use of snow blowers declined during the study period. CONCLUSIONS: Hand injuries remain the main threat of injury among snow blower operators. While trends are declining, given the seriousness of the injuries involved, further public health education campaigns and design modifications are warranted.

College Student E-cigarette Use: A Reasoned Action Approach Measure Development.

Objectives: The purpose of this study was to develop and validate an instrument using the reasoned action approach (RAA) to measure recreational electronic cigarette (e-cigarette) use among college students. Methods: Using a multi-phase, cross-sectional design, a 32-item measure was developed, and the factor structure was explored and confirmed using an exploratory factor analysis (EFA; N = 369) and confirmatory factor analysis (CFA; N = 320), respectively. An exploratory structural equation model (ESEM) and SEM also were employed to examine the relationships between latent constructs and to test the application of the RAA. Results: After removing 9 items, the EFA identified 3 RAA constructs (intention, attitude, social norms), and the ESEM established moderate model fit. The CFA confirmed the 3 factors; however, acceptable model fit was not met until a global social norm variable was loaded onto injunctive and descriptive norms. Based on this 5-factor solution, attitudes (ß = .35, p < .001) and social norms (ß = .50, p <.001) significantly predicted intention to use e-cigarettes. Conclusions: Attitudes and social norms influence college students' intention to use e-cigarettes and should be addressed via health education messaging and prevention programs.

Disparities in Health Care Coverage Among U.S. Born and Mexican/Central American Born Labor Workers in the U.S.

We examined health insurance coverage among U.S. and Mexican/Central American (M/CA) born labor workers living in the U.S. Using data from the 2010-2015 National Health Interview Survey, we employed logistic regression models to examine health insurance coverage and covariates among U.S. and M/CA born labor workers. Prevalence ratios between U.S. and M/CA born workers were also obtained. U.S. born workers had double the prevalence of insurance coverage. Regarding private insurance coverage, U.S. born workers had a higher prevalence of coverage compared to their M/CA born counterparts. Among foreign born workers with U.S. citizenship, the odds of having insurance coverage was greater than that of noncitizens. Additionally, those who had lived in the U.S. for 10 or more years had higher odds of having health insurance coverage. Disparities in health care coverage exist between U.S. born and foreign born labor workers.

Paid Sick Leave Benefits and Adherence to Recommended Screening Tests Among Male Labor Workers in the United States.

OBJECTIVE: We examined the association between availability of paid sick leave and health care utilization and screenings in male labor workers in the United States, and hypothesize that workers with paid sick leave benefits would be more likely to utilize health services. METHODS: Using the 2013 to 2016 National Health Interview Survey (NHIS), labor workers (n = 8553), aged 18 to 64 years, were examined. Logistic regression analyses assessed the association between availability of paid sick leave and the use of preventive services. RESULTS: Thirty-five percent indicated paid sick leave benefits. Participants with available sick leave were more likely to have received screenings and to have utilized heath care services or had a dental visit in the past year. CONCLUSIONS: Availability of paid sick leave to labor workers may increase their use of preventive health care services. Policy that mandates paid sick leave is warranted.

Emergency Department Visits for Hand and Finger Injuries Associated with the Use of Log Splitters.

The purpose of this study was to examine patients treated in an emergency department (ED) for injuries related to the use of log splitters. Data were obtained from the National Electronic Injury Surveillance System for the years 2011-2014. National estimates of ED visits for injuries associated with the use of log splitters were obtained, and descriptive epidemiological characteristics are presented. An estimated 37,000 ED visits for injuries related to the use of log splitters occurred during the study period. The majority of injuries occurred to the hand, with lacerations, fractures/avulsions, and amputations being the most common. The findings indicate that injuries from log splitters constitute a serious public health problem. Efforts to reduce injuries are discussed in accordance with the inherent challenges of detailing the circumstances surrounding these injuries.

Electronic cigarette initiation among minority youth in the United States.

BACKGROUND: Electronic cigarettes (e-cigarette) use among youth is a pressing public health issue, with prevalence of use surpassing that of tobacco cigarettes. While research concerning e-cigarettes has proliferated in recent years, there is a dearth of information regarding those whose first exposure to tobacco products was an e-cigarette. OBJECTIVES: To examine factors associated with e-cigarette initiation among minority youth in the United States. METHODS: Data on minority students in middle and high schools in the United States derived from the 2014 National Youth Tobacco Survey (NYTS) were sampled (weighted N = 27,294,454). We examined e-cigarette initiation among minority youth using logistic regression models to identify related factors. RESULTS: In 2014, 736,158 minority youth were e-cigarette initiators. Odds of e-cigarette initiation was highest among Hispanic youth [adjusted odds ratio (AOR) = 2.70; 95% confidence interval (CI) = 1.60-4.56]. Exposure to e-cigarette advertising (AOR = 1.64; 95% CI = 1.07-2.50), perceptions of little to no harm (AOR = 7.08; 95% CI = 4.03-12.46), and believing e-cigarettes were less addictive than tobacco (AOR = 2.15; 95% CI = 1.52-3.02) were associated with e-cigarette initiation. CONCLUSIONS: Odds of initiating e-cigarette use was highest among Hispanic youth. Among minority youth, e-cigarette initiation was associated with perceptions of harm and addiction potential, as well as exposure to e-cigarette advertising. Therefore, prevention efforts targeting minority youth who are at risk of becoming e-cigarette initiators may benefit by incorporating these factors into prevention campaigns.

2015 Legislative update of e-cigarette youth access and exposure laws.

BACKGROUND: As of November 15, 2013, 22 states had passed laws explicitly addressing youth access to electronic cigarettes (e-cigarettes); by 2014, this increased to 41 states. Also in 2014, more than 13.4% of youth in the U.S. reported using e-cigarettes, making e-cigarette use more prevalent than conventional cigarette use (9.2%). METHODS: We examined 221 bills addressing youth access and exposure to e-cigarettes between January 1 and November 1, 2015. Text searches on individual state general assembly websites and secondary sources were employed for data collection. Laws were analyzed using seven measures identified to protect adolescents from nicotine initiation and use. RESULTS: Two states (MI, PA) and Washington D.C. do not regulate the sale or distribution of e-cigarettes to youth as of November 1, 2015. Additionally, seventeen states have passed laws requiring e-cigarettes to use child-safety packaging to minimize unintended poisoning. As of July 1, 2016, four states (KS, LA, MN, and NC) will tax e-cigarettes. Oregon prohibits the use of e-cigarettes in cars with children under 18years of age, and Wyoming requires the public health department to develop educational campaigns to better educate the state on the risks of nicotine and tobacco products. CONCLUSION: While states are closing the gap of youth nicotine exposure, there remains a need to protect youth from e-cigarettes access, which can cause adverse health effects of brain development, lung function and potentially lead to addiction. Recommendation for the FDA to regulate e-cigarettes federally would close this regulation gap and protect youth across the U.S.

Health Education Counseling During Pediatric Well-Child Visits in Physicians' Office Settings.

OBJECTIVE: The current study assessed factors associated with health education counseling during well-child visits. METHODS: Data from the 2007-2010 National Ambulatory Medical Care Survey (NAMCS) were used to examine well-child visits made to physicians' offices in the United States. Logistic regression models examined the relationship between the provision of health education counseling and selected covariates. Health education provisions measured included injury prevention, nutrition, exercise, tobacco use, and weight reduction. RESULTS: A total of 4837 well-child visits were identified during the study period, which is equivalent to a weighted estimate of 43.4 million well-child visits annually. Multivariate analyses indicated that the length of the well-child visit was the predominant factor associated with delivery of health education counseling. CONCLUSIONS: Provider education and counseling of patients concerning health behaviors were implemented at a low level. Time spent with the patient was associated with the majority of health education counseling. Implications for pediatric practice are discussed.

Prevention counseling among pediatric patients presenting with unintentional injuries to physicians' offices' in the United States.

OBJECTIVES: There is increasing emphasis on preventive care delivery among primary care providers. In accordance with this, health education approaches have been shown to positively influence patients' behavior. As injuries are the leading public health problem among youth, primary care providers may play a critical role in the prevention of unintentional injuries among their pediatric populations. METHOD: Data from the 2007-2010 National Ambulatory Medical Care Survey (NAMCS) were used to examine patient visits presenting to physicians' offices with unintentional injuries. The prevalence of the delivery of injury prevention counseling was assessed, as were factors associated with the provision of injury prevention education. RESULTS: Findings indicated that injury prevention counseling was low. Overall, 14.6% of patients presenting with an unintentional injury received injury prevention counseling. Gender differences were notable, with 8% of injured girls receiving injury education compared to 18% of boys. Results of multivariable logistic regression analyses revealed odds of injury counseling to be 2.4 times more likely among boys when compared to girls (OR=2.4; 95% CI: 1.2-4.6). CONCLUSION: Findings indicate that physician counseling about injury prevention was low. Reasons for the findings are discussed, as are issues related to gender differences in injury risk and prevention.

Injury-related visits and comorbid conditions among homeless persons presenting to emergency departments.

OBJECTIVES: The authors examined the clinical characteristics of homeless patients presenting to emergency departments (EDs) in the United States, with a focus on unintentional and intentional injury events and related comorbid conditions. METHODS: The study included a nationally representative sample of patients presenting to EDs with data obtained from the 2007 through 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). Descriptive and analytical epidemiologic analyses were employed to examine injuries among homeless patients. RESULTS: Homeless persons made 603,000 visits annually to EDs, 55% of which were for injuries, with the majority related to unintentional (52%) and self-inflicted (23%) injuries. Multivariate logistic regression analyses revealed that homeless patients had a higher odds of presenting with injuries related to unintentional (odds ratio [OR]=1.4. 95% confidence interval [CI]=1.1 to 1.9), self-inflicted (OR=6.0, 95% CI=3.7 to 9.5), and assault (OR=3.0, 95% CI=1.5 to 5.9) injuries. CONCLUSIONS: A better understanding of the injuries affecting homeless populations may provide medical and public health professionals insight into more effective ways to intervene and limit further morbidity and mortality related to specific injury outcomes.

Perceived health status and health insurance status: protective factors against health-related debt?

Current health care debate has largely focused on the need for health insurance coverage rather than quality coverage. Yet the economic downturn has resulted in an increasing number of individuals who are uninsured or underinsured, and consequently face financial hardships. Multivariate analyses were used with 95 adults to examine relationships between health insurance, health status, and health debt. Controlling for demographics, and human and financial capital, findings suggest that health debt is not related to health insurance or health status. However, individuals with post-secondary education and non-homeowners appear to be more at risk for accumulating health debt.

Influence of professional preparation and class structure on sexuality topics taught in middle and high schools.

BACKGROUND: This study examined the impact of professional preparation and class structure on sexuality topics taught and use of practice-based instructional strategies in US middle and high school health classes. METHODS: Data from the classroom-level file of the 2006 School Health Policies and Programs were used. A series of multivariable logistic regression models were employed to determine if sexuality content taught was dependent on professional preparation and /or class structure (HE only versus HE/another subject combined). Additional multivariable logistic regression models were employed to determine if use of practice-based instructional strategies was dependent upon professional preparation and/or class structure. Years of teaching health topics and size of the school district were included as covariates in the multivariable logistic regression models. RESULTS: Findings indicated professionally prepared health educators were significantly more likely to teach 7 of the 13 sexuality topics as compared to nonprofessionally prepared health educators. There was no statistically significant difference in the instructional strategies used by professionally prepared and nonprofessionally prepared health educators. Exclusively health education classes versus combined classes were significantly more likely to have included 6 of the 13 topics and to have incorporated practice-based instructional strategies in the curricula. CONCLUSIONS: This study indicated professional preparation and class structure impacted sexuality content taught. Class structure also impacted whether opportunities for students to practice skills were made available. Results support the need for continued advocacy for professionally prepared health educators and health only courses.

Academic achievement, violent victimization, and bullying among U.S. high school students.

The authors examined the relationship between adolescents' experiences with violent victimization and academic achievement. Data from the 2009 Youth Risk Behavior Survey were analyzed for males (N = 8,537) and females (N = 7,816). Multinomial logistic regression analyses were employed to estimate the relationship between academic achievement and violent victimization. Among males and females, 6.6% and 4.4%, respectively, earned grades of mostly Ds or Fs during the past year. Among males, those earning mostly Ds or Fs had an increased odds of having been injured in a fight (adjusted odds ratio [OR] = 2.2, 95% confidence interval [95% CI]: 1.5-3.3) or threatened at school (OR = 2.0, 95% CI: 1.3-2.9) when compared to males who earned mostly As or Bs. Moreover, those who earned mostly Cs were at increased odds of having been threatened at school when compared to males who earned mostly As or Bs (OR = 1.4, 95% CI: 1.1-1.9). Among females, those earning mostly Ds or Fs had a higher odds of having been bullied at school (OR = 1.6, 95% CI: 1.1-2.3 ), threatened at school (OR = 1.5, 95% CI: 1.1-2.3), or violently victimized by an intimate partner (OR = 2.0, 95% CI: 1.4-3.0) when compared to females who earned mostly As or Bs. Similar findings were observed when examining females earning mostly C grades. Academic achievement is linked to victimization patterns among male and female adolescents. Although the temporality of the relationship is unclear, the strength of the associations increase as academic achievement decreases.