A Snapshot of Lead in Consumer Products Across Four US Jurisdictions.

BACKGROUND: Following the removal of lead from gasoline, paint and pipes were thought to be the main sources of lead exposure in the United States. However, consumer products, such as certain spices, ceramic and metal cookware, traditional health remedies, and cultural powders, are increasingly recognized as important sources of lead exposure across the United States. OBJECTIVE: This paper reviews data from four US jurisdictions that conduct in-home investigations for children with elevated blood lead levels (BLLs) to examine the prevalence of lead exposures associated with consumer products, in comparison with housing-related sources. METHODS: Authors reviewed investigation data (2010-2021) provided by California, Oregon, New York City, and King County, Washington, and compared the extent of lead exposures associated with housing-related vs. consumer products-related sources. DISCUSSION: The proportion of investigations identifying consumer products-related sources of lead exposure varied by jurisdiction (range: 15%-38%). A review of US CDC and US FDA alerts and New York City data indicates that these types of lead-containing products are often sourced internationally, with many hand carried into the United States during travel. Based on surveillance data, we believe that US immigrant and refugee communities are at an increased risk for lead exposures associated with these products. To engage health authorities, there is a need for evidentiary data. We recommend implementing a national product surveillance database systematically tracking data on consumer products tested by childhood lead poisoning prevention programs. The data repository should be centralized and accessible to all global stakeholders, including researchers and governmental and nongovernmental agencies, who can use these data to inform investigations. Effectively identifying and addressing the availability of lead-containing consumer products at their source can focus resources on primary prevention, reducing lead exposures for users abroad and in the United States. https://doi.org/10.1289/EHP14336.

Engaging Antiracist And Decolonial Praxis To Advance Equity In Oregon Public Health Surveillance Practices.

Public health surveillance and data systems in the US remain an unnamed facet of structural racism. What gets measured, which data get collected and analyzed, and how and by whom are not matters of happenstance. Rather, surveillance and data systems are productions and reproductions of political priority, epistemic privilege, and racialized state power. This has consequences for how communities of color are represented or misrepresented, viewed, and valued and for what is prioritized and viewed as legitimate cause for action. Surveillance and data systems accordingly must be understood as both an instrument of structural racism and an opportunity to dismantle it. Here, we outline a critique of standard surveillance systems and practice, drawing from the social epidemiology, critical theory, and decolonial theory literatures to illuminate matters of power germane to epistemic and procedural justice in the surveillance of communities of color. We then summarize how community partners, academics, and state health department data scientists collaborated to reimagine survey practices in Oregon, engaging public health critical race praxis and decolonial theory to reorient toward antiracist surveillance systems. We close with a brief discussion of implications for practice and areas for continued consideration and reflection.

Oregon's Approach To Demonstrating The Value Of A Modern Public Health System Through Accountability Metrics.

Oregon's public health system uses accountability metrics to improve health, eliminate inequities, and practice stewardship. First enacted into law during the 2015 legislative session, with additions and clarifications made in the 2017 session, these metrics promote collective action across sectors, bring attention to the root causes of health inequities, and hold public health authorities accountable for performance improvement as they carry out core public health functions. This article describes the development of Oregon's accountability metrics and implications for future practice. In 2023, Oregon's public health leaders adopted a new set of health outcome indicators and process measures for communicable disease control and environmental health, with performance tied to financial incentives. Oregon's process is a model for other states developing an accountability framework in their pursuit of public health transformation. Oregon's work contributes to legislative and other policy decisions for measuring the success of approaches to eliminating health inequities and for applying performance-based incentives within the public health system.

Regime shifts in rocky intertidal communities associated with a marine heatwave and disease outbreak.

Long-term, large-scale experimental studies provide critical information about how global change influences communities. When environmental changes are severe, they can trigger abrupt transitions from one community type to another leading to a regime shift. From 2014 to 2016, rocky intertidal habitats in the northeast Pacific Ocean experienced extreme temperatures during a multi-year marine heatwave (MHW) and sharp population declines of the keystone predator Pisaster ochraceus due to sea star wasting disease (SSWD). Here we measured the community structure before, during and after the MHW onset and SSWD outbreak in a 15-year succession experiment conducted in a rocky intertidal meta-ecosystem spanning 13 sites on four capes in Oregon and northern California, United States. Kelp abundance declined during the MHW due to extreme temperatures, while gooseneck barnacle and mussel abundances increased due to reduced predation pressure after the loss of Pisaster from SSWD. Using several methods, we detected regime shifts from substrate- or algae-dominated to invertebrate-dominated alternative states at two capes. After water temperatures cooled and Pisaster population densities recovered, community structure differed from pre-disturbance conditions, suggesting low resilience. Consequently, thermal stress and predator loss can result in regime shifts that fundamentally alter community structure even after restoration of baseline conditions.

Patient perceptions of and experiences with stigma using telehealth for opioid use disorder treatment: a qualitative analysis.

BACKGROUND: Patients with opioid use disorder (OUD) experience various forms of stigma at the individual, public, and structural levels that can affect how they access and engage with healthcare, particularly with medications for OUD treatment. Telehealth is a relatively new form of care delivery for OUD treatment. As reducing stigma surrounding OUD treatment is critical to address ongoing gaps in care, the aim of this study was to explore how telehealth impacts patient experiences of stigma. METHODS: In this qualitative study, we interviewed patients with OUD at a single urban academic medical center consisting of multiple primary care and addiction clinics in Oregon, USA. Participants were eligible if they had (1) at least one virtual visit for OUD between March 2020 and December 2021, and (2) a prescription for buprenorphine not exclusively used for chronic pain. We conducted phone interviews between October and December 2022, then recorded, transcribed, dual-coded, and analyzed using reflexive thematic analysis. RESULTS: The mean age of participants (n = 30) was 40.5 years (range 20-63); 14 were women, 15 were men, and two were transgender, non-binary, or gender-diverse. Participants were 77% white, and 33% had experienced homelessness in the prior six months. We identified four themes regarding how telehealth for OUD treatment shaped patient perceptions of and experiences with stigma at the individual (1), public (2-3), and structural levels (4): (1) Telehealth offers wanted space and improved control over treatment setting; (2) Public stigma and privacy concerns can impact both telehealth and in-person encounters, depending on clinical and personal circumstances; (3) The social distance of telehealth could mitigate or exacerbate perceptions of clinician stigma, depending on both patient and clinician expectations; (4) The increased flexibility of telehealth translated to perceptions of increased clinician trust and respect. CONCLUSIONS: The forms of stigma experienced by individuals with OUD are complex and multifaceted, as are the ways in which those experiences interact with telehealth-based care. The mixed results of this study support policies allowing for a more individualized, patient-centered approach to care delivery that allows patients a choice over how they receive OUD treatment services.

Data fusion for predicting long-term program impacts.

Policymakers often require information on programs' long-term impacts that is not available when decisions are made. For example, while rigorous evidence from the Oregon Health Insurance Experiment (OHIE) shows that having health insurance influences short-term health and financial measures, the impact on long-term outcomes, such as mortality, will not be known for many years following the program's implementation. We demonstrate how data fusion methods may be used address the problem of missing final outcomes and predict long-run impacts of interventions before the requisite data are available. We implement this method by concatenating data on an intervention (such as the OHIE) with auxiliary long-term data and then imputing missing long-term outcomes using short-term surrogate outcomes while approximating uncertainty with replication methods. We use simulations to examine the performance of the methodology and apply the method in a case study. Specifically, we fuse data on the OHIE with data from the National Longitudinal Mortality Study and estimate that being eligible to apply for subsidized health insurance will lead to a statistically significant improvement in long-term mortality.

Evaluation of a Suspected Overdose Form for Timely Surveillance of Fatal Drug Overdoses, Multnomah County, OR, 2020-2021.

OBJECTIVES: There is a significant delay in finalization of drug overdose deaths, and a need to more quickly identify suspected overdoses to improve public health response. The objective of our study was to describe creation of a suspect overdose form and evaluate its use. DESIGN: Evaluation of a suspected overdose form used to record information related to death investigation with matching to state vital records. We calculated the toxicology turnaround time for matched records, and also calculated sensitivity, specificity, positive predictive value, and negative predictive value of the form compared to vital records as the gold standard. SETTING: Multnomah County, Oregon, deaths investigated by the County Medical Examiner between January 2020 and December 2021. MAIN OUTCOME MEASURE: Sensitivity of the suspected overdose form. RESULTS: We analyzed 2818 matched death records in total during the study period. The average turnaround time for the 1673 records with toxicology results was 101 days. In 2020, sensitivity of the form was 74%, but this increased to nearly 95% in 2021. CONCLUSIONS: Multnomah County's suspected evaluation form provides a timelier indicator of deaths suspected to be from drug overdose, has good sensitivity to detect true overdoses, and can help guide more rapid public health and public safety response activities.

The Ability of Primary Care Practices to Measure and Report on Care Quality.

BACKGROUND: Creating useful clinical quality measure (CQM) reports in a busy primary care practice is known to depend on the capability of the electronic health record (EHR). Two other domains may also contribute: supportive leadership to prioritize the work and commit the necessary resources, and individuals with the necessary health information technology (IT) skills to do so. Here we describe the results of an assessment of the above 3 domains and their associations with successful CQM reporting during an initiative to improve smaller primary care practices' cardiovascular disease CQMs. METHODS: The study took place within an AHRQ EvidenceNOW initiative of external support for smaller practices across Washington, Oregon and Idaho. Practice facilitators who provided this support completed an assessment of the 3 domains previously described for each of their assigned practices. Practices submitted 3 CQMs to the study team: appropriate aspirin prescribing, use of statins when indicated, blood pressure control, and tobacco screening/cessation. RESULTS: Practices with advanced EHR reporting capability were more likely to report 2 or more CQMs. Only one-third of practices were "advanced" in this domain, and this domain had the highest proportion of practices (39.1%) assessed as "basic." The presence of advanced leadership or advanced skills did not appreciably increase the proportion of practices that reported 2 or more CQMs. CONCLUSIONS: Our findings support previous reports of limited EHR reporting capabilities within smaller practices but extend these findings by demonstrating that practices with advanced capabilities in this domain are more likely to produce CQM reports.

A stepwise approach to integrating the new essentials into a master's entry nursing curriculum.

The American Association of Colleges of Nursing (AACN) released updated nursing curriculum Essentials in 2021. The new Essentials document reflects an innovative and unique approach to nursing education and provides a framework for competency-based education and assessment to prepare students to work in a profession that is ever-changing. The first in the state of Oregon, a Masters Entry into Professional Nursing program was launched with a curriculum based on the new Essentials with the goal to remain true to the program's current concept-based approach while incorporating elements of a competency-based curriculum. As with all new programs, curricular design is paramount and requires careful planning to ensure the curriculum aligns with education trends, meets the needs of diverse learners, adheres to regulatory requirements and standards, and has strong faculty buy-in. Curriculum development done in a systematic fashion with faculty input is imperative. All current faculty were invited by the school of nursing (SON) leadership to participate in the curriculum development process. Regularly scheduled meetings were held, and all interested faculty participants were able to provide input. This process also included the SON Curriculum Committee and SON Faculty Council, to ensure all faculty were included in the process and appraised of the curriculum development. The faculty members who participated in the systematic development process then served as advocates for the new curriculum and helped create a smooth transition when the new MEPN program was introduced.

Community Partner Perceptions of Equitable Implementation Practices for a Promotores de Salud Intervention: A Qualitative Assessment.

We conducted focus groups with staff from 5 community-based organizations (21 participants; 86% female, 52% Hispanic/Latino/a/x and 24% Mexican/Mexican American) between August and October 2021. Results highlighted community partner perceptions of practices congruent (e.g., communication that built trust and dismantled power dynamics, a shared mission) and incongruent (e.g., intervention-community misalignment, research driven decision-making) with equitable implementation in the development, implementation, and evaluation of a promotores de salud intervention to increase COVID-19 testing and preventive behaviors among Latinx communities in Oregon. (Am J Public Health. 2024;114(S5):S377-S383. https://doi.org/10.2105/AJPH.2024.307686).

Resistance of rocky intertidal communities to oceanic climate fluctuations.

A powerful way to predict how ecological communities will respond to future climate change is to test how they have responded to the climate of the past. We used climate oscillations including the Pacific Decadal Oscillation (PDO), North Pacific Gyre Oscillation, and El Niño Southern Oscillation (ENSO) and variation in upwelling, air temperature, and sea temperatures to test the sensitivity of nearshore rocky intertidal communities to climate variability. Prior research shows that multiple ecological processes of key taxa (growth, recruitment, and physiology) were sensitive to environmental variation during this time frame. We also investigated the effect of the concurrent sea star wasting disease outbreak in 2013-2014. We surveyed nearly 150 taxa from 11 rocky intertidal sites in Oregon and northern California annually for up to 14-years (2006-2020) to test if community structure (i.e., the abundance of functional groups) and diversity were sensitive to past environmental variation. We found little to no evidence that these communities were sensitive to annual variation in any of the environmental measures, and that each metric was associated with < 8.6% of yearly variation in community structure. Only the years elapsed since the outbreak of sea star wasting disease had a substantial effect on community structure, but in the mid-zone only where spatially dominant mussels are a main prey of the keystone predator sea star, Pisaster ochraceus. We conclude that the established sensitivity of multiple ecological processes to annual fluctuations in climate has not yet scaled up to influence community structure. Hence, the rocky intertidal system along this coastline appears resistant to the range of oceanic climate fluctuations that occurred during the study. However, given ongoing intensification of climate change and increasing frequencies of extreme events, future responses to climate change seem likely.

A machine learning approach to detect potentially harmful and protective suicide-related content in broadcast media.

Suicide-related media content has preventive or harmful effects depending on the specific content. Proactive media screening for suicide prevention is hampered by the scarcity of machine learning approaches to detect specific characteristics in news reports. This study applied machine learning to label large quantities of broadcast (TV and radio) media data according to media recommendations reporting suicide. We manually labeled 2519 English transcripts from 44 broadcast sources in Oregon and Washington, USA, published between April 2019 and March 2020. We conducted a content analysis of media reports regarding content characteristics. We trained a benchmark of machine learning models including a majority classifier, approaches based on word frequency (TF-IDF with a linear SVM) and a deep learning model (BERT). We applied these models to a selection of more simple (e.g., focus on a suicide death), and subsequently to putatively more complex tasks (e.g., determining the main focus of a text from 14 categories). Tf-idf with SVM and BERT were clearly better than the naive majority classifier for all characteristics. In a test dataset not used during model training, F1-scores (i.e., the harmonic mean of precision and recall) ranged from 0.90 for celebrity suicide down to 0.58 for the identification of the main focus of the media item. Model performance depended strongly on the number of training samples available, and much less on assumed difficulty of the classification task. This study demonstrates that machine learning models can achieve very satisfactory results for classifying suicide-related broadcast media content, including multi-class characteristics, as long as enough training samples are available. The developed models enable future large-scale screening and investigations of broadcast media.

Forest carbon sequestration on the west coast, USA: Role of species, productivity, and stockability.

Forest ecosystems store large amounts of carbon and can be important sources, or sinks, of the atmospheric carbon dioxide that is contributing to global warming. Understanding the carbon storage potential of different forests and their response to management and disturbance events are fundamental to developing policies and scenarios to partially offset greenhouse gas emissions. Projections of live tree carbon accumulation are handled differently in different models, with inconsistent results. We developed growth-and-yield style models to predict stand-level live tree carbon density as a function of stand age in all vegetation types of the coastal Pacific region, US (California, Oregon, and Washington), from 7,523 national forest inventory plots. We incorporated site productivity and stockability within the Chapman-Richards equation and tested whether intensively managed private forests behaved differently from less managed public forests. We found that the best models incorporated stockability in the equation term controlling stand carrying capacity, and site productivity in the equation terms controlling the growth rate and shape of the curve. RMSEs ranged from 10 to 137 Mg C/ha for different vegetation types. There was not a significant effect of ownership over the standard industrial rotation length (~50 yrs) for the productive Douglas-fir/western hemlock zone, indicating that differences in stockability and productivity captured much of the variation attributed to management intensity. Our models suggest that doubling the rotation length on these intensively managed lands from 35 to 70 years would result in 2.35 times more live tree carbon stored on the landscape. These findings are at odds with some studies that have projected higher carbon densities with stand age for the same vegetation types, and have not found an increase in yields (on an annual basis) with longer rotations. We suspect that differences are primarily due to the application of yield curves developed from fully-stocked, undisturbed, single-species, "normal" stands without accounting for the substantial proportion of forests that don't meet those assumptions. The carbon accumulation curves developed here can be applied directly in growth-and-yield style projection models, and used to validate the predictions of ecophysiological, cohort, or single-tree style models being used to project carbon futures for forests in the region. Our approach may prove useful for developing robust models in other forest types.

Impact of the Dobbs decision on abortion services from a large tertiary center in Oregon.

OBJECTIVES: Evaluate the impact of the Dobbs vs Jackson decision on abortion care at an academic center in Oregon, a state with no legal restrictions on abortion. STUDY DESIGN: Electronic health records from patients who received an abortion at Oregon's largest tertiary hospital were utilized to compare the years before and after Dobbs. RESULTS: Monthly average abortions increased from 57.8 pre-Dobbs to 77.1 post-Dobbs (p = 0.001). This trend was associated with an increased proportion of out-of-state patients (14.3% vs 9.5%, p = 0.004) presenting with gestational duration ≥26 weeks (23.6% vs 3.7% in-state, p < 0.001). CONCLUSIONS: The Dobbs decision resulted in increased utilization of hospital-based abortion care in a protective state. IMPLICATIONS: This study reflects the critical role of protective states such as Oregon in preserving access to abortion services and the need for continued support to alleviate the impact of nationwide barriers to reproductive healthcare.

Assessment of Risk for Sudden Cardiac Death Among Adolescents and Young Adults After Receipt of COVID-19 Vaccine - Oregon, June 2021-December 2022.

COVID-19 vaccination has been associated with myocarditis in adolescents and young adults, and concerns have been raised about possible vaccine-related cardiac fatalities in this age group. In April 2021, cases of myocarditis after COVID-19 vaccination, particularly among young male vaccine recipients, were reported to the Vaccine Adverse Event Reporting System. To assess this possibility, investigators searched death certificates for Oregon residents aged 16-30 years who died during June 2021-December 2022 for cardiac or undetermined causes of death. For identified decedents, records in Oregon's immunization information system were reviewed for documentation of mRNA COVID-19 vaccination received ≤100 days before death. Among 1,292 identified deaths, COVID-19 was cited as the cause for 30. For 101 others, a cardiac cause of death could not be excluded; among these decedents, immunization information system records were available for 88, three of whom had received an mRNA COVID-19 vaccination within 100 days of death. Of 40 deaths that occurred among persons who had received an mRNA COVID-19 vaccine dose, three occurred ≤100 days after vaccination. Two of these deaths were attributed to chronic underlying conditions; the cause was undetermined for one. No death certificate attributed death to vaccination. These data do not support an association between receipt of mRNA COVID-19 vaccine and sudden cardiac death among previously healthy young persons. COVID-19 vaccination is recommended for all persons aged ≥6 months to prevent COVID-19 and complications, including death.

Exploring indirect effects of a classic trophic cascade between urchins and kelp on zooplankton and whales.

Kelp forest trophic cascades have been extensively researched, yet indirect effects to the zooplankton prey base and gray whales have not been explored. We investigate the correlative patterns of a trophic cascade between bull kelp and purple sea urchins on gray whales and zooplankton in Oregon, USA. Using generalized additive models (GAMs), we assess (1) temporal dynamics of the four species across 8 years, and (2) possible trophic paths from urchins to kelp, kelp as habitat to zooplankton, and kelp and zooplankton to gray whales. Temporal GAMs revealed an increase in urchin coverage, with simultaneous decline in kelp condition, zooplankton abundance and gray whale foraging time. Trophic path GAMs, which tested for correlations between species, demonstrated that urchins and kelp were negatively correlated, while kelp and zooplankton were positively correlated. Gray whales showed nuanced and site-specific correlations with zooplankton in one site, and positive correlations with kelp condition in both sites. The negative correlation between the kelp-urchin trophic cascade and zooplankton resulted in a reduced prey base for gray whales. This research provides a new perspective on the vital role kelp forests may play across multiple trophic levels and interspecies linkages.

Decreased air quality shows minimal influence on peak summer attendance at forested Pacific West national parks.

Wildfires are increasing in duration and intensity across the United States' Pacific West region, resulting in heightened particulate matter from smoke in the atmosphere. Levels of peak particulate matter are concurrent to peak visitor attendance at National Parks, given seasonal alignment with summer vacation travel and heightened forest fire conditions. Particulate matter threatens visitor health and safety and contributes to poor visibility and a deteriorated visitor experience. To assess visitation response to diminished air quality, we utilized wildfire-generated particulate matter (PM2.5) data in conjunction with monthly attendance records for three ecoregions containing eight national parks in Washington, Oregon, and California from 2009 to 2019. We analyzed daily PM2.5 levels from data gridded at the 10 km scale for National Park Service units by Level III forest ecoregions within the National Park Service's Pacific West Unit. Data were then compared to normalized monthly visitation trends for each of the ecoregions using two statistical methods Kendall's Tau and Analysis of Variance (ANOVA) with post-hoc Tukey tests. Results demonstrate that attendance at these national parks does not decrease in response to increased PM2.5 levels. Instead, we see several statistically significant increases in attendance across these ecoregions during periods of reduced air quality. Of 115 shifts between air quality categories during the busy season of July to September, there are no significant decreases in attendance as air quality worsens. These findings suggest that visitors are willing to tolerate reduced air quality compared to other factors such as temperature or precipitation. Given that park units within each ecoregion feature diverse historical contexts, varied built environments, and unique ecological systems, our discussion specifically addresses managerial concerns associated with maintained high levels of visitation during suboptimal, and potentially dangerous, conditions. There is substantial need for specific, scalable approaches to mitigate adverse health and experiential impacts as visitors are exposed to increased risks during a range of exertional activities associated with diverse settings.

Effective dispersal patterns in prairie plant species across human-modified landscapes.

Effective dispersal among plant populations is dependent on vector behaviour, landscape features and availability of adequate habitats. To capture landscape feature effects on dispersal, studies must be conducted at scales reflecting single-generation dispersal events (mesoscale). Many studies are conducted at large scales where genetic differentiation is due to dispersal occurring over multiple generations, making it difficult to interpret the effects of specific landscape features on vector behaviour. Genetic structure at the mesoscale may be determined by ecological and evolutionary processes, such as the consequences of vector behaviour on patterns of gene flow. We used chloroplast haplotypes and nuclear genome SNP surveys to identify landscape features influencing seed and pollen dispersal at a mesoscale within the Rogue River Valley in southern Oregon. We evaluated biotic and abiotic vector behaviour by contrasting two annual species with differing dispersal mechanisms; Achyrachaena mollis (Asteraceae) is a self-pollinating and anemochoric species, and Plectritis congesta (Caprifoliaceae) is biotically pollinated with barochoric seeds. Using landscape genetics methods, we identified features of the study region that conduct or restrict dispersal. We found chloroplast haplotypes were indicative of historic patterns of gene flow prior to human modification of landscapes. Seed dispersal of A. mollis was best supported by models of isolation by distance, while seed-driven gene flow of P. congesta was determined by the distribution of preserved natural spaces and quality habitat. Nuclear genetic structure was driven by both pollen and seed dispersal, and both species responded to contemporary landscape changes, such as urban and agricultural conversion, and habitat availability.