Race and Depressive Symptoms are Associated with the Prevalence of Adolescent Suicide Attempts in Hawai'i, Youth Risk Behavior Survey 2015-2017.

Suicide is death caused by injuring oneself with the intent to die. According to the 2017 National Vital Statistics report, suicide was the second leading cause of death for adolescents 10-24 years old, accounting for 19.2% of deaths in that age group. Aggregated 2015-2017 Hawai'i Youth Risk Behavior Survey (YRBS) data from 12 120 respondents were analyzed. Multivariate logistic regression modeling for complex survey procedure was created using predicted marginals to estimate crude and adjusted prevalence ratios for suicide attempts. After adjusting for race, depressive symptoms, bullying, illicit drug use, alcohol use, and self-harm, youth who experienced bullying (adjusted prevalence ratio=1.75; 95% confidence interval: 1.44-2.12), used illicit drugs (1.89; 1.54-2.31), those with one-time self-harm (2.87; 2.04-4.04), or repeated self-harm (5.31; 4.28-6.60) were more likely to have suicide attempts. Race by depressive symptoms interaction was significant (P <.01), demonstrating the heterogeneity of the stratum-specific measures of association. When depressive symptoms were present, youth who are Native Hawaiian (2.64; 1.68-4.15), Japanese (2.39; 1.44-3.95), other Pacific Islander (2.04; 1.29-3.21), Filipino (1.77; 1.21-2.59), and those who do not describe as only one race/ethnicity (1.74; 1.16-2.62) were more likely to have suicide attempts compared to White. When depressive symptoms were not present, other Pacific Islanders (4.05; 1.69-9.67), Hispanics/Latinos (3.37; 1.10-10.30), Native Hawaiians (3.03; 1.23-7.45), and other race groups (2.03; 1.03-4.00) were more likely to have suicide attempts compared to White. These results demonstrated the importance of screening for depressive symptoms and other risk factors to prevent suicide attempts in adolescents.

Prevalence and Risk Factors for Self-Reported Postpartum Depression Symptoms (SRPDS) in Hawai'i, 2012-2015.

Postpartum depression (PPD) affects an estimated 10% to 20% of women in the United States, but little is known about the risk factors for PPD in Hawai'i. This study sought to identify PPD risk factors and examine whether disparities exist in Hawai'i. Aggregated 2012-2015 Hawai'i Pregnancy Risk Assessment Monitoring System (PRAMS) data from 5572 women with a recent live birth were analyzed. Two questions on the PRAMS survey about mood and interest in activities were used to create a brief measure of Self-Reported Postpartum Depression Symptoms (SRPDS). Multivariate generalized logit analysis was conducted to identify risk factors associated with SRPDS or possible SRPDS, adjusting for maternal race and age, intimate partner violence (IPV), prenatal anxiety, prenatal depression, illicit drug use before pregnancy, and stressful life events (SLEs). About 10.0% of women surveyed had SRPDS and 27.7% had possible SRPDS. SRPDS was more common among Native Hawaiians (adjusted odds ratios=1.77; 95% confidence interval: 1.17-2.70), Filipinos (2.16; 1.33-3.50), Japanese (2.88; 1.67-4.98), and other Pacific Islanders (OPI; 3.22; 1.78-5.82), when compared to white. Women aged 20-29 years (0.39; 0.24-0.65) and 30-52 years (0.41; 0.24-0.69) were less likely to have SRPDS than those 19 years and younger. SRPDS was highest among women who experienced IPV (2.65; 1.37-5.13), prenatal anxiety (2.10; 1.28-3.42), prenatal depression (2.78; 1.47-5.25), or used illicit drugs before pregnancy (1.97; 1.21-3.20). There was an upward trend in SRPDS based on the number of SLEs. Possible SRPDS had similar but smaller effects, suggesting the importance of clinical screening and appropriate follow-up for these high-risk groups.

Household transmission of pandemic (H1N1) 2009, San Antonio, Texas, USA, April-May 2009.

To assess household transmission of pandemic (H1N1) 2009 in San Antonio, Texas, USA, during April 15-May 8, 2009, we investigated 77 households. The index case-patient was defined as the household member with the earliest onset date of symptoms of acute respiratory infection (ARI), influenza-like illness (ILI), or laboratory-confirmed pandemic (H1N1) 2009. Median interval between illness onset in index and secondary case-patients was 4 days (range 1-9 days); the index case-patient was likely to be < or =18 years of age (p = 0.034). The secondary attack rate was 4% for pandemic (H1N1) 2009, 9% for ILI, and 13% for ARI. The secondary attack rate was highest for children <5 years of age (8%-19%) and lowest for adults > or =50 years of age (4%-12%). Early in the outbreak, household transmission primarily occurred from children to other household members and was lower than the transmission rate for seasonal influenza.

Using safety data to describe common injury-producing events examples from the U.S. Air force.

BACKGROUND: The U.S. military leadership has recently increased its efforts to reduce the number of lost-workday injuries for both the active duty and civilian employee components of the total force. The detailed causes and circumstances of those nonfatal injuries-information needed for injury prevention-has largely been unexplored. The purpose of this project was to determine the utility of Air Force safety data for nonfatal injury prevention. METHODS: In 2004, events associated with injury-producing mishaps reported through the U.S. Air Force (USAF) Ground Safety Automated System from 1993-2002 (n = 32,812 injuries) were reconstructed. Essential data elements necessary to reconstruct event causes and circumstances were identified in both coded data and in free-text mishap narratives. Activities and mechanisms were coded in a format similar to that of the ICD-10. A taxonomy was then developed to identify hazard scenarios associated with injury-producing activities or mechanisms. RESULTS: Coded data provided only four data elements (activity, injury event/exposure, nature of injury/body part, and outcome) that were sufficiently descriptive for prevention purposes. Therefore, narrative information was coded and analyzed to obtain additional information. The assembled data enabled identification and description of hazard scenarios associated with the most common injury-producing activities and mechanisms. CONCLUSIONS: Safety reports from the USAF provide detailed mishap descriptions for lost-workday injuries that could support in-depth analysis and more effective preventive efforts. However, some of the most valuable information is found in the pre-text narratives that require coding and classification, such as was conducted for this report in order to be optimally useful for injury epidemiology and prevention.

Mechanisms of slow-pitch softball injuries reported to the HQ Air Force Safety Center a 10-year descriptive study, 1993-2002.

BACKGROUND: Softball is a popular sport in civilian and military populations and results in a large number of lost-workday injuries. The purpose of this study is to describe the mechanisms associated with softball injuries occurring among active duty U.S. Air Force (USAF) personnel to better identify potentially effective countermeasures. METHODS: Data derived from safety reports were obtained from the USAF Ground Safety Automated System in 2003. Softball injuries for the years 1993-2002 that resulted in at least one lost workday were included in the study. Narrative data were systematically reviewed and coded in order to categorize and summarize mechanisms associated with these injuries. RESULTS: This report documents a total of 1181 softball-related mishap reports, involving 1171 active duty USAF members who sustained one lost-workday injury while playing softball. Eight independent mechanisms were identified. Three specific scenarios (sliding, being hit by a ball, and colliding with a player) accounted for 60% of reported softball injuries. CONCLUSIONS: Mechanisms of injury for activities such as playing softball, necessary for prevention planning, can be identified using the detailed information found in safety reports. This information should also be used to develop better sports injury coding systems. Within the USAF and U.S. softball community, interventions to reduce injuries related to the most common mechanisms (sliding, being hit by a ball, and colliding with a player) should be developed, implemented, and evaluated.

Mechanisms of basketball injuries reported to the HQ Air Force Safety Center a 10-year descriptive study, 1993-2002.

BACKGROUND: Basketball is the most popular sport among the U.S. Air Force (USAF) active duty population and causes a large number of lost-workday injuries. The purpose of this study is to describe how basketball injuries occur to allow development of effective countermeasures. METHODS: This study used data derived from safety reports obtained from the USAF Ground Safety Automated System. Basketball injuries for the years 1993-2002 that resulted in at least one lost workday were included in the study conducted in 2003. Narrative data from 32,818 safety reports were systematically reviewed and coded in order to categorize and summarize mechanisms associated with these injuries. RESULTS: A total of 2204 mishap reports involving active duty USAF members playing basketball were documented by the study. This study identified seven mechanisms causing basketball injury. Two similar causes involving jumping (landing awkwardly and landing on someone's foot) accounted for 43% of basketball injuries followed by collisions with other players (10%). CONCLUSIONS: This study shows that mechanisms of basketball-related injury can be identified using the detailed information found in USAF safety reports. Knowledge of leading hazards or mechanisms for basketball injuries can be used to prioritize and develop prevention strategies.

Mechanisms of flag-football injuries reported to the HQ Air Force Safety Center a 10-year descriptive study, 1993-2002.

BACKGROUND: Flag (touch or intramural) football is a popular sport among the U.S. Air Force (USAF) active duty population and causes a substantial number of lost-workday injuries. The purpose of this study is to describe the mechanisms of flag-football injuries to better identify effective countermeasures. METHODS: The data were derived from safety reports obtained from the USAF Ground Safety Automated System. Flag-football injuries for the years 1993-2002 that resulted in at least one lost workday were included in the study conducted in 2003. Narrative data were systematically reviewed for 32,812 USAF mishap reports; these were then coded in order to categorize and summarize mechanisms associated with flag football and other sports and occupational injuries. RESULTS: Nine hundred and forty-four mishap reports involving active duty USAF members playing flag football met the criteria for inclusion into this study. Eight mechanisms of injury were identified. The eight mechanisms accounted for 90% of all flag-football injuries. One scenario (contact with another player) accounted for 42% of all flag-football injuries. CONCLUSIONS: The most common mechanisms of injury caused by playing flag football can be identified using the detailed information found in safety reports. These scenarios are essential to developing evidence-based countermeasures. Results for flag football suggest that interventions that prevent player contact injuries deserve further research and evaluation. The broader implications of this study are that military safety data can be used to identify potentially modifiable mechanisms of injury for specific activities such as flag football.

Injuries to air force personnel associated with lifting, handling, and carrying objects.

BACKGROUND: The U.S. Air Force (USAF) active duty and civilian populations experience a substantial number of lost-workday injuries while lifting, handling, and carrying objects. Back injuries are most frequently reported. PURPOSE: The purpose of this study is to describe the hazard scenarios of lift-handle-carry injuries to better identify effective countermeasures. METHODS: The data were derived from safety reports obtained from the USAF Ground Safety Automated System. Lift-handle-carry injuries for the years 1993-2002 that resulted in at least one lost workday were included in the study. A total of 4085 lost-workday injuries resulting in 24,940 lost workdays for USAF military and civilian members met the criteria for inclusion. Objects associated with these injuries were identified and aggregated to determine the most common causes of lift-handle-carry injuries. RESULTS: Twelve distinct objects or type of objects were identified as the most common source of lift-handle-carry injuries. Among the most common sources of injury were lifting aircraft components, boxes, and furniture. Most importantly, lifting one group of objects, aircraft components, was associated with 33% of all lift-handle-carry injuries. CONCLUSIONS: Safety report data can be used to identify the most common object or object types causing lift-handle-carry injuries. The information included in this report suggests countermeasures that should be considered for implementation and evaluation studies. Countermeasures to address the most common lift-handle-carry injuries, such as lifting aircraft components among aircraft maintenance workers, are warranted.

Association of area socioeconomic status and breast, cervical, and colorectal cancer screening: a systematic review.

BACKGROUND: Although numerous studies have examined the association of area socioeconomic status (SES) and cancer screening after controlling for individual SES, findings have been inconsistent. A systematic review of existing studies is timely to identify conceptual and methodologic limitations and to provide a basis for future research directions and policy. OBJECTIVE: The objectives were to (a) describe the study designs, constructs, methods, and measures; (b) describe the independent association of area SES and cancer screening; and (c) identify neglected areas of research. METHODS: We searched six electronic databases and manually searched cited and citing articles. Eligible studies were published before 2008 in peer-reviewed journals in English, represented primary data on individuals ages > or = 18 years from developed countries, and measured the association of area and individual SES with breast, cervical, or colorectal cancer screening. RESULTS: Of 19 eligible studies, most measured breast cancer screening. Studies varied widely in research design, definitions, and measures of SES, cancer screening behaviors, and covariates. Eight employed multilevel logistic regression, whereas the remainder analyzed data with standard single-level logistic regression. The majority measured one or two indicators of area and individual SES; common indicators at both levels were poverty, income, and education. There was no consistent pattern in the association between area SES and cancer screening. DISCUSSION: The gaps and conceptual and methodologic heterogeneity in the literature to date limit definitive conclusions about an underlying association between area SES and cancer screening. We identify five areas of research deserving greater attention in the literature.