Impact of rural hospital closures on hospitalizations and associated outcomes for ambulatory and emergency care sensitive conditions.

PURPOSE: The purpose of this paper is to examine the impact of rural hospital closures on age-adjusted hospitalization rates for ambulatory care sensitive condition (ACSC) and emergency care sensitive condition (ECSC) and associated outcomes, such as length of stay and in-hospital mortality in hospital service areas (HSAs) that utilized the closed hospital. METHODS: We used the State Inpatient Data from the Healthcare Cost and Utilization Project for 9 states from 2010 to 2017 and classified admissions as ACSC or ECSC. We compared age-adjusted admission rates and length of stay (LOS) for ACSC and ECSC rates and age adjusted in-hospital mortality rate for ECSC among rural ZIP codes in HSAs with a closure to rural ZIP codes in HSAs without closures. We used propensity score-weighted regression analysis and event study design. FINDINGS: Findings suggest that ACSC admission rates started to increase right before the closure. However, this increase levels off 2 years after closure. LOS for ACSC significantly decreased almost a year after closure. ECSC admissions showed a significant decrease for a few quarters 1 year before the closure. CONCLUSIONS: Rural hospital closures were associated with increase in ACSC admissions right before closure and for nearly 2 years post closure as well as decrease in ECSC admissions before closure. As rural hospitals continue to close, efforts to ensure communities affected by these closures maintain access to primary health care may help eliminate increases in costly preventable hospital admissions for ACSC while ensuring access for emergency care services.

Nonmetropolitan COVID-19 Incidence and Mortality Rates Surpassed Metropolitan Rates Within the First 24 Weeks of the Pandemic Declaration: United States, March 1-October 18, 2020.

PURPOSE: This report compares COVID-19 incidence and mortality rates in the nonmetropolitan areas of the United States with the metropolitan areas across three 11-week periods from March 1 to October 18, 2020. METHODS: County-level COVID-19 case, death, and population counts were downloaded from USAFacts.org. The 2013 NCHS Urban-Rural Classification Scheme was collapsed into two categories called metropolitan (large central, large fringe, medium, and small metropolitans) and nonmetropolitan (micropolitan/noncore). Daily COVID-19 incidence and mortality rates were computed to show temporal trends for each of these two categories. Maps showing the ratio of nonmetropolitan to metropolitan COVID-19 incidence and mortality rates by state identify states with higher rates in nonmetropolitan areas than in metropolitan areas in each of the three 11-week periods. FINDINGS: In the period between March 1 and October 18, 2020, 13.8% of the 8,085,214 confirmed COVID-19 cases and 10.7% of the 217,510 deaths occurred among people residing in nonmetropolitan counties. The nonmetropolitan incidence and mortality trends steadily increased and surpassed those in metropolitan areas, beginning in early August. CONCLUSIONS: Despite the relatively small size of the US population living in nonmetropolitan areas, these areas have an equal need for testing, health care personnel, and mitigation resources. Having state-specific rural data allow the development of prevention messages that are tailored to the sociocultural context of rural locations.

Beyond correlates: a review of risk and protective factors for adolescent dating violence perpetration.

Dating violence is a serious public health problem. In recent years, the U.S. Centers for Disease Control and Prevention and other entities have made funding available to community based agencies for dating violence prevention. Practitioners who are tasked with developing dating violence prevention strategies should pay particular attention to risk and protective factors for dating violence perpetration that have been established in longitudinal studies. This has been challenging to date because the scientific literature on the etiology of dating violence is somewhat limited, and because there have been no comprehensive reviews of the literature that clearly distinguish correlates of dating violence perpetration from risk or protective factors that have been established through longitudinal research. This is problematic because prevention programs may then target factors that are merely correlated with dating violence perpetration, and have no causal influence, which could potentially limit the effectiveness of the programs. In this article, we review the literature on risk and protective factors for adolescent dating violence perpetration and highlight those factors for which temporal precedence has been established by one or more studies. This review is intended as a guide for researchers and practitioners as they formulate prevention programs. We reviewed articles published between 2000 and 2010 that reported on adolescent dating violence perpetration using samples from the United States or Canada. In total, 53 risk factors and six protective factors were identified from 20 studies. Next steps for etiological research in adolescent dating violence are discussed, as well as future directions for prevention program developers.

Moving knowledge into action: developing the rapid synthesis and translation process within the interactive systems framework.

The Interactive Systems Framework (ISF) for Dissemination and Implementation presents an overall framework for translating knowledge into action. Each of its three systems requires further clarification and explanation to truly understand how to conduct this work. This article describes the development and initial application of the Rapid Synthesis and Translation Process (RSTP) using the exchange model of knowledge transfer in the context of one of the ISF systems: the Prevention Synthesis and Translation System (see [special issue "introduction" article] for a translation of the Wandersman et al. (Am J Community Psychol 41:3-4, 2008) article using the RSTP). This six-step process, which was developed by and for the Division of Violence Prevention at the Centers for Disease Control and Prevention in collaboration with partners, serves as an example of how a federal agency can expedite the transfer of research knowledge to practitioners to prevent violence. While the RSTP itself represents one of the possible functions in the Prevention Synthesis and Translation System, the resulting products affect both prevention support and prevention delivery as well. Examples of how practitioner and researcher feedback were incorporated into the Rapid Synthesis and Translation Process are discussed.

Dating Matters™: strategies to promote healthy teen relationships.

Teen dating violence (TDV) is a preventable public health problem that has negative consequences for youth. Despite evidence that youth in urban communities with high crime and economic disadvantage may be at particularly high risk for TDV, little work has specifically addressed TDV in these communities. The Centers for Disease Control and Prevention (CDC) has developed a comprehensive approach to prevent TDV-Dating Matters™: Strategies to Promote Healthy Teen Relationships-that addresses gaps in research and practice. This Report from CDC describes the programmatic activities, implementation support, evaluation, and surveillance of the Dating Matters™ initiative, which will be implemented in four urban communities.

Perpetration of physical assault against dating partners, peers, and siblings among a locally representative sample of high school students in Boston, Massachusetts.

OBJECTIVES: To assess the co-occurrence of past-month physical assault of a dating partner and violence against peers and siblings among a locally representative sample of high school students and to explore correlates of dating violence (DV) perpetration. DESIGN: Cross-sectional survey design. SETTING: Twenty-two public high schools in Boston, Massachusetts. PARTICIPANTS: A sample of urban high school students (n = 1398) who participated in the Boston Youth Survey, implemented January through April of 2008. MAIN OUTCOMES MEASURES: Self-reported physical DV in the month before the survey, defined as pushing, shoving, slapping, hitting, punching, kicking, or choking a dating partner 1 or more times. RESULTS: Among the respondents, 18.7%, 41.2%, and 31.2% of students reported past-month perpetration of physical DV, peer violence, and sibling violence, respectively. Among violence perpetrators, the perpetration of DV only was rare (7.9%). Controlling for age and school, the association between sibling violence and DV was strong for boys (adjusted prevalence ratio, 3.81; 95% confidence interval, 2.07-6.99) and for girls (1.83; 1.44-2.31), and the association between peer violence and DV perpetration was strong for boys (5.13; 3.15-8.35) and for girls (2.57; 1.87-3.52). Dating violence perpetration was also associated with substance use, knife carrying, delinquency, and exposure to community violence. CONCLUSIONS: Adolescents who perpetrated physical DV were also likely to have perpetrated peer and/or sibling violence. Dating violence is likely one of many co-occurring adolescent problem behaviors, including sibling and peer violence perpetration, substance use, weapon carrying, and academic problems.

The relative influence of different domains of social connectedness on self-directed violence in adolescence.

Previous research has linked greater social connectedness with a lowered risk of self-directed violence among adolescents. However, few studies have analyzed the comparative strength of different domains of connectedness (e.g., family, peers and school) to determine where limited resources might best be focused. Data to address that gap were taken from the Centers for Disease Control and Prevention's Student Health and Safety Survey, administered to 4,131 7th-12th graders (51.5% female; 43.8% Hispanic; 22.6% African American or Black). Logistic regressions (controlling for age, gender, race/ethnicity, family structure, academic performance, and depressive symptoms) suggest that family connectedness was a stronger predictor than connectedness to peers, school, or adults at school for non-suicidal self-harm, suicidal ideation, suicide plans, and non-fatal suicidal behavior. In some analyses, peer connectedness was unexpectedly a risk factor. Results have implications for prevention of suicide in adolescence, especially in the context of the current trend towards school-based prevention programs.

Sexuality education and adolescents with developmental disabilities: assessment, policy, and advocacy.

People with disabilities are sexual beings who, like all of us, benefit from sexuality education that examines relationship skills and knowledge, attitudes, behaviors, and values that promote healthy sexuality within those relationships. This article provides an overview of landmark policies relevant to persons with disabilities, defines the strengths perspective in the context of curriculum development, and describes a survey built on this perspective that evaluates sexuality education curricula on the strengths rather than the deficits of people.