Differential gene expression and developmental pathologies associated with persistent organic pollutants in sentinel fish in Troutman Lake, Sivuqaq, Alaska.

Persistent organic pollutants (POPs) are lipophilic compounds that bioaccumulate in animals and biomagnify within food webs. Many POPs are endocrine disrupting compounds that impact vertebrate development. POPs accumulate in the Arctic via global distillation and thereby impact high trophic level vertebrates as well as people who live a subsistence lifestyle. The Arctic also contains thousands of point sources of pollution, such as formerly used defense (FUD) sites. Sivuqaq (St. Lawrence Island), Alaska was used by the U.S. military during the Cold War and FUD sites on the island remain point sources of POP contamination. We examined the effects of POP exposure on ninespine stickleback (Pungitius pungitius) collected from Troutman Lake in the village of Gambell as a model for human exposure and disease. During the Cold War, Troutman Lake was used as a dump site by the U.S. military. We found that PCB concentrations in stickleback exceeded the U.S. Environmental Protection Agency's guideline for unlimited consumption despite these fish being low trophic level organisms. We examined effects at three levels of biological organization: gene expression, endocrinology, and histomorphology. We found that ninespine stickleback from Troutman Lake exhibited suppressed gonadal development compared to threespine stickleback (Gasterosteus aculeatus) studied elsewhere. Troutman Lake stickleback also displayed two distinct hepatic phenotypes, one with lipid accumulation and one with glycogen-type vacuolation. We compared the transcriptomic profiles of these liver phenotypes using RNA sequencing and found significant upregulation of genes involved in ribosomal and metabolic pathways in the lipid accumulation group. Additionally, stickleback displaying liver lipid accumulation had significantly fewer thyroid follicles than the vacuolated phenotype. Our study and previous work highlight health concerns for people and wildlife due to pollution hotspots in the Arctic, and the need for health-protective remediation.

Compound-specific stable isotopes of amino acids reveal influences of trophic level and primary production sources on mercury concentrations in fishes from the Aleutian Islands, Alaska.

Total mercury concentrations ([THg]) exceed thresholds of concern in some Steller sea lion (Eumetopias jubatus) tissues from certain portions of the Aleutian Islands, Alaska. We applied compound-specific stable isotope analyses of both carbon and nitrogen in amino acids from fish muscle tissue to quantify the proportional contributions of primary production sources and trophic positions of eight prey species (n = 474 total) that are part of Steller sea lion diets. Previous THg analyses of fish muscle, coupled with monomethylmercury analyses of a subset of samples, substantiated previous findings that fishes from the west of Amchitka Pass, a discrete oceanographic boundary of the Aleutian Archipelago, have higher muscle Hg concentrations relative to fishes from the east. The δ13C values of essential amino acids (EAAs) in fish muscle demonstrated that although most fishes obtained their EAAs primarily from algae, some species varied in the extent to which they relied on this EAA source. The δ15N values of phenylalanine (0.9 to 7.8 ‰), an indicator of the isotopic baseline of a food web, varied widely within and among fish species. Trophic position estimates, accounting for this baseline variation, were higher from the west relative to the east of the pass for some fish species. Trophic magnification slopes using baseline-corrected trophic position estimates indicated similar rates of Hg biomagnification to the east and west of Amchitka Pass. Multiple linear regression models revealed that trophic position was the most important driver of fish muscle [THg] with less variation explained by other parameters. Thus, higher trophic positions but not the rate of Hg biomagnification to the west of Amchitka Pass may play a role in the regional differences in both fish and Steller sea lion [THg]. Although, differences in Hg contamination and uptake at the base of the east and west food webs could not be excluded.

Developing a culturally relevant physical activity guide for Alaska Native Head Start students in rural Alaska: the Got Neqpiaq? Study.

Background: Concern was voiced by Elders, teachers, and parents that and playtime activities of the Head Start preschool programme were not aligned with the local Alaska Native culture in their communities.Methods: The Alaska Native Tribal Health Consortium partnered with 12 Head Start preschool programmes, administered by Rural Alaska Community Action Program in rural Alaska, to explore with community members Alaska Native value-based solutions to the concerns they raised. Local input was gathered via focus groups, interviews, and surveys.Results: We worked together with communities to create a physical activity guide specific to preschool-age children in the region. The guide includes activity descriptions, lesson plans, flash cards, and photos of traditional Alaska Native physical activities and games specific to the region. This manuscript details the community engagement process foundational to the physical activity guide's adoption and implementation.Conclusions: The processes by which the guide was developed were strength-based and participatory. Widespread community engagement and participation led to a guide that was readily adopted because the community had taken ownership of the content. The lessons learned have been invaluable in developing long-term community-based partnerships and in setting the precedent to further incorporate local/regional culture into rural Alaska Head Start programmes.

Experiences of Alaska Native people living with burn injury and opportunities for health system strengthening.

BACKGROUND: Injuries are a leading cause of death and disability for Alaska Native (AN) people. Alaska Native Tribal Health Consortium (ANTHC) is supporting the development of a burn care system that includes a partnership between Alaska Native Medical Center (ANMC) in Anchorage, AK and UW Medicine Regional Burn Center at Harborview Medical Center (HMC) in Seattle, WA. We aimed to better understand the experiences of AN people with burn injuries across the care continuum to aid development of culturally appropriate care regionalization. METHODS: We performed focus groups with twelve AN people with burn injury and their caregivers. A multidisciplinary team of burn care providers, qualitative research experts, AN care coordinator, and AN cultural liaison led focus groups to elicit experiences across the burn care continuum. Transcripts were analyzed using a phenomenological approach and inductive coding to understand how AN people and families navigated the medical and community systems for burn care and areas for improvement. RESULTS: Three themes were identified: 1-Challenges with local burn care in remote communities including limited first aid, triage, pain management, and wound care, as well as long-distance transport to definitive care; 2-Divergence between cultural values and medical practices that generated mistrust in the medical system, isolation from their support systems, and recovery goals that were not aligned with their needs; 3-Difficulty accessing emotional health support and a survivor community that could empower their resilience. CONCLUSION: Participants reported modifiable barriers to culturally competent treatment for burn injuries among AN people. The findings can inform initiatives that leverage existing resources, including expansion of the Extension for Community Healthcare Outcomes (ECHO) telementoring program, promulgation of the Phoenix Society Survivors Offering Assistance in Recovery (SOAR) to AK, coordination of regionalized care to reduce time away from AK and provide more comfortable community reintegration, and define rehabilitation goals in terms that align with personal goals and subsistence lifestyle skills. Long-distance transport times are non-modifiable, but better pre-hospital care could be achieved by harnessing existing telehealth services and adapting principles of prolonged field care to allow for triage, initial care, and resuscitation in remote environments.

Target strength measurements of individual sub-Arctic krill have frequency-dependent differences from scattering model predictions.

Target strength (TS) is commonly used to convert acoustic backscatter from marine organisms to numerical abundance estimates. Shipboard, tank-based TS measurements were made on four sub-Arctic krill species (Euphausia pacifica, Thysanoessa spinifera, Thysanoessa inermis, and Thysanoessa raschii) from the eastern Bering Sea and Gulf of Alaska at discrete frequencies between 42 and 455 kHz. These measurements were compared to scattering model predictions parameterized with data from the same (when possible) individual krill. Statistically significant differences between modeled and experimental estimates at 42, 45, 120, and 131 kHz exceeded 2 dB on average. Variability in the signal-to-noise ratio, animal length, and measurements from two separate narrowband and broadband transducer pairs (at those frequencies) did not account for these differences. Scattering predictions at 120 and 131 kHz were consistent with the expected transition from Rayleigh-to-geometric scattering where models become increasingly sensitive to orientation and body shape variability. Disagreement between modeled and measured TS may be due to using scattering models developed for, and validated on, larger krill (i.e., Euphausia superba) rather than smaller species of krill. Acoustic surveys of smaller (15-30 mm) krill may require further validation of both the generalizability and parameterization of applied scattering models.

The Development of a Community-Led Alaska Native Traditional Foods Gathering.

Traditional foods and foodways are a critical part of health and well-being for Alaska Native/American Indian (ANAI) peoples. However, many of these foods are being replaced by ultra-processed foods high in fat, sugar, and sodium. The cultural knowledge needed to gather, hunt, and fish to acquire these foods is not being passed down to younger generations, due to lingering effects of colonialism, leading to poor health outcomes among ANAI peoples. Southcentral Foundation (SCF) and the Center for Indigenous and Health Equity (CIIHE) are using community-based participatory research to identify and prioritize food sovereignty interventions to strengthen the transmission of cultural knowledge across generations and improve ANAI health. Through the implementation of a comprehensive landscape analysis and the development of a community advisory board, SCF has planned an Alaska Native Traditional Foods Gathering to highlight regional efforts to document, revitalize, and share cultural food knowledge and practices to build healthy communities.

Supporting Traditional Foodways Knowledge and Practices in Alaska Native Communities: The Elders Mentoring Elders Camp.

The transmission of generational knowledge in Alaska Native communities has been disrupted by colonization and led to declining health among Alaska Natives, as evidenced by the loss of knowledge regarding traditional foods and foodways and increasing rates of cardiometabolic disorders impacting Alaska Natives. Elders play a central role in passing down this generational knowledge, but emerging Elders may have difficulty in stepping into their roles as Elders due to the rapid social and cultural changes impacting their communities. The Center for Alaska Native Health Research (CANHR) and the Denakkanaaga Elders Program are partnering with the Center for Indigenous Innovation and Health Equity to uplift and support traditional food knowledge and practices to promote health in Alaska Native communities. Guided by a decolonizing and Indigenizing framework, researchers at CANHR are working with Athabascan Elders in the Interior of Alaska to strengthen and protect the intergenerational transmission of cultural knowledge and practices for emerging Elders. This community-academic partnership will implement and evaluate an Elders Mentoring Elders Camp to focus on repairing and nurturing relationships through the practice and preservation of cultural knowledge and practices, including traditional foodways. This initiative contributes to the intergenerational transmission of knowledge, which is necessary to keep culture alive and thriving.

Significant Geographic Variation in Access to Certified Collagenase Clostridium histolyticum Injectors for Peyronie's Disease Throughout the United States.

INTRODUCTION: We characterize the geographic distribution of providers trained to inject Clostridium histolyticum and identify areas with low provider availability. METHODS: We utilized a publicly available search tool to identify clinical sites offering Clostridium histolyticum in the US The data gathered included the provider's name, specialty, address, and whether the site was considered high-volume (ie, administer ≥20 Clostridium histolyticum injections per year). Data were compared to the AUA Census. RESULTS: In total, 2,388 clinical sites offering Clostridium histolyticum were identified. A total of 894 sites (37%) were high-volume sites. The mean number of locations offering Clostridium histolyticum per 100,000 state residents was 0.69 (SD 0.27). Georgia (1.28), Rhode Island (1.13), and Alaska (1.10) had the highest number, whereas New Mexico (0.10), Maine (0.22), and Delaware (0.30) had the lowest. The mean proportion of urologists providing Clostridium histolyticum to total urologists was 0.17 (SD 0.07). The 3 states with the highest proportion were Georgia (0.37), Alaska (0.31), and Utah (0.30), whereas New Mexico (0.03), Maine (0.05), and Vermont (0.06) had the lowest. CONCLUSIONS: States with low numbers of clinical sites offering Clostridium histolyticum per 100,000 residents relative to other states also had a low total ratio of urologists offering Clostridium histolyticum as a treatment. There is room for urologists in these states and others to expand their practice to offer Clostridium histolyticum and improve patient access to this important nonsurgical treatment option.

Outcomes after ischemic stroke for dual-eligible Medicare-Medicaid beneficiaries in the United States.

BACKGROUND: Medicaid serves as a safety net for low-income US Medicare beneficiaries with limited assets. Approximately 7.7 million Americans aged ≥65 years rely on a combination of Medicare and Medicaid to obtain critical medical services, yet little is known about whether these patients have worse outcomes after stroke than patients with Medicare alone. We compared geographic patterns in dual Medicare-Medicaid eligibility and ischemic stroke hospitalizations and examined whether these dual-eligible beneficiaries had worse post-stroke outcomes than those with Medicare alone. METHODS: We identified fee-for-service Medicare beneficiaries aged ≥65 years who were discharged from US acute-care hospitals with a principal diagnosis of ischemic stroke in 2014. Medicare beneficiaries with ≥1 month of Medicaid coverage were considered dual eligible. We mapped risk-standardized stroke hospitalization rates and percentages of beneficiaries with dual eligibility. Mixed models and Cox regression were used to evaluate relationships between dual-eligible status and outcomes up to 1 year after stroke, adjusting for demographic and clinical factors. RESULTS: At the national level, 12.5% of beneficiaries were dual eligible. Dual-eligible rates were highest in Maine, Alaska, and the southern half of the United States, whereas stroke hospitalization rates were highest in the South and parts of the Midwest (Pearson's r = 0.469, p<0.001). Among 254,902 patients hospitalized for stroke, 17.4% were dual eligible. In adjusted analyses, dual-eligible patients had greater risk of all-cause readmission within 30 days (hazard ratio 1.06, 95% confidence interval [CI] 1.03-1.09) and 1 year (hazard ratio 1.03, 95% CI 1.02-1.05) and had greater odds of death within 1 year (odds ratio 1.20, 95% CI 1.17-1.23) when compared with Medicare-only patients; there was no difference in in-hospital or 30-day mortality. CONCLUSION: Dual-eligible stroke patients had higher readmissions and long-term mortality than other patients, even after comorbidity adjustment. A better understanding of the factors contributing to these poorer outcomes is needed.

Climate change and seismic resilience: Key considerations for Alaska's infrastructure and built environment.

Alaska is one of the most seismically active regions of the world. Coincidentally, the state has also experienced dramatic impacts of climate change as it is warming at twice the rate of the rest of the United States. Through mechanisms such as permafrost thaw, water table fluctuation, and melting of sea ice and glaciers, climatic-driven changes to the natural and built-environment influence the seismic response of infrastructure systems. This paper discusses the challenges and needs posed by earthquake hazards and climate change to Alaska's infrastructure and built environment, drawing on the contributions of researchers and decision-makers in interviews and a workshop. It outlines policy, mitigation, and adaptation areas meriting further attention to improve the seismic resilience of Alaska's built environment from the perspectives of engineering and complementary coupled human-environmental systems.

Tidal gradients, fine-scale homing and a potential cryptic ecotype of wild spawning pink salmon (Oncorhynchus gorbuscha).

The homing behaviour of salmon is a remarkable natural phenomenon, critical for shaping the ecology and evolution of populations yet the spatial scale at which it occurs is poorly understood. This study investigated the spatial scale and mechanisms driving homing as depicted by spawning site-choice behaviour in pink salmon (Oncorhynchus gorbuscha) in Prince William Sound, Alaska. Molecular pedigree analyses of over 30,000 adult spawners in four streams revealed that pink salmon exhibit fine-scale site fidelity within a stream, returning to within <100 m of their parents. Homing behaviours were driven in part by a salinity gradient between intertidal and freshwater environments, with individuals incubated in freshwater environments more than twice as likely to spawn upstream of tidal influence than those incubated in the intertidal. Our findings challenge the traditional view that pink salmon populations are genetically and phenotypically homogenous due to their short freshwater residency as juveniles and high rates of dispersal as returning adults (i.e. straying). This study has important implications for rates of inbreeding, local adaptation and gene flow within populations, and is particularly relevant to the management of salmon hatcheries, given the high incidence of hatchery-origin pink salmon, reared in freshwater hatchery environments, that stray into wild populations of Prince William Sound.

Effects of the soy protein to wheat gluten ratio on the physicochemical and structural properties of Alaska pollock surimi-based meat analogs by high moisture extrusion.

Surimi products have attracted much attention and are widely used in the food industry. Currently, the processing and exploitation of surimi products are mostly based on their gel characteristics. However, the abundant protein in surimi can be rearranged and integrated by high-temperature melting to generate a new surimi product with fibrous structures. In this study, meat analogs (new surimi product) were produced by high moisture extrusion (HME) using Alaska pollock surimi and plant protein (8:2), where the plant protein consisted of different ratios of soy protein and wheat gluten (9:1, 7:3, 5:5, 3:7 and 1:9). The product was marked as SSG because it was composed of Alaska pollock surimi, soy protein and wheat gluten. The structure and color results showed that the hardness and ΔE of SSG decreased, while the fibrous degree and lightness increased with increasing WG content. The observation of the macrostructure and microstructure also showed that the skeleton structure of SSG was more obvious with increasing WG addition, but the viscosity reflected a decreasing trend. Furthermore, an increase in the WG content raised the free water ratio and the total content of ß-sheets, whereas the appropriate plant protein ratio reduced the SSG's thermal stability. In conclusion, Alaskan pollock surimi and the appropriate proportion of plant protein can form structurally stable meat analogs by high moisture extrusion.

"In the beginning, I said I wouldn't get it.": Hesitant adoption of the COVID-19 vaccine in remote Alaska between November 2020 and 2021.

Achieving sufficient COVID-19 vaccination coverage has been hindered in many areas by vaccine hesitancy. Many studies based on large survey samples have characterized vaccine refusal, but there are fewer in-depth qualitative studies that explore hesitant adoption: the middle-ground between vaccine acceptance and refusal, and how individuals may move across this continuum depending on their lived experience. For this paper, we use the narratives of 25 adults living in off-road, predominately Alaska Native communities to describe the complex decision-making processes undertaken by 'hesitant adopters', defined in our study as those who completed their initial COVID-19 series despite reporting hesitancy. Interviewees' stories help illustrate how hesitant adopters' decision-making processes involved making sense of information through interactions with trusted individuals, lived experiences, observations, emotions, and personal motivations. For the majority of these hesitant adopters' (n = 20, 80%) interpersonal interactions were key in helping to make the decision to get vaccinated. Over half of the interviewees (n = 14, 56%) described how conversations with individuals they trusted, including healthcare providers, family, friends, and interactions through their professional network made them feel safe. One third of the hesitant adopters (n = 7, 28%) attributed their decision to get vaccinated based on the influence of Alaska Native Elders including their knowledge, personal experiences, as well as being motivated by the desire to protect them. Independent research was also important to about a quarter of hesitant adopters (n = 6, 24%), and for these interviewees it was the process of gathering information on their own and learning from others, especially healthcare providers who could answer their questions and alleviate their concerns. This paper illustrates the temporality of vaccine decision-making: vaccine acceptance for those who are hesitant may be an ongoing process that is influenced by personal experience, relationships, and context.

Neoskrjabinolepis paradoxa n. sp. from shrews on Sakhalin Island, Russia, with an amended diagnosis of Neoskrjabinolepis Spassky, 1947 (Cestoda: Cyclophyllidea: Hymenolepididae), a key, and a review on geographical distribution of the species.

A taxonomic review was performed on cestodes of the genus Neoskrjabinolepis Spassky, 1947 that parasitize different species of Sorex shrews in different regions of the northern Palearctic and in the Nearctic (Alaska, USA). Information on Palearctic Neoskrjabinolepis cestodes published in various articles is summarized. An overview of the geographical distribution of the Neoskrjabinolepis species is also presented. Currently, the genus includes 17 species. In the European part of the Palearctic, four species of the genus are registered; in the Asian part, 13 species; and on the American continent (Seward Peninsula, Alaska, USA), two species. Descriptions, illustrations, and differential diagnoses are given for a new species of Neoskrjabinolepis, i.e. N. paradoxa n. sp., which was found in shrews Sorex unguiculatus Dobson and S. caecutiens Laxmann on Sakhalin Island. A unique feature of the new species is irregularly alternating genital pores in the uterus series in the strobila. Amended new differential features (positioning of the uterus relative to osmoregulatory canals and alternation of genital pores) of genus diagnosis and an identification key for Neoskrjabinolepis spp. are presented.

Influence of research evidence on the use of cardiovascular clinical prediction rules in primary care: an exploratory qualitative interview study.

BACKGROUND: Cardiovascular clinical prediction rules (CPRs) are widely used in primary care. They accumulate research evidence through derivation, external validation, and impact studies. However, existing knowledge about the influence of research evidence on the use of CPRs is limited. Therefore, we explored how primary care clinicians' perceptions of and experiences with research influence their use of cardiovascular CPRs. METHODS: We conducted an exploratory qualitative interview study with thematic analysis. Primary care clinicians were recruited from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). We used purposeful sampling to ensure maximum variation within the participant group. Data were collected by conducting semi-structured online interviews. We analyzed data using inductive thematic analysis to identify commonalities and differences within themes. RESULTS: Of 29 primary care clinicians who completed the questionnaire, 15 participated in the interview. We identified two main themes relating to the influence of clinicians' perceptions of and experiences with cardiovascular CPR research on their decisions about using cardiovascular CPRs: "Seek and judge" and "be acquainted and assume." When clinicians are familiar with, trust, and feel confident in using research evidence, they might actively search and assess the evidence, which may then influence their decisions about using cardiovascular CPRs. However, clinicians, who are unfamiliar with, distrust, or find it challenging to use research evidence, might be passively acquainted with evidence but do not make their own judgment on the trustworthiness of such evidence. Therefore, these clinicians might not rely on research evidence when making decisions about using cardiovascular CPRs. CONCLUSIONS: Clinicians' perceptions and experiences could influence how they use research evidence in decisions about using cardiovascular CPRs. This implies, when promoting evidence-based decisions, it might be useful to target clinicians' unfamiliarity, distrust, and challenges regarding the use of research evidence rather than focusing only on their knowledge and skills. Further, because clinicians often rely on evidence-unrelated factors, guideline developers and policymakers should recommend cardiovascular CPRs supported by high-quality evidence.

Association between gene methylation and experiences of historical trauma in Alaska Native peoples.

BACKGROUND: Historical trauma experienced by Indigenous peoples of North America is correlated with health disparities and is hypothesized to be associated with DNA methylation. Massive group traumas such as genocide, loss of land and foodways, and forced conversion to Western lifeways may be embodied and affect individuals, families, communities, cultures, and health. This study approaches research with Alaska Native people using a community-engaged approach designed to create mutually-beneficial partnerships, including intentional relationship development, capacity building, and sample and data care. METHODS: A total of 117 Alaska Native individuals from two regions of Alaska joined the research study. Participants completed surveys on cultural identification, historical trauma (historical loss scale and historical loss associated symptoms scale), and general wellbeing. Participants provided a blood sample which was used to assess DNA methylation with the Illumina Infinium MethylationEPIC array. RESULTS: We report an association between historical loss associated symptoms and DNA methylation at five CpG sites, evidencing the embodiment of historical trauma. We further report an association between cultural identification and general wellbeing, complementing evidence from oral narratives and additional studies that multiple aspects of cultural connection may buffer the effects of and/or aid in the healing process from historical trauma. CONCLUSION: A community-engaged approach emphasizes balanced partnerships between communities and researchers. Here, this approach helps better understand embodiment of historical trauma in Alaska Native peoples. This analysis reveals links between the historical trauma response and DNA methylation. Indigenous communities have been stigmatized for public health issues instead caused by systemic inequalities, social disparities, and discrimination, and we argue that the social determinants of health model in Alaska Native peoples must include the vast impact of historical trauma and ongoing colonial violence.

Novel peeling skin condition in neonatal Pacific walruses, Saint Lawrence Island, Alaska, USA.

We describe here a novel peeling skin condition (PSC) in 2 neonatal Pacific walruses (Odobenus rosmarus subsp. divergens). Macroscopically, calves had various degrees of peeling skin exacerbated by mechanical trauma. Lesions occurred in areas subject to friction: ventrum, fore- and hindflippers, and associated joints. Histopathologic features included pseudocarcinomatous epithelial hyperplasia with orthokeratotic hyperkeratosis. Bacterial cocci were present within the stratum corneum. A few intraepidermal clefts were present. Inflammation, epidermolysis, and vasculopathies were not observed. PCR assays were negative for vesivirus and for Staphylococcus aureus exfoliative and toxic shock syndrome toxins. Tissue samples were cultured and bacteria isolated and identified by MALDI-TOF MS as Carnobacterium maltaromaticum, Psychrobacter phenylpyruvicus, Globicatella sanguinis, Streptococcus phocae, Pseudomonas spp., Rahnella aquatilis, and Escherichia coli. Given the young age of the calves and their clinical presentation, congenital ichthyosis was suspected. No genetic differences were detected for sequenced portions of keratin genes (keratin gene K10) between diseased and normal walrus skin. This rare PSC in neonatal Pacific walruses is recognized as novel by indigenous Alaskan marine mammal hunters of the Bering Strait region. A comprehensive diagnostic work-up of future case materials is needed to characterize the underlying biochemical defect(s).

Factors associated with receiving an initial COVID-19 vaccine among Alaskan residents: results from an online cross-sectional survey.

We conducted an online survey of Alaskan adults between May and June, 2022 to identify factors associated with vaccine hesitancy. Of the 948 respondents, approximately 80% reported having received a COVID-19 vaccine. The factors significantly associated with ever receiving COVID-19 vaccine include perceived risk of harm if not vaccinated (PRH), the vaccination status of the respondent's social network (SNW), gender, and education. For each point increase in PRH score, there was more than three times the odds of having ever been vaccinated (OR = 3.42, p < 0.001); and for every point increase in SNW score, there was more than two times the odds of having ever been vaccinated (OR = 2.15, p < 0.001). Males had more than four times the odds of having ever been vaccinated compared to females (OR = 4.55, p < 0.001). Those with a college degree (OR = 2.80, p < 0.05) had greater odds of ever being vaccinated compared to their counterparts. Findings from this sample suggest that, among Alaskans, ever receiving a COVID-19 vaccine is associated with having a majority of their close social networks who have received COVID-19 vaccine and perceiving that not obtaining a COVID-19 vaccine can pose greater risk of harm to themselves than not getting vaccinated. Practical implications of these findings are provided.

Factors Associated with Vaccine Hesitancy in the State of Alaska.

BACKGROUND: Vaccine hesitancy (VH) is a major public health problem which includes not only concerns about vaccine, but often includes beliefs not aligned with evidence. The etiology of VH is complicate, including genuine concerns about vaccine safety to beliefs in disproven or unsubstantiated theories. Understanding VH includes determining the factors associated with people most likely to be susceptible. OBJECTIVES: To identify characteristics of persons more likely to have VH based on perceived vaccine safety. DESIGN: We conducted a cross sectional, targeted online survey of 1,024 respondents. METHODS: The survey collected data on demographics and vaccine beliefs. A seven-question VH scale was created based on an extensive literature review. When measured, this scale had high internal validity based on Cronbach's Alpha (α = 0.80, 95% CI, 0.79, 0.82) and provided a continuous measurement to understand the VH degree. RESULTS: Persons reporting a conservative political ideology had the highest VH score ([Formula: see text] = 15.0), followed by other ([Formula: see text] =12.7), moderate ([Formula: see text] =9.29), and liberal ([Formula: see text] =6.72). Education level was another strong indicator of VH, decreasing from the highest score of high school graduates ( [Formula: see text] = 13.2) to graduate degree holders ([Formula: see text] = 9.22). CONCLUSION: The more conservative a person's political ideology, the higher the VHS. We asked for ideology, rather than political party, although they are related, they are not the same. Ideology influences more domains than voting patterns. Higher educational attainment shows a protective effect against VH. These findings have direct implication for public health interventions, new interventions should be designed to be more accessible for persons with less formal education and more amenable to persons who hold a more conservative ideology.

Nonfatal and Fatal Falls Among Adults Aged ≥65 Years - United States, 2020-2021.

In the United States, unintentional falls are the leading cause of injury and injury death among adults aged ≥65 years (older adults). Patterns of nonfatal and fatal falls differ by sex and state. To describe this variation, data from the 2020 Behavioral Risk Factor Surveillance System and 2021 National Vital Statistics System were used to ascertain the percentage of older adults who reported falling during the previous year and unintentional fall-related death rates among older adults. Measures were stratified by demographic characteristics, U.S. Census Bureau region, and state. In 2020, 14 million (27.6%) older adults reported falling during the previous year. The percentage of women who reported falling (28.9%) was higher than that among men (26.1%). The percentage of older adults who reported falling ranged from 19.9% (Illinois) to 38.0% (Alaska). In 2021, 38,742 (78.0 per 100,000 population) older adults died as the result of unintentional falls. The unintentional fall-related death rate was higher among men (91.4 per 100,000) than among women (68.3). The fall-related death rate among older adults ranged from 30.7 per 100,000 (Alabama) to 176.5 (Wisconsin). CDC's Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative recommends that health care providers screen and assess older adults for fall risk and intervene using effective preventive strategies.