Cannabis Use Among Students in Grades 8, 10, and 12, by Sex - King County, Washington, 2008-2021.

Cannabis use during adolescence is associated with poor outcomes, including cognitive impairment, cannabis use disorder, and impaired driving. To guide prevention and use reduction strategies, Public Health - Seattle & King County described recent trends in cannabis use by sex among King County, Washington students in grades 8, 10, and 12 and examined trends in sex-based differences. Data collected during seven 2008-2021 survey periods by the Healthy Youth Survey (administered by the Washington State Department of Health) and restricted to King County students in grades 8, 10, and 12 (range = 33,439-39,391 students per cycle) were analyzed. Prevalence estimates were generated and sex-based prevalence differences (PDs) in current use (≥1 day during the previous 30 days) and frequent use (≥6 days during the previous 30 days) were assessed. PD models used weighted generalized linear regression with an interaction between sex and survey year. During 2008-2021, cannabis use declined among both male and female students. During 2008-2014, cannabis use was higher among male students than among female students (e.g., PD in 2008 = 4.8%) and not significantly different during 2014-2016; however, in 2021, current-use prevalence was lower among male students than among female students for the first time (PD = -1.3%). Frequent-use prevalence was similar among males and females. By grade levels, the highest prevalence of both current and frequent cannabis use was observed among 12th grade students, followed by 10th and 8th graders. Sex-specific differences by grade mirrored overall patterns. Developing tailored interventions that consider potential differences in risk and protective factors by sex or gender identity could promote equity in youth (grades 8, 10, and 12) cannabis use reduction measures.

Cross-Sector Monitoring and Evaluation Framework: Social, Economic, and Health Conditions Impacted During the COVID-19 Pandemic.

Public Health 3.0 approaches are critical for monitoring disparities in economic, social, and overall health impacts following the COVID-19 pandemic and its associated policy changes to slow community spread. Timely, cross-sector data as identified using this approach help decisionmakers identify changes, track racial disparities, and address unintended consequences during a pandemic. We applied a monitoring and evaluation framework that combined policy changes with timely, relevant cross-sector data and community review. Indicators covered unemployment, basic needs, family violence, education, childcare, access to health care, and mental, physical, and behavioral health. In response to increasing COVID-19 cases, nonpharmaceutical intervention strategies were implemented in March 2020 in King County, Washington. By December 2020, 554 000 unemployment claims were filed. Social service calls increased 100%, behavioral health crisis calls increased 25%, and domestic violence calls increased 25%, with disproportionate impact on communities of color. This framework can be replicated by local jurisdictions to inform and address racial inequities in ongoing COVID-19 mitigation and recovery. Cross-sector collaboration between public health and sectors addressing the social determinants of health are an essential first step to have an impact on long-standing racial inequities. (Am J Public Health. 2021;111(S3):S215-S223. https://doi.org/10.2105/AJPH.2021.306422).

Trends and Characteristics in Marijuana Use Among Public School Students - King County, Washington, 2004-2016.

Use of marijuana at an early age can affect memory, school performance, attention, and learning; conclusions have been mixed regarding its impact on mental health conditions, including psychosis, depression, and anxiety (1-3). Medical marijuana has been legal in Washington since 1998, and in 2012, voters approved the retail sale of marijuana for recreational use to persons aged ≥21 years. The first retail stores opened for business in July 2014. As more states legalize marijuana use by adults aged ≥21 years, the effect of legalization on use by youths will be important to monitor. To guide planning of activities aimed at reducing marijuana use by youths and to inform ongoing policy development, Public Health-Seattle & King County assessed trends and characteristics of past 30-day marijuana use among King County, Washington, public school students in grades 6, 8, 10, and 12. This report used biennial data for 2004-2016 from the Washington State Healthy Youth Survey. Among grade 6 students there was a decreasing trend in self-reported past 30-day marijuana use from 2004 to 2016, while the percentage of grade 8 students who had used marijuana during the past 30 days did not change during that period. Among students in grades 10 and 12, self-reported past 30-day use of marijuana increased from 2004 to 2012, then declined from 2012 to 2016. In 2016, the percentage of students with past 30-day marijuana use in King County was 0.6% among grade 6, 4.1% among grade 8, 13.9% among grade 10, and 25.5% among grade 12 students. Among grade 10 students, 24.0% of past 30-day marijuana users also smoked cigarettes, compared with 1.3% of nonusers. From 2004 to 2016 the prevalence of perception of great risk of harm from regular marijuana use decreased across all grades. Continued surveillance using consistent measures is needed to monitor the impact of marijuana legalization and emerging public health issues, given variable legislation approaches among jurisdictions.

Changes in awareness and use of calorie information after mandatory menu labeling in restaurants in King County, Washington.

OBJECTIVES: We examined population-level impact on customer awareness and use and explored potential disparities in outcomes regarding the King County, Washington, regulation requiring chain restaurants to provide calorie information. METHODS: We analyzed 2008 to 2010 Behavioral Risk Factor Surveillance System data from 3132 English-speaking King County residents aged 18 years and older who reported eating at a regulated chain. We used regression models to assess changes in calorie information awareness and use from prepolicy to postpolicy implementation by customer demographics, health status, and restaurant type. RESULTS: Calorie information awareness and use increased significantly from 2008 to 2010. Unadjusted analyses indicated that the proportion who saw and used calorie information tripled, from 8.1% to 24.8%. Fully adjusted analyses confirmed significant increases. After policy implementation, White, higher income, and obese respondents had greater odds of seeing calorie information. Women, higher income groups, and those eating at a fast-food versus a sit-down chain restaurant were more likely to use this information. CONCLUSIONS: Significant increases in calorie information awareness and use following regulation support the population-wide value of this policy. However, improvements varied across race, income, and gender.

Incarceration and subsequent risk of suicide: A statewide cohort study.

INTRODUCTION: Increasing suicide rates across the United States are disproportionate among populations most impacted by mass incarceration. We sought to determine if incarceration is associated with risk of suicide and firearm suicide after release from prison. METHODS: Using a population-based Washington cohort from Department of Corrections and vital statistics administrative records 1990-2017, individuals were compared to the sex-, age-, and race-matched population of Washington using Poisson regression. Among previously incarcerated individuals, we included incarceration history characteristics to calculate sub-hazard ratios using Cox proportional-hazards models. RESULTS: Of 140,281 individuals released from prison, 484 died by suicide. Suicide risk was 62% higher among previously incarcerated individuals compared with the general population (RR: 1.62; 95% CI: 1.46-1.79). Suicide risk was higher among individuals convicted of firearm-involved crimes (RR: 2.27; 95% CI: 1.79-2.89). Individuals released prior to age 18 had substantially higher risk of firearm suicide than those whose first release occurred between ages 18-24 (sHR: 11.91; 95% CI: 4.30-32.96). CONCLUSION: Our findings highlight the need for improved mental health resources and lethal means safety in this population. Mental health and substance use treatment have been proposed as effective alternatives to incarceration-continuing to study their impacts may reveal additional benefits of reducing suicide.

The effect of age on transmission of 2009 pandemic influenza A (H1N1) in a camp and associated households.

BACKGROUND: A major portion of influenza disease burden during the 2009 pandemic was observed among young people. METHODS: We examined the effect of age on the transmission of influenza-like illness associated with the 2009 pandemic influenza A (H1N1) virus (pH1N1) for an April-May 2009 outbreak among youth-camp participants and household contacts in Washington State. RESULTS: An influenza-like illness attack rate of 51% was found among 96 camp participants. We observed a cabin secondary attack rate of 42% (95% confidence interval = 21%-66%) and a camp local reproductive number of 2.7 (1.7-4.1) for influenza-like illness among children (less than 18 years old). Among the 136 contacts in the 41 households with an influenza-like illness index case who attended the camp, the influenza-like illness secondary attack rate was 11% for children (5%-21%) and 4% for adults (2%-8%). The odds ratio for influenza-like illness among children versus adults was 3.1 (1.3-7.3). CONCLUSIONS: The strong age effect, combined with the low number of susceptible children per household (1.2), plausibly explains the lower-than-expected household secondary attack rate for influenza-like illness, illustrating the importance of other venues where children congregate for sustaining community transmission. Quantifying the effects of age on pH1N1 transmission is important for informing effective intervention strategies.

Area-based socioeconomic characteristics of industries at high risk for violence in the workplace.

This study examined socioeconomic factors associated with the presence of workplaces belonging to industries reported to be at high risk for worker homicide. The proportion of 2004 North Carolina workplaces in high-risk industries was computed following spatial linkage of individual workplaces to 2000 United States Census Block Groups (n = 3,925). Thirty census-derived socioeconomic variables (selected a priori as potentially predictive of violence) were summarized using exploratory factor analysis into poverty/deprivation, human/economic capital, and transience/instability. Multinomial logistic regression models indicate associations between higher proportion of workplaces belonging to high-risk industries and Block Groups with more poverty/deprivation or transience/instability and less human/economic capital. The relationship between human/economic capital and Block Groups proportion of high-risk industry workplaces was modified by levels of transience/instability. Community characteristics therefore contribute to the potential for workplace violence, and future research should continue to understand the relationship between social context and workplace violence risk.

Frequency and determinants of recommended workplace violence prevention measures.

PROBLEM: Limited information exists concerning adoption of workplace violence prevention measures by employers and the factors influencing their adoption. METHODS: A weighted sample of North Carolina workplaces (n=210) in operation January 1994 through March 1998 was used to estimate prevalence of 18 measures and identify community and workplace predictors of having >/=5 recommended measures. RESULTS: Location in a metropolitan area most strongly predicted presence of >/=5 administrative safety measures while a history of workplace violence and being in a high crime area were negatively associated. Belonging to an industry considered to be high-risk for workplace homicide was most strongly associated with having >/=5 environmental safety measures. DISCUSSION: Factors influencing high prevalence of violence prevention measures were related to business type, violence history, and location. Knowledge of factors influencing adoption of recommended workplace violence prevention measures can help tailor interventions to diverse industry settings. IMPACT ON INDUSTRY: An important contribution to the understanding and mitigation of workplace homicide is knowledge of the extent of implementation of recommended workplace violence prevention guidelines and factors influencing their adoption. Identifying factors that influence the prevalence and adoption of workplace violence safety interventions can help to tailor development of interventions to address the issue of workplace homicide across diverse industry settings.

Incident-level risk factors for firefighter injuries at structural fires.

Firefighting is a demanding occupation, laden with hazardous exposures which result in traumatic injuries. Little epidemiologic evidence exists quantifying these factors, however. We conducted an incident-level case-control study of National Fire Incident Reporting System data of the association between firefighter injury and incident characteristics. Risk factors included 5 or more alarms (OR = 3.85; 95% CI, 3.32-4.48), number of stories (> 3 vs. ground level OR = 2.49; 95% CI, 1.43 to 1.55), and at least one civilian injury (OR = 3.69; 95% CI, 3.55-3.84). Risk of injury was reduced for fires originating 49 feet and higher (OR = 0.57; 95% CI, 0.49-0.66). This analysis suggests that fireground-specific situations such as the number of stories or a civilian injury increase the risk of injury. Given the danger of firefighting, the identification of risk factors through epidemiologic methods is vital to developing safety measures.

Menu labeling regulations and calories purchased at chain restaurants.

BACKGROUND: The federal menu labeling law will require chain restaurants to post caloric information on menus, but the impact of labeling is uncertain. PURPOSE: The goal of the current study was to examine the effect of menu labeling on calories purchased, and secondarily, to assess self-reported awareness and use of labels. DESIGN: Single-community pre-post-post cross-sectional study. Data were collected in 2008-2010 and analyzed in 2011-2012. SETTING/PARTICIPANTS: 50 sites from 10 chain restaurants in King County, Washington, selected through stratified, two-stage cluster random sampling. A total of 7325 customers participated. Eligibility criteria were: being an English speaker, aged ≥ 14 years, and having an itemized receipt. The study population was 59% male, 76% white non-Hispanic, and 53% aged<40 years. INTERVENTION: A regulation requiring chain restaurants to post calorie information on menus or menu boards was implemented. MAIN OUTCOME MEASURES: Mean number of calories purchased. RESULTS: No significant changes occurred between baseline and 4-6 months postregulation. Mean calories per purchase decreased from 908.5 to 870.4 at 18 months post-implementation (38 kcal, 95% CI=-76.9, 0.8, p=0.06) in food chains and from 154.3 to 132.1 (22 kcal, 95% CI=-35.8, -8.5, p=0.002) in coffee chains. Calories decreased in taco and coffee chains, but not in burger and sandwich establishments. They decreased more among women than men in coffee chains. Awareness of labels increased from 18.8% to 61.7% in food chains and from 4.4% to 30.0% in coffee chains (both p<0.001). Among customers seeing calorie information, the proportion using it (about one third) did not change substantially over time. After implementation, food chain customers using information purchased on average fewer calories compared to those seeing but not using (difference=143.2 kcal, p<0.001) and those not seeing (difference=135.5 kcal, p<0.001) such information. CONCLUSIONS: Mean calories per purchase decreased 18 months after implementation of menu labeling in some restaurant chains and among women but not men.

Limited percentages of adults in Washington State meet the Dietary Guidelines for Americans recommended intakes of fruits and vegetables.

Nutritious diets that include sufficient intake of fruits and vegetables promote health and reduce risk for chronic diseases. The 2005 Dietary Guidelines for Americans recommend four to 13 servings of fruits and vegetables daily for energy intake levels of 1,000 to 3,200 kcal, including seven to 13 servings for 1,600 to 3,000 kcal/day as recommended for adults aged ≥25 years. The 2006-2007 Washington Adult Health Survey, a cross-sectional study designed to measure risk factors for cardiovascular disease among a representative sample of Washington State residents aged ≥25 years, included a food frequency questionnaire (FFQ). The FFQ included approximately 120 food items and summary questions for fruits and vegetables that were used to compute energy intake and two measures of fruit and vegetable intake. Measure 1 was computed as the sum of intake of individual FFQ fruit and vegetable items; Measure 2 combined the summary questions with selected individual FFQ fruit and vegetable items. Depending on the measure used, approximately 14% to 22% of 519 participants with complete information met the guidelines for fruits, 11% to 15% for vegetables, and 5% to 6% for both fruits and vegetables. Participants aged ≥65 years and women were more likely to meet recommendations, compared with younger participants and men. Despite decades of public health attention, the vast majority of Washington State residents do not consume the recommended amount of fruits or vegetables daily. These findings underscore the need for developing and evaluating new approaches to promote fruit and vegetable consumption.

Nutrition-labeling regulation impacts on restaurant environments.

BACKGROUND: Recent attempts to improve the healthfulness of away-from-home eating include regulations requiring restaurants to post nutrition information. The impact of such regulations on restaurant environments is unknown. PURPOSE: To examine changes in restaurant environments from before to after nutrition-labeling regulation in a newly regulated county versus a nonregulated county. METHODS: Using the Nutrition Environment Measures Survey-Restaurant version audit, environments within the same quick-service chain restaurants were evaluated in King County (regulated) before and 6 and 18 months after regulation enforcement and in Multnomah County (nonregulated) restaurants over a 6-month period. Data were collected in 2008-2010 and analyses conducted in 2011. RESULTS: Overall availability of healthy options and facilitation of healthy eating did not increase differentially in King County versus Multnomah County restaurants aside from the substantial increase in onsite nutrition information posting in King County restaurants required by the new regulation. Barriers to healthful eating decreased in King County relative to Multnomah County restaurants, particularly in food-oriented establishments. King County restaurants demonstrated modest increases in signage that promotes healthy eating, although the frequency of such promotion remained low, and the availability of reduced portions decreased in these restaurants. The healthfulness of children's menus improved modestly over time, but not differentially by county. CONCLUSIONS: A restaurant nutrition-labeling regulation was accompanied by some, but not uniform, improvements in other aspects of restaurant environments in the regulated compared to the nonregulated county. Additional opportunities exist for improving the healthfulness of away-from-home eating beyond menu labeling.

Self-Reported Daily Stress, Squelching of Anger and the Management of Daily Stress and the Prevalence of Uterine Leiomyomata: The Ultrasound Screening Study.

Self-reported daily stress, ways of managing stress and squelching anger were examined in association with uterine leiomyomata (aka fibroids). These stress factors were obtained from 560 Black and 375 White women enrolled in the National Institute of Environmental Health Sciences Uterine Fibroid Study. Race-specific prevalence differences (PD) and 95% confidence intervals (95% CI) were calculated. Black women with severe stress had a prevalence of fibroids that was 11% higher (95% CI: 0%, 21%) than those in the no or mild stress group (referent). White women with severe stress, compared to the referent, had a non-significantly (NS) higher prevalence of fibroids [PD = 7%; 95% CI: (-103, 213)]. For both groups, moderate daily stress was associated with a weak elevation (NS) in fibroid prevalence. Black women who reported squelching their anger had an elevated prevalence of fibroids (8%) compared to non-squelchers [95% CI: (-03, 153)] while there was no association for White women. Women with symptomatic fibroids had higher stress than those without, but exclusion of symptomatic women only slightly attenuated the associations. Consistent with a previous report, symptomatic fibroids may cause stress. However, further research is warranted to prospectively investigate a possible aetiologic role for stress in the development of fibroids.

The association between self-reported major life events and the presence of uterine fibroids.

PURPOSE: Uterine fibroids are the most common benign tumors in reproductive-age women. Factors associated with this condition such as psychosocial stress are still being elucidated. This paper explores the association between major life events (MLE) stress and fibroids. METHODS: Prevalence ratios (PR) and 95% confidence intervals (CI) were used to determine the association between MLE stress (number of events and stress intensity) and fibroids in 556 Black and 373 White women in the Uterine Fibroid Study, 1996-1999. MAIN FINDINGS: Fibroids were prevalent in 74% and 50% of the Black and White women, respectively. The mean number of MLE reported by each race group was two. Among White women, the PR for those who reported at least one event compared with those with no events were significant after adjusting for age and study identified fibroid risk factors (PR [1 and 2 events], 1.7; 95% CI, 1.2-2.5), (PR [3 events], 1.9; 95% CI, 1.3-2.7), and (PR [4 events], 1.5; 95% CI, 1.0-2.1), respectively. At all levels of stress compared with no events, significant associations with fibroids were found among White women. For Black women, the PR for fibroids was only significant in the high stress group compared with those without an experienced event, after adjusting for fibroid risk factors (PR, 1.2; 95% CI, 1.1-1.4). CONCLUSION: Examining the number and stress intensity of MLE enriched our understanding of this stressor and fibroids. Further research is needed to understand the role of stress on fibroids among women.

A comparison of the occurrence and perceived stress of major life events in black and white women.

PURPOSE: To describe the occurrence and perceived stress of major life events, and to investigate whether adjusting for socioeconomic status reduced race/ethnicity differences. METHODS: Black (n = 639) and white (n = 419) women aged 35-49 years responded to 14 major life event questions within the domains of employment, health, relationship, finance, residential change, and crime. MAIN FINDINGS: The total number of life events did not differ by race/ethnicity, but black women reported significantly more events in the domains of relationship, financial, and residential change than white women. White women generally reported higher stress for a given event than black women, although for "residential change" black women reported more severe stress than the white women. CONCLUSIONS: Inclusion of both the occurrence and perceived stress of major life events can improve our understanding of how this stressor may affect health.

Work-related hazards and workplace safety of US adolescents employed in the retail and service sectors.

OBJECTIVE: Our goal was to examine the hazard exposures, work experiences, and workplace safety training of adolescents employed in retail and service jobs in the United States. METHODS: This was a cross-sectional telephone survey among working adolescents, 14 to 18 years old, in the continental United States. Data were collected in 2003. Survey items measured self-reported hazard exposures, training, and supervision experiences of working adolescents. RESULTS: Teens reported working an average of 16.2 hours per week during the school year, including working an average of 2.9 times per week after 7 PM on school nights and 2.6 nights per week after 9 PM. Thirty-seven percent of those under age 16 reported working after 7 PM on a school night, indicating employer violation of federal law. Teens typically perform multiple kinds of tasks in a given job. Higher proportions of females than males are involved in cash handling (84% vs 61%), whereas males are more likely than females to be involved in physically challenging tasks, such as lifting heavy objects (57% vs 22%) or working at heights (35% vs 17%). Despite federal regulations prohibiting teens under 18 from using certain types of dangerous equipment (eg, slicers, dough mixers, box crushers, paper balers) or serving or selling alcohol in places where it is consumed, 52% of males and 43% of females reported having performed > or = 1 prohibited task. Although more males reported receiving safety training, they were also more likely to report working without supervision than their female counterparts. CONCLUSIONS: Teens are exposed to multiple hazards, use dangerous equipment despite federal prohibitions, and work long hours during the school week. They also lack consistent training and adult supervision on the job. It is important for adolescent medicine practitioners to become involved in prevention efforts through both anticipatory guidance and policy advocacy.

Employer policies toward guns and the risk of homicide in the workplace.

This population-based case-control study of North Carolina workplaces evaluated the hypothesis that employers' policies allowing firearms in the workplace may increase workers' risk of homicide. Workplaces where guns were permitted were about 5 times as likely to experience a homicide as those where all weapons were prohibited (adjusted odds ratio=4.81; 95% confidence interval=1.70, 13.65). The association remained after adjustment for other risk factors. The findings suggest that policies allowing guns in the workplace might increase workers' risk of homicide.