Risk factors associated with life jacket wear among adult canoeists and kayakers in the United States, 1999-2017.

Drowning is the most common cause of death in recreational boating. Life jackets prevent drowning, yet adult wear rates remain relatively low on most types of boats. Canoes and kayaks are among the least used boat types, yet maintain the third and first highest annual boating-related drowning rates in 2012, respectively. This 1999-2017 study collected data from 124 study sites across the US. Life jacket wear was calculated for 13 dichotomized risky and non-risky variables, using Chi-square tests. A count variable based on number of risks was created, and Cochran-Armitage trend tests examined linearity in life jacket use. Three illustrative variables for each boat type were represented in tree diagrams. Kayakers had higher wear rates than canoeists among all variables observed. For both boats, the majority of risky conditions had higher life jacket wear rates than their non-risky alternatives. As the number of risks increased, life jacket wear rate increased. Boaters seemingly conduct a mental assessment of risk to determine whether to wear a life jacket.

Factors associated with life jacket use among cabin sailboat and day sailor boaters in the United States.

INTRODUCTION: In 2015, drowning accounted for 68% of the 626 recreational boating related deaths in the United States. Although life jackets are estimated to prevent between 50% to 80% of boating deaths, approximately 83% of sailboat-related drowning victims were reported to not be wearing life jackets. Life jacket use among adult boaters has remained consistently low across most boat types and may vary by boater, boating, and environmental conditions. Although many risky environmental and boating factors may be associated with a higher risk of boating death, drowning occurs in all situations and it is useful to understand adult life jacket wearing behaviors in differing boating situations. METHODS: This study uses observational survey data from 61318 adult sailors collected during the summer months of 1999 - 2017 from 124 selected study sites across 30 states in the US. Life jacket use was compared for day sailors and cabin sailboats by multiple boating, boater, and environmental conditions using Chi-square tests for equality of proportions. Results of these tests led to a choice of 3 informative and scientifically compelling variables to summarize variation in life jacket use for each sailboat type. Odds ratios were calculated comparing life jacket use from each boating situation to the lowest risk situation as determined by the 3 selected variables. These variables were represented in a tree diagram, detailing the additive impact of each factor. Following these analyses, all boating conditions were categorized to be risky or non-risky and a count variable was created for each observation based on the number of risks present. Cochran-Armitage trend tests were conducted to test for linearity in life jacket use for both boat types. RESULTS: The overall life jacket wear rate was higher among adults in day sailor sailboats (51.6%) compared to cabin sailboats (13.8%) and in all measured demographic, boating, and environmental circumstances. Comparing high-risk cabin sailboat conditions of low water temperatures, small boat size, and high wind speed to the lowest-risk situation accounted for a 23.3% range in life jacket wear rate (OR=4.7). Comparing high-risk day sailor sailboat conditions of small boat size, one boater on board, and choppy/rough wave height to the lowest-risk situation accounted for a 39.3% range in life jacket wear rate (OR=5.9). For both boat types, the number of risks present and life jacket wear rate exhibited a statistically significant positive linear relationship at p<0.0001. CONCLUSION: Study results suggest that boaters are aware of the connection between life jacket use and drowning prevention and are more likely to wear life jackets when boating in conditions perceived to be risky. PRACTICAL APPLICATIONS: Boating safety promotion efforts should recommend adult life jacket use in all boating situations, as seemingly non-risky conditions may still result in drownings.

Barriers to cervical cancer screening and follow-up care among Black Women in Massachusetts.

OBJECTIVE: To explore factors that might lead to delays in appropriate cervical cancer screening and diagnosis among Black women in Massachusetts. DESIGN: Qualitative using focus groups. SETTING: Hospitals, health centers, and community-based organizations in Boston, Massachusetts. PARTICIPANTS: Sixty-four participants including Black, non-Hispanic women from the general population and cervical cancer survivors, community leaders in women's health, and health care providers. METHODS: Six focus groups. Data were analyzed using methods based on grounded theory. RESULTS: Findings from interviews revealed that inadequate information and education of providers and patients create barriers to appropriate screening and treatment practices for Black women. Fear, cultural beliefs, and compounding factors related to poverty, gender roles, and health system barriers create delays to screening and follow-up care. Also, unconscious bias, therapeutic delays, and miscommunication are important factors affecting continuity of care. CONCLUSION: These results suggest a need for comprehensive, culturally specific cervical cancer prevention education initiatives and interventions for Black women and strategies to improve patient-provider relationships.

Patient-stated preferences regarding volume-related risk mitigation strategies for hemodialysis.

BACKGROUND AND OBJECTIVES: Larger weight gain and higher ultrafiltration rates have been associated with poorer outcomes among patients on dialysis. Dietary restrictions reduce fluid-related risk; however, adherence is challenging. Alternative fluid mitigation strategies include treatment time extension, more frequent dialysis, adjunct peritoneal dialysis, and wearable ultrafiltration devices. No data regarding patient preferences for fluid management exist. A survey was designed, tested, and administered to assess patient-stated preferences regarding fluid mitigation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A written survey concerning fluid-related symptoms, patient and treatment characteristics, and fluid management preferences was developed. The cross-sectional survey was completed by 600 patients on hemodialysis at 18 geographically diverse ambulatory facilities. Comparisons of patient willingness to engage in volume mitigation strategies across fluid symptom burden, dietary restriction experience, and patient characteristics were performed. RESULTS: Final analyses included 588 surveys. Overall, if allowed to liberalize fluid intake, 44.6% of patients were willing to extend treatment time by 15 minutes. Willingness to extend treatment time was incrementally less for longer treatment extensions; 12.2% of patients were willing to add a fourth weekly treatment session, and 13.5% of patients were willing to participate in nocturnal dialysis three nights per week. Patients more bothered by their fluid restrictions (versus less bothered) were more willing to engage in fluid mitigation strategies. Demographic characteristics and symptoms, such as cramping and dyspnea, were not consistently associated with willingness to engage in the proposed strategies. More than 25% of patients were unsure of their dry weights and typical interdialytic weight gains. CONCLUSIONS: Patients were generally averse to treatment time extension>15 minutes. Patients more bothered (versus less bothered) by their prescribed fluid restrictions were more willing to engage in volume mitigation strategies. Additional study of patient-stated preferences in hemodialysis treatment practices is needed to guide patient care and identify deficiencies in patient treatment and disease-related knowledge.

Trends in life jacket wear among recreational boaters: a dozen years (1999-2010) of US observational data.

We report results from 12 years of US observational data on life jacket use among recreational boaters based on more than 480,000 boaters in 175,000 boats between 1999 and 2010. The overall wear rate was 21.7 per cent, with sharp differences by age and boat types. We found strong increasing trends in wear rates among youth boaters, but among adults, the only increase was on sailboats. The increasing trend among youth is probably due to a combination of expanding laws for mandatory life jacket use among this age group, and targeted educational campaigns promoting life jacket use for children. Future efforts to increase the prevalence of life jacket wear should target groups with low wear rates and boaters on boats most likely to capsize. Policymakers should give serious consideration to regulations requiring adult boaters to wear life jackets while boating.

Work organization and drinking: an epidemiological comparison of two psychosocial work exposure models.

OBJECTIVES: To examine the relationship between two alternative psychosocial work exposure measurement frameworks (i.e., job alienation and job stress) and three drinking behaviours (frequent, heavy and drinking and work). METHODS: A cross-sectional survey was conducted among 3,099 US drinking workers. Job stress conditions were assessed according to the Karasek's job strain model. Alienating job conditions were assessed with measures based on Kohn and Schooler's occupational self-direction concept. Multivariate logistic regression controlling for a wide range of known covariates was used. RESULTS: High strain work showed no associations, while workers in passive jobs had an increased likelihood of heavy (OR = 1.29; 95%CI: 1.02-1.64) and lower likelihood of frequent drinking (OR = 0.71; 95%CI: 0.52-0.97). Unexpectedly, low complexity combined with low constraint related to more frequent drinking (OR = 1.60; 95%CI: 1.22-2.10). No associations with drinking at work were observed. CONCLUSION: Our findings suggest an association between different work environment features and drinking behaviours. Our findings highlight the value of exploring the hypothesized passive pathway of the job strain model together with other theoretical perspectives, such as alienating job conditions.

Drinking social norms and drinking behaviours: a multilevel analysis of 137 workgroups in 16 worksites.

BACKGROUND: Previous studies on worksite drinking norms showed individually perceived norms were associated with drinking behaviours. OBJECTIVE: To examine whether restrictive drinking social norms shared by workgroup membership are associated with decreased heavy drinking, frequent drinking and drinking at work at the worker level. METHODS: The sample included 5338 workers with complete data nested in 137 supervisory workgroups from 16 American worksites. Multilevel models were fitted to examine the association between workgroup drinking norms and heavy drinking, frequent drinking and drinking at work. RESULTS: Multivariate adjusted models showed participants working in workgroups in the most discouraging drinking norms quartile were 45% less likely to be heavy drinkers, 54% less likely to be frequent drinkers and 69% less likely to drink at work than their counterparts in the most encouraging quartile. CONCLUSIONS: Strong associations between workgroup level restrictive drinking social norms and drinking outcomes suggest public health efforts at reducing drinking and alcohol-related injuries, illnesses and diseases should target social interventions at worksites.

Impact of education on knowledge, agricultural practices, and community actions for mosquito control and mosquito-borne disease prevention in rice ecosystems in Sri Lanka.

Mosquito-borne diseases are a major public health threat in Sri Lanka. A 20-week pilot education program to improve community knowledge and mosquito control with participatory and non-chemical approaches was developed, implemented, and evaluated using pre-educational and post-educational surveys in two intervention and two comparison villages. Correlates of baseline knowledge were sex, number of family members, ratio of family members with malaria history, school education level, and availability of electricity at the residence. Participation in the educational program led to improved knowledge of mosquito ecology and disease epidemiology, changes in agricultural practices, and an increase in environmentally sound measures for mosquito control and disease prevention. The variety of actions at the post-educational stage were determined by improved knowledge, but not by sociodemographic characteristics. Such community-based educational interventions are effective in increasing understanding and active involvement in mosquito control and disease prevention in rice ecosystems regardless of sociodemographic characteristics.

Community-based rice ecosystem management for suppressing vector anophelines in Sri Lanka.

Sri Lanka is one of the Asian countries most affected by mosquito-borne diseases, especially malaria. This 18-month study assessed the effectiveness of a new community-based ecosystem management programme to control mosquito vectors in the country's rice ecosystem. Farmers in a malaria-prone village were educated and motivated to engage in source reduction as well as measures to restore and maximise rice ecosystem functions. Over the course of the programme, the impact of farmers' ecosystem management on local mosquito ecology was also examined. Although little impact was detected on Culex and Aedes densities, adult Anopheles density was significantly suppressed in the southwest monsoon season. Rice farmers who manage their ecosystems can reduce the burden of Anopheles mosquitoes, interrupt malaria transmission and prevent the destruction of ecosystems.

Workgroup context and the experience of abuse: An opportunity for prevention.

This study examined the relationship between certain workgroup characteristics and the experience of abuse in the workplace. Data were collected from 6540 workers at sixteen work sites among six Fortune 500 companies. Workgroup cohesiveness, workgroup interdependence, supervisory concern, supervisory presence and the percent of women in the workgroup were tested for associations with perceived hostility, harassment and negativity for both women and men. Workgroup cohesiveness and supervisory concern showed the strongest protective relationships. The percent of women in the workgroup was also protective for women on all three abuse measures and for men in relation to experienced hostility and negativity. Workgroup interdependence demonstrated an unexpected positive association for experienced hostility and harassment for both men and women. Findings that identify workgroup characteristics that are protective for employees experiencing workplace abuse will be useful for prevention planning.