Characterizing Asbestos Hazard Emergency Response Act (AHERA) Compliance in New Jersey: 2008-2017.

CONTEXT: The Asbestos Hazard Emergency Response Act (AHERA) became a law in 1986, and the US Environmental Protection Agency (USEPA) was mandated to promulgate rules to regulate the inspection, management, and abatement of asbestos-containing building materials (ACBM) in schools. This study describes 10 years (2008-2017) of AHERA compliance site inspection data conducted by the New Jersey Department of Health (NJDOH). OBJECTIVES: To establish the level to which inspected NJ schools comply with AHERA regulations, to characterize compliance deficiencies including those that may lead to increased asbestos exposure risk to students and school employees, and to determine whether age, type, and geographic location of school impacted the likelihood of noncompliance. DESIGN: Information collected during 456 unique inspections between 2008 and 2017 was analyzed. SETTING AND PARTICIPANTS: Inspections were conducted at public and private schools in New Jersey. These included elementary, middle, and high schools, as well as charter and vocational/technical schools. MAIN OUTCOME MEASURES: Descriptive statistics and multiple logistic regression modeling of 3 factors, school type, geographical region, and school age. RESULTS: NJDOH inspectors found damage to friable ACBM in 50% (n = 229) of the schools and fiber release episodes in 27% of inspections (n = 121). The case of schools failing to attach warning labels on or immediately adjacent to ACBM was the most frequently noted compliance deficiency over the 10-year period. The modeling output showed that compliance was associated with the type of school and geographical region. CONCLUSIONS: Inspected schools during the 10-year period were in serious noncompliance with AHERA regulations. This included deficiencies that demonstrate a potential exposure to asbestos such as missing ACBM in management plans, damaged ACBM, lack of protection of short-term workers and custodial staff, and the identification of fiber release episodes. Modeling results of specific school characteristics can help direct limited resources to mitigate potential asbestos exposures.

Media Reports as a Tool for Timely Monitoring of COVID-19-Related Deaths Among First Responders-United States, April 2020.

We aimed to describe coronavirus disease 2019 (COVID-19) deaths among first responders early in the COVID-19 pandemic. We used media reports to gather timely information about COVID-19-related deaths among first responders during March 30-April 30, 2020, and evaluated the sensitivity of media scanning compared with traditional surveillance. We abstracted information about demographic characteristics, occupation, underlying conditions, and exposure source. Twelve of 19 US public health jurisdictions with data on reported deaths provided verification, and 7 jurisdictions reported whether additional deaths had occurred; we calculated the sensitivity of media scanning among these 7 jurisdictions. We identified 97 COVID-19-related first-responder deaths during the study period through media and jurisdiction reports. Participating jurisdictions reported 5 deaths not reported by the media. Sixty-six decedents worked in law enforcement, and 31 decedents worked in fire/emergency medical services. Media reports rarely noted underlying conditions. The media scan sensitivity was 88% (95% CI, 73%-96%) in the subset of 7 jurisdictions. Media reports demonstrated high sensitivity in documenting COVID-19-related deaths among first responders; however, information on risk factors was scarce. Routine collection of data on industry and occupation could improve understanding of COVID-19 morbidity and mortality among all workers.

Emergency department security programs, community crime, and employee assaults.

BACKGROUND: Violence against health care workers is a serious occupational health hazard, especially for emergency department (ED) employees. A significant degree of variability in security programs among hospital EDs is present in part due to the absence of federal legislation requiring baseline security features. Nationally, only voluntary guidelines from the Occupational Safety and Health Administration (OSHA) for the protection of health care workers exist. OBJECTIVES: The purpose of this study was to examine ED security programs and employee assault rates among EDs with different financial resources, size, and background community crime rates. METHODS: This cross-sectional survey was conducted among large and small hospitals located in communities with low or high rates of community crime. Hospital financial data were collected through the state health department, and employee assault data were abstracted from hospital OSHA logs. Comparisons were made using a chi-squared or Wilcoxon test. RESULTS: Small hospitals located in towns with low community crime rates implemented the fewest security program features despite having the second highest rate of assault-related OSHA-recordable injuries among ED employees (0.66 per 100,000 staff hours). CONCLUSION: Due to the highly stressful workplace characteristics of EDs, the risk of employee assault is universal among all hospital sizes in all types of communities.

Using median regression to obtain adjusted estimates of central tendency for skewed laboratory and epidemiologic data.

BACKGROUND: Laboratory studies often involve analyses of highly skewed data for which means are not an adequate measure of central tendency because they are sensitive to outliers. Attempts to transform skewed data to symmetry are not always successful, and medians are better measures of central tendency for such skewed distributions. When medians are compared across groups, confounding can be an issue, so there is a need for adjusted medians. METHODS: We illustrate the use of quantile regression to obtain adjusted medians. The method is illustrated by use of skewed nutrient data obtained from black and white men attending a prostate cancer screening. For 3 nutrients, saturated fats, caffeine, and vitamin K, we obtained medians adjusted by age, body mass index, and calories for men in each race group. RESULTS: Quantile regression, linear regression, and log-normal regression produced substantially different adjusted estimates of central tendency for saturated fats, caffeine, and vitamin K. CONCLUSIONS: Our method was useful for analysis of skewed and other nonnormally distributed continuous outcome data and for calculation of adjusted medians.

Work-related asthma in the educational services industry: California, Massachusetts, Michigan, and New Jersey, 1993-2000.

OBJECTIVES: To characterize work-related asthma (WRA) cases working in the educational services industry identified by state-based occupational disease surveillance systems. METHODS: We examined 2,995 WRA cases reported from 1993 to 2000 to four states: California, Massachusetts, Michigan, and New Jersey. RESULTS: A total of 265 (9%) WRA cases were employed in the educational services industry; 69% of cases were classified as new-onset asthma and 31% as work-aggravated asthma. New-onset asthma cases were further classified as occupational asthma (61%) or as reactive airways dysfunction syndrome (8%). The most frequently reported occupation was teachers and teachers' aides (54%). The most frequently reported agents were indoor air pollutants (28%), unspecified mold (16%), dusts (14%), and cleaning products (7%). CONCLUSIONS: Asthma within the educational services industry is an occupational health problem. The health of school employees should also be considered when initiatives addressing asthma among schoolchildren are instituted. The identification, elimination, and/or control of respiratory hazards are important factors for the protection of staff and students alike.

Impact of nutrients on insulin-like growth factor-I, insulin-like growth factor binding protein-3 and their ratio in African American and white males.

OBJECTIVE: Higher levels of insulin-like growth factor-I (IGF-I) and lower levels of IGF binding protein-3 (IGFBP-3) have been associated with an increased risk of prostate cancer. Nutrition is known to partially regulate IGF levels and it is possible that nutritional factors mediate the impact of IGF levels on prostate cancer risk. DESIGN: A cross-sectional analysis of the impact of nutritional factors measured by a dietary questionnaire on plasma levels of IGF-I, IGFBP-3 and their molar ratio. Multiple linear regression analysis was used to test for effects of nutrients on IGF levels. SETTING: Prostate cancer screening at the Hollings Cancer Center in Charleston, South Carolina. SUBJECTS: Ninety-five African American and 138 white males aged 33-83 years attending the screening. RESULTS: In whites, intakes of total, saturated and monounsaturated fats were positively associated with an increase in the molar ratio, while there was no association in African Americans. In African Americans, we found that increasing intake of calcium and dairy servings was positively associated with IGF-I levels. Increased vegetable intake was positively associated with IGFBP-3 in African Americans, while there was no effect in whites. A higher percentage of alcohol in the total diet was significantly associated with a decrease in the molar ratio and an increase in IGFBP-3 in both groups. CONCLUSIONS: Our results confirm previous findings of nutritional determinants of IGF levels. Additionally, we found the impact of several nutrients on IGF levels to be different in whites and African Americans, which warrants further investigation.

Impact of race and baseline PSA on longitudinal PSA.

There is an increasing debate regarding the frequency of prostate-specific antigen (PSA) testing and the current primary screening modality used to detect prostate cancer. The purpose of this study is to determine whether PSA screening intervals should be based on initial PSA. Our study explores longitudinal changes of PSA levels in black and white males separately. Study participants were 768 white and 450 black males attending an annual prostate cancer screening. We fit a longitudinal repeated measures model separately for blacks and whites and estimated the probability of PSA converting to greater than 4.0 ng/ml at a follow-up year given baseline PSA range among males without an abnormal DRE. Black and white males with a baseline PSA between 0 and 1.0 ng/ml, with a healthy or enlarged prostate, have a less than 1% chance that their PSA will increase above 4.0 ng/ml over the following 5 years. Black and white males with a PSA between 1.0 and 1.9 ng/ml have a less than 1% chance of PSA conversion to greater than 4.0 ng/ml over the next year. Our findings further support that annual screening for prostate cancer may not be necessary, specifically males with a baseline PSA less than 2.0 may not need to undergo annual screening. Our results suggest that race does not affect the longitudinal trend of PSA enough to warrant setting screening intervals based on race.

Racial and anthropometric differences in plasma levels of insulin-like growth factor I and insulin-like growth factor binding protein-3.

OBJECTIVES: To analyze the differences in the plasma levels of insulin-like growth factor-I (IGF-I), IGF-binding protein-3 (IGFBP-3), and their ratio between black and white men while controlling for factors that could confound the relationship between IGF levels and race. Furthermore, we analyzed the association between age, height, prostate-specific antigen level, digital rectal examination status, and current smoking status on IGF levels separately in black and white men. Greater levels of IGF-I and lower levels of IGFBP-3 have been associated with an increased risk of prostate cancer in many studies. METHODS: A cross-sectional analysis was performed on 171 white and 130 black men aged 40 to 80 years. Multiple linear regression analysis was used to model the data separately for blacks and whites. A chi-square global test was used to test for racial differences in regression curves. RESULTS: Our results indicated that black men have lower levels of IGFBP-3 and IGF-I and a greater IGF-I/IGFBP-3 ratio than white men across all ages younger than 70, with and without an adjustment for height. We found racial differences in the effect of age and height on levels of IGF-I, IGFBP-3, and the molar ratio. Age had an inverse correlation with IGF-I and IGFBP-3 levels in whites, but no such relationship in blacks. CONCLUSIONS: The differences in IGF levels between blacks and whites may explain some of the racial disparity in prostate cancer risk. Because age and height affect IGF levels differently in black and white men, future analysis exploring the determinants of IGF levels may need to be stratified by race.

Clinical breast examination practices among women undergoing screening mammography.

PURPOSE: To determine the proportion of women who underwent clinical breast examination (CBE) within 12 months before undergoing screening mammography and to examine which factors, if any, were associated with having undergone CBE within 12 months before screening mammography. MATERIALS AND METHODS: A cross-sectional study of 1,135 women presenting for screening mammography was conducted with a self-administered questionnaire. Data were collected regarding sociodemographic information, health care provider information, breast self-examination practices, and CBE history. Data were analyzed with the chi(2) test of independence. RESULTS: One hundred forty (38.5%) of 364 nonwhite women and 366 (57.4%) of 638 white women reported having undergone CBE 12 months before screening mammography. This association between race and CBE was statistically significant before (P <.001) and after adjusting for education, age, and type of referring physician (P <.001). There was a statistically significant association between undergoing CBE within 12 months and age (P <.001), type of referring physician (P <.001), and education level (P <.001). Health insurance status was associated with having undergone CBE within the past 12 months, but it was not a statistically significant association after controlling for race. CONCLUSION: The proportion of women who undergo comprehensive breast cancer screening differs by race, education level, and type of referring physician.