Development of an Index to Measure West Nile Virus Transmission Risk in New Jersey Counties.

We developed an index for use by New Jersey counties to measure West Nile virus (WNV) transmission risk to the human population. We used a latent profile analysis to develop the index, identifying categories of environmental conditions associated with WNV transmission risk to humans. The final model included 4 indicators of transmission risk: mosquito abundance and minimum field infection rate, temperature, and human case count. We used data from 2004 to 2018 from all 21 New Jersey counties aggregated into 11 2-wk units per county per year (N = 3,465). Three WNV risk classes were identified. The Low Risk class had low levels of all variables. The Moderate Risk class had high abundance, average temperature levels, and low levels of the other variables. The High Risk class had substantially above average human case likelihood, average temperature, and high mosquito infection rates. These results suggest the presence of 3 distinct WNV risk profiles, which can be used to guide the development of public health actions intended to mitigate WNV transmission risk to the human population.

The relationship between work and mental health outcomes in Black men after serious injury.

OBJECTIVES: To explore the association between return to work (RTW) and mental health outcomes in Black men in Philadelphia recovering from serious traumatic injuries. METHODS: We analyzed data from 498 Black men aged ≥ 18 years living in Philadelphia who were admitted to a Level I trauma center for injury between January 2013 and June 2017. We used multivariable logistic regression to estimate the association between pre-injury occupation, RTW and depression or PTSD 3 months after hospitalization. RESULTS: In adjusted analyses, men who had not RTW at follow-up had higher odds of poor mental health outcomes than men who had RTW (OR: 2.7, 95% CI: 1.8, 4.2). Additional significant factors included: younger age, lack of or public health insurance and higher lifetime experiences of racism. CONCLUSIONS: The mental health recovery trajectory of injured Black men living in Philadelphia is associated with RTW and other factors that can influence financial stability and economic resources. POLICY IMPLICATIONS: Programmatic strategies that seek to optimize recovery after injury in Black men should include consideration of key structural factors such as employment, financial stability, and the impact of racism-related exposures.

State and Local Government Expenditures and Infant Mortality in the United States.

BACKGROUND AND OBJECTIVES: Evidence suggests that government expenditures on non-health care services can reduce infant mortality, but it is unclear what types of spending have the greatest impact among groups at highest risk. Thus, we sought to quantify how US state government spending on various services impacted infant mortality rates (IMRs) over time and whether spending differentially reduced mortality in some subpopulations. METHODS: A longitudinal, repeated-measures study of US state-level infant mortality and state and local government spending for the years 2000-2016, the most recent data available. Expenditures included spending on education, social services, and environment and housing. Using generalized linear regression models, we assessed how changes in spending impacted infant mortality over time, overall and stratified by race and ethnicity and maternal age group. RESULTS: State and local governments spend, on average, $9 per person. A $0.30 per-person increase in environmental spending was associated with a decrease of 0.03 deaths per 1000 live births, and a $0.73 per-person increase in social services spending was associated with a decrease of 0.02 deaths per 1000 live births. Infants born to mothers aged <20 years had the single greatest benefit from an increase in expenditures compared with all other groups. Increased expenditures in public health, housing, parks and recreation, and solid waste management were associated with the greatest reduction in overall IMR. CONCLUSIONS: Investment in non-health care services was associated with lower IMRs among certain high-risk populations. Continued investments into improved social and environmental services hold promise for further reducing IMR disparities.

Women's Occupational Patterns and Later Life Physical Functioning.

Objective: Timing and accumulation of work-related exposures may influence later life health. This study evaluates the association between women's work patterns and physical functioning. Method: Work history and physical functioning information was collected at baseline for U.S. women ages 50 to 79 years in the Women's Health Initiative Observational Study (N = 75,507). We estimated life course workforce participation patterns using latent class analysis. Associations between work patterns and physical limitations were explored using modified Poisson regression. Results: Compared with working continuously, women who left the workforce early had 8% increased risk and women who worked intermittently had 5% reduced risk of physical limitations later in life. The negative association with intermittent workforce participation was stronger for women with substantively complex work (9% reduced risk) than for women with nonsubstantively complex work (2% reduced risk). Discussion: Life course work patterns and characteristics may contribute to physical functioning later in life among women.

Driver licensing, motor-vehicle crashes, and moving violations among older adults.

INTRODUCTION: Driving is important for well-being among older adults, but age-related conditions are associated with driving reduction or cessation and increased crash risk for older drivers. Our objectives were to describe population-based rates of older drivers' licensing and per-driver rates of crashes and moving violations. METHODS: We examined individual-level statewide driver licensing, crash, and traffic citation data among all New Jersey drivers aged ≥ 65 and a 35- to 54-year-old comparison group during 2010-2014. Rate ratios (RR) of crashes and moving violations were estimated using Poisson regression. RESULTS: Overall, 86% of males and 71% of females aged ≥ 65 held a valid driver's license. Older drivers had 27% lower per-driver crash rates than middle-aged drivers (RR: 0.73, 95% CI: 0.73, 0.74)-with appreciable differences by sex-but 40% higher fatal crash rates (RR: 1.40 [1.24, 1.58]). Moving violation rates among older drivers were 72% lower than middle-aged drivers (RR: 0.28 [0.28, 0.28]). CONCLUSION: The majority of older adults are licensed, with substantial variation by age and sex. Older drivers have higher rates of fatal crashes but lower rates of moving violations compared with middle-aged drivers. Practical applications: Future research is needed to understand the extent to which older adults drive and to identify opportunities to further reduce risk of crashes and resultant injuries among older adults.

Neighborhood Environment and Health of Injured Urban Black Men.

INTRODUCTION: Urban black males are at disproportionately high risk of poor health outcomes; thus, we need to measure neighborhood environments appropriately in order to understand aspects of neighborhoods that influence their mental and physical health. We explored associations between physical and mental health of injured, urban black men with objectively measured and perceived neighborhood characteristics. METHODS: In 2017-2018, we analyzed data from 486 black, adult males in Philadelphia admitted to a trauma center with injury between January 2013 and February 2017. Area-level measures of social, economic, and built environments were obtained from multiple sources. At enrollment, participants answered questions about neighborhood environment and self-reported physical and mental health 30 days before injury. We conducted factor analysis to identify neighborhood characteristics, then estimated odds of poor physical or mental health, accounting for spatial correlation of participants. RESULTS: Poor physical and mental health was reported by 12% and 22% of participants, respectively. In participants' neighborhoods, 29% of adults lived in poverty. Individually, 73% of men reported abandoned buildings, and 31% reported not feeling safe walking around their neighborhood. Physical health was associated with neighborhood poverty and disconnectedness. Mental health was associated with neighborhood economics and individual perceptions of social disorder and safety. Individual-level factors were not correlated with area-level factors. CONCLUSIONS: We found both area-level and individual-level measures were associated with health, perhaps operating through different mechanisms, but individual experiences may not be easily extrapolated from area-level data. By identifying important components of neighborhood environments, we may better understand how neighborhoods contribute to health in vulnerable populations.

Biofidelic Evaluation of the Large Omni-Directional Child Anthropomorphic Test Device in Low Speed Loading Conditions.

Motor vehicle crashes remain the leading cause of death for children. Traditionally, restraint design has focused on the crash phase of the impact with an optimally seated occupant. In order to optimize restrain design for real-world scenarios, research has recently expanded its focus to non-traditional loading conditions including pre-crash positioning and lower speed impacts. The goal of this study was to evaluate the biofidelity of the large omni-directional child (LODC) ATD in non-traditional loading conditions by comparing its response to pediatric volunteer data in low-speed sled tests. Low-speed (2-4 g, 1.9-3.0 m/s) frontal (0°), far-side oblique (60°), and far-side lateral (90º) sled tests, as well as lateral swerving (0.72 g, 0.5 Hz) tests, were conducted using the LODC. The LODC was restrained using a 3-point-belt with an electromechanical motorized seat belt retractor, or pre-pretensioner. Motion capture markers were placed on the head, torso, and belt. The LODC was compared to previously collected pediatric volunteer data as well as the HIII 10 and Q10. Significant difference between the pediatric volunteers and ATDs were identified by comparing the mean ATD response to the pediatric volunteer 95% CI. The LODC exhibited lower forward head excursion (262 mm) compared to pediatric volunteers (263 - 333 mm) in low-speed frontal sled tests (p<0.05), but was closer to the pediatric volunteers than the HIII 10 (179 mm) and Q10 (171 mm). In lateral swerving, the LODC (429 mm) exhibited greater lateral head excursion (p<0.05) compared to pediatric volunteers (115 - 171 mm). The LODC exhibited a greater reduction in kinematics compared to the pediatric volunteers in all loading conditions with a pre-pretensioner. These data provide valuable insight into the biofidelity of the LODC in non-traditional loading conditions, such as evaluating pre-crash maneuvers on occupant response.

Advanced driver assistance systems for teen drivers: A national survey of teen and parent perceptions.

OBJECTIVE: Recently developed advanced driver assistance systems (ADAS) have the potential to compensate for teen driving errors and reduce overall crash risk. To date, very limited research has been conducted on the suitability of ADAS for teen drivers-the population most likely to benefit from such systems. The opportunity for ADAS to reduce the frequency and severity of crashes involving teen drivers is hindered when there is a lack of trust, acceptance, and use of those technologies. Therefore, there is a need to study teen and parent perceptions of ADAS to help identify and overcome any potential barriers to ADAS use. METHODS: A U.S. national survey was developed based on themes from previously conducted teen and parent ADAS focus groups. Survey topics included trust in ADAS, effect of ADAS on teen driver safety and driving behavior, effect of ADAS on skill development, data privacy, and cybersecurity. Responses included 5-point Likert scales and open-ended questions. The survey was managed through an online respondent panel by ResearchNow. Eligibility criteria included licensed teens (16-19 years) and parents of licensed teens. Teen and parent responses were compared using chi-square statistics in SAS 9.4. RESULTS: Two thousand and three (teens = 1,000; parents = 1,003) respondents qualified for and completed the survey between September 1 and September 20, 2017. Overall, teens (72%) and parents (61%) felt that ADAS would have a positive impact on transportation. However, teens were more likely to exhibit a positive outlook on ADAS, whereas parents were more likely to have a negative outlook (P < .01). Teens felt that ADAS would be useful during bad weather or drowsy driving but were less concerned than parents about ADAS intervention during their own risky driving (P < .01). The majority of teens (65%) and parents (71%) agreed that teens should learn to drive on vehicles without ADAS, with parents being more likely to agree than teens (P < .01). Parents (55%) were more likely than teens (47%) to be concerned about insurance companies keeping track of teen driving data (P < .01). Most respondents exhibited some concern of ADAS being susceptible to hacking (57%). CONCLUSIONS: This study represents the first effort to quantify ADAS perceptions among teen drivers and their parents at the U.S. national level. These data highlight potential barriers to ADAS use among teen drivers, including a relative disinterest among teens for ADAS intervention during risky driving as well as concerns among both teens and parents that ADAS will inhibit skill development. These survey findings will help inform educational programs to accelerate fleet turnover and provide the foundation for ADAS optimization and evaluation studies among sociodemographic groups.

Young Driver Compliance With Graduated Driver Licensing Restrictions Before and After Implementation of a Decal Provision.

PURPOSE: In May 2010, New Jersey implemented the first-in-the-nation decal provision to increase intermediate drivers' compliance with Graduated Driver Licensing restrictions and ultimately reduce young driver crashes. We previously found that the provision was associated with a 9.5% decline in crash rates. This study evaluates whether the decal provision was associated with an increase in compliance with passenger and nighttime restrictions. METHODS: We analyzed New Jersey driver licensing and crash data from 2008 through 2012. We used the quasi-induced exposure method to estimate prevalence of noncompliance among 20,593 nonresponsible 17- to 20-year-old intermediate drivers involved in crashes. Multivariate log-binomial regression models compared the monthly prevalence of noncompliance with restrictions pre and post implementation, adjusted for age, sex, season, and area income and population density. Analyses were conducted in 2016-2017. RESULTS: Overall estimated noncompliance with the nighttime restriction was 1.75% before and 1.71% after the decal provision (p = .83). Noncompliance with the passenger restriction was 8.68% before and 8.31% after (p = .35). Introduction of the decal provision was not associated with a change in noncompliance rates. CONCLUSIONS: Compliance rates among New Jersey intermediate drivers were high both before and after the decal provision. Findings do not suggest that the decline in crash rates following implementation was because of increased compliance with nighttime or passenger driving restrictions. Additional research is needed to understand mechanisms by which decal provisions may reduce young driver crashes.

Work Characteristics Associated with Physical Functioning in Women.

Women make up almost half of the labor force with older women becoming a growing segment of the population. Work characteristics influence physical functioning and women are at particular risk for physical limitations. However, little research has explored the effects of work characteristics on women's physical functioning. U.S. women between the ages of 50 and 79 were enrolled in the Women's Health Initiative Observational Study between 1993 and 1998. Women provided job titles and years worked at their three longest-held jobs (n = 79,147). Jobs were linked to characteristics in the Occupational Information Network. Three categories of job characteristics related to substantive complexity, physical demand, and social collaboration emerged. The association between job characteristics and physical limitations in later life, measured using a SF-36 Physical Functioning score <25th percentile, was examined using modified Poisson regression. After controlling for confounding variables, high physical demand was positively associated with physical limitations (RR = 1.09 CI: 1.06-1.12) and substantively complex work was negatively associated (RR = 0.94, CI: 0.91-0.96). Jobs requiring complex problem solving, active learning, and critical thinking were associated with better physical functioning. Employers should explore opportunities to reduce strain from physically demanding jobs and incorporate substantively complex tasks into women's work to improve long-term health.

Occupational physical demand and risk of hip fracture in older women.

OBJECTIVES: Hip fractures are leading causes of disability, morbidity and mortality among older women. Since physical activity helps maintain physical functioning and bone mineral density, occupational physical demand may influence fracture risk. This study investigates the association of occupational physical demand with hip fracture incidence among women. METHODS: The Women's Health Initiative Observational Study is a multiethnic cohort of 93,676 postmenopausal women, 50-79 years of age at enrolment, enrolled from 1994 to 1998 at 40 geographically diverse clinical centres throughout the USA. Outcomes including hip fractures were assessed annually and up to 3 jobs held since age 18 years were reported by each woman. Occupational physical demand levels were assigned for each job through linkage of occupational titles with Standard Occupational Codes and the Occupational Information Network. Average, cumulative and peak physical demand scores both before and after menopause and throughout women's work life were estimated. RESULTS: Women were followed through 2010 for an average of 11.5 years; 1834 hip fractures occurred during this time. We did not observe an overall association of occupational physical demand with subsequent risk of hip fracture after adjusting for age, race/ethnicity, birth region and education. CONCLUSIONS: Previous research on occupations and hip fracture risk in women is inconclusive. This study was able to take critical risk periods into account and control for confounding factors in a large cohort of older women to show that overall occupational physical demand neither increases nor decreases risk of hip fracture later in life.

Campylobacter jejuni infections associated with unpasteurized milk--multiple States, 2012.

In 2012, a multistate outbreak of Campylobacter infections associated with unpasteurized milk resulted in 148 illnesses. A dairy with a Pennsylvania Department of Agriculture unpasteurized milk permit and minimal deficiencies identified during inspection was the outbreak source, demonstrating the ongoing hazards of unpasteurized dairy products.

Evaluation of healthcare-associated infection surveillance in Pennsylvania hospitals.

OBJECTIVE: In Pennsylvania, reporting of healthcare-associated infections (HAIs) was mandated in 2007, and hospitals were encouraged to implement qualified electronic surveillance (QES) systems to assist HAI detection. This study evaluated the usefulness of these systems in reducing HAIs. DESIGN: Online survey and retrospective cohort study. Eligible facilities had a QES or manual system in place for the entire study period and sufficient data in selected hospital units. METHODS: Surveys were sent to infection preventionists (IPs) in all Pennsylvania hospitals to gather qualitative information about their systems. National Healthcare Safety Network data from Pennsylvania hospitals for July 2008 through June 2010 were used to compare catheter-associated urinary tract infection (CAUTI) rates in facilities with and without a QES system. PARTICIPANTS: IPs from 174 facilities responded to the survey. Data from 119 of 234 hospitals were analyzed. RESULTS: IPs in facilities with a QES system reported spending as much time on data management and education as IPs in hospitals with manual surveillance. Significant interaction was observed in CAUTI rates over time between groups of facilities with and without a QES system after controlling for device-utilization ratio, location within hospital, and licensed bed size (P < .01). QES hospitals showed a significant decline in CAUTI rates (P < .01) manual surveillance facilities showed no change in rates (P > .05). CONCLUSIONS: Over the 2-year period, a significant decline in CAUTI rates was observed in facilities with a QES system. This suggests that electronic systems may aid in reducing HAI rates. Additional data are needed to see whether these improvements and trends persist.