Firearm Storage Behaviors - Behavioral Risk Factor Surveillance System, Eight States, 2021-2022.

Secure firearm storage might help reduce access by children and other unauthorized users and the related risk for injury or death. Information about state-specific prevalence of firearm storage practices can be used to develop secure storage messages and programs; however, such information is often unavailable. Data from the Behavioral Risk Factor Surveillance System, by respondent characteristics, were used to estimate prevalence of keeping firearms in or around the home and related storage practices for eight states that administered the firearm safety module in 2021 or 2022. Overall, 18.4% (California) to 50.6% (Alaska) of respondents reported that a firearm was kept in or around their home. Among those with a firearm in or around the home, 19.5% (Minnesota) to 43.8% (North Carolina) reported that a firearm was stored loaded. Across all eight states, approximately one half of those with a loaded firearm stored at least one loaded firearm unlocked. Among respondents with a child and a loaded firearm in the home, 25.2% (Ohio) to 41.4% (Alaska) reported that a loaded firearm was stored unlocked. Variability in firearm storage practices highlights the importance of local data and suggests opportunities to tailor prevention efforts to specific population groups to reduce risk for firearm handling by children without adult supervision, and other unauthorized persons.

Emergency Medical Services Encounters for Firearm Injuries - 858 Counties, United States, January 2019-September 2023.

Firearm-related deaths and injuries have increased in recent years. Comprehensive and timely information on firearm injuries and the communities and geographic locations most affected by firearm violence is crucial for guiding prevention activities. However, traditional surveillance systems for firearm injury, which are mostly based on hospital encounters and mortality-related data, often lack information on the location where the shooting occurred. This study examined annual and monthly rates of emergency medical services (EMS) encounters for firearm injury per 100,000 total EMS encounters during January 2019-September 2023 in 858 counties in 27 states, by patient characteristics and characteristics of the counties where the injuries occurred. Overall, annual rates of firearm injury EMS encounters per 100,000 total EMS encounters ranged from 222.7 in 2019 to 294.9 in 2020; rates remained above prepandemic levels through 2023. Rates were consistently higher among males than females. Rates stratified by race and ethnicity were highest among non-Hispanic Black or African American persons; rates stratified by age group were highest among persons aged 15-24 years. The greatest percentage increases in annual rates occurred in urban counties and in counties with higher prevalence of severe housing problems, higher income inequality ratios, and higher rates of unemployment. States and communities can use the timely and location-specific data in EMS records to develop and implement comprehensive firearm injury prevention strategies to address the economic, social, and physical conditions that contribute to the risk for violence, including improvements to physical environments, secure firearm storage, and strengthened social and economic supports.

Hired crop worker injury risks on farms in the United States during three different periods between 2002 and 2015.

BACKGROUND: Hired crop workers have high incidence of work-related injuries, but little has been documented about potential risks at the national level. METHODS: Data were obtained from a national probability sample of hired crop workers in the United States (U.S.) during 2002-2004 (period I), 2008-2010 (period II), and 2014-2015 (period III). Multivariable logistic regression models of work-related injury were constructed using an occupational exposure adjustment for weeks worked in the previous year. RESULTS: Hired crop workers reporting that their employer did not provide clean drinking water and disposable cups every day were estimated to be at greater odds of injury during all three periods. Having at least some English-speaking ability was associated with increased odds of injury in two periods, while owning a dwelling in the U.S. showed greater injury risk during period II but was associated with lower risk during period III. Other items significantly associated with injury during at least one of the study periods in the final multivariable logistic models included being a direct-hire, a migrant worker, U.S.-born, receiving public aid, and having a health condition. CONCLUSIONS: Hired crop workers are an extremely marginalized population of workers in the U.S. Innovative intervention methods must extend beyond traditional occupational models to focus on the overall health of hired crop workers, including increasing healthcare access, ending agricultural exceptionalism to provide equal regulatory protections afforded to workers in other industries, and adequate enforcement of existing regulations. These findings contribute to the understanding of correlates related to increased work-related injury among hired crop workers, and have implications in fields of prevention, intervention, and policy.

Prevalence estimates and factors associated with violence among older adults: National Intimate Partner and Sexual Violence (NISVS) Survey, 2016/2017.

Abuse of older adults is a public health problem. The National Intimate Partner and Sexual Violence Survey (NISVS) is a nationally-representative, telephone survey for non-institutionalized adults in the United States. To determine the prevalence and factors of intimate partner psychological aggression and physical violence and sexual violence by any perpetrator against older adults, we analyzed NISVS 2016/2017 data (n = 10,171, aged ≥ 60 years). Past 12-month prevalence of psychological aggression, physical violence, and sexual violence was 2.1%, 0.8%, and 1.7%, respectively. Odds of psychological aggression were significantly higher among those with hearing or vision impairment, and lower among those aged ≥70 years. Odds of physical violence were significantly higher for males and for those with hearing or vision impairment. Odds of sexual violence were significantly higher for unpartnered individuals and those with cognitive impairment; and lower for those aged ≥ 70 years. Epidemiologic studies of violence against older adults can inform population-specific prevention strategies.

Participation of Workers of Asian Ancestry in High-Risk Occupations in the United States: 2009 to 2017.

Risk for workplace injury varies by occupation. Participation in high-risk occupations is non-randomly distributed as a function of demographic characteristics. Enhancing understanding of occupational health and safety disparities allows for the creation of actionable knowledge to advance health equity. The specific aim of our analysis was to examine between-group differences in participation in high-risk occupations among workers with an Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese ancestry. Analysis included workers who reported one of the following ancestries: Asian Indian; Chinese; Filipino; Japanese; Korean; or Vietnamese. Observational study used American Community Survey (ACS) Public Use Microdata Sample (PUMS) single-year files from 2009 through 2017. Data on the analytic sample (unweighted = 480,170) was used to estimate per Full-Time Equivalents (FTEs) by year and Asian ancestry. Analysis used the replicate weight method to estimate margins of error. Statistical analysis indicated workers with a Filipino ancestry engage in high-risk occupations at the highest proportion. Observed between-group differences merit further scientific inquiry. Advancing metrology is crucial to promoting the health equity of understudied populations.

Firefighter Fatalities: Crude Mortality Rates and Risk Factors for Line of Duty Injury and Death.

The United States Fire Administration (USFA) provides high-quality data for firefighter deaths (FFDs), but until now these data have not been analyzed for temporal trends. This analysis explores FFDs between 1990 and 2016 to determine high-risk groups for outreach and training. Mortality rates were calculated using USFA information compared against the total number of deaths per year. Rates were compared between 1990-2009 (early period) and 2010-2016 (recent period). Multinomial logistic regression was used to determine predictors of death in firefighters (FFs) by age group (≤45 and >45 years old) and by work status (career vs volunteer). Analysis of 3159 FFDs revealed a decline in crude-rate mortality between 1990-2009 and 2010-2016 (47.4 vs 35 FF deaths per million, P < .0001). FFs of ≤45 years old were less likely to die in the 2010s than in the 1990s-2000s (13.7 vs 24.7 FF deaths per million, P = .0002). Trauma-related deaths decreased (13.1 vs 8.1, P = .0003), whereas CV-related deaths remained constant (19.4 vs 19.5, P = .24). Regression analysis determined that volunteer FFs were more likely to die from burns (OR 1.7, CI: 1.2-2.4, P < .0001) and trauma (OR 1.8, CI: 1.5-2.2, P < .0001) than career FFs. Younger FFs were also more likely to die from burns (OR 10.4, CI: 6.9-15.6, P < .0001) and trauma (OR 6.5, CI: 5.4-7.8, P < .0001). Although overall FFDs were lower after 2010, younger and volunteer FFs saw an increase in burn and trauma-related mortality. Cardiovascular-related fatalities were consistent throughout the study. Future research should continue to make use of high-standard data to track FFDs and efficacy of interventions.

Why Public Health Researchers Should Consider Using Disability Data from the American Community Survey.

The United States (US) federal government allocates hundreds of billions of dollars to provide resources to Americans with disabilities, older adults, and the poor. The American Community Survey (ACS) influences the distribution of those resources. The specific aim of the project is to introduce health researchers to Public Use Microdata Sample file from 2009 to 2011. The overall goal of our paper is to promote the use of ACS data relevant to disability status. This study provides prevalence estimates of three disability related items for the population at or over the age of 15 years who reside in one of the continental states. When population weights are applied to the 7,198,221 individuals in the sample under analysis, they are said to represent 239,641,088 of their counterparts in the US population. Detailed tabulations by state (provided as Microsoft Excel® spreadsheets in ACS output) clearly show disability prevalence varies from state-to-state. Because analyses of the ACS data have the ability to influence resources aiding individuals with physical mobility challenges, its use should be promoted. Particular attention should be given to monetary allocations which will improve accessibility of the existing built environment for the individuals with mobility impairment.

Nationwide Prevalence of Self-Reported Serious Sensory Impairments and Their Associations with Self-Reported Cognitive and Functional Difficulties.

PURPOSE: To estimate the nationwide prevalence of self-reported serious vision impairment (SVI), serious hearing impairment (SHI), and serious dual sensory impairment (DSI; i.e., concomitant SVI and SHI) and to characterize their associations with self-reported cognitive, independent living, self-care, and ambulatory difficulties. DESIGN: The American Community Survey (ACS) is a nationwide cross-sectional survey administered by the United States Census Bureau. PARTICIPANTS: The 2011-2015 ACS sample contains data on 7 210 535 individuals 45 years of age or older. METHODS: Descriptive statistics for each of the 4 mutually exclusive sensory impairment categories no sensory impairment (NSI), SVI, SHI, and serious DSI were calculated using the weighted sample. Adjusted odds ratios using several logistic regressions were calculated using the unweighted sample to measure the magnitude of associations between sensory impairment status and the outcome difficulties. MAIN OUTCOME MEASURES: Self-reported cognitive, independent living, self-care, and ambulatory difficulty. RESULTS: Among individuals 45 years of age or older, the estimated nationwide prevalence of self-reported SVI alone is 2.8%, that of SHI alone is 6.0%, and that of serious DSI is 1.6%. The prevalence of each sensory impairment increases with age. A greater proportion of American Indians or Alaskan Natives experience SVI (4.8%), SHI (8.5%), and serious DSI (3.7%) than any other race or ethnic group (P < 0.001). Individuals reporting serious DSI are more likely to report cognitive impairment, independent living difficulty, self-care difficulty, and difficulty ambulating than individuals with NSI across all age groups (all P < 0.001). Furthermore, serious DSI is associated with greater cognitive and functional difficulties than SVI or SHI alone, and SVI alone has a greater association with cognitive and functional difficulties than SHI alone. CONCLUSIONS: The nationwide prevalence of self-reported serious sensory impairment increases with age and is distributed unequally among different racial and ethnic groups. Any sensory impairment is associated with greater cognitive and functional difficulties than NSI. Additionally, serious DSI is associated with greater difficulties than SVI or SHI alone, and SVI alone is more serious than SHI alone in each of the 4 cognitive and functional difficulties.

Prevalence and Risk for Negative Disability Outcomes Between American Indians-Alaskan Natives and Other Race-Ethnic Groups in the Southwestern United States.

In the USA, some race-ethnic minorities are unjustly relegated to the margins of society. As a consequence, these groups are more frequently found to have risk profiles associated with adverse health than individuals from the majority group (non-Hispanic Whites). Limited research has been devoted to investigating how American Indians and Alaska Natives (AIANs) differ from other race-ethnic minorities and the majority group with regard to prevalence and risk for self-care, independent living, and ambulatory disabilities. Our investigation attempts to quantify both of these tracks by accounting for race-ethnic and poverty status. Our cross-sectional analysis used nationally representative data from the American Community Survey (ACS) 5-year (2009-2013) Public Use Microdata Sample (PUMS) file to address this literature gap. We selected survey participants from the four states with the largest concentration of AIANs in the USA (Arizona, California, New Mexico, and Oklahoma). We used information on 2,428,233 individuals to generalize prevalence of and risk for disability to 49,994,332 individuals in the Southwest US. We found disability (self-reported) prevalence differed between our six race-ethnic groups in statistically significant and complex ways. Population-weighted logistic regression analyses adjusting for age, sex, and citizenship found AIANs have a higher risk for disability than non-Hispanic Whites, non-Hispanic Asians, and Hispanics. In order to impact public health and build a more equitable society, efforts should continue to identify health disparities. Researchers should continue to advance conceptual frameworks on plausible causal mechanisms between markers of social stratification and disablement processes.

Social Security Disability Insurance May Reduce Benefits by 2016: Population at Financial Risk from Reductions.

In the United States, 10.9 million people are receiving Social Security Disability Insurance (SSDI) benefits with an average pay of $12,000 per year. If the U.S. House of Congress fails to enact a new bill by the end of fiscal-year 2016, SSDI benefits are estimated to be reduced by $2,300 per-person per year. In the pass, the U.S. Congress has always found a way to enact new bills capable of maintains benefits at existing levels. The specific aim of this project was to report the number of people potentially at risk for experiencing an economic impact if SSDI benefits are reduced. The cross-sectional analysis used data from the American Community Survey, 2009-2013 Public Use Microdata Sample file. Characteristics on a total of 153,627 actual survey participants were used to generalize findings to 2,748,735 residents of the United States. Results indicate non-Hispanic Whites, the Pacific and South Atlantic geographic divisions are at the largest risk for being affected by changes to SSDI benefits.

A critical analysis of the internal logic in the Life-Space Assessment (LSA) composite score and suggested solutions.

BACKGROUND: An individual's ability to live independently is commonly measured in health research interested in identifying risk factors associated with disablement processes. In order to inform clinical practice, population research has attempted to identify the contraction of "lived-space" by using various survey instruments. PROBLEM: Studies assessing habitual movements over the environment with the Life-Space Assessment (LSA) survey instrument should carefully consider how the LSA Composite Score (LSA-CS) is computed. Until now, no publication has carefully delineated the assumptions guiding the internal logic used in the computation of the LSA-CS. CORE ARGUMENT: Because the internal logic of the LSA may need further justification, a non-data-editing scoring algorithm should be considered. SOLUTION: Compute LSA-CS by only using non-edited data. SPECIFIC AIM: Paper first delineates the logic guiding the algorithm used in the formation of the LSA-CS and explains how the scoring creates and changes participant responses when they conflict with its internal logic. An easy-to-use SAS® 9.3 program for estimating a Non-Data-Edited LSA-CS (NDE-LSA-CS) is also presented. CONCLUSION: Researchers interested in assessing lived-space should carefully consider if the internal logic of the LSA-CS is warranted. Clinicians should know it is important to understand the strengths and weaknesses of outcome measures used when deciding on whether to apply the results of research to direct clinical practice.

An observational study identifying obese subgroups among older adults at increased risk of mobility disability: do perceptions of the neighborhood environment matter?

BACKGROUND: Obesity is an increasingly prevalent condition among older adults, yet relatively little is known about how built environment variables may be associated with obesity in older age groups. This is particularly the case for more vulnerable older adults already showing functional limitations associated with subsequent disability. METHODS: The Lifestyle Interventions and Independence for Elders (LIFE) trial dataset (n = 1600) was used to explore the associations between perceived built environment variables and baseline obesity levels. Age-stratified recursive partitioning methods were applied to identify distinct subgroups with varying obesity prevalence. RESULTS: Among participants aged 70-78 years, four distinct subgroups, defined by combinations of perceived environment and race-ethnicity variables, were identified. The subgroups with the lowest obesity prevalence (45.5-59.4%) consisted of participants who reported living in neighborhoods with higher residential density. Among participants aged 79-89 years, the subgroup (of three distinct subgroups identified) with the lowest obesity prevalence (19.4%) consisted of non-African American/Black participants who reported living in neighborhoods with friends or acquaintances similar in demographic characteristics to themselves. Overall support for the partitioned subgroupings was obtained using mixed model regression analysis. CONCLUSIONS: The results suggest that, in combination with race/ethnicity, features of the perceived neighborhood built and social environments differentiated distinct groups of vulnerable older adults from different age strata that differed in obesity prevalence. Pending further verification, the results may help to inform subsequent targeting of such subgroups for further investigation. TRIAL REGISTRATION: Clinicaltrials.gov Identifier = NCT01072500.

Disability Prevalence According to a Class, Race, and Sex (CSR) Hypothesis.

Disability has been shown to be related in definite ways to social class. In modern industrial societies, disability is influenced by and has the potential to contribute to the production and reproduction of social inequality. However, markers of social stratification processes are sometimes ignored determinants of health. A Class, Race, Sex (CRS) hypothesis is presented to argue that a "low-education disadvantage"; "racial-minority disadvantage"; and "female disadvantage" will compound to affect the risks for being disable. In particular, the CRS hypothesis posits that class is more important than race and the latter more than sex when predicting presence or severity of disability. The cross-sectional study of community-dwelling adults between the ages of 45 and 64 uses data from the American Community Survey (ACS) Public Use Microdata Sample (PUMS) 2008-2012 file. By using 3,429,523 individuals-which weighted equal to 61,726,420-the results of the study suggest the CRS hypothesis applies to both Non-Latino-Blacks and Non-Latino-Whites. There is a "male disadvantage" exception for Non-Latino-Whites. Decreasing between-group differences in health may be achieved by making the age-health association at lower socioeconomic stratum similar to that of the upper socioeconomic strata.

Demographic, Economic, Household, and Health Profile of Grandparents Responsible for Grandchildren.

The objective of this brief report was to outline the demographic, economic, household, and health profile of "grandparents responsible for grandchildren" (GRfGs) in the United States (US). Public Use Microdata Sample (PUMS) from the 2009-2011 American Community Survey (ACS) 3-year file was used to investigate characteristics of GRfGs by race-ethnic groups and the geographical distribution over the US mainland (contiguous states). The 9,177 actual units in the microdata are estimated to represent about 306,122 GRfGs. Population profiles are presented in tables for GRfGs of any age and the characteristics for those aged 65 and over are discussed. Amongst GRfGs aged 65 and over (n=33,168): 27% have ambulatory difficulty; 33% own their home free and clear; 77% have resided in their current residence for more than four years; 41% care for grandchild(ren) with the parent being absent; 61% are married; 36% have a college education; 77% are not in the labor force; and the majority (55%) are Non-Latino-Whites. Qualitative comparisons from descriptive statistics suggest race-ethnic minority GRfGs may be more economically and socially vulnerable than Non-Latino-Whites. Research on GRfGs and efforts on understanding how best to assist them should continue.

Disability Estimates between Same- and Different-Sex Couples: Microdata from the American Community Survey (2009-2011).

Disability and sexual orientation have been used by some to unjustly discriminate against differently-abled and differently-oriented minority groups. Because little is known about the disability rates of individuals in same-sex unions, this technical report presents disability rates by separating couples into: same-sex-female; same-sex-male; different-sex-married; and different-sex-unmarried couples. Data from the American Community Survey (ACS) Public Use Microdata Sample (PUMS) 2009-2011 3-year file is utilized to produce estimates (and their standard errors) for the following six disability items: independent living; ambulatory; self-care; cognitive; hearing; and vision. Estimates of disability by selected geographies-i.e., Public Use Microdata Areas (PUMAs)-are also presented as is a figure showing a PUMA polygon. Qualitative comparisons seem to indicate that: same-sex-female couples have higher rates of disability compared to the other three groups; that in general, disability estimates for individuals in same-sex couples have a greater degree of uncertainty; and that disability-item-allocations are most prevalent in same-sex couples. Because societal marginalization may increase through cumulative processes, public health professionals should continue to seek out ways to identify underserved populations.

Risk for Disability and Poverty Among Central Asians in the United States.

Understanding the disability-poverty relationship among minority groups within the United States (US) populations may help inform interventions aimed at reducing health disparities. Limited information exists on risk factors for disability and poverty among "Central Asians" (immigrants born in Kazakhstan, Uzbekistan, and other Central Asian regions of the former Soviet Union) in the US. The current cross-sectional analysis used information on 6,820 Central Asians to identify risk factors for disability and poverty. Data from the 2009-2013 Public Use Microdata Sample (PUMS) file from the American Community Survey (ACS) indicate that being married, non-Latino-white, and having higher levels of educational attainment are protective against disability and poverty. In contrast, older age, residing in the Middle Atlantic geographic division, and having limited English language ability are risk factors for both disability and poverty. Research should continue to develop risk profiles for understudied immigrant populations. Expanding knowledge on the well-being of Central Asians in the US may help impact public health interventions and inform health policies.

Number of people in the United States experiencing ambulatory and independent living difficulties.

Estimating the characteristics of the "disabled" population is necessary for some governments and of interest to health researchers concerned with producing disability prevalence rates. Because generating easy-to-understand estimates of disability in the population is important, this article provides U.S. population estimates for two disability-related measures by using the 2009 to 2011 American Community Survey Public Use Microdata Sample file. The number of people who have "independent living" and "ambulatory" difficulties is calculated from a sample of 9,204,437 (representing >309 million people). The percentage for "disabled" is found to vary by racial and ethnic category, sex, age, citizenship status, educational attainment, and state-level regions divided by weather.

The Regional Geoboundarization of the Mexican Population in the United States through Saenzian Logic.

The population proliferation of Latinos in the U.S. has propelled them into the new majority-minority. Mexicans make up more than half of all Latinos/as. Social scientists have long known that accounting for social environment is crucial in deciphering how social structures interact with individual human behavior. Academic discourse needs to explicitly delineate the logic and best practices for measuring social contexts. Standardizing how contexts are geographically boundarized and subsequently measured could provide multilevel and spatial modeling researchers a more solid theoretical foundation for nesting individuals and measuring their environment. Context measuring standardization would make cross study comparisons more readily available. This project seeks to contribute to this endeavor by employing and advancing the "Saenzian" logic for regionalizing Mexican origin Latinos/as. The proposed solution applies to social research that uses U.S. Census Bureau microdata to investigate the Mexican population. By using Saenzian concepts, this study explores and proposes three alternatives for geographically regionalizing the Mexican population. Maps are utilized to present the logic for the classical, new, and clustered Saenzian regional classification schemes. Findings comparing the classical and new approach reveal that smaller geographical units reveal important insights that are typically hidden by large polygon conglomerations. Findings from the clustered analysis reveal that regions are more tightly and well defined. A discussion is offered in closing posing basic theoretical questions on what constitutes a region.

Physical performance and short-term mortality in very old Mexican Americans.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Physical performance measures have been found to be strong predictors of adverse outcomes in aging populations. Few studies have examined the predictive ability of physical performance measures exclusively within populations of the very old. This study explores the predictive ability of the Short Physical Performance Battery (SPPB) and its three subcomponents-a timed walk, balance test, and repeated timed chair stands-on mortality in a sample of Mexican Americans aged 75 and older. METHODS: Logistic regression analyses were used with data from the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE), to investigate the relationship between timed walk, balance test, repeated timed chair stands, and the SPPB and mortality over a 2½-year period. RESULTS: The authors find that being unable to complete the timed walk, the balance test, and repeated timed chair stands, or unable to complete any of the SPPB was significantly associated with mortality over 2½ years. CONCLUSION: These findings indicate that physical performance measures may be less predictive of short-term mortality in very old Mexican Americans than previously thought. More research is needed to understand this relationship.