U.S. Army mortality surveillance in active duty soldiers, 2014-2019.

Mortality surveillance is an important activity for capturing information on a population's health. This retrospective surveillance analysis utilizes administrative data sources to describe active duty U.S. Army soldiers who died from 2014 to 2019, and calculate mortality rates, assess trends by category of death, and identify leading causes of death within subpopulations. During the surveillance period, 2,530 soldier deaths were reported. The highest crude mortality rates observed during the 6-year surveillance period were for deaths by suicide, followed by accidental (i.e., unintentional injury) deaths. The crude mortality rates for natural deaths decreased significantly over the 6-year period, by an average of 6% annually. The leading causes of death were suicide by gunshot wound, motor vehicle accidents, suicide by hanging, neoplasms, and cardiovascular events. Significant differences were observed in the leading causes of death in relation to demographic characteristics, which has important implications for the development of focused educational campaigns to improve health behaviors and safe driving habits. Current public health programs to prevent suicide should be evaluated, with new approaches for firearm safety considered.

Demographic, psychosocial, and physical fitness predictors of successful graduation from U.S. Army Ranger School.

U.S. Army Ranger School is an arduous 64-day leadership training course designed to simulate the stressors of combat. Although physical fitness has been shown to be an important predictor of successful graduation for Ranger School, psychosocial characteristics like self-efficacy and grit have not been examined. The purpose of this study is to identify personal, psychosocial, and fitness characteristics associated with successful completion of Ranger School. This study was a prospective cohort examining the association of baseline characteristics of Ranger School candidates with a primary outcome of graduation success. Multiple logistic regression was performed to determine the contribution of demographics, psychosocial, fitness and training characteristics to graduation success. Out of 958 eligible Ranger Candidates, this study obtained graduation status for 670 students, 270 (40%) of which graduated. Soldiers who graduated were younger, more likely to come from units with a higher proportion of previous Ranger School graduates, had higher self-efficacy and faster 2-mile run times. The results from this study suggest that Ranger students should arrive in optimal physical conditioning. Furthermore, training programs that optimize student self-efficacy and units with a high proportion of successful Ranger graduates may confer advantage for this challenging leadership course.

Workplace violence victimization in young workers: An analysis of the US National Crime Victimization Survey, 2008 to 2012.

BACKGROUND: The aim of this study was to measure the frequency of workplace violence (WPV) victimization in 16 to 24-year olds in the United States and compare rates by occupation and demographics. METHODS: As an open cohort, participants 12 years or older in the National Crime Victimization Survey were interviewed at 6-month intervals over a 3-year period from 2008 to 2012. WPV victimization rates were calculated. Weighted, multilevel Poisson regression was used to compare WPV victimization rates by occupation and demographics. RESULTS: The rate of WPV victimization was 1.11 incidents per 1000 employed person-months (95% confidence interval: 0.95-1.27). The highest rates of WPV were in protective service occupations (5.24/1000 person-months), transportation (3.04/1000 person-months), and retail sales (2.29/1000 person-months). Compared with their respective counterparts, lower rates of WPV victimization were found among younger, black, and rural/suburban workers. CONCLUSIONS: Findings identify occupations and target populations in need of future research and evidence-based interventions to improve the working conditions for young workers.

Link for Injured Kids: A Patient-Centered Program of Psychological First Aid After Trauma.

OBJECTIVE: Injury, the most common type of pediatric trauma, can lead to a number of adverse psychosocial outcomes, including posttraumatic stress disorder. Currently, few evidence-based parent programs exist to support children hospitalized after a traumatic injury. Using methods in evaluation and intervention research, we completed a formative research study to develop a new program of psychological first aid, Link for Injured Kids, aimed to educate parents in supporting their children after a severe traumatic injury. METHODS: Using qualitative methods, we held focus groups with parents and pediatric trauma providers of children hospitalized at a Level I Children's Hospital because of an injury in 2012. We asked focus group participants to describe reactions to trauma and review drafts of our intervention materials. RESULTS: Health professionals and caregivers reported a broad spectrum of emotional responses by their children or patients; however, difficulties were experienced during recovery at home and upon returning to school. All parents and health professionals recommended that interventions be offered to parents either in the emergency department or close to discharge among admissions. CONCLUSIONS: Results from this study strongly indicate a need for posttrauma interventions, particularly in rural settings, to support families of children to address the psychosocial outcomes in the aftermath of an injury. Findings presented here describe the process of intervention development that responds to the needs of an affected population.

Characteristics of Farm Equipment-Related Crashes Associated With Injury in Children and Adolescents on Farm Equipment.

PURPOSE: Operating or riding on farm equipment is one of the leading causes of farm-related injuries and fatalities among children and adolescents. The aim of this study is to examine environment, crash, vehicle, and occupant characteristics and the probability of injury, given a crash, in youth under age 18 on farm equipment. METHOD: Data from the Departments of Transportation on farm equipment-related crashes across 9 Midwestern states from 2005-2010 were used. Odds ratios were calculated using logistic regression to assess the relationship between environment, crash, vehicle, and occupant characteristics and the probability of injury, given a crash. FINDINGS: A total of 434 farm equipment-related crashes involved 505 child or adolescent occupants on farm equipment: 198 passengers and 307 operators. Passengers of farm equipment had 4.1 higher odds of injury than operators. Occupants who used restraints had significantly lower odds of injury than those who did not. Furthermore, occupants on farm equipment that was rear-ended or sideswiped had significantly lower odds of injury compared to occupants on farm equipment involved in noncollision crashes. Likewise, occupants on farm equipment that was impacted while turning had significantly lower odds of injury compared to those on equipment that was impacted while moving straight. CONCLUSION: Precautions should be taken to limit or restrict youth from riding on or operating farm equipment. These findings reiterate the need to enforce policies that improve safety measures for youth involved in or exposed to agricultural tasks.

The effects of roadway characteristics on farm equipment crashes: a geographic information systems approach.

BACKGROUND: Tractors and other slow-moving self-propelled farm equipment are often used on public roadway to transfer goods from the farm to a market or distributer. Increased roadway exposure has led to a growing concern on the occurrence of farm equipment crashes. This study aims to compare characteristics of road segments with farm equipment crashes to road segments without farm equipment crashes in the state of Iowa. METHODS: Data were obtained from the Iowa Department of Transportation from 2005 to 2011 on all crashes involving farm equipment, and features of all Iowa roadways. Geographic Information Systems (GIS) was used to identify geospatial features, such as road type, speed limit, traffic volume surface type, road and shoulder width of where a crash occurred. Logistic regression models were used to measure the associations between road characteristics and the occurrence of farm equipment crashes. Crude and adjusted odds ratios and 95% confidence intervals were reported. RESULTS: A total of 1371 farm equipment crashes were reported in Iowa over the 6-year period and geocoded onto a street location. As traffic volume increased, the odds of a crash occurring also increased. Roadways with posted speed limits between 50 and 60 mph were associated with a higher odds of having crashes on them compared to roadways with speeds less than 35 mph (OR = 8.05, 95% CI: 6.59-9.84). Iowa routes (OR = 5.98, 95% CI: 4.97-7.20) had the highest odds of having crashes compared to local routes. Increased road width (OR = 0.90, 95% CI: 0.86-0.94) was associated with a 10% decrease in the odds of a crash. CONCLUSIONS: Higher traffic volume, higher posted speed limits, road type, and smaller road widths were associated with the occurrence of farm equipment crashes. Findings from this study can be used to guide policy to improve roadway design and conditions for all road users.

Evaluating racial disparity in referral source and successful completion of substance abuse treatment.

Health disparity is a significant problem in the United States, and particularly for substance abuse treatment programs. A better understanding of racial differences in treatment pathways associated with successful treatment completion is needed to reduce the existing health disparities. Referral source is a strong predictor of treatment success and most research on health disparities has focused on the criminal justice referrals. However, little research has examined other types of referral sources, and the interaction with race. The current study sought to compare the effect of referral sources on national substance abuse successful treatment completion rates between Black clients (n=324,625) and White clients (n=1,060,444) by examining the interaction of race on referral source and successful treatment completion. Race significantly moderated the difference between referral source and successful treatment completion (Wald χ(2)=1477.73, df=6, p<0.0001). Employment referral was associated with the greatest percentage of successful treatment completion for Black clients. Criminal justice referral was associated with the greatest percentage of successful treatment completion for White clients. Results from the present study support a reevaluation of incentives leading to successful treatment completion with a multicultural perspective.