Evaluating Firearm Violence After New Jersey's Cash Bail Reform.

Importance: Reducing the pretrial detention population has been a cornerstone of movements to end mass incarceration. Across many US cities, there are ongoing public debates on policies that would end pretrial detention due to the inability to afford bail, with some raising concerns that doing so would increase community violence. Objective: To evaluate changes in firearm violence after New Jersey's 2017 bail reform policy that eliminated financial barriers to avoiding pretrial detention. Design, Setting, and Participants: This case-control study used synthetic control methods to examine changes in firearm mortality and combined fatal and nonfatal shootings in New Jersey (2014-2019). New Jersey was chosen because it was one of the first states to systematically implement cash bail reform. Outcomes in New Jersey were compared with a weighted combination of 36 states that did not implement any kind of reform to pretrial detention during the study period. Data were analyzed from April 2023 to March 2024. Exposure: Implementation of New Jersey's cash bail reform law in 2017. Main Outcomes and Measures: Quarterly rates of fatal and nonfatal firearm assault injuries and firearm self-harm injuries per 100 000 people. Results: Although New Jersey's pretrial detention population dramatically decreased under bail reform, the study did not find evidence of increases in overall firearm mortality (average treatment effect on the treated, -0.26 deaths per 100 000) or gun violence (average treatment effect on the treated, -0.24 deaths per 100 000), or within racialized groups during the postpolicy period. Conclusions and Relevance: Incarceration and gun violence are major public health problems impacting racially and economically marginalized groups. Cash bail reform may be an important tool for reducing pretrial detention and advancing health equity without exacerbating community violence.

Assessing reliability of naïve respondent-driven sampling samples by using repeated surveys among people who inject drugs (PWID) in New Jersey.

INTRODUCTION: Respondent-driven sampling (RDS) is widely used to sample populations with higher risk of HIV infection for whom no sampling frames exist. However, few studies have been done to assess the reliability of RDS in real world settings. METHODS: We assessed the reliability of naïve RDS samples using five rounds of the National HIV Behavioral Surveillance - People Who Inject Drugs surveys in Newark, New Jersey from 2005 to 2018. Specifically, we compared the distributions of time-insensitive demographic characteristics in temporally adjacent RDS samples with Monte Carlo Two-Sample Kolmogorov-Smirnov Test with 100,000 replicates. The distributions of time-sensitive demographic characteristics were also compared as sensitivity analyses. RESULTS: The study showed that repeated RDS samples among people who inject drugs in the greater Newark area, New Jersey were reliable in most of time-insensitive demographics and recruitment homophily statistics. Sensitivity analyses of time-sensitive demographics also presented consistencies in most of temporally adjacent samples. CONCLUSIONS: In conclusion, RDS has the potential to provide reliable samples, but demographic characteristics of RDS samples may be easily biased by homophily. Future studies using RDS may need to pay more attention to potential homophily bias and consider necessary diagnostic procedures and sample adjustments.

Impact of environmental pollutants on pediatric brain tumor incidence in New Jersey.

OBJECTIVE: The relationship between environmental contaminants and brain tumor incidence in adults has been thoroughly explored but research into how these contaminants affect pediatric brain tumor (PBT) incidence has not been explored. Children, typically having more limited geographical movement and thus more consistent environmental contaminant exposure, might offer more reliable insights into which environmental contaminants affect the incidence of brain tumors. The present study is the first to focus on exploring whether a possible association exists between the incidence of PBTs and exposure to environmental pollutants in New Jersey (NJ). METHODS: Linear regressions were run between PBT incidence and the concentration of air quality pollutants such as Ozone (O3), Particulate Matter 2.5 (PM2.5), Particulate Matter 10 (PM10), and Carbon Monoxide (CO). Similarly, linear regressions were run between PBT incidence and Elevated Blood Lead Levels (BLL). RESULTS: The study observed a significant positive relationship between O3 and PBT incidence (ß = 0.34, p = 0.028). However, the relationship between PBT incidence, and environmental pollutants such as CO (ß = 0.0047, p = 0.098), PM2.5 (ß = -0.2624, p = 0.74), and PM10 (ß = -0.7353, p = 0.073) were found to be nonsignificant. For elevated BLL, nonsignificant relationships with PBT incidence were observed at 10-14 µg/dL (ß = -39.38, p = 0.30), 15-19 µg/dL (ß = -67.00, p = 0.21), and 20-44 µg/dL (ß = -201.98, p = 0.12). CONCLUSIONS: The results indicate a possible impact of O3 on the incidence of PBTs in NJ. In contrast to the significant links found in prior studies of adult brain tumors, the associations between PBT occurrence and particulate matter were not significant. These findings highlight the importance of further investigating how environmental factors, especially O3, relate to PBTs.

The first record of an established population of Amblyomma maculatum (Acari: Ixodidae) in New Jersey, USA.

Amblyomma maculatum Koch, the Gulf Coast tick, is expanding northward from its original range in the southeastern United States. In 2013, its most northern collection was in Delaware. Amblyomma maculatum has since been found in Connecticut, Illinois, and New York. It is the vector of the human pathogen Rickettsia parkeri, the causative agent of R. parkeri rickettsiosis. We report the first finding of an established population of A. maculatum in Salem County, NJ, with a R. parkeri infection prevalence rate of 23.8%. Our finding of A. maculatum is consistent with other recent findings in the northeastern United States in that specimens were found in open areas devoid of tree canopy. This discovery demonstrates the importance of tick surveillance in order to identify expanding tick populations and the pathogens they may transmit.

Hepatitis C Exposure Diagnosis and Testing in Infants Born to Hepatitis C Virus-infected Mothers.

BACKGROUND: There has been a 5-fold increase in the number of cases of hepatitis C virus (HCV) infection among pregnant women, which is potentially associated with the increase in opioid use. METHODS: This study was a retrospective review of infants born at a tertiary urban hospital in New Jersey, from January 1, 2011 to January 1, 2021, who were born to mothers with a prenatal diagnosis of HCV. RESULTS: Of the 142 mothers with a prenatal diagnosis of HCV, 114 (80%) infants had a diagnosis of HCV exposure in the electronic health records. Of the HCV-exposed infants with follow-up data at 24 months of age, 52 (46%) were tested, with 34 of 52 (65%) receiving adequate testing. Infants documented as HCV exposed were more likely to be born to a mother with nonopioid drug use in pregnancy ( P = 0.01) and have a higher birth weight ( P = 0.03). Of tested infants, those with a higher number of well-child pediatrician visits ( P = 0.01) were more likely to receive adequate testing. Trends showed more polymerase chain reaction testing than antibody testing for those who were inadequately tested. CONCLUSIONS: A significant proportion of infants born to HCV-infected mothers were either not identified at birth (20%) or did not receive adequate testing on follow-up (35%). Further work needs to be done to improve documentation of HCV exposure at birth and follow-up testing to avoid missing congenitally acquired HCV.

Comparison of COVID-19 Symptoms in Correctional Health Care Workers During the Initial and Omicron Surges.

There is a dearth of medical literature that characterizes the experience of correctional health care workers (HCWs) during the COVID-19 pandemic. We performed a retrospective chart review of the results of an ongoing universal SARS-CoV-2 testing program for New Jersey correctional system HCWs and describe their presenting symptoms, perceived exposure, and demographic characteristics during the initial (March 15, 2020, to August 31, 2020) and Omicron (March 1, 2022, to August 31, 2022) COVID-19 surges. Analysis included 123 eligible records. In both surges, nurses had a high proportion of infections and cough was the most commonly reported symptom. Fever was more than twice as commonly reported in the initial surge. During the Omicron surge, nasal symptoms predominated (39.5% [95% CI: 28.4-51.4]) compared with the initial surge (8.5% [95% CI: 2.4-20.4]). Perceived exposure source was predominantly work related during the initial surge and multiple other sources of exposure were identified during the Omicron surge. Ninety-six percent of HCWs received a COVID-19 booster shot by February 2022. The reinfection rate was less than 10% for our initial cohort. Presenting symptoms correlated with the circulating variant. Mass vaccination of staff, the lower virulence of the Omicron variant, and possibly prior infection likely contributed to the milder illness experienced during the Omicron surge.

The influence of primary language on postoperative stroke outcomes.

BACKGROUND: Language barriers have the potential to influence acute stroke outcomes. Thus, we examined postoperative stroke outcomes among non-English primary language speakers. METHODS: Utilizing the Healthcare Cost and Utilization Project State Inpatient Database (2016-2019), we conducted a retrospective cohort study of adults diagnosed with a postoperative stroke in Michigan, Maryland, and New Jersey. Patients were classified by primary language spoken: English (EPL) or non-English (n-EPL). The primary outcome was hospital length-of-stay. Secondary outcomes included stroke intervention, feeding tube, tracheostomy, mortality, cost, disposition, and readmission. Propensity-score matching and post-match regression were used to quantify outcomes. RESULTS: Among 3078 postoperative stroke patients, 6.2 â€‹% were n-EPL. There were no differences in length-of-stay or secondary outcomes, except for higher odds of feeding tube placement (OR 1.95, 95 â€‹% CI 1.10-3.47, p â€‹= â€‹0.0227) in n-EPL. CONCLUSIONS: Postoperative stroke outcomes were comparable by primary language spoken. However, higher odds of feeding tube placement in n-EPL may suggest differences in patient-provider communication.

Enhancing Eastern Equine Encephalitis Virus Surveillance in New Jersey: Optimized Collection of Culiseta melanura.

Eastern equine encephalitis virus (EEEV) causes the most clinically severe neuroinvasive arboviral disease in the United States. The virus is endemic in eastern and Gulf Coast states and the Great Lakes region, causing cases annually. To detect EEEV circulation in its enzootic cycle before the virus infects humans and other mammals, mosquito control agencies in New Jersey have conducted mosquito surveillance using a series of permanent wooden resting box sites since 1975. We conducted 2 field studies, 1 evaluating resting traps and 1 evaluating efficacy of CO2 lures, to optimize collection of Culiseta melanura, the primary enzootic vector of EEEV. Resulting mosquito samples were subjected to molecular analysis to determine EEEV infection rates. Corrugated plastic boxes trapped more bloodfed Cs. melanura than other resting trap types (resting boxes, Centers for Disease Control and Prevention [CDC] resting traps, or fiber pots) and were similar to resting boxes in total number of female Cs. melanura caught. Further, non-baited CDC light traps were more successful in trapping host-seeking Cs. melanura than those baited with dry ice, a CO2 lure. The EEEV RNA was identified in Cs. melanura, Aedes vexans, Anopheles quadrimaculatus, and Uranotaenia sapphirina. Our findings indicate that corrugated plastic boxes and non-CO2 baited traps could improve detection of Cs. melanura. Mosquito control agencies are encouraged to periodically assess their surveillance strategy for EEEV.

Peer Recovery Specialists and Referrals to Treatment: Clinical Correlates Among Patients of an Opioid Overdose Recovery Program in New Jersey.

BACKGROUND: Peer recovery programs increase recovery support and treatment engagement among individuals with opioid use disorder. Peer recovery specialists (PRS) are critical in the cascade of care of treating addiction and related conditions. Work remains to help identify the benefits of PRS, particularly time spent with a PRS as a clinical indicator associated with referral to substance use treatment services. Gaps in the literature do not consider the nested hierarchical intercorrelations of opioid recovery data within multiple emergency departments. PURPOSE: The current study examined demographic and clinical correlates with referral to substance use treatment services including prior engagement within an opioid overdose recovery program, mental health diagnosis, the number of naloxone administrations, prior overdoses, and hospital-level variability of PRS time associated with treatment referrals. METHOD: This study used data collected by providers among patients who engaged in an opioid overdose recovery program. Data were collected between January 2016 and September 2020. Generalized linear mixed effect multilevel regression analyses tested the associations on clinical referral to substance use services. RESULTS: A total of 5655 patients participated in the study (male: 68.91%; age: mean = 37.75 ± 12.43; White non-Hispanic: 62.48%). Significant individual-level associations were identified between demographic and clinical variables and referral to substance use treatment services. At the hospital level, recovery specialist time spent with the patient also showed a positive and significant association with referral to substance use treatment services. CONCLUSION: The cross-level interaction effect displayed that any period of time spent with PRS played an important role for those patients with a greater number of prior overdoses on referral to treatment. Results provide important information on the role of PRS in the cascade of care, as well as the time spent with those in this role for both individuals with varying number of prior overdoses.

Management patterns of multiple magnet ingestion reported to New Jersey Poison Information and Education System.

BACKGROUND: Ingestion of multiple high-powered neodymium rare-earth magnets poses a significant risk for gastrointestinal (GI) injury such as bowel perforation or ischemia. Given the rising incidence of rare earth magnetic ingestions and the corresponding increase in serious injuries in children, published guidelines recommend urgent endoscopic removal of all magnets within endoscopic reach in cases involving ingestions of two or more magnets. RESEARCH QUESTION: Do management patterns for multiple magnet ingestion align with current practice guidelines, and does hospital length of stay (LOS) differ based on the initial emergency department (ED) approach? METHODS: This is a retrospective chart review of consecutive patient encounters reported to the New Jersey Poison Information and Education System (NJPIES) between January 2021 and April 2022 involving multiple magnet ingestion. Potential cases were retrieved from the NJPIES TOXICALL® database, using substance codes relating to magnet or foreign body ingestion. Two-sample T tests were used to determine the statistical difference in the hospital LOS between the group of patients receiving early emergent esophagogastroduodenoscopy (EGD) versus those receiving expectant management on initial presentation. RESULTS: There was a difference in the average LOS of 2.7 days (p = 0.023) longer in the expectant management group with no medical complications in either group. Twenty-five percent or 2 out of 8 cases deviated from guidelines. CONCLUSION: The initial ED decision to pursue expectant management instead of attempting emergent EGD removal of magnets may result in prolonged hospitalization, increased risk for readmission, and delayed definitive removal of magnets due to nonprogression along the GI tract.

Impact of COVID-19 on emergency oral health care in New Jersey.

BACKGROUND: The COVID-19 pandemic led to reduced services of private dental practices. The public emergency clinic of Rutgers School of Dental Medicine (RSDM) (Newark, NJ) faced changing demands during various periods of the pandemic. METHODS: Records of patients visiting the emergency clinic at RSDM during 3 distinct periods (prelockdown, lockdown, teledentistry) from January 10, 2020, through June 30, 2020, were retrospectively reviewed. Qualitative and quantitative attributes pertaining to patient encounters were reviewed and analyzed. RESULTS: A total of 1,799 records were included in this study. Patient visits increased during the early lockdown but were reduced after the implementation of teledentistry. Trends were noted in patient volume, reasons for visits, treatment needs, symptoms, diagnostic methodology, prescription use, and final disposition of patients. CONCLUSIONS: The lockdown affected emergency dental clinic services at RSDM. Teledentistry visits played a key role in screening patients and in facilitating the delivery of oral health care and timely follow-ups to patients who needed urgent in-person emergency visits. PRACTICAL IMPLICATIONS: Data gathered will lead to a better understanding of patients seen in the emergency clinic and can help with long-term planning for both institutional and smaller outpatient clinics during public health emergencies.

The Impact of Social Determinants of Health on the Diagnosis of Type 2 Diabetes Mellitus (T2DM) Among Asian Indians (AIs) in New Jersey: A Secondary Analysis of the BRFSS Survey From 2013 to 2017.

INTRODUCTION: Asian Indians (AIs), the second largest immigrant population in the United States, are disproportionately affected by type 2 diabetes mellitus (T2DM) at a lower age and body mass index (BMI). The purpose of this study was to examine the relationship between social determinants of health (SDOH) and the diagnosis of T2DM among AIs in New Jersey (NJ). METHODOLOGY: This was a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) in NJ from 2013 to 2017. Statistical analyses included descriptive and inferential statistics. RESULTS: Among 1,132 AIs, 16% had T2DM or prediabetes (PDM) and 69.2% were overweight or obese. The risk for T2DM was significantly associated with internet use, older age, having medical check-ups, and having a personal doctor (p ≤ .05). DISCUSSION: These findings inform culturally congruent care by underscoring the importance of weight management, earlier screening, and provider involvement in diabetes prevention strategies for AIs.

Experiences and lessons learned from community-engaged recruitment for the South Asian breast cancer study in New Jersey during the COVID-19 pandemic.

BACKGROUND: South Asians are a rapidly growing population in the United States. Breast cancer is a major concern among South Asian American women, who are an understudied population. We established the South Asian Breast Cancer (SABCa) study in New Jersey during early 2020 to gain insights into their breast cancer-related health attitudes. Shortly after we started planning for the study, the COVID-19 disease spread throughout the world. In this paper, we describe our experiences and lessons learned from recruiting study participants by partnering with New Jersey's community organizations during the COVID-19 pandemic. METHODS: We used a cross-sectional design. We contacted 12 community organizations and 7 (58%) disseminated our study information. However, these organizations became considerably busy with pandemic-related needs. Therefore, we had to pivot to alternative recruitment strategies through community radio, Rutgers Cancer Institute of New Jersey's Community Outreach and Engagement Program, and Rutgers Cooperative Extension's community health programs. We recruited participants through these alternative strategies, obtained written informed consent, and collected demographic information using a structured survey. RESULTS: Twenty five women expressed interest in the study, of which 22 (88%) participated. Nine (41%) participants learned about the study through the radio, 5 (23%) through these participants, 1 (4.5%) through a non-radio community organization, and 7 (32%) through community health programs. Two (9%) participants heard about the study from their spouse. All participants were born outside the US, their average age was 52.4 years (range: 39-72 years), and they have lived in the US for an average of 26 years (range: 5-51 years). CONCLUSION: Pivoting to alternative strategies were crucial for successful recruitment. Findings suggest the significant potential of broadcast media for community-based recruitment. Family dynamics and the community's trust in our partners also encouraged participation. Such strategies must be considered when working with understudied populations.

Evolutionary Insight into the Association between New Jersey Polyomavirus and Humans.

Advances in viral discovery techniques have led to the identification of numerous novel viruses in human samples. However, the low prevalence of certain viruses in humans raises doubts about their association with our species. To ascertain the authenticity of a virus as a genuine human-infecting agent, it can be useful to investigate the diversification of its lineage within hominines, the group encompassing humans and African great apes. Building upon this rationale, we examined the case of the New Jersey polyomavirus (NJPyV; Alphapolyomavirus terdecihominis), which has only been detected in a single patient thus far. In this study, we obtained and analyzed sequences from closely related viruses infecting all African great ape species. We show that NJPyV nests within the diversity of these viruses and that its lineage placement is compatible with an ancient origin in humans, despite its apparent rarity in human populations.

Rutgers Cancer Institute of New Jersey's Community Outreach and Engagement Approach to Cancer Prevention.

Rutgers Cancer Institute of New Jersey (New Brunswick, NJ) is committed to providing cancer prevention education, outreach, and clinical services in our catchment area (CA). Our approach to cancer prevention includes ongoing surveillance to better understand the CA cancer burden and opportunities for intervention, leveraging community partnerships, and vigorously engaging diverse communities to understand and address their needs. This approach considers individual, sociocultural, environmental, biologic, system, and policy-level factors with an equity lens. Rutgers Cancer Institute has had substantial impact on cancer prevention (risk reduction, screening, and early detection) over the past five years, including the development of a CA data dashboard advancing implementation of evidence-based cancer control actions by leveraging 357 healthcare and community partners (with 522 partner sites). Furthermore, we provided professional education (attendance 19,397), technical assistance to community organizations (1,875 support sessions), educational outreach for community members (87,000+ through direct education), facilitated access to preventive services (e.g., 60,000+ screenings resulting in the detection of >2,000 malignant and premalignant lesions), contributed to advances in health policy and population-level improvements in risk reduction behaviors, screening, and incidence. With longer-term data, we will assess the impact of our cancer prevention efforts on cancer incidence, downward shifts in stage at diagnosis, mortality, and disparities.

Molecular and Clinical Epidemiology of SARS-CoV-2 Infection among Vaccinated and Unvaccinated Individuals in a Large Healthcare Organization from New Jersey.

New Jersey was among the first states impacted by the COVID-19 pandemic, with one of the highest overall death rates in the nation. Nevertheless, relatively few reports have been published focusing specifically on New Jersey. Here we report on molecular, clinical, and epidemiologic observations, from the largest healthcare network in the state, in a cohort of vaccinated and unvaccinated individuals with laboratory-confirmed SARS-CoV-2 infection. We conducted molecular surveillance of SARS-CoV-2-positive nasopharyngeal swabs collected in nine hospitals from December 2020 through June 2022, using both whole genome sequencing (WGS) and a real-time RT-PCR screening assay targeting spike protein mutations found in variants of concern (VOCs) within our region. De-identified clinical data were obtained retrospectively, including demographics, COVID-19 vaccination status, ICU admission, ventilator support, mortality, and medical history. Statistical analyses were performed to identify associations between SARS-CoV-2 variants, vaccination status, clinical outcomes, and medical risk factors. A total of 5007 SARS-CoV-2-positive nasopharyngeal swabs were successfully screened and/or sequenced. Variant screening identified three predominant VOCs, including Alpha (n = 714), Delta (n = 1877), and Omicron (n = 1802). Omicron isolates were further sub-typed as BA.1 (n = 899), BA.2 (n = 853), or BA.4/BA.5 (n = 50); the remaining 614 isolates were classified as "Other". Approximately 31.5% (1577/5007) of the samples were associated with vaccine breakthrough infections, which increased in frequency following the emergence of Delta and Omicron. Severe clinical outcomes included ICU admission (336/5007 = 6.7%), ventilator support (236/5007 = 4.7%), and mortality (430/5007 = 8.6%), with increasing age being the most significant contributor to each (p < 0.001). Unvaccinated individuals accounted for 79.7% (268/336) of ICU admissions, 78.3% (185/236) of ventilator cases, and 74.4% (320/430) of deaths. Highly significant (p < 0.001) increases in mortality were observed in individuals with cardiovascular disease, hypertension, cancer, diabetes, and hyperlipidemia, but not with obesity, thyroid disease, or respiratory disease. Significant differences (p < 0.001) in clinical outcomes were also noted between SARS-CoV-2 variants, including Delta, Omicron BA.1, and Omicron BA.2. Vaccination was associated with significantly improved clinical outcomes in our study, despite an increase in breakthrough infections associated with waning immunity, greater antigenic variability, or both. Underlying comorbidities contributed significantly to mortality in both vaccinated and unvaccinated individuals, with increasing risk based on the total number of comorbidities. Real-time RT-PCR-based screening facilitated timely identification of predominant variants using a minimal number of spike protein mutations, with faster turnaround time and reduced cost compared to WGS. Continued evolution of SARS-CoV-2 variants will likely require ongoing surveillance for new VOCs, with real-time assessment of clinical impact.

Development of a COVID-19 Vulnerability Index (CVI) for the Counties and Residents of New Jersey, USA.

The coronavirus disease 2019, or COVID-19, has impacted countless aspects of everyday life since it was declared a global pandemic by the World Health Organization in March of 2020. From societal to economic impacts, COVID-19 and its variants will leave a lasting impact on our society and the world. During the height of the pandemic, it became increasingly evident that indices, such as the Center for Disease Control's (CDC) Social Vulnerability Index (SVI), were instrumental in predicting vulnerabilities within a community. The CDC's SVI provides important estimates on which communities will be more susceptible to 'hazard events' by compiling a variety of data from the U.S. Census and the American Community Survey. The CDC's SVI does not directly consider the susceptibility of a community to a global pandemic, such as the COVID-19 pandemic, due to the four themes and 15 factors that contribute to the index. Thus, the objective of this research is to develop a COVID-19 Vulnerability Index, or CVI, to evaluate a community's susceptibility to future pandemics. With 15 factors considered for CDC's SVI, 26 other factors were also considered for the development of the CVI that covered themes such as socioeconomic status, environmental factors, healthcare capacity, epidemiological factors, and disability. All factors were equally weighted to calculate the CVI based on New Jersey. The CVI was validated by comparing index results to real-world COVID-19 data from New Jersey's 21 counties and CDC's SVI. The results present a stronger positive linear relationship between the CVI and the New Jersey COVID-19 mortality/population and infection/population than there is with the SVI. The results of this study indicate that Essex County has the highest CVI, and Hunterdon County has the lowest CVI. This is due to factors such as disparity in wealth, population density, minority status, and housing conditions, as well as other factors that were used to compose the CVI. The implications of this research will provide a critical tool for decision makers to utilize in allocating resources should another global pandemic occur. This CVI, developed through this research, can be used at the county, state, and global levels to help measure the vulnerability to future pandemics.

Implementation of a State-Level Consortium in New Jersey: Improving Infectious Disease Prevention and Mitigation in Childcare and Educational Settings.

The COVID-19 pandemic underscored the need for effective infectious disease prevention and mitigation efforts within childcare and educational settings, supported by local health departments and state agencies. During the pandemic, rapidly evolving guidance, increased surveillance burden, and the vastly increased volume of inquiries from communities and local health departments led to the development of a state-level childcare and educational consortium in New Jersey. The consortium works with state-level partners to support infectious disease prevention and mitigation efforts of educational entities and local health departments.

Factors associated with health-related quality of life in a cohort of cancer survivors in New Jersey.

BACKGROUND: Although there is extensive literature on correlates of health-related quality of life (HRQoL) among cancer survivors, there has been less attention paid to the role of socioeconomic disadvantage and survivorship care transition experiences in HRQoL. There are few large cohort studies that include a comprehensive set of correlates to obtain a full picture of what is associated with survivors' HRQ0L. This cohort study of recent cancer survivors in New Jersey aimed to explore the association between social determinants of health, health history, health behaviors, survivorship care experiences, and psychosocial factors in HRQoL. METHODS: Eligible survivors were residents of New Jersey diagnosed with genitourinary, female breast, gynecologic, colorectal, lung, melanoma, or thyroid cancers. Participants completed measures of social determinants, health behaviors, survivorship care experiences, psychosocial factors, and HRQoL. Separate multiple regression models predicting HRQoL were conducted for each of the five domains (social determinants, health history, health behaviors, survivorship care experiences, psychosocial factors). Variables attaining statistical significance were included in a hierarchical multiple regression arranged by the five domains. RESULTS: 864 cancer survivors completed the survey. Lower global HRQoL was associated with being unemployed, more comorbidities, a less healthy diet, lower preparedness for survivorship, more unmet support needs, and higher fear about cancer recurrence. Two psychosocial factors, unmet support needs and fear of recurrence, played the most important role in HRQoL, accounting for more than 20% of the variance. Both unmet support needs and fear of recurrence were significant correlates of physical, functional, and emotional HRQoL domains. CONCLUSIONS: Interventions seeking to improve cancer survivors' HRQoL may benefit from improving coordinated management of comorbid medical problems, fostering a healthier diet, addressing unmet support needs, and reducing survivors' fears about cancer recurrence.