Between 1 in 3 and 1 in 8 US teens experienced teen dating violence (TDV) as physical, psychological, sexual, online abuse and future violence, making early prevention a necessity. Rural youth report twice the risk for TDV, and twice the prevalence for physical abuse. However, they continue to be understudied. Rural males remain unlikely to attend research invitations, despite being heavily impacted by social and gender norms that promote male dominance over females - a precursor to dating violence. It is unclear how at-risk rural teenagers view their risk for dating violence, making this information crucial for intervention planning. Methods: We conducted three online focus groups (n = 14) and phone interviews (n = 13) with rural young males (15-24 years) across US regions. This male-only study leveraged the relational dialectics theory (RDT) to investigate rural young males' perceptions of risk and protective factors for TDV, as well as barriers and facilitators for help-seeking in rural contexts. Results: Using an interpretive and dialectical approach, participants described risk perceptions framed as dialectics: (1) Dialectics of Social Tensions identified (a) Unhealthy vs. Abusive Relationship Dialectic; (b) The #MeToo vs. #WeToo Dialectic of Victimhood; (c) Rural vs. Urban Masculinity Dialectic; (d) Present vs. Absent Father Dialectic, and (2) Dialectics of Help-Seeking & Help-Giving showed how Religion; Local Preachers; School Counselors; Peer Mentors; & Social Cohesion function as both risk and protective factors. Conclusion: This study identified several unmet needs, meaningful ways to prevent TDV, encourage abuse disclosure and help-seeking, to improve sustainable anti-TDV interventions.

Objectives: This study aims to investigate the association between the total injury experience rate and occupational status based on the Korea National Health and Nutrition Examination Survey (KNHANES)

Methods: By analyzing data from the KNHANES conducted in 2019, we estimated the injury experience rate according to occupational status of 6,139 participants. Setting the injury experience rate as a dependent variable and occupational status as an independent variable, we performed logistic regression to calculate odds ratios reflecting the likelihood of injury according to occupational status while controlling for relevant covariates.

Results: 459 participants had injury experience over the past 1 year. The skilled agricultural, forestry, and fishery workers among occupational groups, the family business without pay among employment type, and the night work among working type showed the highest rate of injury experience in each categories (14.3%, 12.5%, and 11.3%, respectively). After adjusting for the confounding variables, the experience of injury was significantly related to several occupational factors: skilled agricultural, forestry, and fishery workers (OR = 2.37; 95% CI: 1.46-3.84), family business without pay (OR = 1.99; 95% CI: 1.10-3.60), and night work (OR = 1.96; 95% CI: 1.01-3.78).

Conclusions: The injury experience rate differed depending on the working status. A higher rate of injury experience was found in occupation groups, employment type, and working time in comparison to the unemployed group or no work within past 1 year group. This study would be useful in selecting appropriate priorities for injury management in Korea.

Background: Seat belts are widely considered an important safety measure for preventing motor vehicle crash (MVC) injuries and fatalities. Despite having the highest risk per miles driven for MVCs, only 57% of U.S. high school students reported always wearing a seat belt when riding in a car driven by someone else in 2019.

Methods: We used data from the national Youth Risk Behavior Survey to assess trends in seat belt use among U.S. high school students from 1991 to 2019. We used modified Poisson regression with robust variance estimates to assess trends in overall seat belt use and Jointpoint software to identify critical survey-years for any significant non-linear trends. Then, we fitted a modified Poisson regression model with robust variance estimates and linear splines at critical years to assess the trend in overall seat belt use, adjusting for demographic factors. We used a stratified approach to generate adjusted models by sex, race/ethnicity, and grade level.

Results: A significant change in the overall trend was identified at 2015. The overall prevalence of seat belt use increased by 3.3% per survey-year from 1991 to 2015 and then decreased by 1.8% per survey-year after 2015. Seat belt use increased among all race/ethnicity groups until 2015, then decreased for non-Hispanic Black and Hispanic or Latino students but was stagnant for non-Hispanic White students.

Conclusions: Our findings suggest a need for targeted public health interventions that promote consistent seat belt use among high schools students least likely to wear seatbelts.

Background: COVID-19 has had wide-reaching impacts on mental health globally, especially among frontline workers responding to the pandemic. The pandemic has also exacerbated existing mental health inequities, including among some American Indian/Alaska Native (AI/AN) communities. To help meet the increased need for culturally appropriate and relevant mental health support during the pandemic, we adapted an evidence-informed disaster mental health intervention, Psychological First Aid (PFA), specifically for COVID-19 frontline workers in AI/AN communities.

Methods: A collaborative workgroup of seven AI/AN frontline workers, mental health, and public health professionals guided the PFA cultural adaptation. Additionally, we held two focus group discussions (FGDs) with AI/AN frontline workers responding to the pandemic to gather input on mental health/psychosocial challenges, existing strengths, and additional resources needed. We use the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to detail major adaptations completed.

Results: The adapted PFA resource includes an online guide and training with four modules focused on personal and others’ well-being, supportive communication, practical support, and resources for specific groups. Adaptations primarily included reducing content and text heaviness, updating language and examples to be relevant, and incorporating cultural values.

Conclusions: This culturally adapted resource for AI/AN communities filled a gap related to lack of culturally appropriate mental health and psychosocial for communities most affected by the COVID-19 pandemic. We are currently conducting an ongoing evaluation using an observational, pre/post design, to understand the acceptability and feasibility of PFA and the impact it has on competency and knowledge, and mental health functioning among frontline workers.

Background/Purpose

The aim of this study is to explore the contributing factors leading to intentional drug overdoses in the adolescent population (15-21 year olds). Past data has focused on outcomes and trends, but not on the contributing factors. By focusing on factors and providing specific data on the contribution to self-harm in this vulnerable and at-risk population, suicide and other harm may be avoided.

Methods

This study is a retrospective case series of young adults and teenagers ages 15-21 who presented to a Medical Toxicology service after a serious intentional overdose. Contributing factors, including history of psychiatric disease and substance use were organized into categories to show prevalence. We quantified the young person’s self-identified primary and secondary stressors.

Results/Outcomes

112 patient charts from 3 years (July 2018 -June 2020) were analyzed, specifically focusing on contributing factors leading to the overdose. Highlighted identified factors were: Household instability (55, 49%), Other family stress (44, 39%), Abuse of any kind (35, 31%), Death of a family member/close friend (18, 16%), Family members incarcerated (8, 7%), Peer Influence (10, 9%), and COVID-19 (10, 9%).

Demographics of note: Female (73, 65%) and Hispanic or Latino (40, 37%).

Conclusions

Household instability and family stress are the most common contributing factors. Focus on family empathy and safety may be an effective approach to preventing overdoses.We suggest provision of parental education, highlighting the critical importance of home safe space, and policies that strengthen families.

Background: Marijuana use laws are quickly changing across the United States. As these laws change, access to marijuana and attitudes towards marijuana use may also evolve. This is especially important among adolescents as marijuana use may be harmful to brain development and can negatively impact academic success.

Methods: We used the 2019 state Youth Risk Behavior Survey to explore the relationship between marijuana policy level and recent adolescent marijuana use. Recent marijuana use was defined by asking if the students had used marijuana in the past 30 days. The 44 states included in the study were categorized into three policy categories: no marijuana policy, medical marijuana legalized, or medical and recreational marijuana legalized. A modified Poisson regression was used to find the prevalence ratio (PR) between state policy level and recent adolescent marijuana use, with an adjusted model (aPR) controlling for grade, sex, and race.

Results: No statistically significant association was found for recent adolescent marijuana use in states with medical marijuana laws (aPR=1.05, 95% CI 0.98-1.12) or medical and recreational marijuana laws (aPR=1.06, 95% CI 0.93-1.22) compared to states with no legalized marijuana policies. State prevalence of recent adolescent marijuana use ranged from 10.0% in Utah to 29.1% in New Mexico.

Conclusions: Varying prevalence of recent marijuana use among adolescents across states is likely due to factors beyond marijuana policy level. Therefore, it may be more beneficial to target interventions for adolescent marijuana use based on geographic prevalence of marijuana use rather than on marijuana legalization policies.

Background: The severity of hurricanes is expected to increase as a result of climate change. Hurricanes have been associated with increased risk of hospitalization broadly among older adults, but the characteristics of those hospitalized has not been well-understood. We examined risk of hospitalization among older adults by race/ethnicity, rurality, poverty, age, and county-level median income after four recent, large-scale hurricanes.

Methods: Using Medicare and Medicaid claims data, we conducted a self-controlled case series analysis among older adults in counties with Federal Emergency Management Agency disaster declarations for Hurricanes Harvey, Irma, Florence, and Michael. We compared hospitalization rates in the 30-day post-disaster period against baseline rates in the 230-day pre-disaster period, reporting incidence rate ratios (IRRs) with 95% confidence intervals.

Results: The largest increase in hospitalizations occurred following Hurricane Michael (IRR 1.24; 95%CI 1.195-1.29) with 218 excess hospitalizations and the most modest following Hurricane Harvey (IRR 1.16; 95%CI 1.095-1.137) with 159 excess hospitalizations. Preliminary results show increased risk of hospitalization among adults aged 85+ across all hurricanes (IRR 1.22-1.389) as well as among Black individuals (IRR 1.117-1.261) and individuals residing in counties with median income less than $30,000 (IRR 1.12-1.319) in three of the four hurricanes.

Conclusion: The 30-day post-disaster period was associated with increased risk of hospitalization among older adults, with notable increases among the oldest old, Black individuals, and those in low income counties. Characterizing patterns of healthcare utilization after hurricanes can inform community preparedness for future disasters and policy towards supporting populations at risk for adverse health effects.

Background: Those who suffer from Non-Communicable Diseases (NCDs) have a higher likelihood experiencing negative health outcomes related to their NCDs during disaster situations. Preparedness and the maintenance of NCD control approaches impact post-disaster disease management and health outcomes. The aim of this study is to assess the role of various factors that may influence disaster preparedness and the prevention of negative health outcomes among patients in the United States and Puerto Rico with NCD diagnoses to inform future NCD preparedness programming.

Methods: A cross-sectional survey was administered to patients of Free and Charitable Clinics with a diagnosis of at least 1 NCD to assess their disease management preparedness and evaluate factors that were associated with subsequent negative health outcomes.

Results: Of those surveyed (N=175), 118 patients faced a disaster in their community. Most experienced at least 1 negative health outcome within 3 months (63.6%). 95.1% of the total patients surveyed reported needing consistent access to prescribed medication, but 55.6% reported not having an emergency supply of medications. Meanwhile over a third of patients that faced a disaster, reported difficulty accessing their medications after the disaster experience (39.8%). Those who had difficulty accessing prescribed medications were over 4 times as likely to experience a negative health outcome within three months of a disaster.

Conclusions: Many patients with NCDs are unprepared to manage their chronic conditions in the immediate aftermath of disaster events, putting them at risk of negative health outcomes related to their NCD diagnosis.

Purpose: The Automated Contact Tracing System (ACTS) is designed to alleviate burdens facing Utah’s contact tracing activities, and was built by in-house developers at the Utah Department of Health (UDOH) using existing surveillance databases EpiTrax and REDCap. The objectives of ACTS: alleviate human capacity constraints, increase speed for contact notification, and reach more contacts per SARS-CoV-2 positive person.

Materials & Methods: A locally hosted instance of REDCap was used to create a customizable survey. Application and database automation controlled by custom scripts and triggers that allow for behind-the-scenes management of which investigations qualify for what level of automation. Three types of automation include: full, contact-only, and manually- initiated. NextGen Connect, our interface engine, transforms data from REDCap to EpiTrax, allowing for easy customization of front-end REDCap without data-loss. Data collected from REDCap is imported into EpiTrax within minutes. This allows access for EpiTrax users to utilize this information within existing workflows.

Results: 70,534 case investigation surveys have been sent with 25,154 surveys completed, resulting in a response rate of 35.7%. The majority of recipients respond within four hours. The combination of manual and automated methods of case investigations results in the highest average mean of contacts identified per SARS-CoV-2 positive person.

Conclusions: With data stored in EpiTrax, REDCap could be utilized for new and existing conditions beyond COVID-19 disease. The success of ACTS has initiated discussions to incorporate this functionality into the core of EpiTrax to eliminate the need for other interconnecting systems.

Background

To promote health equity within the field of trauma and injury treatment, clinical trials should strive for unbiased representation.

Methods

A systematic review of randomized clinical trials recruiting US adults for trauma and injury treatment, and initiated between 2008 and 2019, was performed using four databases: Medline, Embase, Central, and the US Clinical Trial registry. The Cochrane Handbook of Systematic Reviews of Interventions and PRISMA guidelines were used to identify trials. Meta-analyses were performed to obtain summary proportions and 95% confidence intervals (CI) of gender, ethnicity, and race groups. Summary proportions were compared with the corresponding Census proportions based on the 2010 US Census.

Results

The systematic review identified 56 trials (total participants, n=9125). All trials reported gender, 23% reported ethnicity (13 trials), and 39% reported race (22 trials). The female proportion (35.5%, 95% CI 27.8-43.6) was lower than Census proportion (51.5%, p<0.001). The proportions of Hispanics (12.9%, 95% CI 2.5-29.5), blacks (20.0%, 95% CI 9.0-33.4), and whites (76.9%, 95% CI 63.2-88.3) were similar to Census proportions (14.2%; 13.9%; 79.8%). Proportions of American Indians (0.00%, 95% CI 0.00-0.14), Asians (0.01%, 95% CI 0.00-0.16), and multiracial individuals (0.18%, 95% CI 0.01-0.57) were lower than Census proportions (1.1%, p=0.030; 5.0%, p<0.001; 1.6%, p<0.001). The proportion of Native Hawaiians and Pacific Islanders (1.2%, 95% CI 0.7-2.1) was higher than Census proportion (0.2%, p<0.001).

Conclusion

These results highlight recruitment disparities in trials relating to trauma and injury treatment. Overall, clinical trials may not reflect the demographics of the populations sought to be served.