Background. The concentration of pharmacologically active tetrahydrocannabinol (THC) in cannabis products has been increasing over the past decade. Concerns about potential harmful health effects of using these increasingly... more
Background. The concentration of pharmacologically active tetrahydrocannabinol (THC) in cannabis products has been increasing over the past decade. Concerns about potential harmful health effects of using these increasingly higher-concentration products have led some states to consider regulation of cannabis product THC concentration. We conducted a scoping review of health effects of high-concentration cannabis products to inform policy on whether the THC concentrations of cannabis product should be regulated or limited. Objectives. We conducted a scoping review to (1) identify and describe human studies that explore the relationship of high-concentration cannabis products with any health outcomes in the literature and (2) create an interactive evidence map of the included studies to facilitate further analyses. Search Methods. An experienced medical information specialist designed a comprehensive search strategy of 7 electronic databases. Selection Criteria. We included human stud...
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ObjectiveAssess changes in cross‐sector collaboration between Nurse‐Family Partnership (NFP) nurse home visitors and community providers in the United States.Data Sources and Study SettingWe collected primary data via internet‐based... more
ObjectiveAssess changes in cross‐sector collaboration between Nurse‐Family Partnership (NFP) nurse home visitors and community providers in the United States.Data Sources and Study SettingWe collected primary data via internet‐based surveys of all NFP nursing supervisors in the United States in 2018, 2020, and 2021.Study DesignWe conducted a panel survey to measure changes in cross‐sector collaboration between NFP nurses and 10 provider types in healthcare and social services. We assessed relational coordination using the validated seven item Relational Coordination Scale and structural integration using four items adapted from the Interagency Collaboration Activities Scale. Responses over time were compared using one‐way analysis of variances (ANOVAs) and pairwise t‐tests. We used the Kruskal–Wallis rank test to assess differences in collaboration by implementing agency type.Data CollectionAll nursing supervisors from NFP implementing agencies in the United States were eligible for...
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Among the millions of children in the United States exposed to public health emergencies in recent years, those with preexisting health conditions face particular challenges. A public health emergency may, for example, disrupt treatment... more
Among the millions of children in the United States exposed to public health emergencies in recent years, those with preexisting health conditions face particular challenges. A public health emergency may, for example, disrupt treatment regimens or cause children to be separated from caregivers. Ongoing shortages of pediatricians and pediatric subspecialists may further exacerbate the risks that children with preexisting conditions face in disaster circumstances. The US Department of Homeland Security recently called for better integration of children's needs into all preparedness activities. To aid in this process, multiple legal concerns relevant to pediatricians and pediatric policymakers must be identified and addressed. Obtaining informed consent from children and parents may be particularly challenging during certain public health emergencies. States may need to invoke legal protections for children who are separated from caregivers during emergencies. Maintaining access to prescription medications may also require pediatricians to use specific legal mechanisms. In addition to practitioners, recommendations are given for policymakers to promote effective pediatric response to public health emergencies.
Research Interests: Pediatrics, Informed Consent, Health insurance, Health Policy, Medicine, and 15 moreBiological Sciences, Crisis Intervention, Humans, Child, Federal Government, Chronic Disease, Civil Defense, Caregivers, Preparedness, Emergencies, Post Disaster Planning, Insurance Coverage, Health Services Accessibility, Medical and Health Sciences, and Disaster planning
Research Interests: Business, Engineering, Political Parties, Indoor Air Quality, Politics, and 15 moreHospitality, Law Enforcement, Policy making, Gaming, Legislation, Local governance, Nevada, Compromise, Disease Control, Strategic Alliance, Campaign Contribution, Legislature, State government, Indoor air, and Preemption
State-level all-payer claims databases (APCDs) are a possible new public health surveillance tool, but their reliability is unclear. We compared Colorado’s APCD with other state-level databases for use in monitoring the opioid epidemic... more
State-level all-payer claims databases (APCDs) are a possible new public health surveillance tool, but their reliability is unclear. We compared Colorado’s APCD with other state-level databases for use in monitoring the opioid epidemic (Colorado Hospital Association and Colorado’s Prescription Drug Monitoring Program database for 2010–2017), using descriptive analyses comparing quarterly counts/rates of opioid-involved inpatient and emergency department visits and counts/rates of 30-day opioid fills between databases. Utilization is lower in the Colorado APCD than the other databases for all outcomes but trends are parallel and consistent between databases. State APCDs hold promise for researchers, but they may be better suited to individual-level analyses or comparisons of providers than for surveillance of public health trends related to addiction.
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Objectives. We examined the effects of key political institutional factors on the advancement of state-level clean indoor air laws.Methods. We performed an observational study of state-level clean indoor air law enactment among all 50 US... more
Objectives. We examined the effects of key political institutional factors on the advancement of state-level clean indoor air laws.Methods. We performed an observational study of state-level clean indoor air law enactment among all 50 US states from 1993 to 2010 by using extended Cox hazard models to assess risk of enacting a relevant law.Results. During the 18-year period from 1993 to 2010, 28 states passed a law covering workplaces, 33 states passed a law covering restaurants, 29 states passed a law covering bars, and 16 states passed a law covering gaming facilities. States with term limits had a 2.15 times greater hazard (95% confidence interval [CI] = 1.27, 3.65; P = .005) of enacting clean indoor air laws. The presence of state-level preemption of local clean indoor air laws was associated with a 3.26 times greater hazard (95% CI = 1.11, 9.53; P = .031) of state-level policy enactment. In the presence of preemption, increased legislative professionalism was strongly associated (hazard ratio = 3.28; 95% CI = 1.10, 9.75; P = .033) with clean indoor air law enactment.Conclusions. Political institutional factors do influence state-level clean indoor air law enactment and may be relevant to other public health policy areas.
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Background Cannabis may be a substitute for opioids but previous studies have found conflicting results when using data from more recent years. Most studies have examined the relationship using state-level data, missing important... more
Background Cannabis may be a substitute for opioids but previous studies have found conflicting results when using data from more recent years. Most studies have examined the relationship using state-level data, missing important sub-state variation in cannabis access. Objective To examine cannabis legalization on opioid use at the county level, using Colorado as a case study. Colorado allowed recreational cannabis stores in January 2014. Local communities could decide whether to allow dispensaries, creating variation in the level of exposure to cannabis outlets. Design Observational, quasi-experimental design exploiting county-level variation in allowance of recreational dispensaries. Subjects Colorado residents Measures We use licensing information from the Colorado Department of Revenue to measure county-level exposure to cannabis outlets. We use the state’s Prescription Drug Monitoring Program (2013–2018) to construct opioid-prescribing measures of number of 30-day fills and tot...
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This is a protocol for a scoping review on the health effects of high-potency cannabis products. The protocol was open for public comment (November 15, 2021 - December 8, 2021) and was reviewed by a Scientific Review Council (Nov 17, 2021).
Nurse home visitors in Nurse-Family Partnership® (NFP) work with mothers experiencing social and economic adversities to improve their and their children's health. Collaboration between nurse home visitors and primary care providers... more
Nurse home visitors in Nurse-Family Partnership® (NFP) work with mothers experiencing social and economic adversities to improve their and their children's health. Collaboration between nurse home visitors and primary care providers (PCPs: healthcare providers and social workers embedded within obstetrics, paediatrics and family medicine practices) can improve service delivery for families experiencing the greatest adversities. However, little is known about how and to what extent PCPs collaborate with home visiting nurses. We conducted a single exploratory case study between April 2019 and February 2020 to better understand how PCPs collaborate with home visiting nurses to meet family needs in one NFP site, purposefully selected for strong collaboration. We conducted in-depth qualitative interviews with 22 PCPs, including 5 nurses, 7 physicians, 7 social workers and 3 non-direct care professionals, including patient navigator and hospital executives. Interviews were recorded, transcribed, validated and coded inductively. Codes were grouped into broader categories and thematic memos across provider role were written to triangulate perspectives. Healthcare providers interacted with home visiting nurses mainly during the referral process, while social workers provided more specific examples of service co-ordination. In this case study, we saw mutual awareness, co-operation and collaboration to serve families with high needs. Even in this case, purposefully selected to represent strong collaboration, there were opportunities to enhance co-ordination to improve the health and social needs of young families experiencing adversity.
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Home‐visiting prevention programs must coordinate with other community providers to be most effective. However, the associations between collaboration and program outcomes are not well understood. This study aimed to examine the... more
Home‐visiting prevention programs must coordinate with other community providers to be most effective. However, the associations between collaboration and program outcomes are not well understood. This study aimed to examine the associations between cross‐sector collaboration in Nurse‐Family Partnership (NFP), a model home‐visiting program, and client‐level outcomes.We used 2018 survey data with NFP supervisors that assessed agency‐level collaboration, as measured by relational coordination and structural integration with nine community provider types (including obstetrics care, substance use treatment, and child welfare). We paired the collaboration survey data with NFP program implementation data from 2014 to 2019 (n = 36,901) to examine outcomes including client retention, client smoking cessation, and childhood injury. We used random‐intercept models with nurse‐level random effects, controlling for client‐level demographics and health, nurse‐level demographics, and agency‐level ...
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Prevention programs like Nurse-Family Partnership® (NFP) must enroll and retain clients of the intended population to maximize program impact. NFP is an evidence-based nurse home visitation program shown in randomized trials to improve... more
Prevention programs like Nurse-Family Partnership® (NFP) must enroll and retain clients of the intended population to maximize program impact. NFP is an evidence-based nurse home visitation program shown in randomized trials to improve maternal and child health and life course outcomes for first-time parents experiencing economic adversity, particularly for mothers with limited psychological resources. The purpose of this study was to understand enrollment and engagement experiences of mothers with previous live births referred to NFP in a formative study of the program for this population, but did not enroll or dropped out before program graduation. We used a grounded theory approach and purposively selected three NFP sites with variation in enrollment rates. We conducted telephone interviews with 23 mothers who were either referred to NFP and declined enrollment or former clients who dropped out before graduation. All interviews were conducted in English, recorded, transcribed, and validated. We developed an iterative codebook with multiple coders to analyze our data in NVivo11 and wrote thematic memos to synthesize data across study sites. Mothers described experiencing overlapping risk factors including physical and behavioral health conditions, child welfare involvement, and housing insecurity. Mothers from all sites discussed how they were referred to the NFP program, their experience of the enrollment process, reasons for enrolling or not enrolling, and reasons for dropping out after initial enrollment. Key themes that influenced mothers’ decision-making were: perceptions of program value, not needing the program, their living situation or being too busy as a deterrence, and past experiences including a distrust of health care. Reasons for attrition were related to no longer needing the service, being assigned a new nurse, being too tired postpartum, and moving out of the service area. One way to support home visiting nurses in family enrollment and engagement is to build their professional capacity to implement trauma-informed strategies given mothers’ life experiences.
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Collaboration across sectors is needed to improve community health, but little is known about collaborative activities among public health prevention programs. Using the Nurse-Family Partnership® (NFP) home visiting program as context,... more
Collaboration across sectors is needed to improve community health, but little is known about collaborative activities among public health prevention programs. Using the Nurse-Family Partnership® (NFP) home visiting program as context, this qualitative study aimed to describe effective collaboration among nurse home visitors, healthcare providers and community support services to serve families experiencing social and economic adversities. We used grounded theory to characterise collaboration with six purposively sampled NFP sites in the United States through in-depth interviews. We interviewed 73 participants between 2017 and 2019: 50 NFP staff, 18 healthcare providers and 5 other service providers. Interviews were recorded, transcribed, validated and analysed in NVivo 11. Validation steps included inter-coder consistency checks and expert review. Thematic memos were synthesised across sites. Most participants perceived collaboration to be important when serving families with complex needs, but substantial variation existed in the degree to which NFP nurses collaborate with providers dependent on provider type and community context. Factors that contributed to effective collaboration were relational in nature, including leadership commitment and provider champions, shared perceptions of trust, respect and value, and referral partnerships and outreach; organisational in terms of mission congruence between providers; and structural such as policy and system integration that facilitated data sharing and communication channels. These findings provide greater insights into effective cross-sector collaboration and care coordination for families experiencing adversities. Collaboration across sectors to promote health among families experiencing adversities requires intentional efforts by all inter-professional providers and continued commitment among all levels of leadership to coordinate services.
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ObjectiveTo assess the degree to which nurses in a national public health home visiting program collaborate with interprofessional providers to serve families experiencing adversity.DesignA descriptive, cross‐sectional survey measured... more
ObjectiveTo assess the degree to which nurses in a national public health home visiting program collaborate with interprofessional providers to serve families experiencing adversity.DesignA descriptive, cross‐sectional survey measured collaborative practices between nurse home visitors, health care, and social service providers. A census of 263 nursing supervisors completed a web‐based survey.MeasurementsThe survey included the validated 7‐item Relational Coordination Scale, adapted items from the Interagency Collaboration Activities Scale on shared resources, and items related to collaboration attitudes and beliefs. Data were analyzed with descriptive statistics.ResultsRelational coordination scores, which are relative measures, ranged from 1 to 5; highest with supplemental nutrition for Women, Infants & Children (M = 3.77) and early intervention (M = 3.44); and lowest with housing (M = 2.55). The greatest sharing of resources was with supplemental nutrition (sum = 12.95) and menta...
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Objectives. To examine the perceived benefits of and barriers to law enforcement agencies providing increased access to voluntary and temporary firearm storage. Methods. We surveyed 448 police chiefs and sheriffs in 8 US Mountain West... more
Objectives. To examine the perceived benefits of and barriers to law enforcement agencies providing increased access to voluntary and temporary firearm storage. Methods. We surveyed 448 police chiefs and sheriffs in 8 US Mountain West states about firearm storage practices, benefits of and barriers to storage, and related attitudes and beliefs. Data collection occurred during the spring and summer of 2016. Results. Nearly three quarters of agencies reported that they are already providing storage and perceive relatively few barriers in doing so. Agency characteristics were not associated with current provision of firearm storage. Among the barriers identified included state laws, limited space, training needs, and community perceptions. Benefits of storage included being perceived positively by the community and supporting health care workers. Conclusions. Engaging with law enforcement agencies in suicide prevention efforts and addressing their perceived barriers to providing tempor...
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BACKGROUND Emergency department (ED) visits involving psychosis and schizophrenia have increased at a rate exceeding population growth in the United States over the past decade. Research shows a strong dose-response relationship between... more
BACKGROUND Emergency department (ED) visits involving psychosis and schizophrenia have increased at a rate exceeding population growth in the United States over the past decade. Research shows a strong dose-response relationship between chronic use of high-potency cannabis and odds of developing symptoms of psychosis. The aim of this study was to evaluate the impact of cannabis legalization on psychosis and schizophrenia-related ED visits in Colorado. METHODS Using administrative data from Colorado Hospital Association (CHA) on county-level quarterly ED visits between January 1, 2013, and December 31, 2018, we applied a difference-in-difference analysis to examine how new exposure to recreational cannabis dispensaries after 2014 differentially influenced the rate of ED visits for psychosis and schizophrenia, comparing counties with no prior medical cannabis dispensary exposure to counties with low or high medical dispensary exposure. RESULTS As recreational dispensaries per 10,000 residents increased, there was no significant association with the rate of schizophrenia ED visits per capita (incidence rate ratio or IRR: 0.95, 95% CI [0.69, 1.30]) while the rate of psychosis visits increased 24% (IRR: 1.24, 95% CI [1.02, 1.49]). Counties with no previous medical dispensaries experienced larger increases in schizophrenia ED visits than counties already exposed to a low level of medical dispensaries, but this effect was not significant. Counties with low baseline medical exposure had lower increases in rates of psychosis visits than counties with high baseline medical exposure (IRR 0.83, 95% CI [0.69, 0.99]). CONCLUSIONS There was a positive association between the number of cannabis dispensaries and rates of psychosis ED visits across all counties in Colorado. Although it is unclear whether it is access to products, or the types of products that may be driving this association, our findings suggest there is a potential impact on the mental health of the local population that is observed after cannabis legalization.
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The aim of this multiple case study report was to assess the level of organizational collaboration between the Nurse-Family Partnership (NFP) and Child Protective Services (CPS) in Colorado, as well as facilitators and barriers to... more
The aim of this multiple case study report was to assess the level of organizational collaboration between the Nurse-Family Partnership (NFP) and Child Protective Services (CPS) in Colorado, as well as facilitators and barriers to effective collaboration between these agencies. A multiple case study was conducted, primarily informed by key informant interviews with NFP nurses and nurse supervisors; CPS caseworkers, supervisors, and senior-level workers; and other community partners familiar with NFP or CPS and/or involved in child maltreatment prevention. The findings indicated that organizational collaboration between NFP and CPS varied tremendously within and among sites and the majority of NFP and CPS staff perceived a need to strengthen local organizational collaboration. The report concludes that organizational collaboration has led to successes in effectively serving high-risk clients. It is recommended that the Colorado Department of Human Services (CDHS) and the NFP National Service Office (NSO) consider policy and programmatic changes to facilitate stronger organizational collaboration between the NFP and CPS.
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Background: Health care reform has resulted in changes throughout the health system, including the Affordable Care Act (ACA) and IRS requirements that nonprofit hospitals conduct community health needs assessments and develop... more
Background: Health care reform has resulted in changes throughout the health system, including the Affordable Care Act (ACA) and IRS requirements that nonprofit hospitals conduct community health needs assessments and develop implementation plans to guide greater investment in their respective communities. This has led to questions of which factors influence hospital interaction and investment in PH systems. Purpose: This paper presents a comprehensive framework, informed by a literature review and expert panel that introduces hypothesized factors related to these outcomes. Methods: To develop a conceptual framework that identifies hypothesized indicators of increased hospital interaction and investment in PH systems, we completed a thorough and iterative review and coding of the literature. We drafted a first version of the conceptual model and convened an expert panel (n=9) to review, further narrow, and refine the conceptual model of indicators. Results: The finalized conceptual ...
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Objective: To explore the use of Health Impact Assessments (HIAs) within non-profit hospital community benefit activities.Methods: We constructed case studies of three HIAs that were conducted in collaboration with Children’s Hospital... more
Objective: To explore the use of Health Impact Assessments (HIAs) within non-profit hospital community benefit activities.Methods: We constructed case studies of three HIAs that were conducted in collaboration with Children’s Hospital Colorado as part of the hospital’s community benefit portfolio. These HIAs were part of a pilot that was funded by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.Results: HIAs provided Children’s Hospital Colorado with a transparent and systematic process for generating evidence-based recommendations with community and stakeholder feedback within the hospital’s community benefit activities. HIAs were used to generate recommendations to inform community benefit planning activities and to generate public policy recommendations to enhance child health. The case studies highlighted several issues that need to be addressed in order to further advance the use of HIA within hospital community ...
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IntroductionSafe storage of guns outside the household while someone is at risk for suicide is important for suicide prevention. Some gun retailers offer temporary firearm storage as a community resource. Others may be willing if... more
IntroductionSafe storage of guns outside the household while someone is at risk for suicide is important for suicide prevention. Some gun retailers offer temporary firearm storage as a community resource. Others may be willing if perceived barriers can be addressed.MethodsWe invited all gun retailers in eight Mountain West states to respond to a questionnaire about the barriers they perceive in offering temporary, voluntary gun storage for community members.ResultsNinety-five retailers responded (25% response rate). Fifty-eight percent believed federal laws make it harder to store guns and 25% perceived state laws to be obstacles. Over 60% cited legal liability in storing and returning guns as barriers. Other important barriers included cost, space and logistical issues of drop off and pick up.ConclusionsStrategies to reduce legal and other barriers will need to be addressed to better engage gun retailers as a community resource for safe gun storage.
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Objective: To determine the association of state laws on nonprofit hospital community benefit spending. Design: We used multivariate models to estimate the association between different types of state-level community benefit laws and... more
Objective: To determine the association of state laws on nonprofit hospital community benefit spending. Design: We used multivariate models to estimate the association between different types of state-level community benefit laws and nonprofit hospital community benefit spending from tax filings. Setting: All 50 US states. Participants: A total of 2421 nonprofit short-term acute care hospital organizations that filled an internal revenue service Form 990 and Schedule H for calendar during years 2009-2015. Results: Between 2009 and 2015, short-term acute care hospitals spent an average of $46 billion per year in total, or $20 million per hospital on community benefit activities. Exposure to a state-level community benefit law of any type was associated with an $8.42 (95% confidence interval: 1.20-15.64) per $1000 of total operating expense greater community benefit spending. Spending amounts and patterns varied on the basis of the type of community benefit law and hospital urbanicity...
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Purpose Safe storage of guns is critical to suicide prevention. This study examines the extent to which law enforcement agencies (LEAs) and gun retailers (GRs) are willing to offer safe gun storage in a variety of circumstances, including... more
Purpose Safe storage of guns is critical to suicide prevention. This study examines the extent to which law enforcement agencies (LEAs) and gun retailers (GRs) are willing to offer safe gun storage in a variety of circumstances, including mental health crises. Methods We invited, with two follow-up reminders, all LEAs and GRs with storefronts in the eight-state Mountain West region to respond to questionnaires. We asked about current storage practices and conditions under which they would offer temporary storage. We also asked about their recommendations for safe storage. We weighted data to adjust for non-response. Results We collected data from 448 LEAs and 95 GRs, representing response rates of 55% and 25% respectively. Most LEAs 74.8% (CI 72.1–77.5) indicated they already provide temporary storage, compared to 47.6% (CI 39.2–56.0) of GRs. LEAs were most willing to provide storage when a family member was concerned about mental health of a teenager (84.8%; CI 82.5–87.1) or adult (83.5%; CI 81.1–85.8) but less likely to offer storage when the reason was protection of visitors, for persons who may be travelling, or when no reason accompanies the request. GRs, while less willing to offer storage in many situations, were open to providing storage for some circumstances not favoured by LEAs. Both groups locking devices within the home but LEAs were slightly more favourable to storage sites (e.g., law enforcement, gun stores) away from the home. Conclusion LEAs and GRs are important resources for gun owning families concerned about suicide, and possibly other risks associated with gun injury. Significance and Contributions to Injury and Violence Prevention Science This is the first study to examine the practices of these key community resources for providing through voluntary and temporary gun storage as a form of injury control.
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Objectives. To examine the extent to which law enforcement agencies (LEAs) and gun retailers are willing to offer voluntary, temporary storage as a part of an overall suicide prevention effort. Methods. We invited all LEAs and gun... more
Objectives. To examine the extent to which law enforcement agencies (LEAs) and gun retailers are willing to offer voluntary, temporary storage as a part of an overall suicide prevention effort. Methods. We invited all LEAs and gun retailers in 8 US states to respond to questionnaires asking about their willingness to offer temporary gun storage and their recommendations to gun owners about safe storage. Results. We collected data in 2016 from 448 LEAs and 95 retailers (response rates of 53% and 25%, respectively). Three quarters of LEAs (74.8%; 95% confidence interval [CI] = 72.1, 77.5) indicated they already provided temporary storage compared with 47.6% (95% CI = 39.2, 56.0) of retailers. LEAs were most willing to provide storage when a gun owner was concerned about the mental health of a family member. Retailers were more receptive than were LEAs to providing storage when visitors were coming or for people wanting storage while traveling. Both groups recommended locking devices w...
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To model rates of 0.08 g/dL blood alcohol concentration (BAC) per se law implementation among the states associated with (1) a federal incentive grant programme and (2) a threat from the federal government to withhold highway... more
To model rates of 0.08 g/dL blood alcohol concentration (BAC) per se law implementation among the states associated with (1) a federal incentive grant programme and (2) a threat from the federal government to withhold highway transportation funds. An observational study of state-level 0.08 g/dL BAC per se law enactment among all 50 US states from 1982 to 2006 using a parametric survival analysis to assess the time-dependent risk of policy enactment. The federal government's threat to withhold transportation funds was associated with a 10.30 times greater hazard (HR: 10.30, 95% CI 3.88 to 27.36) of states adopting a 0.08 g/dL BAC law compared with periods of time when this threat was not in place. The incentive grant programme created by the federal government was associated with a non-significant 17% decrease in the hazard of states adopting a 0.08 g/dL BAC law (HR: 0.83, 95% CI 0.35 to 2.0). In the case of 0.08 g/dL BAC per se laws, the federal government's threat to withho...
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To investigate practices, knowledge, attitudes, and beliefs regarding infant sleep among adolescent mothers, a demographic at high risk for sudden unexpected infant death, and to identify novel public health interventions targeting the... more
To investigate practices, knowledge, attitudes, and beliefs regarding infant sleep among adolescent mothers, a demographic at high risk for sudden unexpected infant death, and to identify novel public health interventions targeting the particular reasons of this population. Seven targeted focus groups including 43 adolescent mothers were conducted at high school daycare centers throughout Colorado. Focus groups were recorded, transcribed, validated, and then analyzed in NVivo 10. Validation included coding consistency statistics and expert review. Most mothers knew many of the American Academy of Pediatrics recommendations for infant sleep. However, almost all teens reported bedsharing regularly and used loose blankets or soft bedding despite being informed of risks. Reasons for nonadherence to recommendations included beliefs that babies are safest and sleep more/better in bed with them, that bedsharing is a bonding opportunity, and that bedsharing is easier than using a separate s...
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Objective. Evaluate the use of a previsit violence risk screen to determine whether screening during routine care increases health care practitioner’s (HCP’s) documentation of violence risk. Methods. Once consented, adolescents filled out... more
Objective. Evaluate the use of a previsit violence risk screen to determine whether screening during routine care increases health care practitioner’s (HCP’s) documentation of violence risk. Methods. Once consented, adolescents filled out the Violence Injury, Protection and Risk Screen Tool (VIPRS). For usual care screen results were not viewed by the HCP. For the intervention screen results were imbedded in the electronic medical record and viewed by the HCP. The primary outcome—documented reference to violence risk—was determined by chart review. Results. Three hundred and fifty-six youth participated. Age was 14.5 years (SD 0.3); 65% female, 45% Hispanic, 38% black. Odds of violence related documentation was 47.4 ( P < .001) in the intervention compared with usual care. Those who were positive on the VIPRS had a 10 times greater odds of receiving a violence intervention compared with controls. Conclusions. Previsit screening for violence risk significantly increases HCP’s docu...
Research Interests: Documentation, Primary Health Care, Electronic Health Records, Suicide prevention, Adolescent, and 15 moreMedicine, Humans, Aggression, Female, Male, Odds ratio, Urban Population, Poison Control, Medical Records, Medical Record, Adolescent Behavior, Clinical Pediatrics, Paediatrics and reproductive medicine, Referral and consultation, and Referral
To describe how the tobacco and gaming industries opposed clean indoor air voter initiatives in 2006, we analyzed media records and government and other publicly available documents and conducted interviews with knowledgeable individuals.... more
To describe how the tobacco and gaming industries opposed clean indoor air voter initiatives in 2006, we analyzed media records and government and other publicly available documents and conducted interviews with knowledgeable individuals. In an attempt to avoid strict “smoke free” regulations pursued by health groups via voter initiatives in Arizona, Ohio, and Nevada, in 2006, the tobacco and gaming industries sponsored competing voter initiatives for alternative laws. Health groups succeeded in defeating the pro-tobacco competing initiatives because they were able to dispel confusion and create a head-to-head competition by associating each campaign with its respective backer and instructing voters to vote “no” on the pro-tobacco initiative in addition to voting “yes” on the health group initiative.
Research Interests: Business, Politics, Environmental Health, Health Policy, Medicine, and 13 moreCalifornia, Humans, Program Development, Tobacco Control, American, Indoor air pollution, Tobacco industry, Confusion, Ballot, Government Regulation, Competitive Behavior , tobacco smoke pollution, and Medical and Health Sciences
Alcohol-involved motor vehicle crashes are a major cause of preventable mortality in the U.S., leading to more than 10,000 fatalities in 2013. Ignition interlocks, or alcohol-sensing devices connected to a vehicle's ignition to... more
Alcohol-involved motor vehicle crashes are a major cause of preventable mortality in the U.S., leading to more than 10,000 fatalities in 2013. Ignition interlocks, or alcohol-sensing devices connected to a vehicle's ignition to prevent it from starting if a driver has a predetermined blood alcohol content (BAC) level, are a promising avenue for preventing alcohol-involved driving. This study sought to assess the effects of laws requiring ignition interlocks for some or all drunk driving offenders on alcohol-involved fatal crashes. A multilevel modeling approach assessed the effects of state interlock laws on alcohol-involved fatal crashes in the U.S. from 1982 to 2013. Monthly data on alcohol-involved crashes in each of the 50 states was collected in 2014 from the National Highway Traffic Safety Administration Fatality Analysis Reporting System. Random-intercept models accounted for between-state variation in alcohol-involved fatal crash rates and autocorrelation of within-state...
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Introduction: Legislator voting behavior is important to public health. We systematically review existing research to explore the use of behavioral science theories to better understand the voting behavior of legislators related to... more
Introduction: Legislator voting behavior is important to public health. We systematically review existing research to explore the use of behavioral science theories to better understand the voting behavior of legislators related to tobacco control issues. Research Question: Do behavioral science theories such as the Theory of Planned Behavior provide useful insights into legislator voting behavior? Methods: We identified relevant tobacco control research in online databases and identified studies that examined determinants of legislator voting behavior in a public health context. To be included, studies had to be: 1) focused on tobacco-related voting behavior; 2), empirically-based; 3) based in a democracy; 4) in English; and 5) identify specific determinants of voting practices. Results: 12 articles met our inclusion criteria. Four papers were specifically grounded in behavioral science theory. These articles all used the Theory of Planned Behavior and the theory's core constru...
The tobacco industry is a major political force in Nevada. The industry dominated state politics through a combination of strategic alliances with the hospitality and gaming industries and campaign contributions. From 1990-2006 the... more
The tobacco industry is a major political force in Nevada. The industry dominated state politics through a combination of strategic alliances with the hospitality and gaming industries and campaign contributions. From 1990-2006 the tobacco industry contributed $552,111 to the state political parties and individuals running for state office. In 1975, health groups in Nevada attempted to pass a legislative proposal, AB 17, that would have required smoking and non-smoking sections in all indoor public places. Although weak by today’s standards, the proposed law was progressive for its time. The health group’s proposal was opposed by the Tobacco Institute, which organized the hospitality and gaming industries and law enforcement agencies into an alliance to oppose the law. The Tobacco Institute successfully weakened AB 17, which, as passed, only required smoking sections in state government workplaces and a limited number of indoor public places. In 1991, preemption was introduced i...
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Policies that benefit public health frequently come into conflict with the objectives and profit motive of private industry. For example, despite the overwhelming scientific evidence that smokefree policies benefit public health, do not... more
Policies that benefit public health frequently come into conflict with the objectives and profit motive of private industry. For example, despite the overwhelming scientific evidence that smokefree policies benefit public health, do not cause economic harm, and are supported by the public, as of January 2012 only 23 states have comprehensive statewide smokefree laws. Similarly, states were slow to adopt .08 g/dl per se blood alcohol concentration (BAC) laws in the 1990's despite evidence supporting their effectiveness. It was not until Congress tied Federal Highway Funds to passage of the law that all 50 states adopted .08g/dl BAC laws in 2006. Understanding the factors that impact the advancement of popular and evidence-based public health policies despite industry opposition is of significant public health importance. State political system factors such as the presence of the ballot initiative process (where citizens vote directly on specific proposals) and preemption (which l...
Background: There is evidence that decisions made in sectors such as transportation, housing, and urban planning affect injury risk. Health impact assessment (HIA) is a pragmatic process to identify the potential health risks and benefits... more
Background: There is evidence that decisions made in sectors such as transportation, housing, and urban planning affect injury risk. Health impact assessment (HIA) is a pragmatic process to identify the potential health risks and benefits of proposed policies, and to inform decision-making. As of November 2013, approximately 300 HIAs have been completed or are in progress in the U.S., many of which address injury-related health pathways. Methods: We reviewed HIAs to identify ones that included injury and violence risks that were not fully recognized or addressed during the decision-making process. Results: In this session, we will define the HIA process, its methods, and describe the potential for HIA to advance the field of injury and violence prevention. We will also present examples of HIAs that have considered pathways with potential injury effects -- 1) implementation of "smart metering" technology that would allow an electric utility provider to remotely connect and ...
Background: Health impact assessment (HIA) is a valuable tool that helps decision-makers in non-health sectors integrate relevant health information into the assessment and planning of proposed projects, programs, or policies. Despite... more
Background: Health impact assessment (HIA) is a valuable tool that helps decision-makers in non-health sectors integrate relevant health information into the assessment and planning of proposed projects, programs, or policies. Despite nearly ten years of experience with HIA in the U.S., information about the impact that HIAs have had on the decisions they address is scarce. Methods: HIA characteristics and outcomes were defined through review of HIA documents and a survey of practitioners. We This was used to developed an evaluation framework for HIA that accounts for the diverse experiences that HIA practitioners reported, and allows for a broad range of definitions of success. Results: By January 2010, 56 U.S. HIAs were identified. Practitioners identified a range of potential mechanisms through which HIA could be successful. HIA practitioners commonly cited decision-maker support and community involvement as important. The diverse range of HIA practices creates challenges for eva...
EXECUTIVE SUMMARY From 1997-2006 the tobacco industry and tobacco trade organizations contributed $464,700 to Ohio state political candidates and political parties, including $88,400 during the 2005-6 election. From 1997-2006 the tobacco... more
EXECUTIVE SUMMARY From 1997-2006 the tobacco industry and tobacco trade organizations contributed $464,700 to Ohio state political candidates and political parties, including $88,400 during the 2005-6 election. From 1997-2006 the tobacco industry and tobacco trade organizations made 77.2% of their total contributions to individuals and organizations affiliated with the Republican Party. Starting in 2000, health advocates made attempts to introduce
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Page 1. Energy based routing techniques in Mobile Ad hoc and Sensor Networks Nguyen Thanh Tung', Gregory K Egan', Bill Lloyd-Smith 2 Brett Pentland' ... The first one is balanced energy consumption (BEC) and the second one... more
Page 1. Energy based routing techniques in Mobile Ad hoc and Sensor Networks Nguyen Thanh Tung', Gregory K Egan', Bill Lloyd-Smith 2 Brett Pentland' ... The first one is balanced energy consumption (BEC) and the second one is improved total energy consumption (ITE). ...
We examined the effects of key political institutional factors on the advancement of state-level clean indoor air laws. We performed an observational study of state-level clean indoor air law enactment among all 50 US states from 1993 to... more
We examined the effects of key political institutional factors on the advancement of state-level clean indoor air laws. We performed an observational study of state-level clean indoor air law enactment among all 50 US states from 1993 to 2010 by using extended Cox hazard models to assess risk of enacting a relevant law. During the 18-year period from 1993 to 2010, 28 states passed a law covering workplaces, 33 states passed a law covering restaurants, 29 states passed a law covering bars, and 16 states passed a law covering gaming facilities. States with term limits had a 2.15 times greater hazard (95% confidence interval [CI] = 1.27, 3.65; P = .005) of enacting clean indoor air laws. The presence of state-level preemption of local clean indoor air laws was associated with a 3.26 times greater hazard (95% CI = 1.11, 9.53; P = .031) of state-level policy enactment. In the presence of preemption, increased legislative professionalism was strongly associated (hazard ratio = 3.28; 95% C...