Understanding risk factor patterns in ATV fatalities: A recursive partitioning approach

Although there are hundreds of ATV-related deaths each year in the United States, contributing factors have not been clearly identified. The purpose of this study was to investigate associations between factors contributing to ATV fatalities using the agent–host–environment epidemiological triangle. Method: Incident reports of ATV fatalities occurring between 2011 and 2013 were obtained from the United States Consumer Product Safety Commission (CPSC). Narrative reports included details of the decedent and a description of the ATV crash. A chi-square automatic interaction detector (CHAID) analysis was performed for three major risk factors representing each facet of the epidemiologic triangle: helmet use (host), type of crash (agent), and location where death occurred (environment). The output of the CHAID analysis is a classification tree that models the relationship between the predictor variables and a single outcome variable. Results: A total of 1193 ATV fatalities were reported to the CPSC during the 3-year study period. In cases with known helmet and/or drug and alcohol use status, descriptive statistics indicated helmets were not worn in 88% of fatalities and use of alcohol or drugs was present in 84% of fatalities. Reoccurring factors within the CHAID analysis included age, helmet use, geographic region of the country, and location (e.g., farm, street, home, etc.) at the time of death. Within the three CHAID models, there were seven significant partitions related to host, one related to agent, and eight related to the environment. Conclusions: This research provides a model for understanding the relationship between risk factors and fatalities. The combination of the CHAID analysis method and the epidemiologic triangle allows for visualization of the interaction between host–agent–environment factors and fatalities. Practical applications: By modeling and characterizing risk factors associated with ATV fatalities, future work can focus on developing solutions targeted to specific factions of ATV users

Health impact assessment of coal-fired boiler retirement at the Martin Drake and Comanche power plants

Includes bibliographical references.Health impact assessment (HIA) is a suite of tools used to characterize potential health effects of policies, projects, or regulations. The objective of this HIA was to understand the impact of decommissioning units at two large coal-fired power plants on mortality and morbidity in the Southern Front Range region of Colorado. Based on Community Multiscale Air Quality (CMAQ) chemical transport models of fine particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) and ozone (O3), we modeled five potential emissions reductions scenarios and estimated the potential health benefits of reduced exposures to PM2.5 and ozone for premature deaths, cardiovascular and respiratory hospitalizations, and other health outcomes for ZIP codes in the Southern Front Range region, including the cities of Denver, Colorado Springs, and Pueblo. Health Benefits Scenarios 1 and 2 estimated the health benefits of shutting down most units at the Comanche plant in Pueblo, CO (one newer unit remained operational) relative to a baseline scenario using emissions from 2011 (Scenario 1) or a counterfactual baseline scenario that accounted for sulfur dioxide emissions controls (scrubbers) installed at the Martin Drake plant in Colorado Springs in 2016 (Scenario 2). Health Benefits Scenario 3 estimated the benefits of shutting down the Martin Drake plant relative to the 2011 baseline. Health Benefits Scenario 4 estimated the health benefits of shutting down the Martin Drake power plant and shutting down all but one boiler at the Comanche power plant relative to a 2011 emissions baseline. Health Benefits Scenario 5 estimated the marginal health benefits of decommissioning these plants (with one remaining coal-fired boiler at Comanche) relative to a counterfactual baseline year that considered emissions controls installed at the Martin Drake facility in 2016. In addition to estimating the number of deaths, hospitalizations, and other health outcomes that would potentially be avoided by reducing emissions at these facilities, we also estimated the monetary impact using outcome valuations typically used in US EPA health benefits analyses and examined the environmental justice implications of reduced emissions and exposures across the Southern Front Range. • For Health Benefits Scenario 1 (Comanche Units 3 and 4 were “zeroed out” and compared to a baseline where all other emissions were at 2011 levels), we estimated that reducing population exposures to PM2.5 would result in 1 (95% CI: 0 - 1) fewer premature death each year. Reductions in PM2.5 and O3 exposures would also result in fewer restricted activity days among adults [5 (95% CI: -3 – 95)] and fewer missed school days for children [27 (95% CI: -19- 582)]. Benefits of retiring the Comanche units were similar when emissions controls at Martin Drake are taken into account (Health Benefits Scenario 2). • For Health Benefits Scenario 3 (emissions at Martin Drake were “zeroed out”), we estimated that reducing population exposures to PM2.5 and O3 would result in 4 (95% CI: 2 - 5) and < 1 (95% CI: 0 - 1) fewer premature deaths each year, respectively. Reductions in PM2.5 and O3 exposures would also result in fewer restricted activity days among adults [10 (95% CI: 0 – 74)] and fewer missed school days for children [4 (95% CI: 2- 5)]. • For Health Benefits Scenario 4, we estimated that reducing population exposures to PM2.5 and O3 would result in 4 (95% CI: 2 - 6) and < 1 (95% CI: 0 - 1) fewer premature deaths each year, respectively. Among the largest annual health benefits are avoided asthma symptom days among children [16 (95% CI: -1 – 141) due to PM2.5 and 13 (95% CI: -348 - 972) due to O3] and minor restricted activity days among adults [69 (95% CI: 0 - 488) due to PM2.5 and 71 (95% CI: -31 - 750) due to O3]. We also estimated that, for Health Benefits Scenario 1, children in the study area would miss 77 (95% CI: -77 - 1180) fewer days of school each year due to lower O3 exposures. • Annual health benefits were lower for Health Benefits Scenario 5 compared to Scenario 4 due to the smaller change in exposure concentration after accounting for the control technologies installed at Martin Drake in 2016. For Health Benefits Scenario 5, we estimated that reducing population exposures to PM2.5 and O3 would result in 2 (95% CI: 1 - 3) and < 1 (95% CI: 0 - 1) fewer premature deaths each year, respectively. Other annual benefits under Health Benefits Scenario 2 included 2 (95% CI: -17 – 44) and 9 (-242 – 678) avoided asthma symptom days due to PM2.5 and O3 exposures, respectively; 28 (95%CI: -2 – 188) and 48 (95%CI: -16 – 513) minor restricted activity days due to PM2.5 and O3 exposures; and 53 (95% CI: -48 – 833) avoided school absences among children due to O3 exposures. • Monetized health benefits when both plants were “zeroed out” ranged from $4.2 million (95$2.1 million - $7.2 million) for Health Benefits Scenario 4 to$1.7 million (95% CI: $0.8 million – 3.2 million) for Health Benefits Scenario 5. Benefits tended to be smaller when only one plant was considered. In all of the analyses, the monetized impacts were driven by the value of avoided premature mortality. In addition, we found that ZIP codes with lower median incomes tended to receive a greater share of the health benefits of decreasing exposures to PM2.5 and O3 resulting from power plant shutdowns. This finding suggests that reducing emissions at the power plants could potentially alleviate some environmental justice concerns in the area

Medication Use Patterns among Urban Youth Participating in School-Based Asthma Education

Although pharmaceutical management is an integral part of asthma control, few community-based analyses have focused on this aspect of disease management. The primary goal of this analysis was to assess whether participation in the school-based Kickin’ Asthma program improved appropriate asthma medication use among middle school students. A secondary goal was to determine whether improvements in medication use were associated with subsequent improvements in asthma-related symptoms among participating students. Students completed an in-class case-identification questionnaire to determine asthma status. Eligible students were invited to enroll in a school-based asthma curriculum delivered over four sessions by an asthma health educator. Students completed a pre-survey and a 3-month follow-up post-survey that compared symptom frequency and medication use. From 2004 to 2007, 579 participating students completed pre- and post-surveys. Program participation resulted in improvements in appropriate use across all three medication use categories: 20.0% of students initiated appropriate reliever use when “feeling symptoms” (p < 0.001), 41.6% of students reporting inappropriate medication use “before exercise” initiated reliever use (p < 0.001), and 26.5% of students reporting inappropriate medication use when “feeling fine” initiated controller use (p < 0.02). More than half (61.6%) of participants reported fewer symptoms at post-survey. Symptom reduction was not positively associated with improvements in medication use in unadjusted and adjusted analysis, controlling for sex, asthma symptom classification, class attendance, season, and length of follow-up. Participation in a school-based asthma education program significantly improved reliever medication use for symptom relief and prior-to-exercise and controller medication use for maintenance. However, given that symptom reduction was not positively associated with improvement in medication use, pharmaceutical education must be just one part of a comprehensive asthma management agenda that addresses the multifactorial nature of asthma-related morbidity

Detection of Viruses from Bioaerosols Using Anion Exchange Resin

This protocol demonstrates a customized bioaerosol sampling method for viruses. In this system, anion exchange resin is coupled with liquid impingement-based air sampling devices for efficacious concentration of negatively-charged viruses from bioaerosols. Thus, the resin serves as an additional concentration step in the bioaerosol sampling workflow. Nucleic acid extraction of the viral particles is then performed directly from the anion exchange resin, with the resulting sample suitable for molecular analyses. Further, this protocol describes a custom-built bioaerosol chamber capable of generating virus-laden bioaerosols under a variety of environmental conditions and allowing for continuous monitoring of environmental variables such as temperature, humidity, wind speed, and aerosol mass concentration. The main advantage of using this protocol is increased sensitivity of viral detection, as assessed via direct comparison to an unmodified conventional liquid impinger. Other advantages include the potential to concentrate diverse negatively-charged viruses, the low cost of anion exchange resin (~$0.14 per sample), and ease of use. Disadvantages include the inability of this protocol to assess infectivity of resin-adsorbed viral particles, and potentially the need for the optimization of the liquid sampling buffer used within the impinger

Original Contribution Do Psychosocial Stress and Social Disadvantage Modify the Association Between Air Pollution and Blood Pressure? The Multi-Ethnic Study of Atherosclerosis

Researchers have theorized that social and psychosocial factors increase vulnerability to the deleterious health effects of environmental hazards. We used baseline examination data (2000)(2001)(2002) from the Multi-Ethnic Study of Atherosclerosis. Participants were 45-84 years of age and free of clinical cardiovascular disease at enrollment (n = 6814). The modifying role of social and psychosocial factors on the association between exposure to air pollution comprising particulate matter less than 2.5 µm in aerodynamic diameter (PM 2.5 ) and blood pressure measures were examined using linear regression models. There was no evidence of synergistic effects of higher PM 2.5 and adverse social/psychosocial factors on blood pressure. In contrast, there was weak evidence of stronger associations of PM 2.5 with blood pressure in higher socioeconomic status groups. For example, those in the 10th percentile of the income distribution (i.e., low income) showed no association between PM 2.5 and diastolic blood pressure (b = −0.41 mmHg; 95% confidence interval: −1.40, 0.61), whereas those in the 90th percentile of the income distribution (i.e., high income) showed a 1.52-mmHg increase in diastolic blood pressure for each 10-µg/m 3 increase in PM 2.5 (95% confidence interval: 0.22, 2.83). Our results are not consistent with the hypothesis that there are stronger associations between PM 2.5 exposures and blood pressure in persons of lower socioeconomic status or those with greater psychosocial adversity. air pollution; blood pressure; population groups; social environment; social medicine; social psychology Abbreviations: CVD, cardiovascular disease; DBP, diastolic blood pressure; ETS, exposure to second-hand smoke; MAP, mean arterial pressure; MESA, Multi-Ethnic Study of Atherosclerosis; PM 2.5 , particulate matter less than 2.5 µm in aerodynamic diameter; PP, pulse pressure; SBP, systolic blood pressure; SES, socioeconomic status

Turning the Tide: Tobacco Industry Political Influence and Tobacco Policy Making in California 1997-1999

The tobacco industry's trend of giving generously to California legislators continued in the 1997-1998 election cycle. Between January 1, 1997, and December 31, 1998, the tobacco industry contributed $615,145 to state legislators and legislative candidates.Since 1991-1992, campaign contributions to legislative candidates and parties by the tobacco industry favored the party in power. However, in the 1997-1998 election cycle, reflecting increasingly partisan contributions by the tobacco industry, Republicans received 81 percent of tobacco industry campaign contributions even though the Democrats controlled both houses of the Legislature.The tobacco industry contributed a total of$848,635 to state legislators and legislative candidates, state constitutional officers, political parties and party controlled committees for the 1997-1998 election cycle. This total is less than the three previous election cycles in the 1990s, and is in part most likely due to the passage of Proposition 208, which placed spending limits on individuals, corporations, and PACs for 1997.On a per member basis, California legislators received more money than the members of Congress, $5,117 per member compared to$4,373 per member. For the 1997-1998 election cycle, Senator Minority Leader Ross Johnson (R- Irvine) the top recipient in California Senate ($111,500) received more money than Senator Lauch Faircloth (R-North Carolina), the top recipient in the United States Senate ($87,999). In addition, Assembly Minority Leader Bill Leonard (R- Rancho Cucamonga) received more tobacco industry campaign contributions ($82,250) than Representative Edward Whitfield (R-Kentucky), who was the top recipient of tobacco industry campaign contributions in the House of Representatives ($34,000).On January 1, 1998, California enacted the country's first state-wide smoke free bar law as an extension of the state smoke free workplace law. The tobacco industry attempted nine times to either delay the enactment of the law, or have the law repealed. The tobacco industry, working primarily through the National Smokers' Alliance, sought to undermine the law by depicting the issue as unfair to small businesses, and problematic in terms of enforcement. Even so, health advocates prevented the law from being repealed.In November 1998, California elected a Democrat to the governorship for the first time since 1982. Governor Gray Davis had begun to remedy the actions of the Wilson Administration in debilitating the state funded California Tobacco Control Program. Though the funding levels for the Proposition 99 programs were at the voted mandated levels, two suits filed against the state for misappropriation of Proposition 99 funds in 1991 and 1995 remain pending. Governor Davis vetoed $32 million the Legislature had appropriated for anti-smoking education programs.On June 12, 1997, the State of California became the 37th state to file suit against the tobacco industry. The state sought damages for violations of California Business and Professions Code and recovery of public health care expenditures for tobacco related disease. The state's claims for medicaid reimbursement were dismissed. The remaining claims were consolidated with the City of Los Angeles, the City and County of San Francisco et al., and two private citizen suits against the tobacco industry. These suits were settled by the Multi-State Master Settlement Agreement in November 1998. California will receive approximately$25 billion of the $206 billion settlement over the next 25 years from the industry. In September 1999, the Legislature passed a bill to have these funds dedicated for health services in the state.Other civil action suits against the tobacco industry are scheduled to be heard beginning in January 2000. These suits are mainly union trust fund suits against the industry, as well as local government failure to warn suits under Proposition 65, the state's toxic enforcement act.In November 1998, the California voters passed Proposition 10, which resulted in the creation of local agencies throughout the state that will promote child development programs and educational campaigns. The proposition won by a vote of 50.5$29,397,147 the tobacco industry spent to defeat it. The program is funded by an additional $.50 tax on cigarettes, and a commensurate tax increase on other tobacco products. The tax increase, along with a price hike from the industry, sales of cigarettes in California decreased 28.6 percent for the first 6 months of 1999

Turning the Tide: Tobacco Industry Political Influence and Tobacco Policy Making in California 1997-1999

The tobacco industry's trend of giving generously to California legislators continued in the 1997-1998 election cycle. Between January 1, 1997, and December 31, 1998, the tobacco industry contributed $615,145 to state legislators and legislative candidates.Since 1991-1992, campaign contributions to legislative candidates and parties by the tobacco industry favored the party in power. However, in the 1997-1998 election cycle, reflecting increasingly partisan contributions by the tobacco industry, Republicans received 81 percent of tobacco industry campaign contributions even though the Democrats controlled both houses of the Legislature.The tobacco industry contributed a total of$848,635 to state legislators and legislative candidates, state constitutional officers, political parties and party controlled committees for the 1997-1998 election cycle. This total is less than the three previous election cycles in the 1990s, and is in part most likely due to the passage of Proposition 208, which placed spending limits on individuals, corporations, and PACs for 1997.On a per member basis, California legislators received more money than the members of Congress, $5,117 per member compared to$4,373 per member. For the 1997-1998 election cycle, Senator Minority Leader Ross Johnson (R- Irvine) the top recipient in California Senate ($111,500) received more money than Senator Lauch Faircloth (R-North Carolina), the top recipient in the United States Senate ($87,999). In addition, Assembly Minority Leader Bill Leonard (R- Rancho Cucamonga) received more tobacco industry campaign contributions ($82,250) than Representative Edward Whitfield (R-Kentucky), who was the top recipient of tobacco industry campaign contributions in the House of Representatives ($34,000).On January 1, 1998, California enacted the country's first state-wide smoke free bar law as an extension of the state smoke free workplace law. The tobacco industry attempted nine times to either delay the enactment of the law, or have the law repealed. The tobacco industry, working primarily through the National Smokers' Alliance, sought to undermine the law by depicting the issue as unfair to small businesses, and problematic in terms of enforcement. Even so, health advocates prevented the law from being repealed.In November 1998, California elected a Democrat to the governorship for the first time since 1982. Governor Gray Davis had begun to remedy the actions of the Wilson Administration in debilitating the state funded California Tobacco Control Program. Though the funding levels for the Proposition 99 programs were at the voted mandated levels, two suits filed against the state for misappropriation of Proposition 99 funds in 1991 and 1995 remain pending. Governor Davis vetoed $32 million the Legislature had appropriated for anti-smoking education programs.On June 12, 1997, the State of California became the 37th state to file suit against the tobacco industry. The state sought damages for violations of California Business and Professions Code and recovery of public health care expenditures for tobacco related disease. The state's claims for medicaid reimbursement were dismissed. The remaining claims were consolidated with the City of Los Angeles, the City and County of San Francisco et al., and two private citizen suits against the tobacco industry. These suits were settled by the Multi-State Master Settlement Agreement in November 1998. California will receive approximately$25 billion of the $206 billion settlement over the next 25 years from the industry. In September 1999, the Legislature passed a bill to have these funds dedicated for health services in the state.Other civil action suits against the tobacco industry are scheduled to be heard beginning in January 2000. These suits are mainly union trust fund suits against the industry, as well as local government failure to warn suits under Proposition 65, the state's toxic enforcement act.In November 1998, the California voters passed Proposition 10, which resulted in the creation of local agencies throughout the state that will promote child development programs and educational campaigns. The proposition won by a vote of 50.5$29,397,147 the tobacco industry spent to defeat it. The program is funded by an additional $.50 tax on cigarettes, and a commensurate tax increase on other tobacco products. The tax increase, along with a price hike from the industry, sales of cigarettes in California decreased 28.6 percent for the first 6 months of 1999

Analysis of Proposition 28: Repeal of Proposition 10 Tobacco Surtax Initiative Statute

Proposition 28, titled the Repeal of Proposition 10 Tobacco Surtax Initiative Statute, would repeal the $.50 tax per pack of cigarettes (and commensurate tax on other tobacco products) enacted on by Proposition 10, passed on November 3, 1998. Proposition 28 would dismantle the California Children and Families First Program, a statewide trust to fund programs for early childhood education, also enacted through Proposition 10. It also prohibits the passage of additional taxes on tobacco products by voter mandate.People are sensitive to the price of cigarettes and other tobacco products. Imposition of the 50 cent tax by Proposition 10 (combined with a wholesale price increase imposed by the tobacco industry to pay for the Master Settlement Agreement that ended state tobacco litigation) substantially reduced cigarette consumption.Repealing the tax could substantially increase cigarette consumption and associated disease and medical costs if the price of cigarettes drops.We analyzed two scenarios, which bracket the likely effects if Proposition 28 passes:1. The tobacco industry raises wholesale prices to increase industry revenues.• Since there is no retail price change, there will be no changes in consumption or tobacco-related disease.• Industry revenues would increase by$617 million.2. The tobacco industry does not change wholesale prices, so the retail price of cigarettes drops and consumption increases.• There would be an additional 114 million packs of cigarettes consumed, increasing industry revenues by $220 million.• There would be an increase in teen smoking, between 7,800 and 46,500 new youth smokers.• An additional 102 low birth weights due to maternal smoking, for an additional$2 million in direct medical costs for the first year following the repeal of the tax.• An additional combined total of 78 heart attacks and strokes for Californians over 35 years of age for an increase of $3 million in direct medical costs for the first year following the repeal of the tax.• Over the longer term, annual medical costs of smoking-induced disease will increase by$500 million annually, with an additional 1,800 annual deaths due to active smoking.• Increase in costs for diseases related to secondhand smoke, especially in childhood diseases caused or exacerbated by secondhand smoke including SIDS, middle ear infections, asthma, bronchitis, pneumonia, and lung cancer, including• 50 to 90 additional low birth weight infants• 5 additional cases of SIDS• 3,400-8,100 additional physician office visits for middle ear infections• 40 to 135 new asthma cases in children• 2,000 to 5,200 additional asthma attacks in children• 780 to 1,600 cases of bronchitis and pneumonia in children• 16 additional lung cancer deaths• 180 to 320 additional heart disease deathsThese two cases bracket the likely effects of enactment of Proposition 28. The actual effect will probably be somewhere between these two scenarios

Data associated with "Health and environmental justice implications of retiring two coal‐fired power plants in the southern Front Range region of Colorado"

R code used to conduct the health impact assessment is available at https://doi.org/10.5281/zenodo.2669422.The dataset includes model predictions of ozone and particulate matter less 2.5 microns in diameter over southern Colorado during years of 2017 and 2035. These files are stored as netCDF files.Despite improvements in air quality over the past 50 years, ambient air pollution remains an important public health issue in the United States. In particular, emissions from coal-fired power plants still have a substantial impact on both nearby and regional populations. Of particular concern is the potential for this impact to fall disproportionately on low-income communities and communities of color. We conducted a quantitative health impact assessment to estimate the health benefits of the proposed decommissioning of coal-fired boilers at two electricity generating stations in the Southern Front Range region of Colorado. We estimated changes in exposures to fine particulate matter (PM2.5) and ozone due to reductions in emission using the Community Multiscale Air Quality model and predicted avoided health impacts and related economic values. In addition to estimating health benefits of reduced emissions, we assessed the distribution of these benefits by population-level socioeconomic status using concentration curves. Across the study area, decommissioning the power plants would result in 4 (95% CI: 2 – 6) avoided premature deaths each year due to reduced PM2.5 exposures and greater reductions in hospitalizations and other morbidities. Health benefits resulting from the modeled shutdowns were greatest in areas with lower median incomes, lower percentages of high school graduates, and higher proportions of households with incomes below the poverty line. However, in our study area, we did not observe higher benefits when examining area-level percentage of residents of color, largely due to the distribution of the smaller proportion of the population in the region that identifies as non-White. Our results suggest that decommissioning the power plants in the southern Front Range and replacing them with zero-emissions sources could have broad public health benefits for residents of Colorado, with larger benefits for those that are socially disadvantaged and historically bear greater environmental pollution burdens. These results also suggested that researchers and decision makers need to consider the unique demographics of their study areas to ensure that important opportunities to reduce health disparities associated with point-source pollution.American Lung Association