A novel Vision Zero leadership training model to support collaboration and strategic action planning

Introduction: While collaboration and cooperation are regarded as foundational to Vision Zero (VZ) and Safe Systems initiatives, there is little guidance on structuring VZ collaboration, conducting collaborative goal setting, and aligning tangible action across organizations. As part of a larger VZ mutual learning model, we developed a VZ Leadership Team Institute to support communities in collaborative VZ strategic planning and goal setting. The purpose of this paper is to describe the development and evaluation of the Institute, which can serve as a foundation for other initiatives seeking to move VZ planning and implementation forward in a collaborative, systems-aware manner.Methods: In June 2021, eight multi-disciplinary teams of 3–6 persons each (n = 42 participants) attended the Institute, representing leaders from communities of various sizes. Surveys were administered pre, immediately post, and 6 months following the Institute. We measured confidence in a range of skills (on a 5-point scale, 1: not confident to 5: very confident). Surveys also measured coalition collaboration pre-Institute and 6 months post-Institute (on a 4-point scale, 1: strongly disagree to 4: strongly agree).Results: The largest increases in confidence from pre- to immediately post-Institute were for collaboratively drafting objectives and actions for VZ goals (pre-mean: 2.6, SD: 0.9 to post-mean: 3.8, SD: 0.9); incorporating equity into goals (pre-mean: 2.8, SD: 1.0 to post-mean: 3.9, SD: 0.8); and knowing how to keep VZ planning and implementation efforts on track (pre-mean: 2.6, SD: 1.0 to post-mean: 3.7, SD: 0.7). For all measures, average confidence in skills decreased from immediately post-Institute to 6 months post-Institute, but remained greater than average scores pre-Institute. Several measures of coalition collaboration maintained high agreement across time, and mean agreement increased for reporting that the future direction of the coalition was clearly communicated to everyone (pre-mean: .6, SD: 0.8; 6 months post-mean: 3.1, SD: 0.4). However, average scores decreased for feeling like the coalition had adequate staffing (pre-mean: 3.0, SD: 0.6; 6 months post-mean: 2.3, SD: 0.5).Discussion: The Institute utilized innovative content, tools, and examples to support VZ coalitions’ collaborative and systems-aware planning and implementation processes. As communities work toward zero transportation deaths and serious injuries, providing effective support models to aid multidisciplinary planning and action around a Safe Systems approach will be important to accelerate progress toward a safer transportation system

Racial and ethnic disparities in motor vehicle crash-related outcomes in North Carolina surrounding the COVID-19 pandemic

Long-term impacts of the COVID-19 pandemic on racial and ethnic disparities in motor vehicle crash (MVC) injuries and death are poorly understood. This study aimed to characterize trends and investigate the heterogeneity of MVC-related disparities in North Carolina across several data sources. Crash reports, emergency department visit records, and death certificates from 2018 to 2021 were used to calculate monthly population-rates of MVC-related public health outcomes. We estimated trendlines using joinpoint regression and compared outcomes across racial and ethnic classifications. MVC and MVC-related injury rates declined in conjunction with NC’s stay-at-home order, while rates of severe outcomes remained unimpacted. By December 2021 rates of MVC-related outcomes met or exceeded pre-pandemic levels, with the highest rates observed among non-Hispanic Black individuals. Racial and ethnic disparities in MVC-related outcomes remained prevalent throughout the COVID-19 pandemic. These results highlight the importance of a holistic approach to traffic injury surveillance when assessing the impact of MVCs

Sociodemographic and clinical predictors of prescription opioid use in a longitudinal community-based cohort study of middle-aged and older adults

Chronic pain prevalence in the United States is likely to increase with an aging population. While opioids have commonly been prescribed to manage pain, their use may be more likely in certain patients. The objective of the study is to assess predictors of prescription opioid use in an adult population with a high prevalence of chronic pain. The simultaneous assessment of a breadth of clinical and sociodemographic factors identified polypharmacy, pain catastrophizing, and depressive symptoms as modifiable predictors of prescription opioid use. These findings support the incorporation of pharmacological review and behavioral approaches into chronic pain management strategies

Sociodemographic and Clinical Predictors of Prescription Opioid Use in a Longitudinal Community-Based Cohort Study of Middle-Aged and Older Adults

Background: Despite declining opioid prescribing rates in the United States, the annual prevalence of prescription opioid use in adults ≥50 years old is estimated to be 40%, higher than that of younger adults (ages 18-29 years, 36%). As the American population ages, understanding factors that contribute to overall opioid use is a necessary first step in the determination and mitigation of inappropriate prescribing and opioid-related harms. Objective: Assess predictors of prescription opioid use in an adult population with a high prevalence of chronic pain. Methods: Data were from a community-based cohort of White and African American adults aged 50-90 years residing in predominantly rural Johnston County, North Carolina. Univariable and multivariable logistic regression models were used to evaluate sociodemographic and clinical factors in non-opioid users (n=795) at baseline (2006-2010) as predictors of opioid use at follow-up (2013-2015). Variables included age, sex, race, obesity (BMI≥30kg/m2), polypharmacy (5+ medications), educational attainment (<12, ≥12 years), employment (unemployed, employed/retired), insurance (uninsured, public, private), Census block group household poverty rate (<12%, 12–24%, ≥25%), depressive symptoms (Center for Epidemiologic Studies Depression Scale ≥16 or depression diagnosis), perceived social support (moderate/poor [<19], strong [≥19]; Strong Ties Measure of Social Support, range 0-20), pain sensitivity (sensitive [<4kg], normal [≥4kg] pressure pain threshold), and pain catastrophizing (high [≥15], moderate/low [<15]; Pain Catastrophizing Helplessness Subscale, range 0-25). Results: At follow-up, 13% (n=100) of participants were using prescription opioids. In univariable models, younger age, female sex, obesity, polypharmacy, unemployment, public (vs. private) health insurance, higher poverty rate, depressive symptoms, poorer perceived social support, pain catastrophizing, and elevated pain sensitivity were independently associated (p<0.05) with opioid use. In the multivariable model, younger age (60 vs. 70 years; adjusted odds ratio, 95% confidence interval=2.52, 1.08−5.88), polypharmacy (2.16, 1.24−3.77), high pain catastrophizing (2.17, 1.33−3.56), and depressive symptoms (2.00, 1.17−3.43) remained significant independent predictors. Conclusion: The simultaneous assessment of a breadth of clinical and sociodemographic factors identified polypharmacy, pain catastrophizing, and depressive symptoms as modifiable predictors of prescription opioid use. These findings support the incorporation of pharmacological review and behavioral approaches into chronic pain management strategies. Further research is warranted to track changes in these factors as prescription opioid use declines nationwide

Sociodemographic and Clinical Predictors of Prescription Opioid Use in a Longitudinal Community-Based Cohort Study of Middle-Aged and Older Adults

Background: Despite declining opioid prescribing rates in the United States, the annual prevalence of prescription opioid use in adults ≥50 years old is estimated to be 40%, higher than that of younger adults (ages 18-29 years, 36%). As the American population ages, understanding factors that contribute to overall opioid use is a necessary first step in the determination and mitigation of inappropriate prescribing and opioid-related harms. Objective: Assess predictors of prescription opioid use in an adult population with a high prevalence of chronic pain. Methods: Data were from a community-based cohort of White and African American adults aged 50-90 years residing in predominantly rural Johnston County, North Carolina. Univariable and multivariable logistic regression models were used to evaluate sociodemographic and clinical factors in non-opioid users (n=795) at baseline (2006-2010) as predictors of opioid use at follow-up (2013-2015). Variables included age, sex, race, obesity (BMI≥30kg/m2), polypharmacy (5+ medications), educational attainment (<12, ≥12 years), employment (unemployed, employed/retired), insurance (uninsured, public, private), Census block group household poverty rate (<12%, 12–24%, ≥25%), depressive symptoms (Center for Epidemiologic Studies Depression Scale ≥16 or depression diagnosis), perceived social support (moderate/poor [<19], strong [≥19]; Strong Ties Measure of Social Support, range 0-20), pain sensitivity (sensitive [<4kg], normal [≥4kg] pressure pain threshold), and pain catastrophizing (high [≥15], moderate/low [<15]; Pain Catastrophizing Helplessness Subscale, range 0-25). Results: At follow-up, 13% (n=100) of participants were using prescription opioids. In univariable models, younger age, female sex, obesity, polypharmacy, unemployment, public (vs. private) health insurance, higher poverty rate, depressive symptoms, poorer perceived social support, pain catastrophizing, and elevated pain sensitivity were independently associated (p<0.05) with opioid use. In the multivariable model, younger age (60 vs. 70 years; adjusted odds ratio, 95% confidence interval=2.52, 1.08−5.88), polypharmacy (2.16, 1.24−3.77), high pain catastrophizing (2.17, 1.33−3.56), and depressive symptoms (2.00, 1.17−3.43) remained significant independent predictors. Conclusion: The simultaneous assessment of a breadth of clinical and sociodemographic factors identified polypharmacy, pain catastrophizing, and depressive symptoms as modifiable predictors of prescription opioid use. These findings support the incorporation of pharmacological review and behavioral approaches into chronic pain management strategies. Further research is warranted to track changes in these factors as prescription opioid use declines nationwide

The impact of alcohol and road traffic policies on crash rates in Botswana, 2004–2011: A time-series analysis

In Botswana, increased development and motorization have brought increased road traffic-related death rates. Between 1981 and 2001, the road traffic-related death rate in Botswana more than tripled. The country has taken several steps over the last several years to address the growing burden of road traffic crashes and particularly to address the burden of alcohol-related crashes. This study examines the impact of the implementation of alcohol and road safety-related policies on crash rates, including overall crash rates, fatal crash rates, and single-vehicle nighttime fatal (SVNF) crash rates, in Botswana from 2004 to 2011. The overall crash rate declined significantly in June 2009 and June 2010, such that the overall crash rate from June 2010 to December 2011 was 22% lower than the overall crash rate from January 2004 to May 2009. Additionally, there were significant declines in average fatal crash and SVNF crash rates in early 2010. Botswana’s recent crash rate reductions occurred during a time when aggressive policies and other activities (e.g., education, enforcement) were implemented to reduce alcohol consumption and improve road safety. While it is unclear which of the policies or activities contributed to these declines and to what extent, these reductions are likely the result of several, combined efforts

Trends and Insights from Transportation Congestion Pricing Policy Research: A Bibliometric Analysis

Toll-based congestion pricing (CP) policies are increasingly implemented globally for alleviating road traffic congestion. Several interconnected factors affecting or induced by CP implementation include air quality/emissions, travel time, and road user safety. We sought to examine and characterize research output and patterns across several domains (e.g., health, policy acceptability) surrounding toll-based CP policies, in order to identify where research has focused and where gaps exist. We conducted a structured review and identified 2333 relevant publications, using semi-supervised and machine learning strategies combined with manual review. Annual publication counts peaked in 2015 (n = 122). Themes identified from title and abstract terms included policy implementation characteristics, advanced transportation modeling methods and approaches, and public perception and acceptability. Authorship networks indicated a lack of interdisciplinary research. Country analyses identified the US, China, and the UK as the most frequently represented countries, and underrepresentation from low-income countries. Findings indicate that research focused on specific road user types (e.g., pedestrians) and safety impacts, and equity considerations were relatively sparse compared to other topics (e.g., policy economics, public perception). Additional research on these critical topics is necessary to ensure that such policies are designed to promote positive and equitable effects on road user health and safety

Racial and ethnic differences and COVID-19 pandemic-related changes in drug overdose deaths in North Carolina

Purpose To examine racial/ethnic differences and COVID-19 pandemic-related changes in key characteristics of drug overdose deaths in North Carolina. Methods We used North Carolina State Unintentional Drug Overdose Reporting System (NC-SUDORS) data to describe specific drug-involvement, bystander presence, and naloxone administration for drug overdose deaths by race/ethnicity during pre-COVID-19 (May 2019–February 2020) and COVID-19 periods (March 2020–December 2020). Results For all racial/ethnic groups, drug overdose death rates and the percentage with fentanyl and alcohol involvement increased from the pre-COVID-19 to COVID-19 period, with fentanyl involvement highest among American Indian/Alaska Native (82.2%) and Hispanic (81.4%) individuals and alcohol involvement highest among Hispanic individuals (41.2%) during the COVID-19 period. Cocaine involvement remained high among Black non-Hispanic individuals (60.2%) and increased among American Indian/Alaska Native individuals (50.6%). There was an increase in the percentage of deaths with a bystander present from the pre-COVID-19 to COVID-19 period for all racial/ethnic groups, with more than half having a bystander present during the COVID-19 period. There was a decrease in the percentage with naloxone administered for most racial/ethnic groups, with the lowest percentage among Black non-Hispanic individuals (22.7%). Conclusions Efforts to address increasing inequities in drug overdose deaths, including expanded community naloxone access, are needed

Identification of structural features of condensed tannins that affect protein aggregation

A diverse panel of condensed tannins was used to resolve the confounding effects of size and subunit composition seen previously in tannin-protein interactions. Turbidimetry revealed that size in terms of mean degree of polymerisation (mDP) or average molecular weight (amw) was the most important tannin parameter. The smallest tannin with the relatively largest effect on protein aggregation had an mDP of ~7. The average size was significantly correlated with aggregation of bovine serum albumin, BSA (mDP: r=-0.916; amw: r=-0.925; p<0.01; df=27), and gelatin (mDP: r=-0.961; amw: r=-0.981; p<0.01; df=12). The procyanidin/prodelphinidin and cis-/trans-flavan-3-ol ratios gave no significant correlations. Tryptophan fluorescence quenching indicated that procyanidins and cis-flavan-3-ol units contributed most to the tannin interactions on the BSA surface and in the hydrophobic binding pocket (r=0.677; p<0.05; df=9 and r=0.887; p<0.01; df=9, respectively). Circular dichroism revealed that higher proportions of prodelphinidins decreased the apparent α-helix content (r=-0.941; p<0.01; df=5) and increased the apparent β-sheet content (r=0.916; p<0.05; df=5) of BSA