Changing Trends in Drug Overdose Mortality in Kentucky: An Examination of Race and Ethnicity, Age, and Contributing Drugs, 2016-2020

OBJECTIVES

Increased drug overdose mortality among non-Hispanic Black people in the United States in the past 5 years highlights the need for better tailored programs and services. We evaluated (1) changes in drug overdose mortality for various racial and ethnic groups and (2) drug involvement to inform drug overdose prevention efforts in Kentucky.

METHODS

We used Kentucky death certificates and postmortem toxicology reports from 2016-2020 (provisional data) to estimate changes in age-adjusted drug overdose death rates per 100 000 standard population.

RESULTS

The age-adjusted drug overdose death rate per 100 000 standard population among non-Hispanic Black residents doubled from 2016 (21.2) to 2020 (46.0), reaching the rate among non-Hispanic White residents in 2020 (48.7; P = .48). From 2016 to 2020, about 80% of these drug overdose deaths involved opioids; heroin involvement declined about 20 percentage points; fentanyl involvement increased about 30 percentage points. The number of psychostimulant-involved drug overdose deaths increased 513% among non-Hispanic Black residents and 191% among non-Hispanic White residents. Cocaine-involved drug overdose deaths increased among non-Hispanic Black residents but declined among non-Hispanic White residents. Drug overdose death rates were significantly lower among Hispanic residents than among non-Hispanic White residents.

CONCLUSIONS

Increased opioid-involved overdose deaths among non-Hispanic Black residents in Kentucky in combination with rapidly expanding concomitant psychostimulant involvement require increased understanding of the social, cultural, and illicit market circumstances driving these rapid trend changes. Our findings underscore the urgent need to expand treatment and harm reduction services to non-Hispanic Black residents with substance use disorder.

Disinfectant use by K-12 school staff to combat SARS-CoV-2

K-12 school staff from Indiana, Kentucky and Ohio were asked about their use of disinfectants to mitigate the spread of COVID-19 in schools. Survey participants (n = 1,555) reported frequent use of disinfectants, often using unknown products, and were provided little to no training on safe and effective use. Participant concerns included student involvement in disinfection, inadequate ventilation, surface contact time, and potential health effects.

Trends in Drug Overdose Mortality Rates in Kentucky, 2019-2020

This cross-sectional study evaluates the changes in drug overdose mortality rates for Kentucky residents between 2019 and 2020.

A Methodology Report for the Life's Snapshot Cohort Study to Investigate the Long-Term Efficacy of a Violence Intervention

Engaged bystander interventions are recognized as "promising" programming to reduce sexual violence (SV), yet little is known of the long-term (>12-month) impact of programming on SV and related forms of gender-based violence. Funded by NIH as a prospective cohort study, Life's Snapshot recruited and followed three waves of high school seniors who had participated in a large high-school cluster-randomized controlled trial to evaluate the effectiveness of the Green Dot bystander intervention. This report provides the study design, recruitment methodology, recruitment and retention rates, survey items, and psychometric properties of measures included in the initial and annual electronic surveys with 24-48 months follow-up.

A Campus Climate/Violence Survey's Psychometrics and Findings

Data from a campus climate/violence survey (CCS) include psychometric information for survey items/scales plus findings from a large state university to promote its usefulness for assessment of interpersonal violence/harassment. This CCS can thus be evaluated for its measurement and documented findings, allowing for benchmarking purposes. An innovative measurement strategy is introduced to comprehensively capture incidence of victimization types through streamlined questioning. Tables provide detailed data for 6,995 undergraduate and graduate/professional students over a 1-year period. Adding to published literature on existing CCSs, this article provides the range of information needed for universities to determine the potential usefulness of a CCS.

Sexual Minority High School Boys' and Girls' Risk of Sexual Harassment, Sexual Violence, Stalking, and Bullying

We report the prevalence and number of violent events of sexual violence, sexual harassment, stalking, and bullying experienced among sexual minority girls, sexual minority boys, heterosexual girls, and heterosexual boys. We conducted covariate-adjusted analyses of variance on 16,243 high school youth from 13 schools in Kentucky. Sexual minority boys and girls and heterosexual girls had higher rates of all forms of violence compared with heterosexual boys, but rates of violence between sexual minority girls and boys were statistically equivalent. Prevention and intervention programs must incorporate elements of minority stress theory to disrupt heterosexist norms that contribute to violence.

Utilization of community health workers in Canada's Children's Oral Health Initiative for indigenous communities

OBJECTIVE

The Children's Oral Health Initiative (COHI) is a federally funded community-based preventive dental programme implemented in geographically remote Canadian Indigenous communities. The study investigated the effect of the availability of local community health workers (COHI Aides) on access to the programme's preventive dental services for children.

METHODS

Twenty-five communities were continuously enrolled in the COHI during the 7-year study period. Communities were categorized as having uninterrupted (all 7 years), intermittent (≥4 years) or sporadic (<4 years) service from a community health worker. Four outcome variables measured longitudinal changes in access to preventive dental services: (i) the number of enrolments; (ii) the number of enrolled children with multiple fluoride varnishes delivered; (iii) the number of enrolled children with sealants placed; and (iv) the number of enrolled children receiving ART.

RESULTS

The general longitudinal trend for programme enrolment and each of the preventive dental service delivery outcomes was similar. Children in communities with uninterrupted service tended to have the highest rates of enrolment and service delivery, which remained constant over time. Children in communities with sporadic service tended to have persistently low rates of enrolment and service delivery over the study period.

CONCLUSIONS

Community health workers were beneficial in promoting programme enrolment, as well as facilitating and augmenting the delivery of preventive dental services.

Direct Effects of the Home, School, and Consumer Food Environments on the Association between Food Purchasing Patterns and Dietary Intake among Rural Adolescents in Kentucky and North Carolina, 2017

Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United States Department of Agriculture-Mathematica) and the Nutrition Environment Measurement Survey for Stores, Restaurants, and Corner Stores. Results: Of 432 adolescents, 55% were normal weight, 24% were overweight, and 21% were obese. There was a direct association between unhealthy food purchasing patterns (shopping frequently at gas stations, fast food, and dollar stores) and consuming more added sugars, when compared to those with a healthy shopping pattern (shopping less frequently at gas stations, fast food, and dollar stores) [Odds Ratio = 2.41 (95% CI (confidence interval) 0.99, 3.82)]. Those who reported always having fruits and vegetables in the home consumed more servings of fruits and vegetables [OR = 0.31 cups (95% CI 0.22, 0.44)] compared to those who reported never having fruits and vegetables in the home. Adolescents attending a school with a low healthy food availability score consumed fewer servings of fruits and vegetables [−0.001 (95% CI −0.001, 0.0001)] compared to those attending a school with a high healthy food availability score. Conclusions: There are direct associations between food purchasing patterns, the home and school food environments, and dietary intake among rural adolescents. These cross-sectional results informed the development of the “Go Big and Bring it Home” program, a text messaging intervention to improve adolescents’ fruit, vegetable, and healthy beverage intake.

QRS duration is associated with atrial fibrillation in patients with left ventricular dysfunction

BACKGROUND

QRSduration (QRSd) is associated with higher mortality and morbidity in patients with left ventricular (LV) dysfunction. The association between QRSd and atrial fibrillation (AF) has not been studied in this patient population.

OBJECTIVES

To investigate the association between QRSd and AF in patients with LV dysfunction.

METHODS

Data were obtained from the National Registry to Advance Heart Health (ADVANCENT) registry, a prospective multicenter registry of patients with left ventricular ejection fraction (LVEF) < or = 40%. A total of 25 268 patients from 106 centers in the United States, were enrolled between June 2003 and November 2004. Demographic and clinical characteristics of patients were collected from interviews and medical records.

RESULTS

: Mean age was 66.3+/-13 years, 71.5% were males, and 81.9% were white. A total of 14 452 (57.8%) patients had a QRSd < 120 ms, 5304 (21.2%) had a QRSd between 120 and 150 ms, and 5269 (21%) had a QRSd > 150 ms. Atrial fibrillation occurred in 20.9%, 27.5%, and 35.5% of patients in the QRS groups, respectively (P < 0.0001). After adjusting for potential AF risk factors (age, gender, race, body mass index, hypertension, diabetes, renal failure, cancer, lung disease, New York Heart Association [NYHA] class, ejection fraction, etiology of cardiomyopathy) and the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and lipid lowering drugs, QRS duration remained independently associated with AF (odds ratio: 1.20, 95% confidence interval: 1.14-1.25).

CONCLUSION

In this large cohort of patients, QRSd was strongly associated with AF and therefore may predict the occurrence of this arrhythmia in patients with LV dysfunction. This association persisted after adjusting for disease severity, comorbid conditions, and the use of medications known to be protective against AF.