December 2019 Highlights

Date: Dec 19 2019

CONTACT: Arnice Cottom, 202-777-3913

American Journal of Public Health February issue research highlights:

Most people with opioid use disorder also using other drugs

Most opioid users are also taking other drugs, suggesting that medical treatment and policies aimed at curbing opioid use need to be broadened to address polysubstance use, a study in the February issue of APHA’s American Journal of Public Health finds.

Researchers examined data on over 15,700 U.S. patients with diagnosed opioid use disorders from 2011 to 2018. Though use of prescription opioids alone dropped during the period, past-month use of illicit opioids such as heroin and fentanyl increased from 45% to 70%. And nearly all patients were using other illicit drugs, such as methamphetamine, crack, cocaine, hallucinogens or a combination.

Work to limit abuse of prescription opioids might have resulted in people with opioid use disorders turning to illicit opioids and other drugs, researchers said.

Polysubstance use suggests that a comprehensive treatment regimen should be developed. That approach is vital to “improving treatment success and preventing the high rates of relapse that are common among substance users,” researchers said.

[Author contact: Theodore J. Cicero, Washington University, St. Louis. “Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis.”]

Rented homes bear brunt of hurricane damage in Puerto Rico

Hurricane Maria in Puerto Rico heavily damaged more rented homes than owned homes, a study in the February issue of AJPH finds.

Researchers examined inspection records from the U.S. Federal Emergency Management Agency of over 306,000 storm-damaged homes caused by the 2017 hurricane. Though renters occupied only 8% of damaged homes, two-thirds of the 8,800 homes that had major damage housed renters. Moreover, rented homes were four times more likely to have been destroyed than those occupied by homeowners.

Household income is a strong determinant of who rents and who owns a home in Puerto Rico. Renters tended to have household incomes half that of homeowners, researchers said. Wind damage rather than flooding accounted for nearly all structural damage.

The findings are consistent with policy efforts in Puerto Rico to provide safer storm-resistant housing for low-income households.

“We believe that our findings may serve to provide additional substantive support for these efforts,” researchers said.

[Author contact: Chenyi Ma, School of Social Policy and Practice, University of Pennsylvania, Philadelphia. “Vulnerability of Renters and Low-Income Households to Storm Damage: Evidence From Hurricane Maria in Puerto Rico”].

High temperatures increase infant mortality

Higher air temperatures can increase risk of infant mortality, according to a study published in February’s AJPH.

Researchers examined records detailing infant mortality rates at Philadelphia hospitals during summer months between 2000 and 2015, and also examined air temperature records.

Infant deaths increased on days with high temperatures, which ranged from about 28-39 degrees Celsius — or 83-103 degrees Fahrenheit. For every 1 degree C increase in minimum daily temperature over 24 degrees C — about 75 degrees F — risk of infant death rose 22%, researchers found.

Researchers identified 1,522 infant deaths during the study period. Nearly 65% of the infants were black, 16% were white and 11% were Hispanic. Almost two-thirds of the children who died were less than 28 days old.

Philadelphia and other urban centers tend to have hotter summer temperatures than surrounding rural areas because of the heat island effect, created by a lack of green space in cities. That likely contributes to infant mortality, researchers said. In addition, hot nighttime temperatures may be more dangerous than hot daytime temperatures to infants, according to the study.

Infants are heat susceptible because of their small bodies and undeveloped physiology for handling heat, among other reasons.

[Author Contact: Lea H. Schinasi, Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA. “High Ambient Temperature and Infant Mortality in Philadelphia, Pennsylvania: A Case-Crossover Study.”}

Public health benefits when additional data used to code cause of death

Models to determine cause of death are more accurate when detailed information on the decedent is combined with death certificate information, according to a study published in February’s AJPH.

Public health relies on cause-of-death data to develop death prevention programs and influence policymaking. But coroners many times mistakenly list cause of death, such as by listing heart failure — which is actually a mode of dying, not a cause of death. Such false causes on death certificates are called “garbage codes.”

Researchers examined data from a death registry in Taiwan for the years 2008 to 2015. They used garbage codes data to compare accuracy of three prediction models: naïve Bayes classifier, coarsened exact matching and multinominal logistic regression. All three models determined actual cause of death correctly only 20% of the time.

Researchers then entered additional demographic and medical data into the models, including multiple possibilities for cause of death. Model accuracy jumped to over 80% for all three models.

“Such findings suggest that collecting contributing (multiple causes of death) should be a necessary step to improving the quality of mortality statistics,” regardless of which distribution model is used, the researchers said.

[Author Contact: Wei-Cheng Lo Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. “Improving the Use of Mortality Data in Public Health: A Comparison of Garbage Code Redistribution Models.”]

AJPH  articles to be published online Dec. 19 include:

  • Trends in e-cigarette, cigarette, cigar, and smokeless tobacco use among U.S. adolescent cohort, 2014-18
  • Indicators to guide and monitor climate change adaptation in the US Pacific Northwest
  • High ambient temperature and infant mortality in Philadelphia, PA: A case-crossover study
  • Vulnerability of Renters and Low-Income Households to Storm Damage: Evidence from Hurricane Maria in Puerto Rico
  • A tobacco control framework for regulating public consumption of cannabis: Multi-state analysis and policy implications
  • Assurances of voluntary compliance: A regulatory mechanism to reduce youth access to e-cigarettes and limit retail tobacco marketing
  • Methods of tracking newborns: New York State Zika Pregnancy and Infant Registry (2015- 2017)
  • A pornography literacy program for adolescents
  • Improving the use of mortality data in public health: A comparison of garbage code redistribution models>
  • State-level changes in firearm laws and rate of workplace homicide, United States, 2011 to 2017
  • Area-wide traffic calming Zone 30 policy of Japan and incidence of road traffic injuries among cyclists and pedestrians
  • Polysubstance use: a broader understanding of substance use during the opioid crisis
  • Cannabis surveillance with Twitter data: emerging topics and social bots
  • Deaths of despair and Brexit votes: cross-local authority statistical analysis in England and Wales

The articles above were published online Dec. 19, 2019, at 4 p.m. EDT by AJPH under “First Look.”

“First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at www.ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Arnice Cottom at APHA. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single-issue access is $30, and online single-article access is $22 at www.ajph.org. For direct customer service, call 202-777-2516, or email us.

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