AJPH August 2018 Highlights

Date: Aug 23 2018

CONTACT: Megan Lowry, 202-777-3913

AJPH publishes new research on long gun age restrictions, social media bots and anti-vaccine conversations, smoke-free colleges, opioid policies, drinking water

American Journal of Public Health October Issue research highlights:

Increasing age restriction to purchase long guns to 21 years could have prevented 1 in 4 school shootings; prevented harm to 1 in 3 school shooting victims

Researchers found 4 of 16 school shooting events from 1982 through 2018 were committed by those aged 18 to 20 years, and all four of those school shootings involved long guns. Persons aged 18 to 20 years were responsible for 31 percent of all school shooting victims (including both those killed and injured). Victims of perpetrators aged 18 to 20 years make up 9 percent of all mass casualty event shootings, and perpetrators 18 to 20 years were responsible for 1 in 8 of all mass casualty event shootings.

The study concludes that an increase in age restrictions to purchase long gun firearms from 18 to 21 years could have potentially prevented 4 of the 16 school shootings in the past 36 years and prevented harm to 1 in 3 of those injured or killed in school shootings. Study authors note the majority of mass shooting events (71 percent) were perpetrated by those who had legally obtained the firearms.

[Author Contact: Joshua D. Brown, Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL “Mass Casualty Shooting Venues, Types of Firearms, and Age of Perpetrators in the United States, 1982–2018”].

How Twitter bots and Russian trolls amplify the vaccine debate on social media

This study examined 1,793,690 vaccine-relevant conversations on Twitter from July 2014 through September 2017. Researchers found bots, Russian trolls and content polluters are significantly more likely to tweet about vaccination than the average Twitter user. Researchers found that troll accounts and sophisticated bots posted roughly equal proportions of pro- and anti-vaccine messages. Content polluters, however, were more likely to post anti-vaccine content. Researchers concluded that the highest proportion of anti-vaccine content is generated by Twitter accounts with unknown or intermediate bot scores, and that their provenance is unknown.

Researchers looked closely at the role played by known Russian troll accounts in the vaccine debate using #VaccinateUS on Twitter, some of which have been identified by Congress or NBC News as interfering in the 2016 presidential election. They found that these tweets were 43 percent pro-vaccine, 38 percent anti-vaccine and 19 percent neutral, spreading messages on both sides of the debate. Researchers noted that messages in these tweets were very polarized, tied both pro- and anti-vaccine messages to U.S. politics, and frequently used emotional appeals referencing freedom and democracy. They also used arguments that researchers note were not observed in the wider Twitter vaccine debate, including arguments related to racial/ethnic divisions, appeals to God and arguments on the basis of animal welfare. These messages also almost singularly focused on the U.S. government.

This study is among the first to quantify to what degree bots and Russian trolls may be damaging public health communications and the spread of misinformation about public health to the general public. The paper concludes that public health professionals should focus on combating anti-vaccine messages themselves, rather than the accounts that spread them.

[Author Contact: David Broniatowski, The George Washington University, Washington, DC. “Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate]. 

Over half of US college and university campuses aren’t tobacco- or smoke-free 

Researchers surveyed over 600 public and private colleges and universities and found 35 percent had tobacco-free policies, 10 percent had smoke-free policies and 54 percent had neither smoke-free nor tobacco-free policies. Private schools were the least likely to have tobacco- or smoke-free policies. Forty-four percent of publicly funded schools are not smoke-free, while 62 percent and 93 percent of privately funded schools and proprietarily funded schools are not smoke-free, respectively. 

The study also found that schools offering only associate degrees and schools located in the Midwest, Northeast and South were more likely to have tobacco- or smoke-free policies. 

[Author Contact: Kelvin Choi, Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD. “Adoption of Tobacco- and Smoke-Free Policies in a US National Sample of Postsecondary Educational Institutions”].

Which opioid policies are projected to save lives?

Researchers projected how current opioid policies will impact the number of opioid-related deaths from 2016 until 2025. They found increasing naloxone availability, promoting needle exchange, expanding medication-assisted addiction treatment and increasing psychosocial treatment increased life years and quality-adjusted life years and reduced deaths through 2025. Other policies reduced opioid prescription supply and related deaths but led some addicted prescription users to switch to heroin use, which increased heroin-related deaths. The authors note that over a longer horizon, some such policies may avert enough new addiction to outweigh the harms. 

The study concluded that no single policy is likely to substantially reduce deaths over 5 to 10 years. Policies focused on services for addicted people improve population health without harming any groups.

[Author Contact: Allison L. Pitt, Department of Management Science and Engineering, Huang Engineering Center, Stanford University, Stanford, CA. “Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic”].

Uninsured, low socioeconomic status and minorities face higher risk of drinking water violations

Researchers found that populations lacking health insurance, facing a lower socioeconomic status and minorities are more likely to experience a drinking water violation.

The study found the majority of first-time drinking water violations occurred among systems serving small populations. Uninsured populations had the highest odds ratio associated with both reported drinking water initial violations and repeat violations. Minorities had a higher odds ratio of both initial and repeat violations.

[Author Contact: Yolanda J. McDonald, Vanderbilt University, Nashville, TN. “Drinking Water Violations and Environmental Justice in the United States, 2011–2015”].

Find a full list of AJPH research papers published online below:

  • Systemic factors and barriers that hamper adequate data collection on the HIV epidemic and its associated inequalities in countries with long-term armed
  • conflicts: lessons from Colombia.
  • Low dose CT screening for lung cancer in 7,189 nuclear weapons workers in the United States
  • Public health surveillance for Zika virus:  how well do the numbers reflect actual disease patterns?
  • Behavioral health, local health department accreditation, and public health 3.0: leveraging opportunities for collaboration
  • Overview of design and methodology:  the Pregnancy Risk Assessment Monitoring System (PRAMS)
  • Accurate or not, the 2020 census will influence public health
  • Effects of the Affordable Care Act on private insurance coverage and treatment of behavioral health conditions in young adults
  • Adoption of tobacco-free and smoke-free policies in a U.S. national sample of postsecondary education institutions
  • Economic value of informal caregiving for persons with dementia: results from 38 states and 2 territories, 2015 and 2016 BRFSS
  • Weaponized health communication: Twitter bots and Russian trolls amplify the vaccine debate
  • Age restrictions for firearm purchases to reduce mass casualty shootings in schools and other venues
  • The Belmont report at 40: reckoning with time
  • Using publicly available data to understand the opioid overdose epidemic: geospatial distribution of discarded needles in Boston, Massachusetts
  • Medicaid enrollment and outreach: examining the link between expansion and public programs
  • Patterns of decline in cardiorespiratory fitness with age among male firefighters in San Diego, California, 2005 - 2015: a longitudinal analysis
  • Modeling health benefits and harms of public policy responses to the US opioid epidemic
  • Distribution of harm reduction kits in a specialty HIV hospital
  • Drinking water violations, population served, and environmental justice in the United States, 2011-2015
  • HIV pre-exposure prophylaxis initiation at a Los Angeles community clinic: differences between eligibility, awareness, and uptake

The articles above were published online August 23, 2018, at 4 p.m. ET 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 Megan Lowry at APHA, 202-777-3913, or email her. 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.

To stay up-to-date on the latest in public health research, sign up for new content email alerts.


The American Journal of Public Health is the monthly journal of the American Public Health Association. APHA champions the health of all people and all communities. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that influences federal policy, has a nearly 150-year perspective and brings together members from all fields of public health. Visit www.apha.org