Joe C. Wen School of Population & Public Health

Introduction: Our goal in this study was to identify stimulant abuser patients who are at specifically high risk of suicide attempt (SAT), in order to prioritize them in preventive and risk mitigation programs.

Methods: We used the California State Emergency Department Database (SEDD) to obtain discharge information for 2011. The SEDD contains discharge information on all outpatient ED encounters, including uninsured patients and those covered by Medicare, Medicaid, and private insurance. We identified SAT and stimulant abuse by using the relevant International Classification of Diseases, Ninth Revision, codes.

Results: The study included 10,124,598 outpatient ED visits. Stimulant abuse was observed in 0.97% of ED visits. Stimulant abuse was more common among young and middle-aged males and people with low median household income. Moreover, it was more common among Native American (1.8%) and Black (1.8%), followed by non-Hispanic White (1.1%) patients. The prevalence of SAT was 2.0% (N = 2000) for ED visits by patients with a history of stimulant abuse, and 0.3% (N = 28,606) for ED visits without a history of stimulant abuse (odds ratio 7.29, 95% confidence interval, 6.97-7.64). The SATs were directly associated with stimulant abuse, younger age (age groups >10), and non-Hispanic White and Native American race. Association of SAT with stimulant abuse was stronger in female patients.

Conclusion: Stimulant abuse was the only modifiable risk factor for suicide attempt in our study. Reaching out to populations with higher prevalence of stimulant abuse (young and middle-aged individuals who are Native American or Black, with lower household income) to control the stimulant abuse problem, may reduce the risk of SAT. In this regard, people who are at higher risk of SAT due to non-modifiable risk factors (younger age, and Native American or White race) should be prioritized. Moreover, controlling stimulant abuse among women may be specifically effective in SAT prevention.

Introduction: The World Health Organization estimates that one million people die by suicide every year. Few studies have looked at factors associated with disposition in patients with chief complaints of depression, suicidal ideation (SI) and suicidal attempts (SA) who present to the emergency department (ED). Our objective was to assess individual determinants associated with ED disposition of patients in depressed patients presenting to the ED.

Methods: We conducted a retrospective study using the National Hospital Ambulatory Medical Care Survey from 2006 to 2008. We used logistic regression to identify factors associated with discharge, in SI, SA and depression patients. Independent variables included socio-demographic information, vital signs, mode of arrival, insurance status, place of residence and concomitant psychiatric diagnosis.

Results: Of the 93,030 subjects, 2,314 met the inclusion criteria (1,362 depression, 353 SI and 599 SA). Patients who arrived by ambulance were less likely to be discharged (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.43-0.92). Hispanic patients and patients age 15 to 29 were likely to be discharged (OR 1.61, 95% CI 1.16-2.24 and OR 1.55, 95% CI 1.15-2.10 respectively). Insurance status and housing status were not significantly associated patient was being discharge from EDs.

Conclusion: The Hispanic population had higher discharge rates, but the reasons are yet to be explored. Patients with SA and SI are discharged less frequently than those with depression, regardless of insurance type or housing status. [West J Emerg Med. 2014;15(2):211–216.]

Introduction: Toxicologic exposures (TE) are a major preventable public health issue, with most cases due to unintentional causes. Although these cases are well documented and reported via the National Poison Data System, there is little information regarding toxicologic exposure cases in the emergency department (ED). The aim of this study was to identify demographic groups at risk for potential poisoning.

Methods: This was a cross-sectional study. We used data from the California State Emergency Department Database (SEDD) 2011 for statistical analysis.

Results: The study included 10,124,598 ED visits in California in 2011. The prevalence of TE was 383.4 (379.6-387.3) per 100,000 visits. Toxicologic exposures were most common among patients aged <10 years (555.4, 95% confidence interval [CI], 544.5-566.5 per 100,000 visits). Overall, TE was more common among males. White patients showed the highest prevalence of TE compared to other racial groups (P <0.001). Subpopulation analysis showed Native American female patients ages 10-19 had a noticeably higher prevalence of TE (1,464.4, 95% CI, 802.9-2444.9 per 100,000). The prevalence of TE was higher in households of higher median income (P <0.001). Prevalence of TE among those with a history of substance use was also elevated. 

Conclusion: Toxicologic exposure cases in the ED are elevated in particular age and race/ethnicity groups, as well as among those with a diagnosis of substance use disorder. The strength of association between these factors and TE in the general population may be different because we examined ED visits only. Further preventive and education strategies are necessary and should target the demographic groups identified in this epidemiological study.

INTRODUCTION: Tobacco control policies aim to limit access, reduce initiation, and mitigate tobacco-related harms, particularly among youth. However, the effectiveness of these policies relies on consistent enforcement to ensure widespread compliance and achieve their intended public health impacts. Socioeconomic vulnerability and neighborhood characteristics have been shown to influence retailer compliance, although existing studies often primarily focus on compliance violations instead of inspections. This study uses Los Angeles (LA) County, California to explore the associations between compliance inspections, violations, and neighborhood social vulnerability. METHODS: We identified inspection and violation data from the Food and Drug Administration (FDA) Tobacco Compliance Check Outcomes database for Los Angeles County, CA (January 1, 2021 to December 31, 2023) and linked these data to census tract level data from the 2022 Centers for Disease Control and Prevention Social Vulnerability Index (SVI). All analyses were conducted at the census-tract level, with separate multivariable models adjusted for tobacco retailer density, and used to examine the relationship between inspections, violations, and neighborhood social vulnerability. FINDINGS: Neighborhood-level social vulnerability significantly predicted the likelihood of tobacco retailer inspections, but not violations. Census tracts with greater socioeconomic vulnerability and housing vulnerability had higher odds of inspections, while census tracts with higher proportions of racial/ethnic minority residents were less likely to undergo compliance inspections. CONCLUSION: The uneven distribution of FDA compliance inspection efforts in socially vulnerable neighborhoods highlights systemic inequities. The results underscore the importance of utilizing equitable enforcement frameworks that leverage tools like SVI to pinpoint high-need areas, optimize resource allocation, and support comprehensive tobacco policy implementation. IMPLICATIONS: This study reveals disparities in Food and Drug Administration compliance inspections with a concentration of inspections identified in socioeconomically vulnerable areas and gaps in predominantly racial/ethnic minority communities. No direct link was found between social vulnerability and violations, suggesting heightened retailer compliance may stem from successful outreach, past regulatory scrutiny, or other factors. Leveraging the Centers for Disease Control and Prevention Social Vulnerability Index can strengthen tobacco control enforcement in high-need areas, ensuring inspections are more equitable and targeted where enforcement gaps and tobacco access remain most pronounced.

Moral injury increasingly describes the distress nurses experience when systemic constraints prevent them from practicing in alignment with their professional values. Moral injury has been theoretically presented as an injury to one’s identity. Professional identity in nursing is “a sense of oneself in relationship to others” which results in an individual “thinking, acting, and feeling like a nurse.” This scoping literature review explores contemporary understandings of nursing professional or moral identity and the association between moral injury and identity among nurses in the United States.

How far does peer influence spread through social networks before dissipating? This study investigates the diffusion of smoking behavior in adolescent friendship networks using longitudinal data from two schools (n = 3154 students) in the National Longitudinal Study of Adolescent to Adult Health. Using Stochastic Actor-Oriented Models, we simulate interventions targeting heavy smokers using various strategies (random, in-degree, eigenvector centrality) and coverage (10 to 100%). A new exponential decay model quantifies influence attenuation, revealing indirect peer influences, or spillover effects, up to three steps from targets. Targeting 10 to 30% of central individuals maximizes smoking reductions, but gains plateau beyond 40 to 50% owing to network saturation. In our analyses, the denser network exhibits broader diffusion and slower decay than the larger, sparser network. This decay metric optimizes intervention design across diverse network structures.

Objective: This study examined HPV and COVID-19 vaccination uptake, attitudes, risk perceptions, and exposure to vaccine misinformation among young adults enrolled at historically Black colleges and universities (HBCUs). Methods: Surveys and focus groups were conducted at three southeastern HBCUs. Quantitative data were analyzed using descriptive statistics, and Wilcoxon rank and ANOVA for group comparisons. Qualitative data were examined through content analysis. Results: Most participants identified as religious and female. A majority (86.2%) reported receiving at least one dose of the COVID-19 vaccine, with 56.3% reporting a COVID-19 booster. For HPV vaccination, only 56.3% reported having received at least one dose. Vaccinated students reported higher perceived risk, stronger social support, greater peer motivation, lower endorsement of misinformation, and more positive vaccine attitudes than unvaccinated peers. Unvaccinated participants reported low vaccine confidence and high complacency. Participants suggested campus-specific recruitment strategies for HPV vaccination efforts. Conclusion: HBCUs can serve as critical settings for advancing sexual health promotion and cancer prevention among Black emerging adults.

BackgroundCharitable food organizations are critical community hubs for promoting food security and nutrition. Few studies have examined whether food pantry organizational features (e.g., setting and size) are associated with the use of health promotion strategies.MethodsThis cross-sectional study used a validated survey instrument (Nutrition Environment Food Pantry Assessment Tool+, NEFPAT+) in partnership with a southern California regional food bank to examine pantry consumer nutrition environments, including client choice models, marketing, and partnership/referral practices. Eligible pantries were: food bank partners, open at least 1/week for public distribution, and in high-poverty cities. We collected surveys from 27 of 35 eligible sites in 2024. We used descriptive statistics to summarize NEFPAT+ objective outcomes and conducted exploratory analyses to assess differences for specific objective results. Mann‒Whitney U tests and Kruskal‒Wallis tests were used to compare NEFPAT+ scores and objective results by pantry setting and size, respectively.ResultsSurveyed food pantries served a median of 450 households per month (range: 50 − 3,000). 52% were located in faith-based settings and 48% in other community settings. The median NEFPAT+ score was 39 out of 95 points (range: 8–61), indicating most pantries were classified as Silver (37%) or Gold (33%). Overall, 81% of pantries made nutritious foods easy to reach/identify, and 63% used client choice. Only 33% reported using certain marketing strategies. Few used local food sourcing or point-of-decision signage. Most pantries (78%) reported having external partnerships, and 74% referred clients to a local resource. Pantries located in other community settings used nutrition-focused strategies (i.e., client choice, healthy eating signage/recipes) and referred/partnered with community organizations (i.e., food, healthcare, employment assistance) at a significantly higher rate compared to pantries in faith-based settings. We did not find statistically significant differences by pantry size.ConclusionsThis community-engaged study reveals how food pantries may function as multifaceted community health hubs for health promotion interventions. Results show both significant organizational strengths and targeted opportunities for improvement, with strategy use varying by food pantry setting type. Future research should evaluate whether pantries in faith-based settings need additional support, engagement, or technical assistance to promote community health in marginalized communities.

INTRODUCTION: State and local jurisdictions in the United States (U.S.) are increasingly adopting flavored tobacco sales restrictions (FTSRs) to mitigate tobacco initiation and use. Policy implementation is highly understudied yet can impact policy effectiveness. This review examines existing literature on state and local FTSR policy design and implementation in the U.S. METHODS: We systematically searched for PubMed articles published by 12/31/2024 which were: original research articles in English focused on a U.S. state or local FTSR that reported at least one policy implementation outcome measure. We excluded articles that were systematic reviews or reported on federal or non-FTSR policy. Guided by policy and implementation science frameworks, we developed a data extraction template to report: policy design elements, study characteristics, and implementation measures (i.e., inputs, activities, outcomes). RESULTS: Of 1,595 articles identified, 30 were retained for review. Most evaluated local FTSRs, and eight evaluated a statewide policy. Pre-post test and cross-sectional study designs were the most common. Frequently reported implementation outcomes were acceptability, appropriateness, feasibility, and fidelity/compliance. Studies with pre-post test designs and comparison groups showed significantly increased fidelity/compliance (i.e., reduced availability of restricted products) in FTSR jurisdictions. A majority (56.7%) detailed an implementation input for infrastructure (e.g., resources) or activity (e.g., outreach). Few described enforcement-related mechanisms. CONCLUSIONS: Key gaps exist in policy implementation articles on state and local FTSRs in the U.S., including infrequent reporting of enforcement agencies and penalties which may impact implementation. Additional mixed methods research is needed to compare FTSR implementation across jurisdictions with varying policy designs.