Moral injury and peri- and post-military suicide attempts among post-9/11 veterans

Background Our goal was to examine the association between moral injury, mental health, and suicide attempts during military service and after separation by gender in post-9/11 veterans. Methods A nationally representative sample of 14057 veterans completed a cross-sectional survey. To examine associations of exposure to potentially morally injurious events (PMIEs; witnessing, perpetrating, and betrayal) and suicidal self-directed violence, we estimated two series of multivariable logistic regressions stratified by gender, with peri- and post-military suicide attempt as the dependent variables. Results PMIE exposure accounted for additional risk of suicide attempt during and after military service after controlling for demographic and military characteristics, current mental health status, and pre-military history of suicidal ideation and attempt. Men who endorsed PMIE exposure by perpetration were 50% more likely to attempt suicide during service and twice as likely to attempt suicide after separating from service. Men who endorsed betrayal were nearly twice as likely to attempt suicide during service; however, this association attenuated to non-significance after separation in the fully adjusted models. In contrast, women who endorsed betrayal were over 50% more likely to attempt suicide during service and after separation; PMIE exposure by perpetration did not significantly predict suicide attempts before or after service among women in the fully adjusted models. Conclusions Our findings indicate that suicide assessment and prevention programs should consider the impact of moral injury and attend to gender differences in this risk factor in order to provide the most comprehensive care.

Waning COVID-19 Vaccine Effectiveness for BNT162b2 and CoronaVac in Malaysia: An Observational Study

Evaluation of vaccine effectiveness over time against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (COVID-19) is important. Evidence on effectiveness over time for the CoronaVac vaccine is lacking despite its widespread use globally. In Malaysia, a diverse set-up of COVID-19 vaccines was rolled out nationwide, and the waning of vaccine protection is a concern. We aimed to investigate and compare waning vaccine effectiveness against COVID-19 infections, COVID-19 related ICU admission and COVID-19 related deaths for BNT162b2 and CoronaVac vaccines. In this observational study, we consolidated nationally representative data on COVID-19 vaccination and patients′ outcomes. Data on all confirmed COVID-19 cases from 1 to 30 September 2021 were used to compare vaccine effectiveness between the ′early′ group (fully vaccinated in April to June 2021) and the ′late′ group (fully vaccinated in Jul to Aug 2021). We used a negative binomial regression model to estimate vaccine effectiveness against COVID-19 infections for both ′early′ and ′late′ groups, by comparing the rates of infection for individuals vaccinated in the two different periods relative to the unvaccinated. Among confirmed COVID-19 cases, we used logistic regression to estimate and compare vaccine effectiveness against ICU admission and deaths between the two different periods. For BNT162b2, vaccine effectiveness against COVID-19 infections declined from 90.8% (95% CI 89.4, 92.0) in the late group to 79.1% (95% CI 75.8, 81.9) in the late group. Vaccine effectiveness for BNT162b2 against ICU admission and deaths were comparable between the two different periods. For CoronaVac, vaccine effectiveness waned against COVID-19 infections from 74.4% in the late group (95% CI 209 70.4, 77.8) to 30.0% (95% CI 18.4, 39.9) in the early group. It also declined significantly against ICU admission, dropping from 56.1% (95% CI 51.4, 60.2) to 29.9% (95% CI 13.9, 43.0). For deaths, however, CoronaVac′s effectiveness did not wane after three to five months of full vaccination. Vaccine effectiveness against COVID-19 infections waned after three to five months of full vaccination for both BNT162b2 and CoronaVac in Malaysia. Additionally, for CoronaVac, protection against ICU admission declined as well. Evidence on vaccine effectiveness over time informs evolving policy decisions on vaccination.

An Analysis of Household Perceptions of Water Costs across the United States: A Survey Based Approach

Research analyzing perceptions of water services has focused on water quality, water safety, and the propensity to consume water from different sources. It has not assessed perceptions of water costs. To address this knowledge gap, this study collected nationally representative survey data from households in the United States about water issues and incorporated these data into logistic regression models. In doing so, our study advances the water and public policy literature in three ways. One, it addresses the need for household resolution information about water issues given the absence of data at this scale in the United States. Two, it creates and utilizes one-of-a-kind survey data to understand the perceptions of household water bills and the drivers of these perceptions. Three, we assess the impact of proposed solutions to improve water affordability on household perceptions of water costs. Model results indicate low-income and households in underrepresented groups were more likely to perceive their water bills to be too high. The perception of water costs also varied geographically. From a policy perspective, model results indicate utilities can positively affect perceptions of water bills via the frequency of water billing and provision of payment assistance programs.

Politics is making us sick: The negative impact of political engagement on public health during the Trump administration

Objectives To quantify the effect of politics on the physical, psychological, and social health of American adults during the four-year span of the Trump administration. Methods A previously validated politics and health scale was used to compare health markers in nationally representative surveys administered to separate samples in March 2017 (N = 800) and October 2020 (N = 700). Participants in the 2020 survey were re-sampled approximately two weeks after the 2020 election and health markers were compared to their pre-election baselines. Results Large numbers of Americans reported politics takes a significant toll on a range of health markers—everything from stress, loss of sleep, or suicidal thoughts to an inability to stop thinking about politics and making intemperate social media posts. The proportion of Americans reporting these effects stayed stable or slightly increased between the spring of 2017 and the fall of 2020 prior to the presidential election. Deterioration in measures of physical health became detectably worse in the wake of the 2020 election. Those who were young, politically interested, politically engaged, or on the political left were more likely to report negative effects. Conclusions Politics is a pervasive and largely unavoidable source of chronic stress that exacted significant health costs for large numbers of American adults between 2017 and 2020. The 2020 election did little to alleviate those effects and quite likely exacerbated them.

The January 6 Insurrection and America's Standing Abroad: Natural Experimental Evidence from Five Unexpectedly Interrupted Public Opinion Surveys

American geopolitical power partly relies on foreign public support for its leadership. Pundits worry that this support is evaporating now that the United States—which claims to be the world’s beacon of democracy—has itself experienced democratic back- sliding. I provide the first natural experimental test of this hypothesis by exploiting that the January 6 insurrection of the US Capitol unexpectedly occurred while Gallup was conducting nationally-representative surveys in India, Indonesia, Malaysia, Romania, and Vietnam. Because Gallup uses random digit dialing I can identify the effect by comparing US leadership approval among respondents that were interviewed just before, and just after, January 6, 2021. I find that the insurrection had no effect on US approval. If even a violent attempt to overturn a free and fair election does not affect US approval abroad it is unlikely that any other domestic anti-democratic event will.

Financial vulnerability and the impact of COVID-19 on American households

In May 2020, Westat, in partnership with Stanford University School of Medicine, conducted a nationally-representative household survey of American attitudes and behaviors regarding COVID-19. In this article, we examine what the Coronavirus Attitudes and Behaviors Survey tells us about the impact of COVID-19 on financial status and how this impact varies by demographic characteristics, the presence of health risk factors, and financial status (including employment factors). The survey reveals significant inequality in financial impact, as those who were most financially vulnerable prior to the pandemic found themselves under greater financial strain, while those who were more financially secure have experienced a neutral or even positive impact of the pandemic on household finances. These findings have important implications for public policy as policymakers seek to target aid to those who need it most.

Association between social phobia and the risk of arrhythmia using the Korean National Sample Cohort: a retrospective cohort study

Background Social phobia shares symptoms with arrhythmias, such as palpitations and chest discomfort. However, it is unclear how social phobia is associated with the actual risk of arrhythmia. This study aimed to investigate whether social phobia is associated with the risk of arrhythmia using a nationally representative sample cohort. Methods This retrospective cohort study assessed data from the 2002–2013 Korean National Health Insurance Service National Sample Cohort. Using 1:3 propensity score matching for sex, age, income, and insurance status, 1514 patients with social phobia and 4542 control group patients were included in the study. Social phobia and arrhythmia were defined per the International Classification of Diseases, 10th revision. Using cox proportional hazard regression, hazard ratios (HRs) were calculated to estimate the risk of arrhythmia in patients with social phobia. Results There were statistically significant associations between social phobia history and elevated risks of arrhythmia. Patients with social phobia had a higher risk of arrhythmia after adjusting with covariates (HR = 1.78, 95%CI = 1.25–2.55). Among different types of arrhythmias, atrial fibrillation and flutter presented the highest risk (HR = 2.20, CI = 1.06–4.57) compared to paroxysmal tachycardia (HR = 1.07, CI = 0.39–2.91) and other cardiac arrhythmias (HR = 1.83, CI = 1.16–2.89). Conclusion This study identified the association between social phobia and the risk of arrhythmia in a South Korean representative cohort. These results suggest that social phobia should be treated properly to reduce arrhythmia risks.

The Effects of Tobacco Coverage in the Public Communication Environment on Young People’s Decisions to Smoke Combustible Cigarettes

In today’s complex media environment, does media coverage influence youth and young adults’ (YYA) tobacco use and intentions? We conceptualize the “public communication environment” and effect mediators, then ask whether over time variation in exogenously measured tobacco media coverage from mass and social media sources predicts daily YYA cigarette smoking intentions measured in a rolling nationally representative phone survey (N = 11,847 on 1,147 days between May 2014 and June 2017). Past week anti-tobacco and pro-tobacco content from Twitter, newspapers, broadcast news, Associated Press, and web blogs made coherent scales (thetas = 0.77 and 0.79). Opportunities for exposure to anti-tobacco content in the past week predicted lower intentions to smoke (Odds ratio [OR] = 0.95, p < .05, 95% confidence interval [CI] = 0.91–1.00). The effect was stronger among current smokers than among nonsmokers (interaction OR = 0.88, p < .05, 95% CI = 0.77–1.00). These findings support specific effects of anti-tobacco media coverage and illustrate a productive general approach to conceptualizing and assessing effects in the complex media environment.

Intake of Animal Protein and Dietary Sources in the Colombian Population: Results of the National Nutrition Survey (ENSIN-2015)

Background. There is a lack of knowledge in Colombia about dietary intake and sources of animal protein. Design. Cross-sectional, nationally representative surveys. Setting. Colombia. Participants. n = 32,457 participants aged from 1 to 64 years. The sample analyzed included 21,036 boys and nonpregnant girls, 10,099 adults, and 1,322 pregnant women, 118 of whom were below 18 years of age. Results. Protein intake was 32.9 g/d (95% CI: 32.4, 33.4) per 1,000 kilocalories. The relative contribution (%) of total protein to the total energy intake/day (acceptable macronutrient distribution) was 13.2% (95% CI: 13.0, 13.3). The acceptable macronutrient distribution (AMDR) for animal protein for those aged 1 to 64 years was 7.8% (95% CI: 7.6, 8.0), with a minimum of 7.1% (95% CI: 6.7, 7.5), which was for children aged from 13 to 17 years, and a maximum of 8.3% (95% CI: 8.1, 8.5), for children aged from 1 to 4 years ( P = 0.018 ). For all groups, animal protein made up the majority of total proteins, with 62.6% (95% CI: 61.7, 63.6) for preschoolers, 55.8% (95% CI: 53.2, 58.4) for school-aged children, 54.6% (95% CI: 53.0, 56.1) for adolescents, 58.1% (95% CI: 57.5, 58.7) for adults, and 57.5% (95% CI: 55.2, 59.7) for pregnant women ( P = 0.027 ). The three main dietary sources of animal protein were red meat (17.8%), chicken (16.3%), and eggs (10.5%). The sources of vegetal protein were bread-arepa-pasta (20.0%), cereals (19.8%), and legumes (8.2%). Conclusions. Protein intake is excessive according to the Recommended Dietary Allowance (RDA), while it is not excessive from the perspective of the AMDR.