INTRODUCTION: Geographic and urbanization differences in female suicide trends across the U.S. necessitates suicide prevention efforts on the basis of geographic variations. The purpose of this study was to assess female suicide rates by mechanism within Census divisions and by urbanicity to help inform geographically tailored approaches for suicide prevention strategies. METHODS: Data from 2004 to 2018 were obtained from the National Vital Statistics System (analyzed in 2021). Annual counts of female suicides were tabulated for firearm, suffocation, and drug poisoning and stratified by the U.S. Census division and urbanicity. Age-adjusted rates were calculated to describe female suicide incidence by geographic areas and urbanicity. Data were analyzed annually and by 5-year timeframes. Trends in annual female suicide rates by mechanism for 3 urbanization levels were identified using Joinpoint Regression. Annual percent change estimates were calculated for age-adjusted female suicide rates between 2004 and 2018. RESULTS: Female suicide rates by mechanism were not homogeneous within Census divisions or by urbanization levels. Suicide rates by mechanism across Census divisions within the same urbanization level varied (range=3.38-11.15 [per 100,000 person per year]). From 2014 to 2018 in large metropolitan areas in the northern divisions, rates for suffocation were higher than for firearms and drug poisoning. During the same period, in all urbanization levels in southern divisions, rates for firearms were higher than for suffocation and drug poisoning. CONCLUSIONS: Female suicide mechanisms vary by urbanization level, and this variation differs by region. These results could inform female suicide prevention strategies on the basis of mechanism, urbanization, and geographic region.

Timely morbidity surveillance of sheltered populations is crucial for identifying and addressing their immediate needs, and accurate surveillance allows us to better prepare for future disasters. However, disasters often create travel and communication challenges that complicate the collection and transmission of surveillance data. We describe a surveillance project conducted in New Jersey shelters after Hurricane Sandy, which occurred in November 2012, that successfully used cellular phones for remote real-time reporting. This project demonstrated that, when supported with just-in-time morbidity surveillance training, cellular phone reporting was a successful, sustainable, and less labor-intensive methodology than in-person shelter visits to capture morbidity data from multiple locations and opened a two-way communication channel with shelters.

Surface water contaminants in Kentucky during and after 2011 flooding were characterized. Surface water samples were collected during flood stage (May 2-4, 2011; n = 15) and after (July 25-26, 2011; n = 8) from four different cities along the Ohio River and were analyzed for the presence of microbial indicators, pathogens, metals, and chemical contaminants. Contaminant concentrations during and after flooding were compared using linear and logistic regression. Surface water samples collected during flooding had higher levels of E. coli, enterococci, Salmonella, Campylobacter, E. coli O157:H7, adenovirus, arsenic, copper, iron, lead, and zinc compared to surface water samples collected 3-months post-flood (P < 0.05). These results suggest that flooding increases microbial and chemical loads in surface water. These findings reinforce commonly recommended guidelines to limit exposure to flood water and to appropriately sanitize contaminated surfaces and drinking wells after contamination by flood water.

Aflatoxins contaminate approximately 25% of agricultural products worldwide. They can cause liver failure and liver cancer. Kenya has experienced multiple aflatoxicosis outbreaks in recent years, often resulting in fatalities. However, the full extent of aflatoxin exposure in Kenya has been unknown. Our objective was to quantify aflatoxin exposure across Kenya. We analysed aflatoxin levels in serum specimens from the 2007 Kenya AIDS Indicator Survey - a nationally representative, cross-sectional serosurvey. KAIS collected 15,853 blood specimens. Of the 3180 human immunodeficiency virus-negative specimens with ≥1 mL sera, we randomly selected 600 specimens stratified by province and sex. We analysed serum specimens for aflatoxin albumin adducts by using isotope dilution MS/MS to quantify aflatoxin B1-lysine, and normalised with serum albumin. Aflatoxin concentrations were then compared by demographic, socioeconomic and geographic characteristics. We detected serum aflatoxin B1-lysine in 78% of serum specimens (range = <LOD-211 pg/mg albumin, median = 1.78 pg/mg albumin). Aflatoxin exposure did not vary by sex, age group, marital status, religion or socioeconomic characteristics. Aflatoxin exposure varied by province (p < 0.05); it was highest in Eastern (median = 7.87 pg/mg albumin) and Coast (median = 3.70 pg/mg albumin) provinces and lowest in Nyanza (median = <LOD) and Rift Valley (median = 0.70 pg/mg albumin) provinces. Our findings suggest that aflatoxin exposure is a public health problem throughout Kenya, and it could be substantially impacting human health. Wide-scale, evidence-based interventions are urgently needed to decrease exposure and subsequent health effects.

INTRODUCTION: Exposure to mercury, a toxic metal, occurs primarily from inhaling mercury vapors or consuming methylmercury-contaminated fish. One third of all anthropogenic mercury emissions worldwide are from artisanal gold mining, which uses mercury to extract gold. Although recent reports suggest that the Madre de Dios region in Peru (with >30,000 artisanal miners) has extensive mercury contamination, residents had never been assessed for mercury exposure. Thus, our objective was to quantify mercury exposure among residents of an artisanal mining town in Madre de Dios and to assess risk factors for exposure. METHODS: We conducted a cross-sectional assessment of 103 residents of an artisanal gold mining town in July 2010. Each participant provided a urine and blood sample and completed a questionnaire assessing potential exposures and health outcomes. We calculated geometric mean (GM) urine total mercury and blood methylmercury concentrations and compared log-transformed concentrations between subgroups using linear regression. RESULTS: One third (34.0 %) of participants were gold miners. All participants had detectable urine total mercury (GM, 5.5 mug/g creatinine; range, 0.7-151 mug/g creatinine) and 91 % had detectable blood methylmercury (GM, 2.7 mug/L; range, 0.6-10 mug/L); 13 participants (13 %) reported having kidney dysfunction or a neurological disorder. Urine total mercury concentrations were higher among people who heated gold-mercury amalgams compared with people who never heated amalgams (p < 0.05); methylmercury concentrations were higher among fish consumers compared with nonfish consumers (p < 0.05). CONCLUSION: Our findings suggest that mercury exposure may be widespread in Huaypetue.

Thyroid hormones, which influence body metabolism and development, could be affected by persistent organic pollutants. We sought to examine the relationship between polybrominated biphenyls (PBBs) and polychlorinated biphenyls (PCBs) and thyroid disease. We employed incidence density sampling to perform a nested case control analysis of the Michigan Long-Term PBB Cohort. Cohort members (n=3333) were exposed to PBBs through contaminated cattle feed in 1973-1974 and to PCBs through daily life. Those with detectable serum PBB and PCB concentrations at enrollment were categorized into tertiles of PBB and PCB exposure. Case-patients were cohort members answering "Yes" to "Has a healthcare provider ever told you that you had a thyroid problem?" during follow-up interviews; control-patients were cohort members answering "No". We used odds ratios (OR) with 95% confidence intervals (CI) to compare odds of thyroid disease by PBB and PCB exposure and by various risk factors. Total cumulative thyroid disease incidence after 33years was 13.9% among women and 2.6% among men. After adjusting for body mass index, we found no statistically significant differences in odds of any type of thyroid disease among women or men with elevated PBB or PCB exposure. Compared to control-patients, women with thyroid disease had increased odds of being overweight/obese (OR=2.82, 95% CI: 1.94-4.11) and developing infertility (OR=1.71, 95% CI: 1.08-2.69), diabetes (OR=1.61, 95% CI: 1.04-2.51), or arthritis (OR=1.71, 95% CI: 1.18-2.50) during follow-up. Additional research should explore potential associations between PBBs/PCBs and thyroid disease among children exposed in utero.

INTRODUCTION: Heat illness is a leading cause of death and disability among U.S. high school athletes. METHODS: To examine the incidence and characteristics of heat illness among high school athletes, CDC analyzed data from the National High School Sports-Related Injury Surveillance Study for the period 2005-2009. RESULTS: During 2005-2009, the 100 schools sampled reported a total of 118 heat illnesses among high school athletes resulting in ≥1day of time lost from athletic activity, a rate of 1.6 per 100,000 athlete-exposures, and an average of 29.5 time-loss heat illnesses per school year. The average corresponds to a weighted average annual estimate of 9,237 illnesses nationwide. The highest rate of time-loss heat illness was among football players, 4.5 per 100,000 athlete-exposures, a rate 10 times higher than the average rate (0.4) for the eight other sports. Time-loss heat illnesses occurred most frequently during August (66.3%) and while practicing or playing football (70.7%). No deaths were reported. CONCLUSIONS: Consistent with guidelines from the National Athletic Trainers' Association, to reduce the risk for heat illness, high school athletic programs should implement heat-acclimatization guidelines (e.g., set limits on summer practice duration and intensity). All athletes, coaches, athletic trainers, and parents/guardians should be aware of the risk factors for heat illness, follow recommended strategies, and be prepared to respond quickly to symptoms of illness. Coaches also should continue to stress to their athletes the importance of maintaining proper hydration before, during, and after sports activities. IMPACT OF INDUSTRY: By implementing preventive recommendations and quickly recognizing and responding to heat illness, coaches, athletic trainers, and the sporting community can prevent future deaths.

CONTEXT: High school athletes sustain more than 1.4 million injuries annually. National high school sports injury surveillance forms the foundation for developing and evaluating preventive interventions to reduce injury rates. For national surveillance, individuals must report consistently and accurately with little one-on-one interaction with study staff. OBJECTIVE: To examine the feasibility of relying on high school coaches as data reporters in a national, Internet-based sports injury surveillance study, using the same methods that have already proven successful in the National High School Sports-Related Injury Surveillance Study, which calls on certified athletic trainers (ATs) as reporters. DESIGN: Prospective injury surveillance study. SETTING: Eighteen United States high schools PARTICIPANTS: Athletic trainers and varsity coaches for football, boys' and girls' soccer, and boys' and girls' basketball. MAIN OUTCOME MEASURE(S): Quantity and quality of exposure and injury reports. RESULTS: All enrolled ATs participated, compared with only 43.0% of enrolled coaches. Participating ATs submitted 96.7% of expected exposure reports, whereas participating coaches submitted only 36.5%. All ATs reported athlete exposures correctly, compared with only 2 in 3 coaches. Participating ATs submitted 338 injury reports; participating coaches submitted only 55 (16.3% of the 338 submitted by ATs). Injury patterns differed between AT-submitted and coach-submitted injury reports, with ATs reporting a higher proportion of ankle injuries and coaches reporting a higher proportion of knee injuries. The reports submitted by ATs and coaches for the same injury had low agreement for diagnosis and time loss, with only 63.2% and 55.3% of pairs, respectively, providing the same response. The ATs lacked more responses for demographic questions, whereas coaches lacked more responses regarding the need for surgery. CONCLUSIONS: Whenever possible, ATs should be the primary data reporters in large, national studies. In high schools without access to an AT, researchers must be willing to devote significant time and resources to achieving high participation and compliance from other reporters.