Third State Research Articles

COVID-19 latent age-specific mortality in US states: a county-level spatio-temporal analysis with counterfactuals

During the COVID-19 pandemic, which spanned much of 2020–2023 and beyond, daily case and death counts were recorded globally. In this study, we examined available mortality counts and associated case counts, with a focus on the estimation missing information related to age distributions. In this paper, we explored a model-based paradigm for generating age distributions of mortality counts in a spatio-temporal context. We pursued this aim by employing Bayesian spatio-temporal lagged dependence models for weekly mortality at the county level. We compared three US states at the county level: South Carolina (SC), Ohio, and New Jersey (NJ). Models were developed for mortality counts using Bayesian spatio-temporal constructs, incorporating both dependence on current and cumulative case counts and lagged dependence on previous deaths. Age dependence was predicted based on total deaths in proportion to population estimates. This latent age field was generated as counterfactuals and then compared to observed deaths within age groups. The optimal retrospective space–time models for weekly mortality counts were those with lagged dependence and a function of caseload. Added random effects were found to vary across states: Ohio favored a spatially correlated model, while SC and NJ favored a simpler formulation. The generation of age-specific latent fields was performed for SC only and compared to a 15-month, 13-county data set of observed >65 age population. It is possible to model spatio-temporal variations in mortality at the county level with lagged dependencies, spatial effects, and case dependencies. In addition, it is also possible to generate latent age-specific fields based on estimates of death risk (using population proportions or more sophisticated modeling approaches). More detailed data will be needed to make more calibrated comparisons for future epidemic monitoring. The proposed discrepancy tool could serve as a useful resource for public health planners in tailoring interventions during epidemic situations.

Sexual orientation and gender identity (SOGI) data collection: Feasibility of implementation.

338 Background: The 2011 Institute of Medicine report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding called for consistent recording of sexual orientation and gender identity (SOGI) data in clinical settings. In 2016, SOGI data were listed as required elements in the Uniform Data System (HRSA); however, implementation of this recommendation is inconsistent. The state of New Jersey (NJ) mandated SOGI data collection for patients seen within any healthcare system in NJ to start in June 2023. Jefferson Health (JH), a health system with locations in both Pennsylvania (PA) and NJ, provided SOGI data collection education for its NJ staff. The Sidney Kimmel Cancer Center (SKCC) at JH has clinical sites in both states. In this study, we report on SOGI data collection between SKCC PA (Center City/CC) and SKCC NJ to assess the impact of the educational preparation on data collection. Methods: Patients seen at SKCC’s CC and NJ locations from May 16, 2023 to May 15, 2024 were included. SOGI data between both locations were compared to assess the impact of the educational preparation. Data were collected from the electronic record. Results: Of the 6,921 patients in CC, 1,725 identified as female, 859 identified as male, 67 chose not to disclose their gender identity, and 4270 had missing data. Of the 1788 patients in NJ, 1,118 identified as female, 449 identified as male, 12 chose not to disclose, 209 had missing data. (Table). Conclusions: Educational preparation resulted in significantly improved SOGI data collection with a significant drop in missing data. Regular recording and analysis of SOGI data can identify health inequities, support the design of targeted interventions, and evaluate the effectiveness of LGBTQIA+ healthcare initiatives. SOGI data comparison. Center City (CC)/PA New Jersey (NJ) Total 6921 1788 Female Gender 1725 (24.9%) 1118 (62.5%) Male Gender 859 (12.4%) 449 (25.1%) Chose not to disclose 67 (0.01%) 12 (0.01%) Missing data 4270 (61.7%) 209 (11.7%)

Correction to: Jurisdictional homogeneity and coterminous local government borders: a comparison of counties in New Jersey and New York State

Correction to: Jurisdictional homogeneity and coterminous local government borders: a comparison of counties in New Jersey and New York State

Intellectual Ability and Sexual Recidivism Risk Assessment: Comparing Predictive Accuracy in an Incarcerated U.S. Sample.

While studies indicate that individuals with intellectual disabilities (ID) and borderline intellectual functioning (BIF) are overrepresented among those incarcerated for sexual offenses, there is a paucity of research with respect to risk assessment for this population, particularly among incarcerated U.S. samples. This gap is concerning given that individuals perceived as high risk may be denied bail, given harsher sentences, or subject to civil confinement. The present study examined the predictive validity of the Static-99 and Static-99R, which rely on historical predictors, and the MnSOST-R, which includes a dynamic subscale. Archival records were used to compare individuals with (n = 459) and without (n = 459) ID/BIF released from New Jersey state prisons between 1996 and 2007, with an average follow-up period of 5.7 years. All three instruments demonstrated good predictive validity for those without ID/BIF, while only the MnSOST-R produced a significant AUC value for those with ID/BIF. Reincarceration rates for those with ID/BIF within high-risk groups ranged from 0% to 8%, similar to the overall recidivism base rate of 4%. Results highlight the need for additional research to determine which risk factors should be considered for those with ID/BIF.

Association between Socioeconomic Status and Vaccination Hesitancy, Reluctancy and Confidence among Asian-Americans Living in the State of New Jersey

BackgroudSocioeconomic status (SES) plays a vital role in determining vaccination uptake and attitudes. Vaccine hesitancy varies among different communities, yet knowledge of vaccine attitudes among Asian-Americans is limited.ObjectiveThis study aims to investigate the relationship between SES and vaccine attitudes among Asian-Americans in the State of New Jersey (NJ).MethodsAsian-Americans aged ≥ 18 years living in NJ were included (N = 157). SES was measured by education level, employment type, employment status, and household income. The primary outcomes were vaccine hesitancy, reluctance, and confidence for COVID-19, influenza, and pneumococcal vaccines. Descriptive and inferential statistics were performed. Multivariable logistic regression was used to identify associations between SES and vaccine hesitancy while controlling for confounders such as age, gender, birthplace, and religion.ResultsAmong 157 participants, 12.1% reported vaccine hesitancy. There was no statistically significant association between vaccine hesitancy and education level (p = 0.68), employment status (p = 1), employment type (p = 0.48), and household income (p = 0.15). Multivariable logistic regression modeling confirmed that none of the SES predictor variables were associated with vaccine hesitancy. However, as exploratory finding, gender was found to be a significant predictor, with males having lower odds of vaccine hesitancy than females (Adjusted OR = 0.14; p < 0.05). Confidence in influenza and pneumococcal vaccines increased during the pandemic, from 62.34% to 70.13% and from 59.2% to 70.51%, respectively. For the COVID-19 vaccine, 73.1% of participants reported having “a lot of confidence” in taking vaccine.ConclusionMost sampled Asian-Americans in NJ have high confidence in taking COVID-19 vaccines, and there is no significant association between vaccine hesitancy and SES.

Newer New Jersey work-based learning teachers during the COVID-19 pandemic: school safety regarding ventilation, trainings, and awareness of government agencies resources

ABSTRACT New Jersey (NJ) Safe Schools Program (NJSS) provides code-required trainings for NJ teachers supervising students in work-based learning (WBL) experiences. During the COVID-19 pandemic, increased use of chemical cleaning, sanitization, and disinfectant products (CSDPs) led to ventilation and other health concerns. NJSS conducted two surveys of newer NJ WBL teachers between October 2021 and June 2023, with a follow-up in fall 2022 for those who completed initial surveys before summer 2022. This study focused on questions regarding workspace ventilation; respirator and CSDPs trainings; awareness of government resources for safety and health (S&H); and demographics. Over 65% of participant classrooms have operable windows or ventilation systems, while 13% of school salons have ceiling fans. Half of participants didn’t receive training on handling CSDPs, although 90% were aware of government S&H resources. Data suggested teachers have well-ventilated workspaces and are aware of different resources available, which is important to continue post COVID-19.

The Impact of New Jersey's 2020 E-Cigarette Flavor Ban on E-Cigarette, Cigarette, and Cigar Sales in NJ.

On April 20, 2020, New Jersey (NJ) implemented a comprehensive ban on the sale of flavored e-cigarettes. This study compares sales of e-cigarettes, cigarettes, and cigars before and after the law. Data were biweekly retailer scanner sales in NJ convenience stores for e-cigarettes, cigarettes, and cigars between August 2019 and December 2020. We used Joinpoint regression to assess sales trends for cigarettes (non-menthol, menthol), cigars (unflavored, flavored), and e-cigarettes (unflavored, fruit/sweet/concept flavor, menthol flavor) in the 36 weeks before and 36 weeks after a statewide ban on flavored e-cigarettes. Flavored e-cigarette sales, not including menthol, significantly decreased over the study period while menthol e-cigarette sales significantly increased until the e-cigarette flavor ban took effect, after which these sales rapidly declined through May 2020, then slowed. Unflavored e-cigarette sales declined through September 2019, then grew modestly until the flavored e-cigarette ban, after which sales significantly increased. Flavored cigar sales increased between March and May 2020, then declined; non-flavored cigar sales increased between mid-February and early July 2020, then declined. Cigarette sales were decreasing before the flavored e-cigarette ban but after, significantly increased until June 2020. Overall, there was no significant trend in the average biweekly percent change for cigarette sales. Flavored e-cigarette sales were declining prior to the ban but the pace of the decline accelerated following federal and state restrictions on flavored e-cigarette sales, then slowed by the second half of 2020, with a brief period of increased cigarette and cigar sales immediately following the ban. New Jersey's 2020 statewide e-cigarette flavor ban offered the opportunity to observe how sales of e-cigarette, cigarette, and cigar products shifted after the change. The effect of the state law, at least in the short-term, was decreased sales of flavored e-cigarettes and increased sales of unflavored e-cigarettes. Research on long term policy effects is needed.

Dynamic Behavior of Systemic Insecticide Residues in Snapdragons

Pesticide application is used in horticulture to reduce plant damage from organisms such as insects and mites. Systemic insecticides are highly efficacious and readily taken up by plant tissues. However, pesticide-treated plants may impose risks to nontarget insects or other organisms within ecosystems. In this study, insecticide residues in nectar, leaves, and flower petals of the horticulturally significant herbaceous annual snapdragon, Antirrhinum majus (Lamiales: Plantaginaceae), were assessed at two locations over several weeks following foliar and drench treatment with five systemic insecticides. Concentrations of the insecticides were determined by liquid chromatography–mass spectrometry. The independent effects Application Method, Application Rate, and Time were statistically significant among all active ingredients in the three matrices in both sites in California (CA) and New Jersey (NJ). The interaction effects were also generally statistically significant in the CA site but less consistently so in the NJ site, dependent on the active ingredient and matrix. Post hoc analyses found the highest residue concentrations in leaves and the lowest in nectar, a trend generally consistent over time regardless of active ingredient for both the CA and NJ sites. The results of this study are discussed in the context of conserving pollinators and other beneficial insects. It is recommended that similar studies should be implemented in different geographical regions and climates, along with multiyear studies for perennial ornamental plants.

Moving Trend Analysis Methodology for Hydro-meteorology Time Series Dynamic Assessment

In the last 30 years, there are many publications in the literature due to global warming and climate change impacts exhibiting non-stationary behaviors in hydro-meteorology time series records especially in the forms of increasing or decreasing trends. The conventional trend analyzes cover the entire recording time with a single straight-line trend and slope. These methods do not provide information about up and down partial moving trends evolution at shorter durations along the entire record length. This paper proposes a dynamic methodology for identifying such evolutionary finite duration moving trend method (MTM) identifications and interpretations. The purpose of choosing MTM was to investigate the dynamic partial trend evolution over the recording period so that dry (decreasing trend) and wet (increasing trend) segments could be objectively identified and these trends could assist in water resources management in the study area. The moving trend analysis is like the classical moving average methodology with one important digression that instead of arithmetic averages and their horizontal line representations, a series of finite duration successive increasing and decreasing trends are identified over a given hydro-meteorology time series record. In general, partial moving trends of 10-year, 20-year, 30-year and 40-year occur above or below the overall trend and thus provide practical insight into the dynamic trend pattern with important implications. The moving trend methodology is applied to annual records of Danube River discharges, New Jersey state wise temperatures and precipitation time series from the City of Istanbul.

Impact of environmental pollutants on pediatric brain tumor incidence in New Jersey

ObjectiveThe relationship between environmental contaminants and brain tumor incidence in adults has been thoroughly explored but research into how these contaminants affect pediatric brain tumor (PBT) incidence has not been explored. Children, typically having more limited geographical movement and thus more consistent environmental contaminant exposure, might offer more reliable insights into which environmental contaminants affect the incidence of brain tumors. The present study is the first to focus on exploring whether a possible association exists between the incidence of PBTs and exposure to environmental pollutants in New Jersey (NJ). MethodsLinear regressions were run between PBT incidence and the concentration of air quality pollutants such as Ozone (O3), Particulate Matter 2.5 (PM2.5), Particulate Matter 10 (PM10), and Carbon Monoxide (CO). Similarly, linear regressions were run between PBT incidence and Elevated Blood Lead Levels (BLL). ResultsThe study observed a significant positive relationship between O3 and PBT incidence (β = 0.34, p = 0.028). However, the relationship between PBT incidence, and environmental pollutants such as CO (β = 0.0047, p = 0.098), PM2.5 (β = −0.2624, p = 0.74), and PM10 (β = −0.7353, p = 0.073) were found to be nonsignificant. For elevated BLL, nonsignificant relationships with PBT incidence were observed at 10–14 µg/dL (β = −39.38, p = 0.30), 15–19 µg/dL (β = −67.00, p = 0.21), and 20–44 µg/dL (β = −201.98, p = 0.12). ConclusionsThe results indicate a possible impact of O3 on the incidence of PBTs in NJ. In contrast to the significant links found in prior studies of adult brain tumors, the associations between PBT occurrence and particulate matter were not significant. These findings highlight the importance of further investigating how environmental factors, especially O3, relate to PBTs.

Quantifying Disparities in Per- and Polyfluoroalkyl Substances (PFAS) Levels in Drinking Water from Overburdened Communities in New Jersey, 2019-2021.

Policymakers have become increasingly concerned regarding the widespread exposure and toxicity of per- and polyfluoroalkyl substances (PFAS). While concerns exist about unequal distribution of PFAS contamination in drinking water, research is lacking. We assess the scope of PFAS contamination in drinking water in New Jersey (NJ), the first US state to develop regulatory levels for PFAS in drinking water. We test for inequities in PFAS concentrations by community sociodemographic characteristics. We use PFAS testing data for community water systems (CWS) () from the NJ Department of Environmental Protection (NJDEP) from 2019 to 2021 and demographic data at the block group level from the US Census to estimate the demographics of the NJ population served by CWS. We use difference in means tests to determine whether CWSs serving "overburdened communities" (OBCs) have a statistically significant difference in likelihood of PFAS detections. OBCs are defined by the NJDEP to be census block groups in which: a) at least 35% of the households qualify as low-income, b) at least 40% of the residents identify as people of color, or c) at least 40% of the households have limited English proficiency. We calculate statewide summary statistics to approximate the relative proportions of sociodemographic groups that are served by CWSs with PFAS detections. We find that 63% of all CWSs tested by NJDEP from 2019 to 2021 had PFAS detections in public drinking water, collectively serving 84% of NJ's population receiving water from CWSs. Additionally, CWSs serving OBCs had a statistically significant higher likelihood of PFAS detection and a higher likelihood of exposure above state MCLs. We also find that a larger proportion of people of color lived in CWS service areas with PFAS detections compared to the non-Hispanic white population. These findings quantitatively identify disparities in PFAS contamination of drinking water by CWS service area and highlight the extent of PFAS drinking water contamination and the importance of PFAS remediation efforts for protecting environmental health and justice. https://doi.org/10.1289/EHP12787.

Validity of ICD-10-based algorithms to identify patients with influenza in inpatient and outpatient settings.

To evaluate the validity of ICD-10-CM code-based algorithms as proxies for influenza in inpatient and outpatient settings in the USA. Administrative claims data (2015-2018) from the largest commercial insurer in New Jersey (NJ), USA, were probabilistically linked to outpatient and inpatient electronic health record (EHR) data containing influenza test results from a large NJ health system. The primary claims-based algorithms defined influenza as presence of an ICD-10-CM code for influenza, stratified by setting (inpatient/outpatient) and code position for inpatient encounters. Test characteristics and 95% confidence intervals (CIs) were calculated using test-positive influenza as a reference standard. Test characteristics of alternative outpatient algorithms incorporating CPT/HCPCS testing codes and anti-influenza medication pharmacy claims were also calculated. There were 430 documented influenza test results within the study period (295 inpatient, 135 outpatient). The claims-based influenza definition had a sensitivity of 84.9% (95% CI 72.9%-92.1%), specificity of 96.3% (95% CI 93.1%-98.0%), and PPV of 83.3% (95% CI 71.3%-91.0%) in the inpatient setting, and a sensitivity of 76.7% (95% CI 59.1%-88.2%), specificity of 96.2% (95% CI 90.6%-98.5%), PPV of 85.2% (95% CI 67.5%-94.1%) in the outpatient setting. Primary inpatient discharge diagnoses had a sensitivity of 54.7% (95% CI 41.5%-67.3%), specificity of 99.6% (95% CI 97.7%-99.9%), and PPV of 96.7% (95% CI 83.3%-99.4%). CPT/HCPCS codes and anti-influenza medication claims were present for few outpatient encounters (sensitivity 3%-10%). In a large US healthcare system, inpatient ICD-10-CM codes for influenza, particularly primary inpatient diagnoses, had high predictive value for test-positive influenza. Outpatient ICD-10-CM codes were moderately predictive of test-positive influenza.

Genetic Diversity Analysis of Anisogramma anomala in the Pacific Northwest and New Jersey.

Anisogramma anomala, a biotrophic ascomycete, causes eastern filbert blight (EFB) of hazelnuts (Corylus spp.). EFB is endemic in eastern North America, preventing the commercial production of European hazelnut (C. avellana L.). In contrast, the historic absence of A. anomala in the Pacific Northwest (PNW) supported the development of a robust hazelnut industry. Circa 1960, A. anomala was inadvertently introduced into southwestern Washington, causing orchard devastation. Distribution of the pathogen in the PNW has been hypothesized to be the result of a single-point introduction. This study aimed to investigate the single-point introduction hypothesis of A. anomala by comparing the genetic diversity of A. anomala samples from the PNW and New Jersey (NJ). Specimens from the main PNW production region (n = 60) and an area within the pathogen's native range, NJ (n = 151), were genotyped using 15 simple sequence repeat (SSR) markers. The following were used to assess genetic diversity and population structure: allelic summary statistics, discriminant analysis of principal components, network median-joining tree, analysis of multilocus genotypes, and allelic population diversity analysis. Analyses separated the samples into one cluster containing all the PNW isolates, and five clusters of NJ isolates. The PNW samples were nearly genetically uniform, and the NJ isolates were diverse. These findings support the hypothesis that A. anomala in the PNW was derived from a single-point introduction and corroborate previous studies that have shown A. anomala is very diverse in NJ. This indicates that maintaining restrictions on the movement of Corylus into the PNW is important to prevent the introduction of new populations of A. anomala, thus protecting the PNW hazelnut industry.

Twenty years of private well testing in New Jersey: A review of the United States's most comprehensive well water testing regulation

Abstract Since the adoption of New Jersey (NJ) Private Well Testing Act (PWTA) over 20 years ago, approximately 134,000 wells have been tested, representing an estimated 34% of the private wells in NJ. The PWTA requires testing of raw water from residences with a private well at real estate transfer. Landlords are required to test private wells every five years and provide results to tenants. There are up to 43 required parameters including bacteria, volatile organic compounds (VOCs), synthetic organic compounds (SOCs), arsenic, iron, lead, mercury, nitrates, gross alpha radioactivity, uranium, three per- and polyfluoroalkyl substances (PFAS), alongside secondary contaminants iron, manganese, and pH. Among tested wells, 15.7% had at least one or more exceedance of a primary drinking water standard. The most common exceeding contaminants have historically been gross alpha radioactivity and arsenic, but since the inclusion of PFAS in 2022, over 12% of wells have exceeded for at least one PFAS. Jurisdictions interested in developing real estate private well testing policies can contemplate many of the findings, successes, and limitations of NJ's PWTA and should consider private well testing policies as a part of a larger private well program which brings together local, state, and federal resources.

ARRIVE Together: A Qualitative Process Evaluation of the New Jersey State Police Co-responding Pilot Program

Law enforcement personnel are often first to respond to calls involving behavioral health emergencies. However, encounters with law enforcement are more dangerous and lethal for people with behavioral health conditions. Co-responding models, wherein law enforcement and behavioral health professionals respond to calls together, are among the top programs developed to improve responding to behavioral health crises. The current study describes a qualitative process evaluation of a co-responding pilot program in New Jersey: “Alternative Responses to Reduce Instances of Violence & Escalation” (ARRIVE Together). The evaluation centered on the experience of the co-responding team as to their perceptions of specific deployments and of the program implementation overall. Semi-structured interviews were conducted following 10 consecutive encounters (three interviews per encounter; February-March 2022). Transcripts were transcribed and thematically analyzed by two trained researchers independently. Once thematically analyzed, researchers determined a consensus and developed a SWOT analysis report. Thematic analysis produced six major themes: communication, staffing, training, resources, community outreach, and deployments with minors. Overall, participants were enthusiastic about the program, but they shared numerous observations about ways in which the program could be improved. Sample size, the brief follow-up window, and lack of generalizability to other contexts were among the most limiting factors. Further research should include an effectiveness evaluation and extend to urban and suburban communities and communities of color. Future research should also explore after-response affects including accessibility to follow-up care. The current study gives insight into piloting a co-responding model for approaching behavioral health crisis calls.

Commentary: trends in interests of new public health students concerning environmental health

IntroductionThis paper was based on data from the core course in environmental health (EH) for master’s in public health students at Rutgers School of Public Health (SPH), Rutgers Biomedical and Health Sciences at Rutgers, and The State University of New Jersey (NJ).MethodsThe multi-part poll or survey of students was in the first module (2 weeks) of the course’s eight module organization on Rutgers Canvas Learning Management System. We collected data every time the first author led this course section during the three academic semesters of each calendar year 2015-2023 (excluding winter 2022-summer 2023 due to grants buyout during COVID-19 pandemic).ResultsData suggested interesting trends and changes in geographic levels of interest over time for EH. When examining interests separately for urban EH and rural EH, the trend was toward approximately equal interests in local, county and state levels (lower than national level—U.S. or student’s home country/nation—but higher than global level). This is where many EH job opportunities are located. Overall, 95% of students reported they believed climate change is real, and 95% of students agreed (“yes”) human activities including combustion sources of pollution contribute to climate change. No one stated “no;” the rest were not sure at the time.DiscussionThese insights from new public health students across majors/concentrations in NJ could inform other accredited SPH across the U.S. and in other nations to help plan future versions of core courses in EH or SPH-wide integrated core courses in compliance with required competencies for accreditation.

Temporal Trend in Revascularization for Patients With Ischemic Cardiomyopathy and Multivessel Coronary Artery Disease.

Current guidelines recommend revascularization in patients with ischemic cardiomyopathy (ICM). However, there is limited information about the trends and outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in ischemic cardiomyopathy patients with multivessel coronary artery disease. Using New Jersey state mandatory registries, 8083 patients with ischemic cardiomyopathy with CABG or PCI revascularization for multivessel coronary artery disease from 2007 to 2018 were included in the analysis. Joinpoint regression and multivariable logistic regression analyses were performed to assess the annual percentage change in trends and predictors of the 30-day mortality rate, respectively. A decline in CABG procedures was observed from 2007 to 2011 (annual percentage change, -11.5%; P=0.003), followed by stabilization. The PCI trend remained unchanged from 2007 to 2010 and then increased significantly (annual percentage change, 3.2%; P=0.02). In the subsample of patients with proximal left anterior descending artery plus circumflex and right coronary artery, CABG was a predominant procedure until 2011, and the proportion of both procedures did not differ thereafter. In the subsample of patients with left anterior descending artery and any other artery stenosis, PCI remained dominant from 2007 to 2018, while in patients with left main and any other artery stenosis, CABG remained dominant from 2007 to 2018 (P<0.001). The 30-day risk-adjusted mortality rate was higher after PCI versus CABG for each year, but after adjustment for completeness of revascularization, there was no difference between groups. The patterns of revascularization procedures for patients with ischemic cardiomyopathy with multivessel coronary artery disease have changed over the years, as evidenced by the changes in CABG and PCI trends. CABG and PCI had comparable 30-day risk-adjusted mortality risks.

COVID-19 prevention behaviors and dietary habits among undergraduate students: A health belief model approach.

Physical and social disruptions resulted from the COVID-19 pandemic, affecting young adults in higher education. The purpose of this survey research is to unveil COVID-19 related beliefs using the Health Belief Model, and COVID-19 prevention behaviors, including self-reported fruit and vegetable consumption among university students. A cross-sectional survey was administered to 304 male and female undergraduate students from diverse ethnic backgrounds and majors at a New Jersey state university using convenience sampling. Variables measured included frequency of COVID-19 prevention behaviors (e.g.: wearing indoor mask, handwashing), and consumption of fruit and vegetables (dark green and orange vegetables) over the previous week. Health Belief Model constructs were assessed namely perceived susceptibility to COVID-19, severity, benefits, barriers, and self-efficacy. Statistical distributions were computed for the entire sample and t-tests were investigated for subgroups of age and sex. The sample mean age was 21.7 (SD = 4.7) years with 222 females (73%) and 82 males (27%), and 46% identified as White, non-Hispanics. Participants consumed a mean of 0.95 cups of fruit, 0.81 cups of green vegetables, and 0.46 cups of orange vegetables. Female students practiced more COVID-19 prevention behaviors with a mean difference of 0.26 (p<0.001), perceived greater severity from the virus (Δ = 0.37, p = 0.002) and had stronger perceptions of benefits (Δ = 0.18, p = 0.041), barriers (Δ = 0.21, p = 0.046), and self-efficacy (Δ = 0.20, p = 0.020) than their male counterparts. Older students (aged 23 and above) adopted more COVID-19 prevention behaviors (Δ = -0.35, p = 0.001) and perceived less barriers (Δ = 0.24, p = 0.047) than their younger peers. Nutrition educators and health professionals need to emphasize the importance of adopting preventive health behaviors among university students as strategies to mitigate the severity of COVID-19. Addressing barriers younger male and female students may elevate their motivation and self-efficacy to enact health behaviors.

Jurisdictional homogeneity and coterminous local government borders: a comparison of counties in New Jersey and New York State

Jurisdictional homogeneity and coterminous local government borders: a comparison of counties in New Jersey and New York State

Amenorrhea and Stress Fractures in Female New Jersey Division III Collegiate Runners: An Opportunity for Increased Health Education

BACKGROUND: In the National Collegiate Athletic Association (NCAA), 9.1% of the injuries reported by women’s cross-country athletes between 2014-2019 were fractures. Both history of amenorrhea and prior stress fractures have been found to predict incidence of subsequent bone stress injuries among female athletes. Although excessive exercise is a major contributor to the development of amenorrhea, there are currently no studies on the association between amenorrhea and stress fractures in New Jersey (NJ) National NCAA Division III Women’s cross country or track athletes. This study aims to determine if there is an association between incidence of amenorrhea and subsequent occurrence of stress fractures among this population, and to identify a possible area for increased reproductive health education. METHODS: This is a survey-based study. Participants were female athletes over the age of 18 who currently participate in collegiate cross country or track running at a NJ Division III school. Coaches of the Division III cross country and track teams in NJ distributed a survey to their female athletes to gain participants for this study. Survey data included information on participant menstrual history, stress fracture history, and athletic involvement. Participants also indicated if their school’s staff had ever educated them on the importance of menstrual regularity and athletics. Descriptive statistics and comparison between groups were analyzed. RESULTS: In total, 68 survey responses were collected. Survey respondents included female NJ cross country and track athletes ages 18-23, from a total of eight institutions. During training or competition, 58.8% of the study participants missed at least one menstrual cycle and 45.6% experienced a stress fracture. There is a significant association between having missed at least one menstrual cycle during training or competition and the number of stress fractures experienced by the athlete (p = 0.044). Only 30.9% of respondents indicated that someone from their school’s staff spoke to them about the importance of maintaining regular menstruation during training. CONCLUSION: This study confirms that both amenorrhea and stress fractures are commonly seen among NJ NCAA Division III female cross country and track athletes. Our data also highlights a need for increased education of NJ Division III female athletes regarding the importance of maintaining regular menstruation as a means of stress fracture prevention. Further investigation of the role of amenorrhea on the incidence of stress fractures may shine light on an important area for prevention and increased health education.