Rocky Mountain States Research Articles

Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths

In the United States, estimates of excess deaths attributable to the COVID-19 pandemic have consistently surpassed reported COVID-19 death counts. Excess deaths reported to non-COVID-19 natural causes may represent unrecognized COVID-19 deaths, deaths caused by pandemic health care interruptions, and/or deaths from the pandemic's socioeconomic impacts. The geographic and temporal distribution of these deaths may help to evaluate which explanation is most plausible. We developed a Bayesian hierarchical model to produce monthly estimates of excess natural-cause mortality for US counties over the first 30 mo of the pandemic. From March 2020 through August 2022, 1,194,610 excess natural-cause deaths occurred nationally [90% PI (Posterior Interval): 1,046,000 to 1,340,204]. A total of 162,886 of these excess natural-cause deaths (90% PI: 14,276 to 308,480) were not reported to COVID-19. Overall, 15.8 excess deaths were reported to non-COVID-19 natural causes for every 100 reported COVID-19 deaths. This number was greater in nonmetropolitan counties (36.0 deaths), the West (Rocky Mountain states: 31.6 deaths; Pacific states: 25.5 deaths), and the South (East South Central states: 26.0 deaths; South Atlantic states: 25.0 deaths; West South Central states: 24.2 deaths). In contrast, reported COVID-19 death counts surpassed estimates of excess natural-cause deaths in metropolitan counties in the New England and Middle Atlantic states. Increases in reported COVID-19 deaths correlated temporally with increases in excess deaths reported to non-COVID-19 natural causes in the same and/or prior month. This suggests that many excess deaths reported to non-COVID-19 natural causes during the first 30 mo of the pandemic in the United States were unrecognized COVID-19 deaths.

Millennium Health sounds the alarm on xylazine: It's moving west

Formerly restricted mainly to the East Coast, xylazine, a dangerous (if misused) animal tranquilizer, is moving into the West, according to a new epidemiological report from Millenium Health. Based on an analysis of 160,000 urine drug tests this year from treatment programs, xylazine — which is now present on the street combined with illicit fentanyl — is emerging as a threat in California, Oregon, New Mexico and Alaska, as well as the Rocky Mountain states. Currently, Pennsylvania, North Carolina and Ohio have the highest rates of xylazine positivity in the nation.

Compound climate extreme events threaten migratory birds’ conservation in western U.S.

In a warming world, more intense and frequent compound climate extreme events pose serious challenges to biodiversity and conservation on Earth as one of the 2030 United Nations’ sustainable development goals (SDGs): “Life On Land” (SDG 15). In summer 2020, concurrent swelling wildfires and a sudden cold snap in the western U.S. killed a massive number of migratory birds. In August 2020, the hot and humid weather in response to the wildfire radiation and the oceanic evaporation could result in killing heat stress for migratory birds along the coastal shoreline, particularly in California. The heat and smoke of wildfires forced the migratory birds to abandon such feeding grounds towards inland regions, where water and food are naturally scarce, before being physiologically ready for their long-distance flyways. Then, a cold snap during 8–11 September in the Rocky Mountain states in the western U.S. urged those already weak migratory birds to fly southward before effectively recovering their physical and mental capabilities. This durable extreme starvation finally brought the skinny migrants low in the southwestern U.S. However, such ecological cascade effects of compound climate risks have rarely been acknowledged as a serious threat to migratory birds’ conservation in both scientific literature and ecosystems’ management practice. To improve our chances of saving birds’ biodiversity on Earth, hence, conscious policies and sustained efforts must immediately be arranged through SDG 13 (“Climate Actions”) based on scientific evidence and knowledge.

Native American Age at Death in the USA.

There are persistent disparities in mortality rates between Native Americans and other groups in the USA. Public-use mortality data severely limits the ability of researchers to examine contextual factors that might explain these disparities. Using restricted-use mortality microdata, we examine the relationship between geographic location, specific causes of death, and age at death. We show that Native American women, on average, die 13 years earlier than White women; Native American men, on average, die 12 years earlier than White men. These disparities are largest in the northern Great Plains and Rocky Mountain states. The disparity in age at death is in part due to Native Americans dying from diseases at younger ages than White Americans. Native American women and men die younger and more often from homicide in counties with persistently higher White male to female ratios. Native American men also die younger and more often from homicide when White male to female ratios increase within their county over time.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41996-021-00095-0.

A storyline view of the projected role of remote drivers on summer air stagnation in Europe and the United States

Storylines of atmospheric circulation change, or physically self-consistent narratives of plausible future events, have recently been proposed as a non-probabilistic means to represent uncertainties in climate change projections. Here, we apply the storyline approach to 21st century projections of summer air stagnation over Europe and the United States. We use a Climate Model Intercomparison Project Phase 6 (CMIP6) ensemble to generate stagnation storylines based on the forced response of three remote drivers of the Northern Hemisphere mid-latitude atmospheric circulation: North Atlantic warming, North Pacific warming, and tropical versus Arctic warming. Under a high radiative forcing scenario (SSP5-8.5), models consistently project increases in stagnation over Europe and the U.S., but the magnitude and spatial distribution of changes vary substantially across CMIP6 ensemble members, suggesting that future projections are not well-constrained when using the ensemble mean alone. We find that the diversity of projected stagnation changes depends on the forced response of remote drivers in individual models. This is especially true in Europe, where differences of ∼2 summer stagnant days per degree of global warming are found amongst the different storyline combinations. For example, the greatest projected increase in stagnation for most European regions leads to the smallest increase in stagnation for southwestern Europe; i.e. limited North Atlantic warming combined with near-equitable tropical and Arctic warming. In the U.S., only the atmosphere over the northern Rocky Mountain states demonstrates comparable stagnation projection uncertainty, due to opposite influences of remote drivers on the meteorological conditions that lead to stagnation.

Identification of Rickettsia spp. and Babesia conradae in Dermacentor spp. Collected from Dogs and Cats Across the United States.

In the United States, Dermacentor variabilis and Dermacentor andersoni are considered key vectors for Rickettsia rickettsii, the causative agent of Rocky Mountain spotted fever. Through regional surveillance, a wide diversity of Rickettsia spp. have been documented in D. variabilis, and Dermacentor spp. has been suggested as potential vectors for various other pathogens, including Babesia spp. and Ehrlichia canis. To better define the prevalence and diversity of pathogens in Dermacentor spp. across the United States, 848 ticks collected from dogs and cats in 44/50 states in 2018–2019 were tested by PCR for Rickettsia spp.-specific 17 kDa and ompA gene fragments; a subset of Dermacentor spp. was also tested with PCR, targeting fragments of the 18S and large subunit region rRNA genes of Babesia spp. and 16S rRNA genes of E. canis. Rickettsia spp. was identified in 12.5% (106/848) of ticks. Species detected include Rickettsia montanensis (n = 64 ticks), Rickettsia bellii (n = 15 ticks), Rickettsia rhipicephali (n = 13 ticks), Rickettsia peacockii (n = 8 ticks), Rickettsia amblyommatis (n = 3 ticks), Rickettsia cooleyi (n = 1 tick), and unclassified Rickettsia spp. (n = 2 ticks). Ticks with R. montanensis and R. bellii were submitted from every U.S. region; R. rhipicephali was predominantly detected in ticks from the southern half of the United States, and all R. peacockii-positive ticks were D. andersoni that originated from the Rocky Mountain states. Ehrlichia canis was not detected in any Dermacentor spp., and Babesia conradae was detected in two Dermacentor albipictus. Because most ticks had fed on dogs or cats before submission, these findings do not implicate a given Dermacentor sp. as a primary vector of these agents, but in regard to Rickettsia spp., the data do support other published work showing D. variabilis harbors a diversity of Rickettsia species with unknown implications for animal and human health.

Spatial Patterns of Purposeful Social Networking and Socioeconomic Influences: Towards a Mature, Inclusive Networked Society in the U.S.

Social media use in the United States has been steadily increasing over the past decade as various social media platforms have become the primary channel of online engagement for the American internet user. Today, Americans use social media to communicate with friends, family, and peers, access entertainment and education, engage in various business and commercial activities, and influence the lifestyles of consumers. As the spectrum of purposeful use of social media diversifies, this paper examines geographic patterns of social media adoption, diffusion, and utilization in U.S. counties. Alongside, the paper also examines demographic and socioeconomic determinants of purposeful social media utilization. Overall, the study sheds light on an important aspect of the contemporary digital divide in the United States.To examine purposeful social network and media use, the paper focuses on penetration of popular social media/networking platforms such as Facebook, Twitter, LinkedIn, Instagram, and YouTube in U.S. counties. The purpose of use of such platforms – to engage in e-communication, e-commerce, e-entertainment, e-health, and e-education are also examined through the dual lenses of geographic and socioeconomic variations. By borrowing from Adoption-Diffusion Theory (ADT) and Spatially Aware Technology Utilization Model (SATUM), the paper’s conceptual framework posits associations of 18 independent variables with 17 indicators of social media penetration and purposeful usage. Spatial patterns and disparities of social media penetration and purposeful use are analyzed and provide important clues about the geography of the social media digital divide. For example, social media penetration and purposeful use in counties in the U.S. rural south are found to rival counties in the Rocky Mountain States and in some cases exceed counties in urban metropolitan areas in the West- and East Coasts. The presence of spatial bias in social media penetration and use is also diagnosed using spatial autocorrelation analysis. This in turn influences the Ordinary Least Squares (OLS) regression-based analysis of socioeconomic, infrastructural, and social capital underpinnings. For a sample of 3,076 counties in the lower 48 states, leading determinants of purposeful social media use are found to be age structure, urbanization, race/ethnicity and professional, scientific, technical services and overall service sector occupations are found to influence social network access and purposeful use. These findings have important policy implications to broaden the reach and impacts of social media in the U.S.Overall, as the digital divide literature expands its focus from access to information and communication technologies (ICTs) to their actual use and ultimate impact, this study is unique due to its focus on purposeful use of social media. Sourcing data from a variety of public- and private sources, the study focuses on social media usage as well as access and sheds light on county-level disparities and their socioeconomic underpinnings. As purposeful internet use continues to diversify, the findings of this study can inform social media adoption, diffusion, and use policies in light of the COVID-19 pandemic to ensure that all Americans can participate and engage in online activities and derive benefits in an equitable way.

Effects of Climate Change on Natural-Caused Fire Activity in Western U.S. National Forests

Climate change, with warming temperatures and shifting precipitation patterns, may increase natural-caused forest fire activity. Increasing natural-caused fires throughout western United States national forests could place people, property, and infrastructure at risk in the future. We used the fine K nearest neighbor (KNN) method coupled with the downscaled Multivariate Adaptive Constructed Analogs (MACA) climate dataset to estimate changes in the rate of natural-caused fires in western United States national forests. We projected changes in the rate of minor and major forest fires from historical (1986–2015) to future (2070–2099) conditions to characterize fire-prone national forests under a range of climate change scenarios. The results indicate that climate change can add to the occurrence of forest fires in western United States national forests, particularly in Rocky Mountain, Pacific Southwest, and Southwestern United States Forest Service regions. Although summer months are projected to have the highest rate of natural-caused forest fire activity in the future, the rate of natural-caused forest fires is likely to increase from August to December in the future compared to the historical conditions. Improved understanding of altered forest fire regimes can help forest managers to better understand the potential effects of climate change on future fire activity and implement actions to attenuate possible negative consequences.

Dermacentor variabilis is the Predominant Dermacentor spp. (Acari: Ixodidae) Feeding on Dogs and Cats Throughout the United States.

Throughout North America, Dermacentor spp. ticks are often found feeding on animals and humans, and are known to transmit pathogens, including the Rocky Mountain spotted fever agent. To better define the identity and distribution of Dermacentor spp. removed from dogs and cats in the United States, ticks submitted from 1,457 dogs (n = 2,924 ticks) and 137 cats (n = 209 ticks) from veterinary practices in 44/50 states from February 2018-January 2020 were identified morphologically (n = 3,133); the identity of ticks from regions where Dermacentor andersoni (Stiles) have been reported, and a subset of ticks from other regions, were confirmed molecularly through amplification and sequencing of the ITS2 region and a 16S rRNA gene fragment. Of the ticks submitted, 99.3% (3,112/3,133) were Dermacentor variabilis (Say), 0.4% (12/3,133) were D. andersoni, and 0.3% (9/3,133) were Dermacentor albipictus (Packard). While translocation of pets prior to tick removal cannot be discounted, the majority (106/122; 87%) of Dermacentor spp. ticks removed from dogs and cats in six Rocky Mountain states (Montana, Idaho, Wyoming, Nevada, Utah, and Colorado) were D. variabilis, suggesting this species may be more widespread in the western United States than is currently recognized, or that D. andersoni, if still common in the region, preferentially feeds on hosts other than dogs and cats. Together, these data support the interpretation that D. variabilis is the predominant Dermacentor species found on pets throughout the United States, a finding that may reflect recent shifts in tick distribution.

Epidemiologic assessment of benzodiazepine exposure among suicide deaths in Colorado, 2015\u20132017

BackgroundSuicide rates have been climbing in the U.S., particularly in Rocky Mountain states such as Colorado. Benzodiazepines have been linked with suicidal ideation, but there have been few population level assessments of this link. We conducted a public health assessment to determine the epidemiology and prevalence of recent benzodiazepine exposure, among suicide deaths in Colorado from 2015 to 17.MethodsThis epidemiologic assessment linked Colorado’s Prescription Drug Monitoring Program, death certificate data, and Violent Death Reporting System to determine patterns of benzodiazepine exposure among suicide deaths in Colorado between 2015 and 2017. Recent benzodiazepine exposure was defined as receiving a prescription within 30 days of death or having a positive toxicology screen post-mortem.ResultsAmong the 3465 suicide deaths in Colorado between 2015 and 2017, 20% had recent benzodiazepine exposure, and nearly 50% of those also had recent opioid exposure. Recent benzodiazepine exposure was more common among females than males (34% versus 16%). Among suicide deaths, those who died via drug overdose were more likely to have had recent benzodiazepine exposure (48%), compared to suicides by firearm (17%), hanging/asphyxiation (13%) and all other methods (approximately 20%).ConclusionsBenzodiazepines have been linked to suicidal ideation, but population level assessments of benzodiazepine exposure among suicide deaths are rare. Our epidemiologic assessment indicates a relatively high prevalence of recent benzodiazepine exposure that warrants further investigation from both clinical and public health perspectives.

Little Trailer Park on the Prairie: Determinants of Site Rents in Parks in the Great Plains and Rocky Mountain States

Recent research has indicated that the manufactured housing industry is highly heterogeneous, mainly because both demand conditions and zoning restrictiveness vary enormously from one locale to another. There is little formal empirical work on the industry, especially in the low population density region that encompasses the Great Plains (including Texas) and Rocky Mountain states. Using a data set with nearly 60,000 manufactured housing sales transactions for the regions, we explore the determinants of park lot rents using a GMM 3SLS model. Both park lot rent levels, their determinants, and responses to local multi-family and single-family housing conditions vary from one economic region to another.

Social Media Use in American Counties: Geography and Determinants

This paper analyzes the spatial distribution and socioeconomic determinants of social media utilization in 3109 counties of the United States. A theory of determinants was modified from the spatially aware technology utilization model (SATUM). Socioeconomic factors including demography, economy, education, innovation, and social capital were posited to influence social media utilization dependent variables. Spatial analysis was conducted including exploratory analysis of geographic distribution and confirmatory screening for spatial randomness. The determinants were identified through ordinary least squares (OLS) regression analysis. Findings for the nation indicate that the major determinants are demographic factors, service occupations, ethnicities, and urban location. Furthermore, analysis was conducted for the U.S. metropolitan, micropolitan, and rural subsamples. We found that Twitter users were more heavily concentrated in southern California and had a strong presence in the Mississippi region, while Facebook users were highly concentrated in Colorado, Utah, and adjacent Rocky Mountain States. Social media usage was lowest in the Great Plains, lower Midwest, and South with the exceptions of Florida and major southern cities such as Atlanta. Measurements of the overall extent of spatial agglomeration were very high. The paper concludes by discussing the policy implications of the study at the county as well as national levels.

Modeling Emissions and Ozone Air Quality Impacts of Future Scenarios for Energy and Power Production in the Rocky Mountain States.

This study examines air quality impacts of scenarios for energy production and use in 2030 across Colorado, northern New Mexico, Utah, and Wyoming. Scenarios feature contrasting levels of oil and gas production and shares of electricity from coal, natural gas, and renewables. Hourly emissions are resolved for individual power plants; oil and gas emissions are basin-specific. Ozone decreased from 2011 to the 2030 baseline, with median and 90th percentile reductions in maximum daily 8 h average (MDA8) ozone across the four-state domain of 3.5 and 7.1 ppb, respectively, resulting in 200 fewer premature deaths annually. Relative to the 2030 baseline, MDA8 ozone increased in the "cheap gas" scenario, with median and 90th percentile increases of 0.1 and 1.0 ppb, and declined in a scenario with greenhouse gas (GHG) emissions fees, with median and 90th percentile reductions of 0.2 and 1.5 ppb. Reduced coal generation lowered SO2 emissions in all future scenarios compared to 2011. GHG emissions from electricity and oil and gas production declined by 4% (CO2-equivalent) from 2011 to the 2030 baseline, increased by 10% from the 2030 baseline to the cheap gas scenario, and declined by 28% from the 2030 baseline to the GHG fees scenario.

The Concept of Place in the American West

This paper surveys the most significant ways in which the American West has been viewed as a place and region. Starting with Thomas Jefferson’s Louisiana Purchase of 1803, we follow the expansion of the West as a region throughout American history. Jefferson worked out a plan which involved the creation of territories which later became states, following a certain procedure. Inside the larger West, there are many Wests: the prairie states of the Midwest (also called the “Bread Basket” of America), the Rocky Mountain states, the Pacific Northwest, the Southwest and California. We analyze the myths and images associated with the west in American culture, and the influence of Frederick Jackson Turner’s essay dedicated to “the Frontier”. We discuss the New Historicism approach and the way in which it criticizes Tuner. Then we discuss the reflection of the West in the visual arts (the major landscape painters and in the work of the western movie director John Ford). We bring arguments to support the idea that the West is a construct of human experience and a cultural concept, more than a “place”.

Distribution of a New Invasive Species, Sipha maydis (Heteroptera: Aphididae), on Cereals and Wild Grasses in the Southern Plains and Rocky Mountain States.

Sipha maydis Passerini (Heteroptera: Aphididae) is a cereal pest with an extensive geographical range that includes countries in Europe, Asia, Africa, and South America. Reports of S. maydis in the United States have been infrequent since it was first detected in California, 2007. Two studies, focused (NW CO) and multistate (OK, TX, NM, CO, UT, WY), were conducted to determine the distribution and host range of S. maydis in the Rocky Mountain and Southern Plains states over a 3-yr period, 2015-2017. In 2015, focused sampling in NW Colorado found S. maydis at 59% of the 37 sites, primarily on wheat. Sipha maydis did not survive extreme winter temperatures from late December 2015 to early January 2016 that ranged from -9.0 to -20.9°C over a 9-d period, which resulted in no aphids detected in 2016. In the multistate study, S. maydis occurred in 14.6% of 96 sites sampled in 2015, 8% of 123 sites in 2016, and 9% of 85 sites in 2017 at wide range of altitudes from 1,359 to 2,645 m. Sipha maydis occurred mainly in NW and SW Colorado and NE New Mexico along with a few sites in NE Colorado, SE Utah, and SE Wyoming. This aphid mainly infested wheat followed by a variety of eight wild grass species. No parasites, predators, sexual morphs, or significant plant damage occurred at the sites. Sipha maydis utilized 14 hosts in the United States including 8 new host records, which expands its host range to 52 plant species worldwide. Sipha maydis may be of concern to wheat, barley, and sorghum production in the United States if its populations continue to increase.

Late summer glacial meltwater contributions to Bull Lake Creek stream flow and water quality, Wind River Range, Wyoming, USA

ABSTRACTThe Wind River Range in Wyoming contains more glacial ice than any other location within the USA’s Rocky Mountain states of Colorado, Idaho, Montana, and Wyoming. Bull Lake Creek watershed in the southeast portion of the range contains five major (0.6–1.5 km2) glaciers along with numerous smaller glaciers that contribute to the Wind River. Field measurements were made of discharge from the Knife Point and Bull Lake Glaciers to determine the contribution of glacial meltwater to the river system. Water samples were collected and analyzed for stable isotopes, major ions, nutrients, and selected trace elements. Meltwater from the two glaciers contributed 13.9% to Bull Lake Creek streamflow (site BL-3), with all glaciers within the Bull Lake Creek watershed estimated to be contributing 55.6% to the streamflow of Bull Lake Creek (United States Geological Survey gage) during the August 2015 study period. Hydrogen and oxygen stable isotope analysis indicated as much as 80% of late summer discharge in the upper Bull Lake Creek watershed was attributed to glacial meltwater. This study also found that nutrients (NO3 – NO2, total P) from glacial meltwater can be a significant source of nutrient loading to Bull Lake Creek.

Association Between Postpartum Breast Cancer Diagnosis and Metastasis and the Clinical Features Underlying Risk

In women 45 years or younger, breast cancer diagnosis after childbirth increases the risk for metastasis and death, yet limited data exist to define this window of risk and associated prognostic factors. To assess the window of elevated risk for metastasis following a postpartum breast cancer (PPBC) diagnosis and whether clinical prognostic factors are associated with the increased risk. This multicenter cohort study conducted using cases from the Colorado Young Women's Breast Cancer Cohort diagnosed between January 1, 1981, and December 31, 2014, included 701 women 45 years or younger with stage I to III invasive breast cancer for whom parity data, including time of last childbirth, were available. Data analysis was conducted from July 1 to September 30, 2017. This study involved a tertiary care academic hospital-based breast center and its regional affiliates with cases from the greater Rocky Mountain region. Primary exposures were prior childbirth or no childbirth, time between most recent childbirth and breast cancer diagnosis, and time between breast cancer diagnosis and metastasis. The primary outcome was distant metastasis-free survival. A total of 701 women 45 years or younger from the greater Rocky Mountain states region were included in the analysis; mean (SD) age at diagnosis was 37.9 (5.1) years. Breast cancer diagnosis within 10 years after parturition was associated with elevated risk for metastasis, particularly in women with stage I or II disease. In addition, women with PPBC diagnosed within 10 years of a completed pregnancy that was estrogen receptor-positive showed distant metastasis-free survival similar to that of nulliparous patients with estrogen receptor-negative cancer, and women with estrogen receptor-negative PPBC had further reduced metastasis-free survival. Moreover, women with PPBC had increased lymphovascular invasion and lymph node involvement. In addition, tumor-associated Ki67 positivity identified 129 patients with luminal B cancer in the cohort that, independent of parity status, had poorer prognosis compared with patients with luminal A cancer, although it did not reach statistical significance. Diagnosis of PPBC within 10 years post partum appears to be associated with an increased risk for metastasis. This increased risk was highest in stages I and II cancer at diagnosis and present in both patients with estrogen receptor-positive and estrogen receptor-negative cancer, persisting in estrogen receptor-positive cases for up to 15 years after diagnosis. Postpartum breast cancer diagnoses were not associated with increased Ki67 index but were associated with increased lymphovascular invasion and lymph node involvement compared with breast cancer in nulliparous patients.

Learning Outside the Classroom: How Principals Define and Prepare to Be Instructional Leaders

This qualitative study surveyed 50 practicing principals in a Rocky Mountain state to explore what elements of their responsibilities these educational leaders identified as part of their instructional leadership roles. The study also examined what experiences these principals identified as helpful in preparing them to assume the role of school instructional leader, specifically in the areas of teacher supervision and evaluation, the use of technology to support student learning, and the use of data to inform instructional practices. These areas have been identified through research as significant elements of instructional leadership. By identifying the specific actions that principals identify as their instructional leadership responsibilities, programs that prepare school leaders and state and district personnel who provide professional development for principals can develop learning experiences that could more effectively support principals’ success as instructional leaders.

Preliminary report on the Silver content of soils in Northeastern Wisconsin July-August 1977

..These studies have led to the conclusion that silver iodide used for cloud seeding poses no immediate threat to either people or the ecosystem in general. However, since most of the data have been obtained over the relatively short time span of the last decade and in limited geographical regions (the most extensive work has been done in the Rocky Mountain states), it seems prudent to monitor weather modification activities when they are extended into new areas.....

New Immobilization Guidelines Change EMS Critical Thinking in Older Adults With Spine Trauma

Objective: The impact of immobilization techniques on older adult trauma patients with spinal injury has rarely been studied. Our advisory group implemented a change in the immobilization protocol used by emergency medical services (EMS) professionals across a region encompassing 9 trauma centers and 24 EMS agencies in a Rocky Mountain state using a decentralized process on July 1, 2014. We sought to determine whether implementing the protocol would alter immobilization methods and affect patient outcomes among adults ≥60 years with a cervical spine injury. Methods: This was a 4-year retrospective study of patients ≥60 years with a cervical spine injury (fracture or cord). Immobilization techniques used by EMS professionals, patient demographics, injury characteristics, and in-hospital outcomes were compared before (1/1/12–6/30/14) and after (7/1/14–12/31/15) implementation of the Spinal Precautions Protocol using bivariate and multivariate analyses. Results: Of 15,063 adult trauma patients admitted to nine trauma centers, 7,737 (51%) were ≥60 years. Of those, 237 patients had cervical spine injury and were included in the study; 123 (51.9%) and 114 (48.1%) were transported before and after protocol implementation, respectively. There was a significant shift in the immobilization methods used after protocol implementation, with less full immobilization (59.4% to 28.1%, p < 0.001) and an increase in the use of both a cervical collar only (8.9% to 27.2%, p < 0.001) and not using any immobilization device (15.5% to 31.6%, p = 0.003) after protocol implementation. While the proportion of patients who only received a cervical collar increased after implementing the Spinal Precautions Protocol, the overall proportion of patients who received a cervical collar alone or in combination with other immobilization techniques decreased (72.4% to 56.1%, p = 0.01). The presence of a neurological deficit (6.5% vs. 5.3, p = 0.69) was similar before and after protocol implementation; in-hospital mortality (adjusted odds ratio = 0.56, 95% confidence interval: 0.24–1.30, p = 0.18) was similar post–protocol implementation after adjusting for injury severity. Conclusions: There were no differences in neurologic deficit or patient disposition in the older adult patient with cervical spine trauma despite changes in spinal restriction protocols and resulting differences in immobilization devices.