June 2020 Highlights

Date: Apr 16 2020

  • Lack of transportation impedes access to health care
  • Bike sharing reduces crashes between cars, cyclists
  • Firearms contribute to increases in brain injury-related deaths
  • Labels on juice drinks for kids blur nutritional value

To request a full copy of any of these studies or for information on scheduling interviews with an expert, contact Arnice Cottom

American Journal of Public Health June issue research highlights:

Lack of transportation impedes access to health care

Nearly 6 million U.S. adults delay medical care each year because they lack transportation to health care facilities, a study in the June issue of APHA’s American Journal of Public Health finds.

Researchers examined data from the National Health Interview Survey between 1997 and 2017, analyzing responses from people who said they had delayed care in the past year.

In 2017, about 5.8 million adults reported delaying doctor’s visits because they lacked transportation, the researchers found. Overall, about 2% of women said they delayed care because of transportation barriers in 2017, as did 1.5% of men.

Education played a role, with the least educated having the hardest time getting to health care facilities. Income was also a factor: About 7% of people who delayed care because of transportation barriers had yearly earnings below the U.S. poverty line.

Nearly 12% of people who delayed care said they had poor health, suggesting chronic ailments may have played a role in lack of access to transportation. Of those respondents, 7% had kidney problems and nearly 7% were stroke survivors.

“Transportation barriers to health care have a disproportionate impact on individuals who are poor and who have chronic conditions,” the researchers said.

[Author Contact: Mary K. Wolfe, Department of City and Regional Planning, University of North Carolina at Chapel Hill. Chapel Hill, North Carolina. “Transportation Barriers to Health Care in the United States: Findings from the National Health Interview Survey, 1997-2017”]

Bike sharing reduces crashes between cars, cyclists

City bike-share programs result in more people bicycling, while also lowering the risk of crashes between cars and cyclists, a study in the June issue of AJPH finds. Researchers reviewed data from Philadelphia, examining crashes between cars and cyclists that were listed in the Pennsylvania Department of Transportation Public Crash Database between 2010 and 2018.

Researchers looked at over 4,450 crashes that resulted in vehicle damage and at least one injury. Before the introduction of Indego — Philadelphia’s city-run bike-sharing program — in 2015, such crashes decreased on average about 1%.

But from 2015-2018, after Indego was in use, crashes involving cars and bikes decreased by 13%. The drop occurred even though more bicyclists were riding in the city and no citywide bike infrastructure had been built to help protect the riders.

The “safety-in-numbers theory” may explain the decrease, according to study researchers. With more bicyclists throughout Philadelphia, drivers changed their behavior, watching out for bicyclists, resulting in proportionally fewer crashes, they said.

“Our results suggest that, in the long run, bicycle-share programs do not lead to increases in the rates of bicyclist injuries caused by crashes with motor vehicles and, in fact, may accelerate their decrease,” the researchers suggested.

[Author contact: Ghassan B. Hamra, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. “Motor Vehicle Crashes Involving a Bicycle Before and After Introduction of a Bike Share Program in Philadelphia, Pennsylvania, 2010-2018"]

Firearms contribute to increases in brain injury-related deaths

Deaths from traumatic brain injuries have increased in the U.S. in recent years, with firearm-related suicides accounting for almost half of the surge, a study in the June issue of AJPH finds.

Researchers examined records in the National Vital Statistics System from 2008 to 2017, focusing on information on deaths from head injuries. Over 500,000 cases were identified, involving both adolescents and adults. Intent and means of death were classified using data from the National Center for Health Statistics.

The researchers found that firearm suicide accounted for about 48% of the increase in TBI-related deaths over the study period. Unintentional falls accounted for about 44% of the increase, followed by gun-related homicides, at about 4%, nonfirearm-related suicides, at about 1%, and other causes making up the remainder.

Most of the TBI-related firearm suicides involved men. In 2017, almost 18,000 men died by that means, compared to about 2,700 women. Over 60% of the deaths occurred at home. Public health and safety workers should prioritize suicide prevention, especially through policies restricting or limiting access to a firearm, the researchers said.

“Safe storage of firearms among people at risk, and training of health care providers and community members to identify and support people who may be thinking of suicide, are part of a comprehensive public health approach to suicide prevention,” they said.

[Author contact: Gabrielle F. Miller, PHD , Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta. “Traumatic Brain Injury-Related Deaths From Firearm Suicide: United States, 2008-2017”]

Labels on juice drinks for kids blur nutritional value

Labels on juice drinks are not helpful in determining which products are healthy for children, a study in June’s AJPH finds.

Researchers examined federal laws governing juice labels, then analyzed information from 39 children’s juice drinks. While the U.S. Food and Drug Administration specifies offers terms that may be used to describe a product on its label — such as 100% juice, flavored water, juice drink or natural flavor — deceptive labeling makes it difficult to distinguish healthy products from those with added sugar and sweeteners with no nutritional value, the researchers found.

“We identified numerous labeling practices that obscure the true nature of drinks purporting to contain juice and would make it difficult for consumers to identify healthier products,” the researchers said. “Labeling practices appear to be designed to blur the distinction between drinks recommended for children and those containing added sugar or nonnutritive sweeteners.”

While health and nutrition experts recommend that children do not consume products with added sugar and sweeteners, the confusing labeling practices make it hard for consumers to select healthy products, the study found.

“The FDA should revise its regulations to ensure the labels for drinks containing or purporting to contain juice are clear and not misleading,” the researchers said.

[Author contact: Jennifer L. Pomeranz, School of Global Public Health, New York University, New York City. “Children’s Fruit ‘Juice’ Drinks and FDA Regulations: Opportunities to Increase Transparency and Support Public Health”]

Check out the full list of AJPH research papers that published online April 16:

  • Flavored e-cigarette sales in the U.S. under self-regulation from January 2015 through October 2019
  • Cannabis-infused edible products in Colorado: Food safety and public health implications
  • Future directions for incorporating intersectionality into quantitative population health research
  • Stigma, opioids and public health messaging: The need to disentangle behavior from identity
  • Transportation barriers to health care in the U.S.: Findings from the NHIS, 1997-2017
  • Indoor tanning trends among U.S. adults, 2007-2018
  • The use of small-area estimates in place-based health research
  • Safe Start community health worker program: A multisector partnership to improve perinatal outcomes among low-income pregnant women with chronic health conditions
  • Visual ethnography: decriminalization and stable housing equals motivation, stability and recovery among Latinx populations
  • Sexual assault, alcohol use and gender of sexual partners among cisgender women seeking care at U.S. college health centers, 2015-2018
  • Barriers to health care among adults with minoritized identities in the United States, 2013-2017
  • Motor vehicle crashes involving a bicycle before and after introduction of a bike-share program in Philadelphia, Pennsylvania, 2010-2018
  • Smoking behavior in low-income and high-income adults immediately following California Proposition 56 tobacco tax increase
  • Children’s fruit juice drinks and FDA regulations: Opportunities to increase transparency and support public health
  • Laws mandating co-prescription of naloxone and their impact on naloxone prescription in five U.S. states, 2014-2018
  • Financial toll of untreated perinatal mood and anxiety disorders among 2017 births in the United States
  • Traumatic brain injury-related deaths due to firearm suicide, United States, 2008-2017
  • Spillover effects of job skills training on substance misuse among low-income youth with employment barriers: A longitudinal cohort study

The articles above were published online April 16, at 4 p.m. ET by AJPH.

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at ajph.org

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Arnice Cottom at APHA. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single-issue access is $30, and online single-article access is $22 at AJPH.org. For direct customer service, call 202-777-2516, or  email us.

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