American Journal of Public Health research highlights:

Note: Hyperlinks to the studies will go live following the embargo lift on March 21, 2017, at 4 p.m. EDT.

Counties in southern U.S. states face highest risk of Zika infections

Newswise — Researchers examined where and how transmission of Zika virus is most likely to occur in the contiguous United States. They evaluated two types of transmission risk: sexually and via Aedes aegypti mosquito bites. They looked at predictors of sexually transmitted infections as a surrogate for unprotected sexual activity, and analyzed the demographic distribution of the A. aegypti mosquito across 3,108 counties in the U.S.

Results found 507 counties that had the highest risk of virus exposure via mosquito bites or unprotected sexual activity. The counties were concentrated in southern states extending northward along the Atlantic coast and southern California, with the highest predicted risk in Mississippi counties.

“Identifying areas with higher transmission risk can inform prevention strategies and vector control, and assist in planning for diagnosis and treatment,” the authors explained.

[“Potential High-Risk Areas for Zika Virus Transmission in the Contiguous United States.” Contact: Enbal Shacham, PhD, Med, Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri.]

Government pays 40 percent of costs for initial hospitalization for firearm injuries

Researchers analyzed the costs associated with initial hospitalizations for firearm-related injuries in the U.S. They used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify patients admitted for firearm-related injuries from 2006 to 2014. They converted charges from hospitalization to costs, adjusting based on inflation to 2014 dollars.

Results showed that the total cost for initial inpatient hospitalization for firearm-related injuries was $6.61 billion. The largest proportion of costs was for patients with governmental insurance coverage, totaling $2.70 billion, and was divided between Medicaid and Medicare. Self-pay individuals accounted for $1.56 billion in costs.

“From 2006 to 2014, the cost of initial hospitalizations for firearm-related injuries averaged $734.6 million per year. Medicaid paid one-third and self-pay patients one quarter of the financial burden,” the authors explained. “These figures substantially underestimate true health care costs. Firearm-related injuries are costly to the U.S. health care system and are particularly burdensome to government insurance and the self-paying poor.”

[“Costs and Financial Burden of Initial Hospitalizations for Firearm Injuries in the United States, 2006–2014.” Contact: Sarabeth A. Spitzer, Stanford Division of General Surgery, Stanford University School of Medicine, Stanford, California.]

Sexual assault victimization of women in U.S. Army linked to negative mental health and career outcomes

Researchers examined associations of administratively recorded sexual assault victimization among women in the U.S. Army during their military service, with subsequent mental health and negative career outcomes. They used data from the Army Study to Assess Risk and Resilience in Service members to match all 4,238 female regular Army soldiers with administratively recorded sexual assault victimization from 2004 to 2009. They also analyzed associations of victimization with administratively recorded mental health treatment, suicide attempt and Army career outcomes over the subsequent 12 months.

Results found that women with administratively recorded sexual assault had significantly elevated odds of subsequent mental health treatment, posttraumatic stress disorder treatment, suicide attempt, demotion and attrition.

“Sexual assault victimization is associated with considerable suffering and likely decreased force readiness,” the authors explained.

[“Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army.” Contact: Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.]

Find a full list of AJPH research papers to be published online on March 21, 2017, at 4 p.m. EDT below:• Potential High-Risk Areas for Zika Virus Transmission in the Contiguous United States• Estimating the Proportion of Childhood Cancer Cases and Costs Attributable to the Environment in California • Costs and Financial Burden of Initial Hospitalizations for Firearm Injuries in the United States, 2006–2014• Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army• Sales of Nicotine-Containing Electronic Cigarette Products: United States, 2015• Disability Items From the Current Population Survey (2008–2015) and Permanent Versus Temporary Disability Status• Injury Mortality in Individuals With Autism• Supply-Side Disruption in Cocaine Production Associated With Cocaine-Related Maternal and Child Health Outcomes in the United States• Jail Booking as an Occasion for HIV Care Reengagement: A Surveillance-Based Study• Universal Mandatory Reporting Policies and the Odds of Identifying Child Physical Abuse• State-Level Progress in Reducing the Black–White Infant Mortality Gap, United States, 1999–2013• Scaling Up a Water, Sanitation, and Hygiene Program in Rural Bangladesh: The Role of Program Implementation• Social and Built Environmental Correlates of Predicted Blood Lead Levels in the Flint Water Crisis• Physical, Mental, and Financial Impacts From Drought in Two California Counties, 2015 • The Affordable Care Act, Insurance Coverage, and Health Care Utilization of Previously Incarcerated Young Men: 2008–2015• Video-Based Grocery Shopping Intervention Effect on Purchasing Behaviors Among Latina Shoppers

The articles above will be published online March 21, 2017, at 4 p.m. EDT by AJPH under “First Look.” “First Look” 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

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