June 2021 Issue of AJPH Comprises the Effects of COVID-19 on Drug Overdoses, E-cigarette Use, and Public Health Measures and Strategies

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American Journal of Public Health June issue highlights:

• Fatal drug overdoses increased during the COVID-19 pandemic
• COVID-19 pandemic associated with drop in youth e-cigarette use
• Public health measures avert more COVID-19 deaths than hospital surge response
• Better COVID-19 mitigation strategies could help protect correctional staff

Fatal drug overdoses increased during the COVID-19 pandemic

Drug-related overdose deaths in the U.S. went up during the first half of 2020, according to a new study in the June issue of AJPH.

Using data from the Centers for Disease Control and Prevention, researchers found that nearly 9,200 people died from a drug overdose in May 2020, making it the deadliest month on record for drug overdoses and representing a more than 57% increase over May 2019. Most states experienced large increases in drug overdose mortality last year, with West Virginia, Kentucky and Tennessee reporting the highest.

Overall, overdose deaths in the first seven months of 2020 went up by 35%, compared with the same period in 2019. Researchers estimated it is “very likely” that 2020 will represent the largest year-to-year increase in overdose deaths in recent U.S. history.

“The drastic exacerbations of the U.S. overdose crisis described here warrant renewed investments in overdose surveillance and prevention during the pandemic response and post-pandemic recovery efforts,” the study stated.

[Author contact: Joseph Friedman, University of California-Los Angeles Center for Social Medicine and Humanities, Los Angeles, California. “COVID-19 and the Drug Overdose Crisis: Uncovering the Deadliest Months in the United States, January-July 2020”]

COVID-19 pandemic associated with drop in youth e-cigarette use

Measures to stop the spread of COVID-19 have had a variety of unintended impacts, including fewer young people using electronic cigarettes, finds a new study in the June issue of AJPH.

To measure the change, researchers used data from a continuous, weekly cross-sectional online survey of youth and young adults. More than 5,750 people completed the survey over the study period, which spanned Jan-June 2020. Results showed that odds of current e-cigarette use were significantly lower during the COVID-19 pandemic among youths ages 15 to 17 and young adults ages 18 to 20.

E-cigarette users who reported barriers to accessing the nicotine products — such as limited store hours or affordability — were also more likely to report reductions in their use of e-cigarettes. Researchers said the finding suggests that “retail point of sale remains an important location for intervention efforts to reduce youth and young adult e-cigarette use.”

“It cannot be assumed that the observed reductions in the prevalence of e-cigarette use among youths and young adults will continue when the pandemic subsides and societal activities resume,” researchers wrote. “As schools resume in-person classes, it will be important to have school-based policies and proper training to empower staff to intervene in e-cigarette use and sharing among youths in school settings.”

[Author contact: Jennifer Kreslake, Schroeder Institute, Washington, D.C. “E-Cigarette Use Among Youths and Young Adults During the COVID-19 Pandemic: United States, 2020”]

Public health measures avert more COVID-19 deaths than hospital surge response

Public health interventions had a greater impact on minimizing preventable COVID-19 deaths than hospital critical care surge response, according to a June AJPH study.

The goal of the study was to create a data-driven tool to rapidly detect where pandemic-related demand for critical care services would overwhelm county-level surge capacity and to compare the outcomes of public health responses against medical ones. Researchers found the tool was able to “rapidly determine, with reasonable accuracy,” which U.S. counties were facing an urgent threat to medical capacity due to COVID-19 over three- to six-week time horizons.

Using the tool, the study found that in areas with increased demand, surge response could avert 104,120 additional deaths. However, the percentages of lives saved from high levels of contact reduction were 1.9 to 4.2 times greater than high levels of hospital surge response.

“The disaster response tool shows the clear and primary importance of nonpharmaceutical public health interventions in averting deaths during the first months of a viral pandemic,” study authors wrote. “Those strategies coupled with innovative surge response by the medical system should be able to meet COVID-19 demand and minimize preventable deaths across most U.S. counties.”

[Author contact: Charles C. Branas, Columbia University Mailman School of Public Health, New York, New York. “A Spatiotemporal Tool to Project Hospital Critical Care Capacity and Mortality From COVID-19 in US Counties”]

Better COVID-19 mitigation strategies could help protect correctional staff

Catching COVID-19 is more likely for correctional staff working in facilities where measures such as physical distancing are more challenging to practice, finds a new study in June’s AJPH.

Researchers set out to examine the epidemiology and risk factors associated with COVID-19 infection among staff at the Federal Bureau of Prisons between March-June 2020. The case rate among bureau staff was about 1,766 cases per 100,000 people overall and about 4,286 cases per 100,000 in correctional facilities with outbreaks, higher than among cruise ship staff and lower than staff working in homeless shelters during a similar time period.

Working in dorm-style housing and in detention centers were strong risk factors for infection, compared to cell-based housing. Institution type was also associated with infection risk: working in a stand-alone, low-security facility was a greater risk factor for COVID-19 infection than working in a stand-alone, high-security one.

“Augmented voluntary staff testing, measures to increase physical distancing (i.e., retrofitting and reducing populations in dorm-style housing), limited staff interactions between institutions within a complex, and continued testing and quarantining of new and transferring inmates could help prevent or contain future outbreaks,” researchers wrote.

[Author contact: Robin L. Toblin, U.S. Public Health Service Commissioned Corps. “SARS-CoV-2 Infection Among Correctional Staff in the Federal Bureau of Prisons”]

Check out the full list of AJPH research papers that published online in our First Look area.

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.

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