This paper introduces a novel framework that integrates agent-based mobility simulation with social network analysis to model epidemic diffusion, using Las Vegas as a high-stakes test bed. By mining real-world transportation, demographic, and geographic data, we construct a high-resolution, dynamic contact network that captures the heterogeneous interactions among key subpopulations. Applying graph theory and diffusion modeling to this evolving network demonstrates that epidemic risk is structurally determined by critical transmission hotspots (major resorts, transport hubs) and is highly sensitive to the initial seeding location, with an introduction at the airport leading to a far more explosive outbreak than one in a residential zone. We demonstrate how distinct population groups play unique network roles: tourists act as primary importation vectors, while hospitality workers serve as crucial bridging nodes between otherwise disconnected clusters. The model also shows how some agents achieve “immunity by circumstance” due to mobility patterns that isolate them from high-traffic areas. Our experiments prove that targeted interventions, such as capacity limits at identified hotspots, substantially outperform universal restrictions. The framework validated in Las Vegas provides a transferable tool for strategic epidemic preparedness, offering a new paradigm for data-driven public health policy applicable to any globally connected urban center.

Objective: This study aimed to (1) determine whether there was an association between a diagnosis of traumatic encephalopathy syndrome (TES) and changes in three specific serum biomarkers, and (2) determine head impact exposure thresholds among both TES+ and TES− groups. Setting: Data were collected from Cleveland Clinic’s Professional Athletes Brain Health Study (PABHS). Participants: This study included 192 professional combat athletes, 35 years of age and older. Athletes must be actively fighting or retired with a minimum of 10 professional fights over their careers. Design/Intervention: This was a retrospective observational study of the PABHS longitudinal cohort. Main Measures: The generalized linear model with the generalized estimating equation for repeated measurements was used to compare various biomarkers between both active and retired TES− and TES+ groups. Results: The odds ratio for TES diagnosis was 5.44 (95% CI = 2.48, 11.94; P < .0001) among active fighters and 10.75 (95% CI = 3.52, 32.85; P < .0001) among retired fighters, indicating the odds for a TES diagnosis were over 5 times greater for active fighters with every fight completed at or beyond 30 professional fights. Retired fighters had 10 times greater odds of TES diagnosis with every fight completed at or beyond 15 professional fights. Likewise, the odds of a TES diagnosis were 2.0% (95% CI = 0.3, 3.1; P = 0.0039) greater with each pg/mL increase of glial fibrillary acidic protein (GFAP). No relationship was observed between a TES diagnosis and neurofilament light chain or P-tau231. Conclusion: This study provides preliminary evidence that progressively elevated levels of the GFAP blood biomarker increase the odds of a TES diagnosis among retired professional fighters. Further evaluation is required to improve clarity and understanding of the relationship between progressive changes in the GFAP blood biomarker and a TES diagnosis, specifically evaluating the duration of chronicity and exposure thresholds.

Temporal variability and methodological differences in data normalization, among other factors, complicate effective trend analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater surveillance data and its alignment with coronavirus disease 2019 (COVID-19) clinical outcomes. As there is no consensus approach for these analyses yet, this study explored the use of piecewise linear trend analysis (joinpoint regression) to identify significant trends and trend turning points in SARS-CoV-2 RNA wastewater concentrations (normalized and non-normalized) and corresponding COVID-19 case rates in the greater Las Vegas metropolitan area (Nevada, USA) from mid-2020 to April 2023. The analysis period was stratified into three distinct phases based on temporal changes in testing protocols, vaccination availability, SARS-CoV-2 variant prevalence, and public health interventions. While other statistical methodologies may require fewer parameter specifications, joinpoint regression provided an interpretable framework for characterization and comparison of trends and trend turning points, revealing sewershed-specific variations in trend magnitude and timing that also aligned with known variant-driven waves. Week-level trend agreement corroborated previous findings demonstrating a close relationship between SARS-CoV-2 wastewater surveillance data and COVID-19 outcomes. These findings guide future applications of advanced statistical methodologies and support the continued integration of wastewater-based epidemiology as a complementary approach to traditional COVID-19 surveillance systems.

OBJECTIVES:Clinical criteria for Traumatic Encephalopathy Syndrome (ccTES) were developed for research purposes to reflect the clinical symptoms of Chronic Traumatic Encephalopathy (CTE). The aims of this study were to 1) determine whether there was an association between the research diagnosis of TES and impaired postural balance among retired professional fighters, and 2) determine repetitive head impacts (RHI) exposure thresholds among both TES positive and TES negative groups in retired professional fighters when evaluating for balance impairment. METHODS:This was a pilot study evaluating postural balance among participants of the Professional Athletes Brain Health Study (PABHS). Among the cohort, 57 retired professional fighters met the criteria for inclusion in this study. A generalized linear model with generalized estimating equations was used to compare various balance measures longitudinally between fighters with and without TES. RESULTS:A significant association was observed between a TES diagnosis and worsening performance on double-leg balance assessments when stratifying by RHI exposure thresholds. Additionally, elevated exposure to RHI was significantly associated with increased odds of developing TES; The odds for TES diagnosis were 563% (95% CI = 113, 1963; p-value = 0.0011) greater among athletes with 32 or more professional fights compared to athletes with less than 32 fights when stratifying by balance measures. Likewise, the odds for TES diagnosis were 43% (95% CI = 10, 102; p-value = 0.0439) greater with worsening double leg stance balance in athletes exposed to 32 or more fights. CONCLUSION:This pilot study provides preliminary evidence of a relationship between declining postural balance and a TES diagnosis among retired professional fighters with elevated RHI exposure. Further research exploring more complex assessments such as the Functional Gait Assessment may be of benefit to improve clinical understanding of the relationship between TES, RHI, and balance.

Background Employment and household responsibility are critical health determinants. The COVID-19 pandemic altered the work and social landscapes in Nevada, USA through closures of workplaces and schools/childcare centers, changing patterns of employment, and household responsibilities. This study aimed to measure changes in employment status and perceived housework responsibilities among Nevada adults in December 2020, before widespread availability of COVID-19 vaccines in a pandemic-affected economy. Methods Using a cross-sectional telephone survey of 1,000 Nevada adults, this study compared respondent experiences and perceptions of employment and time spent on housework in December 2020 to pre-pandemic using multinominal logistic, proportional odds, and logistic models. Results 70.52% of participants experienced no employment change; roughly 24% reported being fired/laid-off, working reduced hours, or quitting. Chi-square analyses found participants of color more likely than Whites to report being fired/laid-off or working reduced hours (p-value = 0.0005), though these findings were not significant in our models. Participants in the lowest income bracket had higher odds of being fired/laid off (p-value = 0.0030), and participants aged 65+ were less likely to experience employment change (p-value<0.0001). 32.43% of participants reported more time spent on housework. Multivariate analyses showed age is significantly associated with changes in both employment status (p-value<0.0001) and housework time (p-value<0.0001); income is a significant factor for employment status change (p-value = 0.0024). Of those reporting their households spent more time on housework, females were 2.90 times (95% CI = 1.66, 5.05, p-value = 0.0002) more likely to report taking on the additional work. Conclusions Results demonstrate a disproportionate burden in employment change and/or more perceived household responsibilities on lower income and younger respondents, and females reporting they are more likely to take on additional housework. Understanding systemic vulnerabilities related to employment status and household responsibilities is necessary to aid impacted communities and to plan for future emergencies.

The COVID-19 pandemic intensified concerns regarding food and housing insecurity in the United States, particularly among vulnerable populations. After the pandemic prompted a shutdown of nonessential businesses in Nevada, unemployment rose dramatically as the gaming, tourism, and hospitality industries struggled. This study analyzed the results of two telephone surveys of Nevada adults’ experiences in 2020 (n = 1000) and 2021 (n = 1002). The results demonstrate between 2020 and 2021 an 8.24 percentage point decline in food insecurity (FI) from 30.2% to 21.96% and a 12.58 percentage point increase in housing insecurity (HI) from 12.27% to 24.85%. Age, disability status, and certain categories of race/ethnicity and income were associated with both HI and FI in 2020, but disability was no longer significant in 2021. Instead, spouse/partner-status, living with children ≤ 18-years-old and receipt of SNAP benefits were significantly associated with FI in 2021. In particular, health status became a significant factor of both HI and FI. People of color experienced FI disparities compared to Whites. Asians/Hawaiians/Pacific Islanders were 3.22 times (95% CI 1.51, 6.86) more likely to experience FI in 2021 than Whites. A matched, longitudinal analysis also revealed that Whites experienced a significant 9.1 percentage point estimated decline in the probability of FI between 2020 and 2021. However, the reduction among non-White participants was statistically insignificant at 2.5 percentage points. Results indicate the importance of supporting the food and housing needs of people of color and individuals with disabilities. Further research should especially investigate the comparative FI rate among Asians/Hawaiians/Pacific Islanders in 2021 and offer solutions to the soaring prevalence of housing insecurity.

BACKGROUND AND OBJECTIVES:Due to current limitations in diagnosing chronic traumatic encephalopathy (CTE) clinically, traumatic encephalopathy syndrome (TES) has been proposed as the clinical presentation of suspected CTE. This study aimed to determine whether there was an association between a clinical diagnosis of TES and subsequent temporal decline in cognitive or MRI volumetric measures. METHODS:This was a secondary analysis of the Professional Athletes Brain Health Study (PABHS), inclusive of active and retired professional fighters older than 34 years. All athletes were adjudicated as TES positive (TES+) or TES negative (TES-) based on the 2021 clinical criteria. General linear mixed models were used to compare MRI regional brain volumes and cognitive performance between groups. RESULTS:A total of 130 fighters met inclusion criteria for consensus conference. Of them, 52 fighters (40%) were adjudicated as TES+. Athletes with a TES+ diagnosis were older and had significantly lower education. Statistically significant interactions and between-group total mean differences were found in all MRI volumetric measurements among the TES+ group compared with those among the TES- group. The rate of volumetric change indicated a significantly greater increase for lateral (estimate = 5,196.65; 95% CI = 2642.65, 7750.66) and inferior lateral ventricles (estimate = 354.28; 95% CI = 159.90, 548.66) and a decrease for the hippocampus (estimate = -385.04, 95% CI = -580.47, -189.62), subcortical gray matter (estimate = -4,641.08; 95% CI = -6783.98, -2498.18), total gray matter (estimate = -26492.00; 95% CI = -50402.00, -2582.32), and posterior corpus callosum (estimate = -147.98; 95% CI = -222.33, -73.62). Likewise, the rate of cognitive decline was significantly greater for reaction time (estimate = 56.31; 95% CI = 26.17, 86.45) and other standardized cognitive scores in the TES+ group. DISCUSSION:The 2021 TES criteria clearly distinguishes group differences in the longitudinal presentation of volumetric loss in select brain regions and cognitive decline among professional fighters 35 years and older. This study suggests that a TES diagnosis may be useful in professional sports beyond football, such as boxing and mixed martial arts. These findings further suggest that the application of TES criteria may be valuable clinically in predicting cognitive decline.

Hesitancy toward the COVID-19 vaccine has hindered its rapid uptake among the Hispanic and Latinx populations. The study aimed to use the Multi-Theory Model (MTM) for health behavior change to explain the intention of initiating and sustaining the behavior of COVID-19 vaccination among the Hispanic and Latinx populations that expressed and did not express hesitancy towards the vaccine in Nevada. Using a quantitative cross-sectional and survey-based research study design, data were collected using a 50-item questionnaire and analyzed using multiple linear regression modeling. Of 231 respondents, participatory dialogue (b = 0.113, p < 0.001; b = 0.072, p < 0.001) and behavioral confidence (b = 0.358, p < 0.001; b = 0.206, p < 0.001) displayed significant associations with the initiation of COVID-19 vaccine acceptance among vaccine-hesitant and non-vaccine-hesitant individuals. Emotional transformation (b = 0.087, p < 0.001; b = 0.177, p < 0.001) displayed a significant association with the sustenance of COVID-19 vaccine acceptance among vaccine-hesitant and non-vaccine-hesitant individuals. Results from this study provide evidence that the MTM is a useful tool in predicting COVID-19 vaccine acceptance behavior among Hispanics and Latinxs in Nevada, and it should be used in intervention designs and messaging to promote vaccine uptake.

Contaminated surfaces are one of the ways that coronavirus disease 2019 (COVID-19) may be transmitted. SARS-CoV-2 can be detected on environmental surfaces; however, few environmental sampling studies have been conducted in nonclinical settings. The objective of this study was to detect SARS-CoV-2 RNA on environmental surfaces in public areas in Las Vegas, Nevada. In total, 300 surface samples were collected from high-touch surfaces from high-congregate public locations and from a public health facility (PHF) that was visited by COVID-19 patients. Environmental samples were analyzed with quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR) using SARS-CoV-2 specific primers and probes for three target genes. Results showed that 31 out of 300 (10.3%) surface samples tested positive for SARS-CoV-2, 24 at the PHF and 7 in high-congregate public locations. Concentrations ranged from 102 to 106 viral particles per 3 ml sample on a wide variety of materials. The data also showed that the N gene assay had greater sensitivity compared to the S and ORF gene assays. Besides frequently touched surfaces, SARS-CoV-2 was detected in restrooms, on floors and surfaces in contact with floors, as well as in a mop water sample. The results of this study describe the extent and distribution of environmental SARS-CoV-2 contamination in public areas in Las Vegas, Nevada. A method using the N gene PCR assay was developed for SARS-CoV-2 environmental monitoring in public areas. Environmental monitoring with this method can determine the specific sites of surface contamination in the community and may be beneficial for prevention of COVID-19 indirect transmission, and evaluation and improvement of infection control practices in public areas, public health facilities, universities, and businesses.

BACKGROUND AND PURPOSE:While impacts of the pandemic on family well-being have been documented in the literature, little is known about the psychological challenges faced by children and their parents as schools reopen after mandated closures. Therefore, the purpose of this study was to determine if sending children back to in-person school impacts the mental health of parents and the perceived mental health of their children.METHODS:This cross-sectional descriptive study recruited a nationally representative, non-probability sample of parents or guardians (n = 2100) of children attending grades K-12 in the United States (U.S.) through a 58-item web-based survey. The univariate, bivariate, and multivariate statistical tests were used to analyze the data.RESULTS:The mean scores of parental Coronavirus anxiety and Coronavirus obsession were significantly different between race/ethnic groups of parents. Parents with children going to private schools had significantly higher mean scores for Coronavirus anxiety and obsession compared to parents whose children are attending public schools. Nearly 55% of parental Coronavirus anxiety was explained by the generalized anxiety, separation anxiety, child's vulnerability to infection, and school type of the child. Similarly, 52% of parental Coronavirus obsession was explained by the generalized anxiety, separation anxiety, child's vulnerability to infection, and social phobia of the children.CONCLUSIONS:The COVID-19 pandemic has a substantial impact on psychological well-being of parents and their school-going children. Findings of this study will inform policy makers in developing targeted interventions to address unique needs of families with school-going children.

Background: Asthma, a chronic, non-communicable disease has been shown to negatively affect mental health and quality of life among adults. Annually approximately 8% of adult Nevadans report current asthma symptoms and 12.6% report having a lifetime diagnosis. The purpose of this study was to evaluate the association between asthma and depression and explore quality of life factors affecting adult Nevadans with asthma.Methods: Using behavioral risk factor surveillance system (BRFSS) data, this study evaluated the association between self-reported asthma and depression in Nevada using weighted multiple logistic regression. BRFSS asthma call-back survey (ACBS) data were used to determine the frequency and extent of quality of life factors affecting a sub-sample of respondents with asthma.Results: After adjustment, adult Nevadans with current asthma were 3.22 times as likely (95% CI: 2.26-4.58) to be depressed compared to those without asthma. Adult Nevadans with lifetime asthma were 2.6 times as likely (95% CI: 1.88-3.61) to be depressed compared to those without lifetime asthma. ACBS respondents indicated depression (38%), activity limitations (40%), sleep disturbance (26%), missing work or activities (31%), cost-related challenges (20%), healthcare usage (33%), environmental trigger exposure (96%) and severe asthma as indicated by use of oral corticosteroids (5%). The most significant correlations were found between depression, missing work/activities, activity limitation, emergency room /urgent care visits, oral corticosteroid use and reporting cost as a barrier.Conclusions: Asthma presence is associated with depression and negatively affects quality of life among adult Nevadans. A public health approach including education and outreach is critical to reduce the impact of asthma on mental health and quality of life.

Background: The current epidemic of opioid overdoses in the United States necessitates a robust public health and clinical response. We described patterns of non-fatal opioid overdoses (NFOODs) in a small western region using data from the 9-1-1 Computer Assisted Dispatch (CAD) record and electronic Patient Clinical Records (ePCR) completed by EMS responders. We determined whether CAD and ePCR variables could identify NFOOD cases in 9-1-1 data for intervention and surveillance efforts. Methods: We conducted a retrospective analysis of 1 year of 9-1-1 emergency medical CAD and ePCR (including naloxone administration) data from the sole EMS provider in the response area. Cases were identified based on clinician review of the ePCR, and categorized as definitive NFOOD, probable NFOOD, or non-OOD. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the most prevalent CAD and ePCR variables were calculated. We used a machine learning technique-Random-Forests (RF) modeling-to optimize our ability to accurately predict NFOOD cases within census blocks. Results: Of 37,960 9-1-1 calls, clinical review identified 158 NFOOD cases (0.4%), of which 123 (77.8%) were definitive and 35 (22.2%) were probable cases. Overall, 106 (67.1%) received naloxone from the EMS responder at the scene. As a predictor of NFOOD, naloxone administration by paramedics had 67.1% sensitivity, 99.6% specificity, 44% PPV, and 99.9% NPV. Using CAD variables alone achieved a sensitivity of 36.7% and specificity of 99.7%. Combining ePCR variables with CAD variables increased the diagnostic accuracy with the best RF model yielding 75.9% sensitivity, 99.9% specificity, 71.4% PPV, and 99.9% NPV. Conclusion: CAD problem type variables and naloxone administration, used alone or in combination, had sub-optimal predictive accuracy. However, a Random Forests modeling approach improved accuracy of identification, which could foster improved surveillance and intervention efforts. We identified the set of NFOODs that EMS encountered in a year and may be useful for future surveillance efforts.

Objective: Whereas states continue to experiment with liberalized marijuana laws, how these laws impact health, education, and social factors is not yet fully understood. In this study, we examined whether chronic school absenteeism rates changed in Washington State in the presence of recreational marijuana dispensaries pursuant to implementation of the state’s recreational marijuana laws. Methods: We conducted a secondary analysis using school district chronic absenteeism rates before and after the presence of recreational dispensaries. Results: The results of the independent samples t-test showed no statistically significant difference in chronic absenteeism rates among districts with or without recreational marijuana dispensaries. Conclusions: The finding of no statistical significance for chronic absenteeism in districts with and without recreational dispensaries – a pattern that largely persisted among at-risk groups – supports that the presence of recreational marijuana dispensaries seems neither to exacerbate nor improve chronic school absenteeism rates. This finding is important for policymakers, practitioners, and researchers trying to understand the changing marijuana legal landscape.

AbstractObjectives:Food security and school attendance are both important for health, well-being and academic performance of children and adolescents. However, their intersection remains underexamined, especially in the USA. The current study considered the association between elementary school-level absenteeism and household food insecurity.Design:The current study linked school-level absenteeism and household food insecurity rates using geographic information system mapping and applied the tobit regression model to examine their association.Setting:The Clark County, Nevada, public school district – the fifth largest in the USA and in a state with disproportionate food insecurity and chronic school absenteeism rates.Participants:Data consisted of school-level absenteeism rates from 185 elementary schools and census tract-level household food insecurity rates.Results:Average daily attendance rates were lower for schools with catchment areas that had higher average household food insecurity (FI), decreasing by −0·0232 % per 1 % increase in FI rate (P-value = 0·022). They were also significantly associated with most absenteeism risk factors. Average daily attendance rate was negatively associated with Free and Reduced Lunch eligibility percentage (−0·010 per 1 % increase in FI, P-value < 0·001) and Individualized Education Program participation percentage (−0·039 % per 1 % increase in FI, P-value = 0·033), but positively associated with parent–teacher conference participation rate (0·006 % per 1 % increase in FI, P-value = 0·025) and white student percentage (0·011 % per 1 % increase in FI, P-value = 0·022).Conclusions:The current study suggests a link between household food insecurity and elementary school-level absenteeism. Understanding this link is important for policy and practice because schools are frequent settings for food insecurity mitigation interventions.

In December 2020, we conducted a telephone survey to determine what factors are connected to COVID-19 vaccine hesitancy among adults in Nevada. The survey was based on factors identified in other studies, such as demographic variables (age, race, ethnicity, gender, household income, urbanicity, educational attainment), health status, previous COVID-19 infections, social media engagement, adherence to social distancing guidelines, beliefs about COVID-19, and political ideology identifications. Using a proportional odds model, we compared vaccine hesitancy levels to determine the odds of being more likely versus unlikely to get the COVID-19 vaccine. Of 1,000 people surveyed, 30.4% exhibited vaccine hesitancy. Findings showed that adults with significantly lower odds of vaccine hesitancy included those who were male, older, worried about COVID-19 infection or its community effects, adhered to social distancing, and reported higher incomes. Adults who identified as African American or Black or as multiple or "other" races exhibited significantly higher odds of vaccine hesitancy than White adults. Adults self-identifying as conservative had significantly higher odds of vaccine hesitancy than others. Vaccine hesitancy levels suggest possible hurdles to addressing the COVID-19 pandemic in a state with high visitor volumes and demographics that resemble the country's future as minority White, highlighting possible lessons for future pandemics. Most measures of COVID-19 worry were not significantly associated with vaccine hesitancy, suggesting that vaccination efforts should focus on other motivators. COVID-19 vaccination efforts should also directly encourage uptake by younger and middle-aged adults who are female, African American, have lower incomes, and identify as conservative.