The physical demands on U.S. service members have increased significantly over the past several decades as the number of military operations requiring overseas deployment have expanded in frequency, duration, and intensity. These elevated demands from military operations placed upon a small subset of the population may be resulting in a group of individuals more at-risk for a variety of debilitating health conditions. To better understand how the U.S Veterans health outcomes compared to non-Veterans, this study utilized the U.S. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) dataset to examine 10 different self-reported morbidities. Yearly age-adjusted, population estimates from 2003 to 2019 were used for Veteran vs. non-Veteran. Complex weights were used to evaluate the panel series for each morbidity overweight/obesity, heart disease, stroke, skin cancer, cancer, COPD, arthritis, mental health, kidney disease, and diabetes. General linear models (GLM’s) were created using 2019 data only to investigate any possible explanatory variables associated with these morbidities. The time series analysis showed that Veterans have disproportionately higher self-reported rates of each morbidity with the exception of mental health issues and heart disease. The GLM showed that when taking into account all the variables, Veterans disproportionately self-reported a higher amount of every morbidity with the exception of mental health. These data present an overall poor state of the health of the average U.S. Veteran. Our study findings suggest that when taken as a whole, these morbidities among Veterans could prompt the U.S. Department of Veteran Affairs (VA) to help develop more effective health interventions aimed at improving the overall health of the Veterans.

Cigarette butts, which are also known as tobacco product waste (TPW), are the single most collected item in environmental trash cleanups worldwide. This study used an online survey tool (Qualtrics) to assess knowledge, attitudes, and perceptions regarding this issue among individuals representing the Framework Convention Alliance (FCA). The FCA has about 680 members on its listserv, including non-governmental tobacco control advocacy groups that support the implementation of the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC). Respondents (n = 65) represented countries from all six WHO regions. The majority (82%) had heard the term TPW, and they all considered TPW as an environmental harm at some level. Additionally, 29% of respondents failed to identify that “cigarette filters make smoking easier”. Most (73%) correctly identified TPW components; however, fewer (60%) correctly identified the composition of cigarette butts. The majority (57%) were unfamiliar with Extended Producer Responsibility (EPR) and Product Stewardship (PS) as possible environmental intervention strategies. Respondents expressing opinions concurred that adding a litter fee to fund TPW programs will aid in reducing tobacco use and reduce the environmental impacts of TPW (100%); that prevention, reduction, and mitigation of TPW could be an important part of international tobacco control programs (98%); and, that banning smoking in outdoor venues could reduce TPW (95%). Only 16% reported effective prevention or clean-up efforts in their countries. Weighted rankings revealed that respondents’ saw the national government, the tobacco industry, and state governments as the most important in addressing TPW. The results of this research will inform continuing international discussions by the FCTC Conference of the Parties (COP) regarding environmental policies that may be addressed within FCTC obligations.

One of the United Nations Millennium Development Goals is to reduce the global proportion of people who do not have access to safe drinking water. In the past, the typical strategy to reach this goal has been the use of investment-intensive centralized infrastructure development for water supplies. However, there is increasing evidence suggesting that improving water quality at the source does not guarantee safe water at point-of-use. This study examined water quality, waterborne disease incidence and water system use over time in two small rural indigenous communities of Baja California, Mexico, before and after drinking-water infrastructure improvements. Community Promotoras collected data on the incidence of gastrointestinal illness through face-to-face surveys. Concurrently, water samples from the old and new water sources and household water storage containers were analyzed for fecal coliforms. Although source water quality was significantly improved in both communities (p < 0.05), neither community had a significant decrease in the level of contaminated drinking water sampled at the household level. No significant decrease in gastrointestinal illness was found after the improvements to the source water supply. These results indicate that point-of-use contamination and acceptance of the new sources may be a critical point for intervention when attempting to assure access to safe water, especially in rural communities.

Background: Chagas disease is a zoonotic infection caused by the parasite Trypanosoma cruzi, which affects an estimated 8–11 million people globally. Chagas disease is almost always associated with poverty in rural areas and disproportionately impacts immigrants from Latin America living in the United States. Approximately 20–30% of people who are infected with Chagas disease will develop a chronic form of the infection that can be fatal if left untreated. Chagas disease is vastly underestimated in the United States, often goes undiagnosed and is not well understood by most U.S. healthcare providers. One of the most important ways at reducing barriers to improving diagnostics of Chagas disease in the U.S. is giving healthcare providers the most up-to-date information and access to leading experts. Methods: An online webinar was conducted for healthcare providers, veterinarians and public health professionals using Chagas disease expert panelists. Pre and post tests were administered to participants (n = 57) to determine the efficacy in raising awareness and to determine key focus areas for improving knowledge. A Wilcoxon rank-sum was used for non-parametric variables equivalent and for questions that assessed knowledge the McNemar’s Chi-Square test was used. Results: There were statistically significant learning increases in multiple categories including transmission (p = <.001), clinical presentation (p = 0.016), diagnostics (p = <.001), and treatment (p = <.001). Conclusion: Providing easily accessible learning opportunities using validated testing and evaluations should be further developed for rural healthcare providers in the U.S. as well as healthcare providers serving under represented populations such as immigrants. There is a clear lack of knowledge and awareness surrounding Chagas disease in the United States and just by raising awareness and providing education on the topic, lives will be saved.

Chronic diseases affect a disproportionate number of United States (US) veterans, causing significant long-term health issues and affecting entitlement spending. This longitudinal study examined the health status of US veterans as compared to non-veterans pre- and post-COVID-19, utilizing the annual Center for Disease Control and Prevention (CDC) behavioral risk factor surveillance system (BRFSS) survey data. Age-adjusted descriptive point estimates were generated independently for 2003 through 2021, while complex weighted panel data were generated from 2011 and onward. General linear modeling revealed that the average US veteran reports a higher prevalence of disease conditions except for mental health disorders when compared to a non-veteran. These findings were consistent with both pre- and post-COVID-19; however, both groups reported a higher prevalence of mental health issues during the pandemic years. The findings suggest that there have been no improvements in reducing veteran comorbidities to non-veteran levels and that COVID-19 adversely affected the mental health of both populations.