Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.52434
Alexander R Levesque, Jessica Bytautas, Justine M Baek, Donna Spaner, Naheed Dosani, Venkata Vanganur, Trevor Morey
Importance: People experiencing homelessness face higher rates of early mortality, multimorbidity, and unmet needs at the end of life, but despite these risks, they often encounter systemic barriers to accessing palliative care. Outreach-based models have emerged to address this gap, yet little is known about how these models are perceived by those receiving care.
Objective: To evaluate a palliative care outreach intervention, the Palliative Education and Care for the Homeless (PEACH) program, from the perspective of patients living with homelessness and life-limiting illness.
Design, setting, and participants: This qualitative descriptive study using semistructured interviews with adult PEACH patients was conducted in Toronto, Ontario, Canada, between May 1, 2023, and November 30, 2024. PEACH participants were sampled purposively or conveniently. Interviews were conducted in person or by phone, transcribed verbatim, and analyzed using a reflexive, iterative approach informed by interpretive qualitative description.
Exposure: Receipt of care from the PEACH program during the research period.
Main outcomes and measures: Patients' experiences with the PEACH program, perspectives on program benefits, and evaluation of program strengths and weaknesses.
Results: Fourteen patients between the ages of 20 and 70 years were interviewed: 7 with malignant conditions and 7 with nonmalignant conditions. All but 2 participants were men. The mean (range) duration of contact with PEACH at interview was 18 (3-69) months. Six major themes were identified: life before PEACH, outreach and community care, medical needs, social needs, relational care, and constructive feedback. PEACH addressed barriers by providing low-barrier access and coordination across health care professionals. Participants described improvements in pain and symptom management, mental health, access to supplies, and support with income and housing. The team's compassionate, person-centered approach, described as relational care, was central to participants' trust and engagement. Many said they would not be alive without the intervention. Although most feedback was positive, some participants noted areas for improvement, including communication gaps and lack of a single assigned palliative care physician.
Conclusions and relevance: In this qualitative study of a palliative care outreach intervention from the perspective of people experiencing homelessness, participants emphasized the need for an accessible, compassionate approach that addresses medical and social needs. Findings offer insights for future outreach program development and evaluation.
{"title":"Patient Perspectives on Palliative Care Outreach to Adults Living With Homelessness.","authors":"Alexander R Levesque, Jessica Bytautas, Justine M Baek, Donna Spaner, Naheed Dosani, Venkata Vanganur, Trevor Morey","doi":"10.1001/jamanetworkopen.2025.52434","DOIUrl":"10.1001/jamanetworkopen.2025.52434","url":null,"abstract":"<p><strong>Importance: </strong>People experiencing homelessness face higher rates of early mortality, multimorbidity, and unmet needs at the end of life, but despite these risks, they often encounter systemic barriers to accessing palliative care. Outreach-based models have emerged to address this gap, yet little is known about how these models are perceived by those receiving care.</p><p><strong>Objective: </strong>To evaluate a palliative care outreach intervention, the Palliative Education and Care for the Homeless (PEACH) program, from the perspective of patients living with homelessness and life-limiting illness.</p><p><strong>Design, setting, and participants: </strong>This qualitative descriptive study using semistructured interviews with adult PEACH patients was conducted in Toronto, Ontario, Canada, between May 1, 2023, and November 30, 2024. PEACH participants were sampled purposively or conveniently. Interviews were conducted in person or by phone, transcribed verbatim, and analyzed using a reflexive, iterative approach informed by interpretive qualitative description.</p><p><strong>Exposure: </strong>Receipt of care from the PEACH program during the research period.</p><p><strong>Main outcomes and measures: </strong>Patients' experiences with the PEACH program, perspectives on program benefits, and evaluation of program strengths and weaknesses.</p><p><strong>Results: </strong>Fourteen patients between the ages of 20 and 70 years were interviewed: 7 with malignant conditions and 7 with nonmalignant conditions. All but 2 participants were men. The mean (range) duration of contact with PEACH at interview was 18 (3-69) months. Six major themes were identified: life before PEACH, outreach and community care, medical needs, social needs, relational care, and constructive feedback. PEACH addressed barriers by providing low-barrier access and coordination across health care professionals. Participants described improvements in pain and symptom management, mental health, access to supplies, and support with income and housing. The team's compassionate, person-centered approach, described as relational care, was central to participants' trust and engagement. Many said they would not be alive without the intervention. Although most feedback was positive, some participants noted areas for improvement, including communication gaps and lack of a single assigned palliative care physician.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study of a palliative care outreach intervention from the perspective of people experiencing homelessness, participants emphasized the need for an accessible, compassionate approach that addresses medical and social needs. Findings offer insights for future outreach program development and evaluation.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2552434"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12809365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.51878
Jordan L Thomas, Robyn A Ellis, Krystel AbiKaram, Shady Abohashem, Anahita Dua, Emily S Lau, Maureen J MacDonald, Karen K Miller, Suzanne L Pineles, Rachel P Rosovsky, Ahmed Tawakol, Michael T Osborne, Antonia V Seligowski
<p><strong>Importance: </strong>Stress and its psychiatric consequences-including depression, anxiety, and posttraumatic stress disorder (PTSD)-are pertinent to women's cardiovascular health, but research on intersections with relevant sex-specific factors (eg, hormonal contraceptives) is lacking.</p><p><strong>Objective: </strong>To examine whether stress-related psychiatric diagnoses moderate associations between hormonal contraceptive use and cardiovascular and thrombotic risk.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included electronic health record data collected from a US hospital-based biobank and analyzed from May 2, 2024, to November 3, 2025. Participants were women aged 18 to 55 years who consented into the biobank before or on September 12, 2020.</p><p><strong>Exposures: </strong>Lifetime history of stress-related psychiatric disorders, including depression (major depressive disorder), anxiety (generalized anxiety disorder, social anxiety disorder, or panic disorder), and PTSD, defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes and analyzed as separate diagnoses, and lifetime history of combined hormonal contraceptive use, defined by RxNorm codes.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were major adverse cardiovascular events (MACE; defined as ICD-10 codes for infarction, unstable angina, heart failure, coronary revascularization, peripheral vascular disease, peripheral revascularization, stroke, and/or transient ischemic attack) and deep-vein thrombosis (DVT). Three 2-step hierarchical logistic regressions per outcome were conducted.</p><p><strong>Results: </strong>In this sample of 31 824 women (mean [SD] age, 38.5 [10.6] years), over one-third (11 950 women [37.6%]) had hormonal contraceptive use history, and stress-related disorders were common (depression, 9116 women [28.5%]; anxiety, 3533 women [11.1%]; PTSD, 1992 women [6.3%]). Associations were mixed across the stress-related disorders, in that depression and anxiety did not moderate associations between contraceptive use and MACE or DVT. In contrast, PTSD modified the association between contraceptive use and MACE but not that between contraceptive use and DVT. Analyses stratified by PTSD status found that only women without PTSD using contraceptives had lower odds for MACE (odds ratio, 0.69; 95% CI, 0.87-3.24). The odds ratio for MACE among women with PTSD was greater than 1, but the finding was not statistically significant (odds ratio, 1.68; 95% CI, 0.87-3.24).</p><p><strong>Conclusions and relevance: </strong>In this retrospective cohort study, combined hormonal contraceptive use was associated with lower cardiovascular risk in women regardless of depression or anxiety. These protective associations did not extend to women with PTSD, suggesting that there are unique cardiovascular processes in the context of this stress-
重要性：压力及其精神后果——包括抑郁、焦虑和创伤后应激障碍（PTSD）——与女性心血管健康有关，但缺乏与相关性别特异性因素（如激素避孕药）的交叉研究。目的：探讨应激相关的精神病学诊断是否与激素避孕药的使用与心血管和血栓形成风险之间存在中度关联。设计、环境和参与者：这项回顾性队列研究包括从美国一家医院的生物银行收集的电子健康记录数据，并从2024年5月2日至2025年11月3日进行分析。参与者是年龄在18至55岁之间的女性，她们在2020年9月12日之前或之后同意进入生物库。暴露：与压力相关的精神疾病的终生病史，包括抑郁症（重度抑郁症）、焦虑症（广泛性焦虑症、社交焦虑症或恐慌症）和创伤后应激障碍（PTSD），由国际疾病和相关健康问题统计分类第十版（ICD-10）代码定义并作为单独诊断进行分析，以及使用联合激素避孕药的终生历史，由RxNorm代码定义。主要结局和措施：主要结局为主要不良心血管事件（MACE，定义为ICD-10编码，包括梗死、不稳定型心绞痛、心力衰竭、冠状动脉血运重建、外周血管疾病、外周血运重建、卒中和/或短暂性脑缺血发作）和深静脉血栓形成（DVT）。对每个结果进行了三个两步层次逻辑回归。结果：本组31 824例女性（平均[SD]年龄38.5[10.6]岁）中，超过三分之一（11 950例[37.6%]）有激素避孕药使用史，常见应激相关疾病（抑郁症9116例[28.5%]；焦虑症3533例[11.1%]；PTSD 1992例[6.3%]）。与压力相关的疾病之间的关联是混合的，抑郁和焦虑并没有缓和避孕药使用与MACE或DVT之间的关联。相比之下，创伤后应激障碍改变了避孕药使用与MACE之间的关系，但没有改变避孕药使用与DVT之间的关系。按创伤后应激障碍状况分层分析发现，只有没有创伤后应激障碍的妇女使用避孕药发生MACE的几率较低（优势比0.69;95% CI 0.87-3.24）。PTSD患者中MACE的优势比大于1，但该发现无统计学意义（优势比为1.68；95% CI为0.87-3.24）。结论和相关性：在这项回顾性队列研究中，无论是否有抑郁或焦虑，联合使用激素避孕药与较低的心血管风险相关。这些保护性关联并未延伸到患有PTSD的女性，这表明在这种压力相关障碍和激素避孕药使用的背景下存在独特的心血管过程，值得进一步研究。
{"title":"Hormonal Contraceptive Use, Stress Disorders, and Cardiovascular and Thrombotic Risk in Women.","authors":"Jordan L Thomas, Robyn A Ellis, Krystel AbiKaram, Shady Abohashem, Anahita Dua, Emily S Lau, Maureen J MacDonald, Karen K Miller, Suzanne L Pineles, Rachel P Rosovsky, Ahmed Tawakol, Michael T Osborne, Antonia V Seligowski","doi":"10.1001/jamanetworkopen.2025.51878","DOIUrl":"10.1001/jamanetworkopen.2025.51878","url":null,"abstract":"<p><strong>Importance: </strong>Stress and its psychiatric consequences-including depression, anxiety, and posttraumatic stress disorder (PTSD)-are pertinent to women's cardiovascular health, but research on intersections with relevant sex-specific factors (eg, hormonal contraceptives) is lacking.</p><p><strong>Objective: </strong>To examine whether stress-related psychiatric diagnoses moderate associations between hormonal contraceptive use and cardiovascular and thrombotic risk.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included electronic health record data collected from a US hospital-based biobank and analyzed from May 2, 2024, to November 3, 2025. Participants were women aged 18 to 55 years who consented into the biobank before or on September 12, 2020.</p><p><strong>Exposures: </strong>Lifetime history of stress-related psychiatric disorders, including depression (major depressive disorder), anxiety (generalized anxiety disorder, social anxiety disorder, or panic disorder), and PTSD, defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes and analyzed as separate diagnoses, and lifetime history of combined hormonal contraceptive use, defined by RxNorm codes.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were major adverse cardiovascular events (MACE; defined as ICD-10 codes for infarction, unstable angina, heart failure, coronary revascularization, peripheral vascular disease, peripheral revascularization, stroke, and/or transient ischemic attack) and deep-vein thrombosis (DVT). Three 2-step hierarchical logistic regressions per outcome were conducted.</p><p><strong>Results: </strong>In this sample of 31 824 women (mean [SD] age, 38.5 [10.6] years), over one-third (11 950 women [37.6%]) had hormonal contraceptive use history, and stress-related disorders were common (depression, 9116 women [28.5%]; anxiety, 3533 women [11.1%]; PTSD, 1992 women [6.3%]). Associations were mixed across the stress-related disorders, in that depression and anxiety did not moderate associations between contraceptive use and MACE or DVT. In contrast, PTSD modified the association between contraceptive use and MACE but not that between contraceptive use and DVT. Analyses stratified by PTSD status found that only women without PTSD using contraceptives had lower odds for MACE (odds ratio, 0.69; 95% CI, 0.87-3.24). The odds ratio for MACE among women with PTSD was greater than 1, but the finding was not statistically significant (odds ratio, 1.68; 95% CI, 0.87-3.24).</p><p><strong>Conclusions and relevance: </strong>In this retrospective cohort study, combined hormonal contraceptive use was associated with lower cardiovascular risk in women regardless of depression or anxiety. These protective associations did not extend to women with PTSD, suggesting that there are unique cardiovascular processes in the context of this stress-","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2551878"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12761333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.52140
William M Garneau, Eric C Strain, Michael I Fingerhood
{"title":"Challenges With Buprenorphine Initiation in the Fentanyl Era-Adapting Effectively to the Moment.","authors":"William M Garneau, Eric C Strain, Michael I Fingerhood","doi":"10.1001/jamanetworkopen.2025.52140","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.52140","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2552140"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.53179
Gabriella Morabito, Giovanni Corrao, Carlo Giaquinto, Anna Cantarutti, Costanza Di Chiara
Importance: Influenza and tetanus-diphtheria-acellular pertussis (Tdap) vaccinations during pregnancy offer protection to infants from infections. However, evidence about their effectiveness against hospitalization and emergency department (ED) visits associated with influenza and pertussis remains limited.
Objective: This study aimed to evaluate the association of maternal influenza and Tdap vaccinations with influenza- and pertussis-related hospitalizations and ED visits in infants younger than 6 months.
Design, setting, and participants: This population-based cohort study used the health care utilization databases from the Lombardy region of Italy. Pregnant individuals who received the influenza and Tdap vaccine among all live-birth pregnancies in 2018 to 2022 were included. Each vaccinated mother was matched with a nonvaccinated counterpart based on month and year of delivery, gestational age at birth, and pregnancy multiplicity. Analyses were performed from April 2024 to February 2025.
Exposures: Exposures of interest were influenza and Tdap vaccinations during pregnancy.
Main outcomes and measures: The primary outcomes were infant hospitalizations or ED visits due to influenza and pertussis. Cox regression models were fitted to estimate the hazard ratio (HR) of each outcome associated with the corresponding maternal vaccine. Vaccine effectiveness (VE) was calculated as VE = (1 - HR) × 100%.
Results: This study included 53 448 pregnant individuals who received the Tdap vaccine and 5347 who received influenza vaccine. The maternal vaccination coverage (ie, proportion of vaccinated pregnant individuals among those eligible) was 5359 (6.4%) for influenza and 70 119 (41.0%) for Tdap, respectively. Infants born to mothers who received the influenza and Tdap vaccine had a lower risk of hospitalization or ED visit for influenza (VE, 69.7%; 95% CI, 8.7%-90.0%) and pertussis (VE, 88.6%; 95% CI, 11.5%-98.5%), respectively.
Conclusions and relevance: This study found that maternal influenza and Tdap vaccinations were associated with reduced influenza- and pertussis-related hospitalization or ED visits in infants younger than 6 months. Given the low vaccination coverage, it is crucial to implement maternal vaccination campaigns to enhance infant health outcomes.
{"title":"Maternal Vaccine Receipt and Infant Hospital and Emergency Visits for Influenza and Pertussis.","authors":"Gabriella Morabito, Giovanni Corrao, Carlo Giaquinto, Anna Cantarutti, Costanza Di Chiara","doi":"10.1001/jamanetworkopen.2025.53179","DOIUrl":"10.1001/jamanetworkopen.2025.53179","url":null,"abstract":"<p><strong>Importance: </strong>Influenza and tetanus-diphtheria-acellular pertussis (Tdap) vaccinations during pregnancy offer protection to infants from infections. However, evidence about their effectiveness against hospitalization and emergency department (ED) visits associated with influenza and pertussis remains limited.</p><p><strong>Objective: </strong>This study aimed to evaluate the association of maternal influenza and Tdap vaccinations with influenza- and pertussis-related hospitalizations and ED visits in infants younger than 6 months.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study used the health care utilization databases from the Lombardy region of Italy. Pregnant individuals who received the influenza and Tdap vaccine among all live-birth pregnancies in 2018 to 2022 were included. Each vaccinated mother was matched with a nonvaccinated counterpart based on month and year of delivery, gestational age at birth, and pregnancy multiplicity. Analyses were performed from April 2024 to February 2025.</p><p><strong>Exposures: </strong>Exposures of interest were influenza and Tdap vaccinations during pregnancy.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were infant hospitalizations or ED visits due to influenza and pertussis. Cox regression models were fitted to estimate the hazard ratio (HR) of each outcome associated with the corresponding maternal vaccine. Vaccine effectiveness (VE) was calculated as VE = (1 - HR) × 100%.</p><p><strong>Results: </strong>This study included 53 448 pregnant individuals who received the Tdap vaccine and 5347 who received influenza vaccine. The maternal vaccination coverage (ie, proportion of vaccinated pregnant individuals among those eligible) was 5359 (6.4%) for influenza and 70 119 (41.0%) for Tdap, respectively. Infants born to mothers who received the influenza and Tdap vaccine had a lower risk of hospitalization or ED visit for influenza (VE, 69.7%; 95% CI, 8.7%-90.0%) and pertussis (VE, 88.6%; 95% CI, 11.5%-98.5%), respectively.</p><p><strong>Conclusions and relevance: </strong>This study found that maternal influenza and Tdap vaccinations were associated with reduced influenza- and pertussis-related hospitalization or ED visits in infants younger than 6 months. Given the low vaccination coverage, it is crucial to implement maternal vaccination campaigns to enhance infant health outcomes.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2553179"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.48703
Gregor Berger, Isabelle Häberling, Sophie Emery, Mona Albermann, Noemi Baumgartner, Kristin Nalani, Michael Strumberger, Lars Wöckel, Suzanne Erb, Silke Bachmann, Ulrich Müller-Knapp, Brigitte Contin-Waldvogel, Amir Yamini, Bruno Rhiner, Renate Drechsler, Ulrike Held, Kelly Reeve, Priska Heinz, Dagmar Pauli, Klaus Schmeck, Martin Hersberger, Susanne Walitza
<p><strong>Importance: </strong>Meta-analyses of ω-3 fatty acids for depression have reported inconsistent results, and pediatric evidence is sparse. Promotion of unproven supplements may delay evidence-based care.</p><p><strong>Objective: </strong>To evaluate whether adjunctive ω-3 fatty acid supplementation improves outcomes in moderate-to-severe pediatric major depressive disorder (MDD).</p><p><strong>Design, setting, and participants: </strong>In a multicenter, double-blind, placebo-controlled randomized clinical trial at 5 Swiss child and adolescent psychiatry centers, 257 youths with MDD were enrolled and randomized between April 28, 2017, and March 24, 2022, and followed up for 36 weeks, with final analysis from July 1, 2022, to January 26, 2023. Analysis was based on intention to treat.</p><p><strong>Interventions: </strong>Participants received ω-3 fatty acids, 1.5 g/d (1 g of eicosapentaenoic acid [EPA] and 0.5 g of docosahexaenoic acid [DHA], 2:1 ratio), or medium-chain triglyceride placebo in combination with standardized psychotherapy. Antidepressant use was permitted per national guidelines.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the trajectory of Children's Depression Rating Scale-Revised (CDRS-R) scores analyzed with a joint mixed-effects and time-to-event model accounting for dropout or initiation of off-trial antidepressant therapy. Secondary outcomes included response (≥30% reduction in CDRS-R scores), remission (CDRS-R score ≤28), self-rated depression, quality of life, suicidality, and safety.</p><p><strong>Results: </strong>Of 257 randomized participants (mean [SD] age, 15.7 [1.7] years; 188 [73.2%] female; mean [SD] CDRS-R score, 58.5 [8.8]), 129 received ω-3 supplements and 128 received placebo. The mean (SD) CDRS-R scores decreased similarly in both groups: at 12 weeks, 45.93 (11.98) vs 46.08 (12.99); at 36 weeks, 36.50 (13.12) vs 36.83 (15.46). The adjusted mean difference in CDRS-R scores was 0.77 (95% CI, -1.39 to 2.93; P = .49) points. The hazard ratio for time to dropout was 1.22 (95% CI, 0.83-1.79; P = .32). Response occurred in 34 of 109 (31.2%) ω-3 recipients vs 43 of 110 (39.1%) placebo recipients at 12 weeks; remission occurred at 36 weeks in 30 of 94 ω-3 recipients (31.9%) vs 37 of 90 (41.1%) placebo recipients (all differences were nonsignificant). Secondary measures and suicidality improved without between-group differences. EPA plus DHA levels expressed by the ω-3 index rose by a mean (SD) of 4.33% (1.54%) and 4.88% (2.38%) at 12 and 36 weeks, respectively, in the ω-3 arm, confirming adherence. A total of 76 serious adverse events were reported in 97 participants, with 31 occurring in the placebo arm and 45 in the ω-3 arm. These included 28 suicide attempts, but no deaths or permanent disabilities. None of these were judged to be causally related to the study medication.</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, adjunctive ω-3 adm
{"title":"ω-3 Fatty Acids in Pediatric Major Depressive Disorder: A Randomized Clinical Trial.","authors":"Gregor Berger, Isabelle Häberling, Sophie Emery, Mona Albermann, Noemi Baumgartner, Kristin Nalani, Michael Strumberger, Lars Wöckel, Suzanne Erb, Silke Bachmann, Ulrich Müller-Knapp, Brigitte Contin-Waldvogel, Amir Yamini, Bruno Rhiner, Renate Drechsler, Ulrike Held, Kelly Reeve, Priska Heinz, Dagmar Pauli, Klaus Schmeck, Martin Hersberger, Susanne Walitza","doi":"10.1001/jamanetworkopen.2025.48703","DOIUrl":"10.1001/jamanetworkopen.2025.48703","url":null,"abstract":"<p><strong>Importance: </strong>Meta-analyses of ω-3 fatty acids for depression have reported inconsistent results, and pediatric evidence is sparse. Promotion of unproven supplements may delay evidence-based care.</p><p><strong>Objective: </strong>To evaluate whether adjunctive ω-3 fatty acid supplementation improves outcomes in moderate-to-severe pediatric major depressive disorder (MDD).</p><p><strong>Design, setting, and participants: </strong>In a multicenter, double-blind, placebo-controlled randomized clinical trial at 5 Swiss child and adolescent psychiatry centers, 257 youths with MDD were enrolled and randomized between April 28, 2017, and March 24, 2022, and followed up for 36 weeks, with final analysis from July 1, 2022, to January 26, 2023. Analysis was based on intention to treat.</p><p><strong>Interventions: </strong>Participants received ω-3 fatty acids, 1.5 g/d (1 g of eicosapentaenoic acid [EPA] and 0.5 g of docosahexaenoic acid [DHA], 2:1 ratio), or medium-chain triglyceride placebo in combination with standardized psychotherapy. Antidepressant use was permitted per national guidelines.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the trajectory of Children's Depression Rating Scale-Revised (CDRS-R) scores analyzed with a joint mixed-effects and time-to-event model accounting for dropout or initiation of off-trial antidepressant therapy. Secondary outcomes included response (≥30% reduction in CDRS-R scores), remission (CDRS-R score ≤28), self-rated depression, quality of life, suicidality, and safety.</p><p><strong>Results: </strong>Of 257 randomized participants (mean [SD] age, 15.7 [1.7] years; 188 [73.2%] female; mean [SD] CDRS-R score, 58.5 [8.8]), 129 received ω-3 supplements and 128 received placebo. The mean (SD) CDRS-R scores decreased similarly in both groups: at 12 weeks, 45.93 (11.98) vs 46.08 (12.99); at 36 weeks, 36.50 (13.12) vs 36.83 (15.46). The adjusted mean difference in CDRS-R scores was 0.77 (95% CI, -1.39 to 2.93; P = .49) points. The hazard ratio for time to dropout was 1.22 (95% CI, 0.83-1.79; P = .32). Response occurred in 34 of 109 (31.2%) ω-3 recipients vs 43 of 110 (39.1%) placebo recipients at 12 weeks; remission occurred at 36 weeks in 30 of 94 ω-3 recipients (31.9%) vs 37 of 90 (41.1%) placebo recipients (all differences were nonsignificant). Secondary measures and suicidality improved without between-group differences. EPA plus DHA levels expressed by the ω-3 index rose by a mean (SD) of 4.33% (1.54%) and 4.88% (2.38%) at 12 and 36 weeks, respectively, in the ω-3 arm, confirming adherence. A total of 76 serious adverse events were reported in 97 participants, with 31 occurring in the placebo arm and 45 in the ω-3 arm. These included 28 suicide attempts, but no deaths or permanent disabilities. None of these were judged to be causally related to the study medication.</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, adjunctive ω-3 adm","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2548703"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12761337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.50664
Erika G Cordova-Ramos, Stacey Y Ruiz, Genevieve G Guyol, Nikita S Kalluri, Mei Elansary, Margaret McConnell, Margaret G Parker
<p><strong>Importance: </strong>There are well-documented racial and ethnic disparities in preterm birth in the US. The role of household income in temporal preterm birth trends remains largely unexplored.</p><p><strong>Objective: </strong>To examine US preterm birth trends by household income from 2011 to 2021, as well as associations between income and preterm birth according to race and ethnicity.</p><p><strong>Design, setting, and participants: </strong>This US population-based, cross-sectional study used data on 411 469 mothers of infants aged 2 to 4 months from the nationally representative Pregnancy Risk Assessment Monitoring System database from 2011 to 2021. Data were analyzed from January to April 2024.</p><p><strong>Exposures: </strong>Mothers reported annual household income, which was categorized as less than 100% of the federal poverty level (FPL), 100% to 199% of the FPL, and 200% or more of the FPL based on year, state, and household size.</p><p><strong>Main outcome and measures: </strong>The main outcome was preterm birth, defined as birth at less than 37 weeks' gestation. Maternal self-reported race and ethnicity was defined as American Indian or Alaska Native, Asian, Hispanic (any race), non-Hispanic Black, non-Hispanic White, and other or multiracial. Trends in preterm birth by income categories were examined, and modified Poisson regression models were built to (1) examine the association between income and preterm birth, (2) adjust for sociodemographic and pregnancy-related covariates, (3) adjust additionally for race and ethnicity, and (4) introduce an interaction between race and ethnicity and income.</p><p><strong>Results: </strong>Among 411 469 (weighted 20 million) mother-infant dyads (0.8% American Indian or Alaska Native, 5.5% Asian, 15.5% Hispanic, 14.1% non-Hispanic Black, 58.9% non-Hispanic White, and 3.1% other or multiracial), rates of preterm birth increased significantly over time in the groups reporting an annual household income of less than 100% of the FPL (2011, 9.7%; 2021, 11.1%) and 100% to 199% of the FPL (2011, 7.8%; 2021, 10.0%). The preterm birth rate was highest among households reporting household income less than 100% of the FPL within all racial and ethnic groups except Asian. Non-Hispanic Black mothers had the highest rates of preterm birth across all income categories. The association of income with preterm birth remained significant after adjusting for covariates but attenuated to the null after including race and ethnicity in the model. In the lowest income group, non-Hispanic Black mothers had a 19% greater risk of preterm birth compared with non-Hispanic White mothers (adjusted relative risk [ARR], 1.19; 95% CI, 1.11-1.27), whereas in the highest income group, non-Hispanic Black mothers had a 13% greater risk of preterm birth compared with non-Hispanic White mothers (ARR, 1.13; 95% CI, 1.01-1.26).</p><p><strong>Conclusions: </strong>In this population-based cross-sectional study, household i
{"title":"Trends in US Preterm Birth Rates by Household Income and Race and Ethnicity.","authors":"Erika G Cordova-Ramos, Stacey Y Ruiz, Genevieve G Guyol, Nikita S Kalluri, Mei Elansary, Margaret McConnell, Margaret G Parker","doi":"10.1001/jamanetworkopen.2025.50664","DOIUrl":"10.1001/jamanetworkopen.2025.50664","url":null,"abstract":"<p><strong>Importance: </strong>There are well-documented racial and ethnic disparities in preterm birth in the US. The role of household income in temporal preterm birth trends remains largely unexplored.</p><p><strong>Objective: </strong>To examine US preterm birth trends by household income from 2011 to 2021, as well as associations between income and preterm birth according to race and ethnicity.</p><p><strong>Design, setting, and participants: </strong>This US population-based, cross-sectional study used data on 411 469 mothers of infants aged 2 to 4 months from the nationally representative Pregnancy Risk Assessment Monitoring System database from 2011 to 2021. Data were analyzed from January to April 2024.</p><p><strong>Exposures: </strong>Mothers reported annual household income, which was categorized as less than 100% of the federal poverty level (FPL), 100% to 199% of the FPL, and 200% or more of the FPL based on year, state, and household size.</p><p><strong>Main outcome and measures: </strong>The main outcome was preterm birth, defined as birth at less than 37 weeks' gestation. Maternal self-reported race and ethnicity was defined as American Indian or Alaska Native, Asian, Hispanic (any race), non-Hispanic Black, non-Hispanic White, and other or multiracial. Trends in preterm birth by income categories were examined, and modified Poisson regression models were built to (1) examine the association between income and preterm birth, (2) adjust for sociodemographic and pregnancy-related covariates, (3) adjust additionally for race and ethnicity, and (4) introduce an interaction between race and ethnicity and income.</p><p><strong>Results: </strong>Among 411 469 (weighted 20 million) mother-infant dyads (0.8% American Indian or Alaska Native, 5.5% Asian, 15.5% Hispanic, 14.1% non-Hispanic Black, 58.9% non-Hispanic White, and 3.1% other or multiracial), rates of preterm birth increased significantly over time in the groups reporting an annual household income of less than 100% of the FPL (2011, 9.7%; 2021, 11.1%) and 100% to 199% of the FPL (2011, 7.8%; 2021, 10.0%). The preterm birth rate was highest among households reporting household income less than 100% of the FPL within all racial and ethnic groups except Asian. Non-Hispanic Black mothers had the highest rates of preterm birth across all income categories. The association of income with preterm birth remained significant after adjusting for covariates but attenuated to the null after including race and ethnicity in the model. In the lowest income group, non-Hispanic Black mothers had a 19% greater risk of preterm birth compared with non-Hispanic White mothers (adjusted relative risk [ARR], 1.19; 95% CI, 1.11-1.27), whereas in the highest income group, non-Hispanic Black mothers had a 13% greater risk of preterm birth compared with non-Hispanic White mothers (ARR, 1.13; 95% CI, 1.01-1.26).</p><p><strong>Conclusions: </strong>In this population-based cross-sectional study, household i","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2550664"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12761331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Importance: </strong>Asian faculty members remain underrepresented in leadership positions within academic medicine, despite comprising a substantial proportion of the workforce. The structural and cultural factors associated with the slower advancement remain underexplored in empirical literature and institutional policy.</p><p><strong>Objectives: </strong>To examine the barriers to career advancement among Asian faculty members, assess perceptions and understanding of sponsorship, and identify institutional strategies to promote broader access to sponsorship opportunities and leadership development.</p><p><strong>Design, setting, and participants: </strong>This qualitative study employed 5 focus groups conducted between January 18 and July 17, 2024, supplemented by real-time polling before and after an educational intervention. Thematic analysis of transcripts was used to identify common barriers and recommendations, with poll data providing a descriptive context. In a single, large private nonprofit and research intensive academic medical center in the northeastern United States, self-identified Asian or Asian American midlevel faculty members at the associate professor level participated. Participants were recruited via institutional office outreach, and responses from all recruited participants were included in the study. Data were analyzed from July 25 to September 24, 2024.</p><p><strong>Exposure: </strong>An educational session distinguishing sponsorship from mentorship, followed by a facilitated group discussion and anonymous survey participation using the Poll Everywhere platform.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes included changes in participants' self-reported understanding of sponsorship and identification of perceived personal, institutional, and departmental barriers to career advancement. Thematic categories were derived from focus group transcripts and corroborated with quantitative poll responses.</p><p><strong>Results: </strong>Of the 32 participants who completed the survey, 18 (56.3%) initially believed that they had a sponsor; after the intervention, this percentage decreased to 37.5% (12 of 32) once sponsorship was more clearly defined. The participation rate was 93.7% (30 of 32) among those who joined the focus groups. Reported barriers included cultural norms discouraging self-promotion, limited access to decision-makers, intersectional identity challenges, and perceptions of institutional opacity and favoritism. Faculty emphasized the value of transparent nomination processes, intentional sponsor training, and relationship-centered sponsorship models.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study of midlevel Asian faculty members, participants faced persistent, multifactorial barriers to leadership in academic medicine, amplified by cultural values and institutional norms. Institutions must formalize sponsorship programs, ensure transparent advance
{"title":"Sponsorship and Career Advancement for Asian Medical Faculty.","authors":"Dale Sebastian, Karina Gonzalez Herrera, Mohini Ranganathan, Angeli Landeros-Weisenberger, Darin Latimore","doi":"10.1001/jamanetworkopen.2025.53241","DOIUrl":"10.1001/jamanetworkopen.2025.53241","url":null,"abstract":"<p><strong>Importance: </strong>Asian faculty members remain underrepresented in leadership positions within academic medicine, despite comprising a substantial proportion of the workforce. The structural and cultural factors associated with the slower advancement remain underexplored in empirical literature and institutional policy.</p><p><strong>Objectives: </strong>To examine the barriers to career advancement among Asian faculty members, assess perceptions and understanding of sponsorship, and identify institutional strategies to promote broader access to sponsorship opportunities and leadership development.</p><p><strong>Design, setting, and participants: </strong>This qualitative study employed 5 focus groups conducted between January 18 and July 17, 2024, supplemented by real-time polling before and after an educational intervention. Thematic analysis of transcripts was used to identify common barriers and recommendations, with poll data providing a descriptive context. In a single, large private nonprofit and research intensive academic medical center in the northeastern United States, self-identified Asian or Asian American midlevel faculty members at the associate professor level participated. Participants were recruited via institutional office outreach, and responses from all recruited participants were included in the study. Data were analyzed from July 25 to September 24, 2024.</p><p><strong>Exposure: </strong>An educational session distinguishing sponsorship from mentorship, followed by a facilitated group discussion and anonymous survey participation using the Poll Everywhere platform.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes included changes in participants' self-reported understanding of sponsorship and identification of perceived personal, institutional, and departmental barriers to career advancement. Thematic categories were derived from focus group transcripts and corroborated with quantitative poll responses.</p><p><strong>Results: </strong>Of the 32 participants who completed the survey, 18 (56.3%) initially believed that they had a sponsor; after the intervention, this percentage decreased to 37.5% (12 of 32) once sponsorship was more clearly defined. The participation rate was 93.7% (30 of 32) among those who joined the focus groups. Reported barriers included cultural norms discouraging self-promotion, limited access to decision-makers, intersectional identity challenges, and perceptions of institutional opacity and favoritism. Faculty emphasized the value of transparent nomination processes, intentional sponsor training, and relationship-centered sponsorship models.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study of midlevel Asian faculty members, participants faced persistent, multifactorial barriers to leadership in academic medicine, amplified by cultural values and institutional norms. Institutions must formalize sponsorship programs, ensure transparent advance","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2553241"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12789948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.53413
Christopher B Gage, Jacob C Kamholz, Jonathan R Powell, Michelle M J Nassal, Henry E Wang, Ashish R Panchal
Importance: During out-of-hospital cardiac arrest (OHCA), initial airway device choice as well as final device choice in the event of failure may both influence overall procedural success and patient outcomes. Understanding national practice patterns in airway device placement may inform resuscitation strategies and system-level quality improvement.
Objective: To assess patterns in the order of advanced airway device use for adults in the United States receiving OHCA treatment during emergency medical service (EMS) activations.
Design, setting, and participants: This retrospective cross-sectional study used data from the National EMS Information System (NEMSIS) database from January 2018 to December 2023. During this period, NEMSIS included more than 256 million EMS activations from nearly 14 000 agencies across 54 states and territories. Activations for 911 responses during adult OHCA with advanced airway device attempts after EMS arrival, with documented success (yes or no) and number of attempts, were included.
Exposures: Advanced airway devices documented by EMS clinicians.
Main outcome and measures: Order of advanced airway device use, measured by EMS clinician documentation.
Results: From 2018 to 2023, EMS reported 2 365 224 activations involving adults having an OHCA, with 650 440 patients (0.3%) receiving either endotracheal intubation (ETI) and/or supraglottic airway (SGA). Most patients received a successful initial airway device attempt (503 774 [77.4%]). Although ETI was the most common initial airway device (458 546 [70.5%]), SGA had a higher first-pass success rate (93.0% vs 71.0%). Among patients whose first ETI attempt failed (133 177 of 458 546 [29.0%]), the final documented device remained ETI in 72 167 cases (72.3%) and changed to SGA in 27 651 (27.7%). Among patients whose first SGA attempt failed, 13 480 (61.9%) remained with SGA and 3388 (38.1%) were switched to ETI.
Conclusions and relevance: In this cross-sectional study, most patients with OHCA received ETI as the first advanced airway procedure, despite higher SGA first-pass success. Among patients whose initial attempt failed, most continued with the same device. However, switching from ETI to SGA had a higher final success rates. These findings highlight the importance of airway device sequence in prehospital care and may inform training and protocols for airway management.
{"title":"Advanced Airway Device Use Order During Out-of-Hospital Cardiac Arrest.","authors":"Christopher B Gage, Jacob C Kamholz, Jonathan R Powell, Michelle M J Nassal, Henry E Wang, Ashish R Panchal","doi":"10.1001/jamanetworkopen.2025.53413","DOIUrl":"10.1001/jamanetworkopen.2025.53413","url":null,"abstract":"<p><strong>Importance: </strong>During out-of-hospital cardiac arrest (OHCA), initial airway device choice as well as final device choice in the event of failure may both influence overall procedural success and patient outcomes. Understanding national practice patterns in airway device placement may inform resuscitation strategies and system-level quality improvement.</p><p><strong>Objective: </strong>To assess patterns in the order of advanced airway device use for adults in the United States receiving OHCA treatment during emergency medical service (EMS) activations.</p><p><strong>Design, setting, and participants: </strong>This retrospective cross-sectional study used data from the National EMS Information System (NEMSIS) database from January 2018 to December 2023. During this period, NEMSIS included more than 256 million EMS activations from nearly 14 000 agencies across 54 states and territories. Activations for 911 responses during adult OHCA with advanced airway device attempts after EMS arrival, with documented success (yes or no) and number of attempts, were included.</p><p><strong>Exposures: </strong>Advanced airway devices documented by EMS clinicians.</p><p><strong>Main outcome and measures: </strong>Order of advanced airway device use, measured by EMS clinician documentation.</p><p><strong>Results: </strong>From 2018 to 2023, EMS reported 2 365 224 activations involving adults having an OHCA, with 650 440 patients (0.3%) receiving either endotracheal intubation (ETI) and/or supraglottic airway (SGA). Most patients received a successful initial airway device attempt (503 774 [77.4%]). Although ETI was the most common initial airway device (458 546 [70.5%]), SGA had a higher first-pass success rate (93.0% vs 71.0%). Among patients whose first ETI attempt failed (133 177 of 458 546 [29.0%]), the final documented device remained ETI in 72 167 cases (72.3%) and changed to SGA in 27 651 (27.7%). Among patients whose first SGA attempt failed, 13 480 (61.9%) remained with SGA and 3388 (38.1%) were switched to ETI.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, most patients with OHCA received ETI as the first advanced airway procedure, despite higher SGA first-pass success. Among patients whose initial attempt failed, most continued with the same device. However, switching from ETI to SGA had a higher final success rates. These findings highlight the importance of airway device sequence in prehospital care and may inform training and protocols for airway management.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2553413"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12797093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1001/jamanetworkopen.2025.51345
Anisha P Ganguly, Peyton K Pretsch, Noel T Brewer, Lisa P Spees, Michael G Hudgens, Busola Sanusi, Lynn Barclay, Alicia Carter, Stephanie B Wheeler, Jennifer S Smith
<p><strong>Importance: </strong>Human papillomavirus (HPV) self-collection increases cervical cancer screening uptake among women underscreened for cervical cancer, particularly those from marginalized low-income and racial and ethnic backgrounds. Underscreened women are also at high risk for other sexually transmitted infections (STIs) that can be similarly screened via self-collection.</p><p><strong>Objective: </strong>To evaluate an intervention streamlining testing for other STIs alongside HPV self-collected samples among low-income women.</p><p><strong>Design, setting, and participants: </strong>This is a secondary analysis of the My Body, My Test-3 study, a randomized clinical trial testing a mailed self-collection intervention to improve cervical cancer screening. The My Body, My Test-3 study was conducted from April 2016 to December 2019 in 22 counties in North Carolina among low-income women overdue for cervical cancer screening. This analysis included participants randomized to the trial intervention group with valid STI and HPV results. Data analysis occurred from October 2024 to February 2025.</p><p><strong>Intervention: </strong>The intervention included a mailed self-collection kit and instructions to self-collect a cervicovaginal sample. Samples were tested for other STIs and HPV using the Aptima assay.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a positive test result for other STIs (including chlamydia, gonorrhea, and trichomoniasis). A risk factor analysis was conducted to identify factors associated with testing positive for other STIs. Secondary outcomes included rate of follow-up care and perceptions of self-collection among participants with positive STI results.</p><p><strong>Results: </strong>Among 327 participants (median [IQR] age, 42 [25-63] years; 38 [8.6%] Hispanic, 146 [44.7%] non-Hispanic Black, and 133 [40.7%] non-Hispanic White), 51 (15.6%) tested positive for other STIs and 51 (15.6%) tested positive for HPV; 7 (2.1%) tested positive for both. Risk factors for other STIs included non-Hispanic Black race and ethnicity compared with non-Hispanic White race and ethnicity (adjusted odds ratio [aOR], 4.1; 95% CI, 1.5-11.6), having 2 or more sexual partners in the last year compared with having none (aOR, 5.7; 95% CI, 1.0-31.4), single marital status compared with married or partnered status (aOR, 5.6; 95% CI, 1.1-27.9), and current smoking compared with none (aOR, 4.1; 95% CI, 1.7-10.4). Among participants who tested positive for other STIs, 34 (66.7%) received follow-up care. Most participants (130 [84.4%]) preferred testing for both HPV and other STIs in the future.</p><p><strong>Conclusions and relevance: </strong>In this secondary analysis of a randomized clinical trial of 327 participants, nearly 1 in 6 tested positive for other STIs via streamlined testing in a mailed HPV self-collection intervention. Self-collection may improve both cervical cancer and STI screening for women from
{"title":"Streamlined Self-Collection Screening for Sexually Transmitted Infections and Human Papillomavirus: A Single-Group Secondary Analysis of a Randomized Clinical Trial.","authors":"Anisha P Ganguly, Peyton K Pretsch, Noel T Brewer, Lisa P Spees, Michael G Hudgens, Busola Sanusi, Lynn Barclay, Alicia Carter, Stephanie B Wheeler, Jennifer S Smith","doi":"10.1001/jamanetworkopen.2025.51345","DOIUrl":"10.1001/jamanetworkopen.2025.51345","url":null,"abstract":"<p><strong>Importance: </strong>Human papillomavirus (HPV) self-collection increases cervical cancer screening uptake among women underscreened for cervical cancer, particularly those from marginalized low-income and racial and ethnic backgrounds. Underscreened women are also at high risk for other sexually transmitted infections (STIs) that can be similarly screened via self-collection.</p><p><strong>Objective: </strong>To evaluate an intervention streamlining testing for other STIs alongside HPV self-collected samples among low-income women.</p><p><strong>Design, setting, and participants: </strong>This is a secondary analysis of the My Body, My Test-3 study, a randomized clinical trial testing a mailed self-collection intervention to improve cervical cancer screening. The My Body, My Test-3 study was conducted from April 2016 to December 2019 in 22 counties in North Carolina among low-income women overdue for cervical cancer screening. This analysis included participants randomized to the trial intervention group with valid STI and HPV results. Data analysis occurred from October 2024 to February 2025.</p><p><strong>Intervention: </strong>The intervention included a mailed self-collection kit and instructions to self-collect a cervicovaginal sample. Samples were tested for other STIs and HPV using the Aptima assay.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a positive test result for other STIs (including chlamydia, gonorrhea, and trichomoniasis). A risk factor analysis was conducted to identify factors associated with testing positive for other STIs. Secondary outcomes included rate of follow-up care and perceptions of self-collection among participants with positive STI results.</p><p><strong>Results: </strong>Among 327 participants (median [IQR] age, 42 [25-63] years; 38 [8.6%] Hispanic, 146 [44.7%] non-Hispanic Black, and 133 [40.7%] non-Hispanic White), 51 (15.6%) tested positive for other STIs and 51 (15.6%) tested positive for HPV; 7 (2.1%) tested positive for both. Risk factors for other STIs included non-Hispanic Black race and ethnicity compared with non-Hispanic White race and ethnicity (adjusted odds ratio [aOR], 4.1; 95% CI, 1.5-11.6), having 2 or more sexual partners in the last year compared with having none (aOR, 5.7; 95% CI, 1.0-31.4), single marital status compared with married or partnered status (aOR, 5.6; 95% CI, 1.1-27.9), and current smoking compared with none (aOR, 4.1; 95% CI, 1.7-10.4). Among participants who tested positive for other STIs, 34 (66.7%) received follow-up care. Most participants (130 [84.4%]) preferred testing for both HPV and other STIs in the future.</p><p><strong>Conclusions and relevance: </strong>In this secondary analysis of a randomized clinical trial of 327 participants, nearly 1 in 6 tested positive for other STIs via streamlined testing in a mailed HPV self-collection intervention. Self-collection may improve both cervical cancer and STI screening for women from","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 1","pages":"e2551345"},"PeriodicalIF":9.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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