Preventive medicine最新文献

Introduction: Firearm injuries are a leading cause of death for youth/young-adults. We utilized latent class analysis to identify distinct motivational/behavioral patterns of firearm possession in a youth/young-adult emergency department sample to inform prevention strategies.

Methods: Cross-sectional data were obtained from surveys conducted among youth/young-adults (age = 16-29; n = 1311) seeking emergency department treatment (7/10/2017-6/25/2018). Latent class analysis was performed for individuals reporting firearm possession (n = 223) using five variables: carriage frequency, social carriage, risky firearm behaviors, ownership/carriage for protection, and recreational ownership/carriage. Descriptive statistics were examined.

Results: In this sample, 17.0 % reported having firearms (age-22.7; 48.0 %-male; 49.3 %-Black; 52.5 %-public assistance). Latent class analysis identified four classes: 1-recreational possession (n = 51); 2-possession for protection with low carriage (n = 60); 3-carriage for protection with low risky firearm behaviors (n = 76); and 4-carriage for protection with high risky firearm behaviors (n = 36). Class-1 (recreational possession) had low firearm victimization, violence exposure, and community violence. This class primarily kept long-guns with secure storage patterns. Class-2 (protection with low carriage) were mostly female youth/young-adults with children and reported moderately high rates of violence exposure. Nearly 20 % stored their firearm unlocked. Class-3 and -4 endorsed firearm carriage for protection, with Class-4 also engaging in risky firearm behaviors. Both classes had high violence exposure; however, Class-4 had higher risk profiles including higher marijuana misuse, mental health symptoms, and firearm victimization.

Conclusions: Among an emergency department sample, four distinct firearm possession classes emerged with different risk levels. Understanding firearm behaviors and risk/protective factors is critical to tailoring healthcare-focused interventions to address individual needs and reduce injury risk.

Background: National mandates require screening for and addressing health-related social needs (HRSNs) in healthcare settings. However, differences in HRSN screening process (i.e., completed screenings, screening results, documented offer of assistance, documented assistance request) have been reported by population subgroup. Knowledge of the most effective HRSN screening and intervention methods is limited. We sought to describe differences in completed HRSN screenings, screening results, and assistance request rates across patient and healthcare visit characteristics.

Methods: We examined data from all patients aged ≥18 years and residing in the US receiving services at a large, Midwestern healthcare system with a goal to screen all patients for HRSN at least once annually between July 2021-June 2023 (n = 1,190,488). We examined the proportion of patients with any HRSN screening, with any reported HRSN, asked whether they wanted assistance, or who requested assistance for a reported HRSN stratified by patient demographics and healthcare visit characteristics (i.e., payer, screening location, who completed the screening).

Results: Less than half of eligible patients (47.0 %) were screened for HRSNs. About one-sixth (16.9 %) reported any HRSN. Although most patients reporting HRSNs were asked whether they wanted assistance, only about one-quarter (26.8 %) responded affirmatively. Proportions included in each step of the HRSN screening process significantly differed by patient and healthcare visit characteristics.

Discussion: This study is one of the first to investigate various steps of a population-wide HRSN screening program. Our findings suggest that examining differences in HRSN screening process by population subgroup is key to addressing HRSNs through a health equity lens.

Background: Premature atherosclerotic cardiovascular disease (ASCVD) is increasing in young adults (<55 years old). While research suggests females who smoke cigarettes have a higher risk of ASCVD than males, studies on the impact of exclusive e-cigarette and dual use on premature ASCVD are limited. This study investigated the association between tobacco use and self-reported premature ASCVD and explored potential sex differences.

Methods: Using pooled data from 480,317 adults (ages 18-54; ~50 % female) from the 2020-2022 Behavioral Risk Factor Surveillance System from the United States, logistic regression models assessed associations between cigarette and e-cigarette use patterns and self-reported premature ASCVD. Tobacco use categories were defined as: non-use, former use (cigarettes, e-cigarettes), and current use (cigarettes, e-cigarettes) and dual use. Self-reported premature ASCVD was defined as self-reported angina or coronary heart disease, heart attack, or stroke. Weighted analyses were conducted for the overall sample and stratified by sex.

Results: After controlling for potential confounders, former exclusive cigarette (adjusted OR: 1.47 [95 % CI 1.29, 1.67]), current exclusive cigarette (1.68 [1.47-1.94]) and current dual (2.03 [1.69-2.44]) use were associated with higher odds of self-reported premature ASCVD. There was no significant association for e-cigarette use. Sex-specific analyses revealed similar patterns but the magnitude of these associations varied between males and females.

Conclusion: Both sexes showed higher odds of self-reported premature ASCVD for dual and exclusive cigarette use. Although the cross-sectional design precludes causal inferences, the findings suggest comprehensive tobacco cessation programs tailored to diverse use patterns are needed to reduce the burden of premature ASCVD.

Objective: As countries adopt more lenient cannabis use policies, perception of harm from secondhand cannabis smoke (SHCS) exposure is decreasing and most cannabis smoking is taking place at home. We quantified the relationship of reported in-home cannabis smoking with perceived harm from SHCS exposure.

Methods: The analytic sample comprised 28,154 adult respondents, from 21 countries, to the annual cross-sectional Global Drug Survey (2021) of users of licit or illicit drugs. Respondents reported perception of harm to non-smoking residents from SHCS exposure and past 30-day cannabis smoking in the home by anyone. Logistic regression estimated covariate-adjusted odds ratios and 95 % confidence intervals of in-home cannabis smoking (yes/no). The association between harm perception and in-home cannabis smoking by country of residence was also quantified.

Results: Sixty-one percent reported no in-home cannabis smoking in the last 30 days; mean perception of harm of SHCS exposure on a 10-point scale was 5.2. Those at the 75th (vs 25th) percentile of perceived harm had 70 % higher odds (OR = 1.7, 95 % CI = 1.6-1.8) of no in-home cannabis smoking. In all countries of residence, higher perception of harm was associated with reporting no in-home cannabis smoking, although not all were statistically significant. The strongest association was seen in Sweden (OR = 3.9, 95 % CI = 1.5-11.9) and New Zealand (OR = 2.3, 95 % CI = 2.0-2.7).

Conclusions: Respondents who perceived SHCS as harmful were less likely to report in-home cannabis smoking. If this association subsequently proves causal, increasing awareness of the harms associated with SHCS exposure could substantially reduce residential cannabis secondhand smoke exposure.