Public Health Reports最新文献

Objectives: Sugar-sweetened beverages (SSBs) are the leading contributor of added sugars in the diets of children, adolescents, and young adults aged 2 to 19 years and are associated with chronic diseases, including oral health conditions such as dental caries. We assessed the possible association between the consumption of soda or sports drinks (SSDs), 2 types of SSBs, and past-year dentist visits among American Indian or Alaska Native (AI/AN) high school students because this population has unique challenges related to oral health (eg, barriers to access to care) that might increase SSD consumption and decrease the frequency of dentist visits.

Methods: We analyzed data from the 2023 national Youth Risk Behavior Survey and used a 3-stage cluster sampling design to produce a nationally representative sample of students in grades 9 through 12 attending public and private schools. We examined the association between consumption of SSDs or water and having seen a dentist during the past 12 months for a dental check-up, examination, teeth cleaning, or other dental work among 2770 AI/AN students.

Results: Among 2770 AI/AN students, the weighted prevalence of having a dentist visit during the past 12 months was 67.6%. Students who consumed SSDs more frequently were less likely to have had a past-year dentist visit (adjusted prevalence ratio = 0.7; 95% CI, 0.5-0.9), whereas students who drank water ≥3 times per day were more likely to have had a past-year dentist visit (adjusted prevalence ratio = 1.3; 95% CI, 1.0-1.7).

Conclusions: Community efforts to reduce consumption of SSBs such as SSDs, encourage healthier beverages such as water, and promote oral health visits in AI/AN communities could improve oral health outcomes.

To help people with COVID-19 and their contacts quickly understand guidelines to prevent transmission, the Centers for Disease Control and Prevention (CDC) developed an interactive calculator that indicated whether and how long to stay home, get tested, wear face masks, and adopt other precautions. The CDC COVID-19 Calculator used a web-based chatbot format that mimicked a 2-person conversation. The calculator had the following design specifications: (1) reach an audience of people with COVID-19 (who tested positive or were symptomatic for COVID-19) and their close contacts and (2) provide an answer to the question "When can I leave home?" in less than 1 minute. To measure the use of the calculator, we analyzed the number of anonymous unique visitors and median visit time. The calculator had approximately 13.6 million visitors by March 1, 2024. The median visit time was 38 seconds, and approximately 65% of visits were via smartphones. The millions of unique visitors to the CDC COVID-19 Calculator demonstrated the usefulness of a conversational chatbot format to provide public health guidance. Future research should assess whether such tools influence behavior.

Objectives: In Maine, rabies postexposure prophylaxis (PEP) administration is reportable to public health. We sought to determine the objectives of the Maine Center for Disease Control and Prevention's (Maine CDC's) PEP administration surveillance system and whether the method of conducting surveillance through a manual health care provider (hereinafter, provider) reporting system meets these objectives. We also compared provider-reported PEP administrations with administrations identified in emergency department (ED) data.

Methods: During September 2022, we interviewed 8 Maine CDC epidemiologists to determine system objectives. We obtained and compared PEP administration data from provider reporting system and ED data and summarized each dataset by year, exposing animal, and facility. We assessed the ability of each source to address surveillance system objectives by comparing data elements with each objective.

Results: Maine CDC epidemiologists described the following objectives of the surveillance system: (1) track potential human exposures to rabid or potentially rabid animals, (2) document PEP administration trends, and (3) ensure PEP is correctly administered. They determined the third objective is not being achieved by the current system. During January 2018-June 2022, we identified 538 provider-reported PEP administrations and 1191 PEP administrations through ED data. ED data were more timely than provider reports and identified more PEP administrations, but 28% of ED records did not contain information on the exposing animal.

Conclusions: Maine CDC can use ED data to document PEP administration trends in near-real time. ED data obtained from syndromic surveillance might be used in tandem with or in place of Maine CDC's traditional PEP surveillance system. We are building more complex queries that more fully capture PEP administrations to have a thorough understanding of PEP administered in Maine.

Objective: Rural residents experience higher rates of postpartum uninsurance than their urban counterparts, contributing to rural-urban disparities in maternal health outcomes. We examined how Medicaid expansion under the Affordable Care Act affected rural-urban disparities in the rates of postpartum health insurance coverage among low-income women.

Methods: We used nationally representative data from the 2010-2012 and 2015-2019 American Community Survey to compare rates of postpartum health insurance coverage among low-income women in states that expanded Medicaid and states that did not expand Medicaid (difference-in-differences analysis). We analyzed changes in disparities in postpartum health insurance coverage between women living in rural areas and women living in urban areas (difference-in-difference-in-differences analysis).

Results: Women living in rural areas had the greatest increases in postpartum health insurance coverage, with a 17.0 percentage-point increase in states that expanded Medicaid (95% CI, 13.9-20.2) and an 11.5 percentage-point increase in states that did not expand Medicaid (95% CI, 9.2-13.8). Any postpartum health insurance coverage among rural residents relative to urban residents increased by 4.8 percentage points (95% CI, 2.0-7.7) in states that expanded Medicaid compared with states that did not. We observed similar trends for Medicaid postpartum health insurance coverage specifically.

Conclusions: Rural women had greater increases in postpartum health insurance coverage relative to urban women following Medicaid expansion, thereby reducing geographic disparities in health insurance coverage during the postpartum period. Future research should focus on whether disproportionate gains in health insurance coverage for rural communities led to increased access to care during the postpartum period.

We examined compliance with England's calorie labeling regulations, which require large out-of-home food businesses to display the calories of prepared food and drink at the point of choice, such as menus. By using website data from large out-of-home food businesses, we found that all businesses (n = 77) provided calorie labeling somewhere on their websites. However, fewer than half (48%; n = 37) did not provide calorie labels on the default menu (ie, the first menu that a consumer is likely to see). Compliance with the policy's implementation guidance was greatest for the label's position (81%; n = 62) and lowest for prominent formatting (40%; n = 31), while 71% (n = 55) of businesses provided the statement of daily calorie needs. We observed differences among types of out-of-home food businesses, but we did not test them because of the small sample size. Our results suggest imperfect adherence to England's calorie labeling regulations, thus undermining the policy's impact. As the policy's review approaches, policy makers should consider strategies for ensuring compliance.

Objective: Diabetes is a leading cause of various adverse health outcomes, and its prevalence has risen substantially in the United States in recent decades. While the prevalence of diabetes has stabilized in recent years, geographic disparities remain, particularly in the South. We analyzed the spatial and temporal trends of diabetes prevalence in the United States and identified geographic disparities.

Methods: We conducted a geographic-temporal analysis of Centers for Disease Control and Prevention chronic disease indicator data using a bayesian hierarchical model to assess changes in diabetes prevalence across US divisions and over time from 2011 through 2021.

Results: We estimated that diabetes prevalence rates per 1000 population declined in the United States from 56.5 in 2011 to 53.2 in 2021. The East South Central division had a high prevalence rate of diabetes (8.4), followed by New England (5.4) and West South Central (3.4). The diabetes prevalence rate was higher among men (2.64 per 1000 population) than among women.

Conclusion: Our findings highlight the need for continued public health efforts, such as reducing rates of obesity and improving health care access, to mitigate the prevalence of diabetes in the South and to maintain the continued decrease in prevalence rates in the coming years.

Objectives: Physical inactivity is associated with socioeconomic and social levels; thus, individuals of low socioeconomic status are less likely than individuals of high socioeconomic status to exercise. We assessed the association between socioeconomic status and changes in physical activity levels among children from 2002 to 2017 in Peru.

Methods: We conducted a secondary data analysis of the Young Lives Study (n = 2052 children aged 8 years [at baseline] and 15 years [at the end of follow-up]), a cohort with data collected in Peru. The outcomes were insufficient physical activity (<5 days of physical activity per week) and physical inactivity (<1 day of physical activity per week), and the exposure variable consisted of 2 socioeconomic indicators (maternal education and wealth index). We assessed the association between outcomes and exposures by using Poisson regression models and reported relative risks (RRs) and 95% CIs.

Results: Of 1888 participants at baseline, the mean (SD) age was 7.9 (0.3) years and 946 (50.1%) were male. The prevalence of physical inactivity and insufficient physical activity was 9.1% (n = 172) and 59.4% (n = 1122), respectively. After 7.0 (SD = 0.1) years of follow-up, in the multivariable model, a high wealth index was associated with low levels of physical activity, but maternal education was not. Thus, children with a high (vs low) level of wealth index had higher rates of physical inactivity (RR = 2.11; 95% CI, 1.47-3.03) and insufficient physical activity (RR = 1.11; 95% CI, 1.03-1.19).

Conclusions: Wealth index was associated with insufficient physical activity and physical inactivity, but maternal education was not. Our results suggest the need to promote physical activity levels according to social context.

Objectives: Nearly half of US adults have hypertension. The prevalence of hypertension is higher among adults with disabilities than among those without disabilities; however, national estimates use old data and definitions, and hypertension awareness and control are understudied. This study compared hypertension prevalence, awareness, and control among adults with and without disabilities.

Methods: We analyzed data from the National Health and Nutrition Examination Survey (August 2021-August 2023) for adults aged ≥18 years (N = 5999). To determine disability status, we used the Washington Group on Disability Statistics questionnaire, which covers the domains of seeing, hearing, walking, communication, cognition, self-care, upper-body function, and affect. Hypertension was defined as blood pressure ≥130/80 mm Hg or use of antihypertensive medication. Among adults with hypertension, awareness was defined as self-report of physician diagnosis and control as blood pressure <130/80 mm Hg. We estimated adjusted prevalence ratios (APRs) using logistic regression, adjusting for demographic and health characteristics and accounting for the complex survey design.

Results: Hypertension prevalence was significantly higher among adults with disabilities than among those without disabilities (57.2% vs 45.1%; P < .001). Among those with hypertension, the prevalence of awareness (71.3% vs 55.0%; P < .001) and control (27.3% vs 18.4%; P < .001) was significantly higher among adults with disabilities than among those without disabilities. Adjusted analyses showed a higher prevalence of hypertension (APR = 1.12; 95% CI, 1.04-1.21), awareness (APR = 1.22; 95% CI, 1.14-1.30), and control (APR = 1.31; 95% CI, 1.12-1.54) among adults with disabilities than among those without disabilities.

Conclusions: Primary prevention may be particularly important for adults with disabilities. Improving awareness and control remains a key public health challenge regardless of disability status.

At the national and state levels, data on changes over time in fruit and vegetable intake among young children are limited. Using nationally representative data from the National Survey of Children's Health during 2021-2023, we examined trends in daily fruit and vegetable intake among children aged 1 to 5 years. We conducted trend analyses nationally, by age, and by state. We found no significant linear trends in daily fruit or vegetable intake at the national level or by age. At the state level, fruit intake increased significantly from 2021 to 2023 in Connecticut (from 65.8% to 77.2%; P = .049), Illinois (from 68.5% to 77.8%; P = .03), and Montana (from 66.1% to 81.0%; P = .01) and decreased significantly in Massachusetts (from 82.2% to 65.0%; P = .001); no state had significant changes in daily vegetable intake. Lack of improvement in daily fruit and vegetable intake among young children emphasizes the continued need for monitoring and evidence-based interventions.