Public Health Reports最新文献

Objectives: Cardiometabolic diseases (CMDs) are highly prevalent in Mexico. We analyzed the evolution of mortality from CMDs in Mexico at the national and state level, as well as their contribution to years of life lost (YLL), from 1998 through 2022.

Methods: We conducted an observational study based on a public database. We calculated age-standardized mortality rates, conducted joinpoint regression analyses to determine changes in the trend and magnitude of mortality over time, and calculated YLL from CMDs among people in Mexico nationally and by state.

Results: From 1998 through 2022, the age-standardized mortality rate from CMDs increased by 14.9% in Mexico. These rates reached their highest levels in 2020 and 2021 during the COVID-19 pandemic. In 2022, people aged 0 through 84 years had 3.9 YLL from CMDs, which represented an increase of 0.4 years compared with 1998. From 1998 through 2022, age-standardized mortality rates increased for heart disease, diabetes mellitus, and hypertension but decreased for stroke.

Conclusions: Mortality and YLL from CMDs have steadily increased among people in Mexico, driven mainly by heart disease and diabetes mellitus. YLL attributable to CMDs could be prevented by early care and health prevention policies. Decision makers should work to implement robust and enduring health policies focused on shared risk factors underlying these diseases.

Vulvovaginal candidiasis (VVC) is an infection caused by the yeast Candida that affects more than 50% of women in their lifetime. We aimed to describe VVC among American Indian/Alaska Native (AI/AN) girls and women who were receiving care in the Indian Health Service (IHS) system during 2016-2022. We calculated the annual VVC prevalence per 1000 IHS user population and examined underlying medical conditions, previous diagnoses, and antifungal treatment. Among 6 million female patient-years, 70 766 patients had ≥1 VVC diagnosis code (2022 prevalence: 14.2 per 1000 IHS user population). Frequent previous or concurrent diagnoses included diabetes (24.8%), urinary tract infection (13.6%), screening for sexually transmitted infection (13.2%), and unspecified acute vaginitis or vulvitis (13.0%). Approximately one-third (33.1%) of patients received fluconazole, and 25.7% received prescription topical antifungal medication. VVC was a common condition among AI/AN patients who accessed care in the IHS health care system. VVC prevalence among AI/AN patients was similar to the prevalence among the broader US population. These data provide a baseline for future studies to evaluate diagnostic and treatment practices for VVC among AI/AN people.

Nicotine pouches are noncombustible products that contain nicotine but no tobacco plant material. With rising popularity and increased media attention surrounding ZYN and other nicotine pouch brands, questions remain about whether empirical evidence exists on the public health effects of these products. This review highlights how nicotine pouches, including ZYN, are rising in appeal and prevalence of use, particularly among adolescents and young adults. The use of nicotine pouches is also more prevalent among people who use other tobacco products (vs those who do not), including electronic cigarettes (e-cigarettes), and some people report using nicotine pouches to help reduce or quit the use of e-cigarettes or combustible tobacco products. Nicotine pouches deliver amounts of nicotine similar to other tobacco products and do so at a rate similar to other oral nicotine products, including some US Food and Drug Administration (FDA)-approved nicotine replacement therapies. In addition, nicotine pouches have the potential to be tobacco harm-reduction products if unintended harms can be minimized, although more research is needed to determine the health effect profile of nicotine pouches under naturalistic use conditions. Overall, additional research is needed to verify the results from industry-funded studies, further understand product characteristics that influence nicotine delivery and health effects, and translate findings to real-world use behaviors. This additional research could help determine whether nicotine pouches have a robust evidence base to meet the public health standard by which FDA evaluates new tobacco products.

Objectives: Menthol flavoring is a critical public health issue, but prior research has largely represented the voices of White adults who smoke menthol cigarettes, who represent a small subset of adults who smoke menthol cigarettes in the United States. This study compared perceptions of a hypothetical menthol cigarette or flavored cigar (MC/FC) ban among Black and White adults who smoke menthol cigarettes.

Methods: Participants were a convenience sample of 2113 Black and 1087 White adults who smoke menthol cigarettes, collected through Amazon Mechanical Turk from July 2023 through January 2024. Participants reported opinions about an MC/FC ban, the likely public health outcomes, and a hypothetical impact of the ban on their smoking behavior. We used stepwise logistic regression to model factors associated with ban opposition or ambivalence.

Results: More than one-third of adults who smoke menthol cigarettes supported an MC/FC ban (37.2% Black vs 34.5% White; P = .13), but Black (vs White) adults who smoke menthol cigarettes were more likely to endorse the public health benefits of a ban, as assessed via agreement with 5 statements of US Food and Drug Administration rationale (mean [SD] number of statements endorsed, 3.0 [1.7] vs 2.4 [1.8]; P < .001). Smoking more cigarettes per day, believing that menthol cigarettes are more addictive or harder to quit than nonmenthol cigarettes, and intending to continue using nicotine under a ban increased the odds of opposition or ambivalence to the ban.

Conclusions: Targeted outreach to those who consume predominantly menthol products and those who do not intend to quit nicotine could increase support of an MC/FC ban among adults who smoke menthol cigarettes.

Objective: Homelessness is a pervasive and pressing problem in the United States and is associated with health risks and premature mortality. However, accurately defining and classifying homeless status can be complex, and assessment of homelessness status requires careful consideration of the data collection process. We assessed the validity of the ascertainment of homeless status on death certificates.

Methods: We quantitatively compared the classification of homeless status from 2023 Multnomah County, Oregon, medical examiner data (considered the gold-standard source, due to the in-depth investigation and extensive data available as a case narrative) with housing status from Oregon Health Authority 2023 vital record (death certificate) data alone. We also described people with an indication of homelessness in the 2023 medical examiner data but not in the 2023 vital record data and considered possible causes of this misclassification.

Results: A total of 171 of 394 (43%) decedents whom we classified as homeless via medical examiner data had an address listed in the final death certificate; all were significantly younger (aged 42 y) than the 223 people with concordant records (aged 46 y).

Conclusions: We found that the presence of an address on a death certificate does not rule out homelessness at the time of death, especially among younger decedents. Other jurisdictions should assess the accuracy of their homeless classification data, as more research is necessary to quantify the presence of misclassification.

Objective: Disease intervention specialists (DISs) play a crucial role in the public health workforce by conducting essential tasks such as contact tracing, contact interviews, and providing referrals for services to control disease spread. Despite the importance of DISs, research is lacking on the job tasks that they perform and the role that they serve in public health agencies. The objective of this study was to identify the unique skill sets of DISs relative to other public health occupations.

Methods: We used a national dataset of job postings in the United States to conduct a comparative analysis of the skills required for 3 occupations: DISs, epidemiologists, and community health workers. We examined job listings posted from July 2022 through February 2023 to determine the frequency of certain skills, and we tested for significant differences in skill mentions across these occupations.

Results: Job postings for DISs were significantly more likely than those for community health workers and epidemiologists to require expertise in areas such as case management (30%), communicable disease control (49%), infectious disease knowledge (33%), and disease prevention techniques (18%).

Conclusions: This study highlights the specialized nature of DISs in managing disease-related public health interventions and supporting population health. Improved data collection is needed to support workforce planning, training, and policy development to ensure the continued effectiveness and reach of DISs in public health systems.