Public Health Reports最新文献

Despite Alzheimer disease and related dementias/disorders (ADRD) being a substantial public health concern, the Deaf community remains underrepresented in ADRD research. We examined the extent and nature of existing literature on ADRD in the Deaf community. We conducted a scoping review following Arksey and O'Malley's framework, adhering to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched 7 databases for peer-reviewed studies published in English, with no restrictions on publication date or study design. Inclusion studies addressed ADRD within the Deaf community and examined aspects such as diagnosis, care, and communication. Our search identified 435 articles, of which 16 met the inclusion criteria. Studies primarily originated from the United Kingdom and Finland, followed by the United States. Most used qualitative methodologies and explored lived experiences and communication barriers. Common themes included limited access to culturally competent care and caregiving challenges. Few studies highlighted diagnostic interventions but noted a general scarcity of resources tailored to Deaf populations. Notable gaps emerged in geographic focus, the range of studied variables, and the lack of validated sign language-based diagnostic instruments and interventions. We recommend expanding research beyond the Global North (ie, higher-income industrialized countries with greater access to resources), incorporating more longitudinal and intersectional approaches, and tailoring resources for Deaf communities. The review underscores the need for culturally competent care, improved diagnostic tools, and policy reforms to address ADRD-related disparities in the Deaf community. Future research should prioritize inclusive methodologies and community-driven interventions to enhance health outcomes and equity for Deaf individuals affected by ADRD.

Objective: In 2020, the National Institutes of Health (NIH) established the Community Engagement Alliance (CEAL) to ensure that communities experiencing health disparities had a voice in finding effective solutions. This mixed-methods study evaluated processes and outcomes of CEAL.

Methods: We used the National Academy of Medicine's Assessing Meaningful Community Engagement conceptual model to guide our evaluation. Data sources for the evaluation included interviews, programmatic data, community surveys, and partner surveys. We assessed the domains of strengthened partnerships, expanded knowledge, and improved health, health programs, and policies.

Results: CEAL teams built a robust partnership network that reached populations most affected by COVID-19, facilitated knowledge increases among community members and partner organizations, and positively affected COVID-19 vaccination rates.

Conclusions: This evaluation suggests that the infrastructure built by CEAL teams could be leveraged to address additional topics and populations of interest and enhance future National Institutes of Health-funded efforts in community-engaged research.

Objectives: Fetal alcohol syndrome (FAS) is frequently undiagnosed or misdiagnosed, particularly among populations at elevated risk of the condition. We examined the prevalence of FAS among children aged 0 to 5 years enrolled in Medicaid, described characteristics of affected children, and evaluated diagnostic timing between children in foster care and children not in foster care.

Methods: We conducted a retrospective analysis of Medicaid Transformed Analytic Files for children born from 2015 through 2017 with FAS diagnoses (n = 771), following each birth cohort for 5 years. We used descriptive statistics to examine prevalence rates and demographic characteristics. Multivariate linear regression models assessed differences in diagnostic timing between children in foster care and children not in foster care, controlling for demographic factors.

Results: The overall FAS prevalence per 100 000 children aged 0 to 5 years enrolled in Medicaid was 7.7, increasing from 5.1 in 2015 to 11.4 in 2017. Children in foster care represented 60.2% (n = 464) of the FAS cohort. Although behavioral assessments occurred at similar ages for both groups, children in foster care received FAS diagnoses 4.6 to 5.4 months later than children not in foster care (P < .001). The time between the first behavioral assessment and FAS diagnosis was 2.1 to 3.9 months longer for children in foster care than for children not in foster case.

Conclusions: Children in foster care had substantial delays in diagnosis compared with children not in foster care. Initial access to behavioral assessment appears equitable; however, barriers exist in the progression from assessment to diagnosis for children in foster care. Implementing targeted screening protocols, improving cross-system information sharing, and enhancing health care provider training could reduce diagnostic delays and improve outcomes for this population.

Objective: Most people in the United States are unaware that alcohol causes cancer and increases heart disease risk. Warning labels on alcohol containers can increase knowledge about these harms. Yet, it is unclear if Americans support this policy. We assessed attitudes toward cancer and heart disease warning labels on alcohol containers.

Methods: In May 2024, we surveyed 1095 adults (aged ≥18 y) participating in AmeriSpeak, a nationally representative panel of the US noninstitutionalized civilian adult population. We analyzed support for warning labels overall and by sociodemographic characteristics by using descriptive statistics weighted to represent the US population.

Results: Overall, 4 in 10 respondents supported cancer or heart disease warning labels on alcohol containers. Fewer than 10% opposed warning labels; many were neutral. More young adults (aged 18-29 y; 57.9% [95% CI, 44.6%-70.0%]) than older adults (aged ≥60 y; 36.0% [95% CI, 30.3%-42.1%]) supported cancer warning labels (P = .04). More women (50.8%; 95% CI, 45.0%-56.6%) than men (40.5%; 95% CI, 34.1%-47.2%) supported heart disease warning labels (P = .03).

Conclusions: Most people in the United States are neutral about or support cancer and heart disease warning labels on alcohol containers. Leveraging warning labels is a cost-effective way to inform the public about alcohol's link to cancer and heart disease.

Objectives: During the past century, the age of menarche (onset of the first menstrual cycle) has dropped worldwide, with a decline of 2 or 3 months every 10 years in the United States. The adverse health effects of this change are just starting to be understood. Little is known about how the age of menarche affects the future health of African American women. Our objective was to examine the association between early menarche and cardiovascular disease in African American women.

Methods: The study sample included 2397 African American women in the Jackson Heart Study (64% of the total original cohort). We examined the association of early menarche (at age <12 y) with prevalent coronary heart disease, myocardial infarction, stroke, hypertension, diabetes, general obesity, and abdominal obesity.

Results: The mean (SD) baseline age of participants was 55.2 (12.5) years, with a mean (SD) age of menarche of 12.8 (1.8) years; 20.6% of these women experienced early menarche. After adjustment for relevant covariates, early menarche was significantly associated with increased odds of coronary heart disease (odds ratio [OR] = 2.16; 95% CI, 1.44-3.22), myocardial infarction (OR = 1.90; 95% CI, 1.17-3.08), hypertension (prevalence ratio [PR] = 1.15; 95% CI, 1.07-1.24), general obesity (PR = 1.22; 95% CI, 1.14-1.31), and abdominal obesity (PR = 1.14; 95% CI, 1.08-1.20).

Conclusions: Among this cohort, early menarche was a risk factor for the development of cardiovascular disease among African American women. Addressing this risk requires policies and clinical guidelines that recognize early menarche as a marker for early intervention.

Objectives: Concern is growing about rising opioid use disorder (OUD) rates and limited knowledge of how socioeconomic status (SES) and health factors interact. We examined whether health status moderates the relationship between SES and OUD among individuals with nonmedical opioid use.

Methods: We analyzed data from 10 984 adults aged ≥18 years in the 2015-2019 National Survey on Drug Use and Health. Logistic regression estimated odds of OUD using self-reported health (good/very good/excellent vs fair/poor) and SES indicators (education, income, employment, and marital status). Interaction terms tested whether health status modified SES-OUD associations.

Results: Fair/poor health increased OUD odds, whereas college graduation and employment were linked to lower odds. Interaction analyses showed that among those with fair/poor health, higher SES corresponded to increased OUD odds. Those with fair/poor health and a college degree had substantially higher odds of OUD (odds ratio [OR] = 3.35; P < .001) than less educated peers. Among those with fair/poor health, individuals with annual family incomes ≥$75 000 also had higher OUD odds (OR = 1.84; P = .03) than those with incomes <$20 000, and employment was associated with increased OUD odds (OR = 1.61; P = .008). Individuals who were widowed/divorced/separated (OR = 0.36; P < .001) and never married (OR = 0.48; P = .001) had lower OUD odds than married individuals.

Conclusions: Health status significantly moderated SES-OUD associations. Among those in poor health, higher SES was linked to greater OUD odds. Prevention and treatment efforts should consider how SES and health jointly shape OUD vulnerability.

Objectives: It is unclear how the incidence of each pediatric diabetes subtype changed during the COVID-19 pandemic. We assessed changes in the incidence of pediatric type 1 diabetes, pediatric type 2 diabetes, and prediabetes during the COVID-19 pandemic.

Methods: We analyzed data from young people aged <19 years without prior diabetes in a large integrated US health care system from March 2017 through February 2023 using interrupted time-series analyses to compare prepandemic and pandemic rates and trends in the incidence of type 1 diabetes, type 2 diabetes, and prediabetes.

Results: Of 288 574 pediatric patients, 242 were diagnosed with type 1 diabetes, 239 with type 2 diabetes, and 4438 with prediabetes. The incidence of type 1 diabetes did not change after pandemic onset in the interrupted time-series analysis. Although the incidence of type 2 diabetes and prediabetes changed with a single interruption analysis, an exploratory model of 2 interruptions revealed a better fit for each: for type 2 diabetes, the model showed a significant rise (128%; P < .001) and subsequent decrease after the early pandemic period; for prediabetes, it revealed a 142% increase (P = .005) with a rising trend (12% per month) early in the pandemic, followed by a 9% monthly downward trend.

Conclusion: Among this population, the COVID-19 pandemic did not affect the incidence of pediatric type 1 diabetes but was associated with significant increases in the incidence of type 2 diabetes and prediabetes, particularly early in the pandemic. Future work can build on these results to better understand how pandemic-related factors, including activity restrictions and COVID-19 disease, affected rates of pediatric type 2 diabetes and prediabetes and inform future public health practices.