Preventive Medicine Reports最新文献

Objective: To investigate 15-year changes in public awareness of the social determinants of health (SDoH) between 2007 and 2023.

Methods: A 2007 survey of 1172 Wisconsin, U.S. adults is compared to a 2023 survey of 1631 Wisconsin adults. In both surveys, respondents were asked to rate 16 factors regarding how strongly each impacts health. Regression analyses examine how demographic factors differentiate responses in both survey years.

Results: In both 2007 and 2023, the four most highly rated factors affecting health were: personal health practices, stress, health insurance, and access to affordable health care. Between 2007 and 2023, there was little or no increase, and even some decrease, in endorsement of many social determinants of health like income, education, housing, and social support. Older adults, women, and those with lower income were generally more likely to endorse the SDoH in both years. Party identification was the demographic factor that most strongly differentiated responses, with Democrats rating more highly many of the social determinants of health than either Republicans or Independents in both years. This differentiation by party identification was even stronger in 2023 than 2007.

Conclusions: Despite consistent research documenting the social determinants of health, growing health care and policy attention to the social determinants of health, and population exposure to a variety of social determinants during the COVID-19 pandemic, there is little or no increase in public recognition of the social determinants of health, and notable increasing partisan divides.

Introduction: Cigarette smoking is among the largest risk factors for cognitive decline in later life. This study examines the associations between hospitality smoke-free coverage in the US and the prevalence of self-rated cognitive function decline and disparities therein.

Methods: I use the repeated cross-sectional Behavioral Risk Factor Surveillance data collected between 2017 and 2022 from a sample of Americans 45 years and older and estimate logistic regression models predicting self-rated cognitive function decline by calculated smoke-free hospitality coverage in restaurants and bars.

Results: Fully adjusted models indicate a marginally statistically significant 0.16 percentage point reduction [CI -0.35 to 0.02] in the probability of self-rated cognitive function decline for a 10 % increase in the smoke-free bar coverage. The effect is statistically significant and larger for women, a 0.29 [CI -0.50 to -0.01] percentage point decrease, and for non-smokers, a 0.35 [CI -0.56 to -0.15] percentage point decrease. I do not find a parallel effect of smoke-free restaurant laws and I find no effect of either law on self-rated cognitive function decline-related limitations in daily life for either hospitality law.

Conclusions: The findings suggest that smoke-free bar laws could play a role in preventing cognitive decline among older adults in the United States. Effective public health strategies against cognitive decline should include both targeted and broad-based policy measures.

Objectives: To investigate the prevalence of spine symptoms and spine disability, self-care and care seeking behaviors in a random sample of Indigenous adults residing in Cross Lake, northern Manitoba, Canada.

Study design and setting: Orally administered survey in Cree or English to a representative sample of Pimicikamak citizens from the treaty (n = 150/1931 houses) and non-treaty (n = 20/92 houses) land, between May and July 2023. Questions (n = 154) were derived from the 2018 First Nations Regional Health Survey, 2020 Canadian Community Health Survey, and 2021 The Global Burden of Disease study, covering demographics, spine symptoms, chronic conditions, activity limitations, general health, self-care, medication, and satisfaction with care. We used descriptive and cross-tabulations and consulted the community for data interpretation.

Results: The survey was completed by 130 adults (65 % females, mean age, 48.4 years). Nearly all participants (89.6 %) reported having spine symptoms in the past four weeks, with a majority experiencing activity limitations lasting one day or more due to neck (77.9 %) or low back pain (55.6 %). Chronic neck and low back pain "sometimes or often" limited activities of daily living (52.8 % and 74.1 % respectively). Nearly two-third (65.4 %) did not have concomitant mood problems. Future preferred care included self-care (88.5 %), over-the- counter medication (64.6 %), seeing an allied care provider (45.4 %), a traditional healer (26.2 %), a nurse or a medical doctor (22.3 %).

Conclusion: Spine symptoms were highly prevalent and significantly impacted activities of daily living. Nearly half of respondents felt that they could benefit from care provided by allied health providers.

Objective: HAPpEN aims to implement and evaluate a holistic general practitioner-centered, interdisciplinary obesity management strategy in rural Germany, focusing on feasibility, health outcomes, and economic benefits.

Methods: HAPpEN is a 12-month, pragmatic single-arm, multicenter trial, informed by a formative survey, and initiated in April 2023 with 98 obese participants (body mass index, BMI ≥ 30 kg/m²) in Kulmbach, Germany. The program integrates nutritional counseling, physical activity, and behavior change techniques, including smartphone-based self-monitoring. Monthly consultations help set personalized goals using a multi-stage grading scale. Primary outcomes include BMI, body weight, waist circumference, heart rate, blood pressure and parameters, while secondary outcomes assess quality of life, wellbeing, health literacy, social interaction, and digital therapy support.

Results: The baseline cohort (mean age: 46.9 ± 11.8 years, 74.1 % female) exhibited high obesity rates (mean BMI: 40.1 ± 6.1 kg/m²), with 48.5 % classified as grade III obese. Common comorbidities were hypertension (51.8 %), dyslipidemia (30.5 %) and diabetes (21.8 %). Chronic joint paint, mainly in the knees and hips, affected up to 82.4 %. A familial aggregation of obesity, diabetes, and cardiovascular diseases was noted, alongside behavioral challenges such as lack of physical activity (81.8 %) and unhealthy eating habits (56.8 %).

Conclusion: HAPpEN addresses obesity's multifactorial nature through general practitioner-led, community-based, and digital strategies to promote sustainable lifestyle changes in rural areas. The trial aims to inform primary care obesity management guidelines, focusing on improving health literacy, patient engagement, and long-term clinical benefits. German Clinical Trials Register: DRKS00033916.

Background: In the United States, African/Black American (henceforth Black) men face significantly higher mortality rates from colorectal cancer (CRC) compared to other gender, racial, and ethnic groups. Although CRC is preventable and treatable with early detection, screening rates among Black men remain low. This study aimed to synthesize existing literature on the barriers and facilitators (determinants) of CRC screening to offer guidance to primary care teams in their efforts to improve screening uptake.

Methods: We performed a comprehensive systematic review of full-text, peer-reviewed studies published in English to explore the various determinants influencing CRC screening among Black men. Using key terms like "Black or African American," "male," and "colorectal cancer screening," we searched databases including PubMed, PsychInfo, CINAHL, and Embase, published between 2009 and 2022.

Findings: The search identified 1235 articles, with 54 meeting the inclusion criteria. Most studies were cross-sectional, examining determinants across the socioecological system. Key barriers included a lack of CRC screening knowledge, poor patient-provider communication, lack of access to screening, and medical mistrust stemming from systemic racism. Significant facilitators included aging, receiving a provider recommendation, having social support, and effective culturally appropriate outreach strategies.

Conclusions: Key themes and significant findings from the review provide actionable strategies for primary care teams. These include enhancing knowledge about CRC screening within the patient population, improving patient-provider interactions, and reducing barriers to accessing screening. Future research should aim to develop culturally appropriate and collaborative preventive care strategies to improve screening adherence and CRC-related outcomes.

Objective: To review the epidemiological evidence of cervical cancer among Indigenous women living in Latin America.

Methods: We conducted a systematic review of the evidence contained in 10 databases spanning 2003-2019. Two reviewers independently compared papers' titles and abstracts against the inclusionary criteria, and a third reviewer resolved discrepancies. Blinded reviewers performed the selection. The articles were organized into the following categories: rates, access, and screening; prevalence of precursor lesions; prevalence and genotypes of Human papillomavirus (HPV); and HPV coinfections.

Results: Of the 874 manuscripts we reviewed, 25 were included in the final analysis. We found that cervical cancer is the leading cancer in terms of incidence and mortality among Indigenous women; it presents in advanced stages and is associated with poor survival rates. The prevalence of precursor lesions was higher in women who were geographically isolated. Screening appears to improve outcomes, but women may experience delays in their diagnosis and treatment. Some studies reported populations with a very high prevalence of high-risk Human papillomavirus (hrHPV), and the most frequent genotypes were not different from those of the general population. Chlamydia trachomatis was significantly associated with HPV infection.

Conclusions: The data suggested a lack of indicators regarding cervical cancer and its precursor lesions, HPV infection, and cancer indicators. Health policies should target this vulnerable population.

Objective: Discrimination is a social determinant contributing to health inequities in the United States (US). This study investigated the prevalence of, and sociodemographic disparities in, perceived everyday discrimination among a national sample of US adults.

Methods: We used data from the 2023 National Health Interview Survey (n = 27,538) and estimated the prevalence of three perceived everyday discrimination outcomes (1) any discrimination, (2) unique components of the discrimination experience, and (3) the Everyday Discrimination Scale (EDS) (range: 0-20) overall and by age, sex assigned at birth, race and ethnicity, sexual orientation, educational attainment, income-to-poverty ratio, and urban-rural status.

Results: Over half of US adults experienced any discrimination (55.8 %), and the most common form of perceived discrimination was being treated with less respect (45.2 %). Adults who were younger (aged 18-44), female, non-Hispanic Black, sexual minority, some college-educated, low income, or urban-living generally reported higher discrimination. For example, among the sample, non-Hispanic Black (vs. non-Hispanic White) (OR: 1.61, 95 % CI: 1.44-1.81) and sexual minority (vs. heterosexual) (OR: 2.48, 95 % CI: 2.12-2.90) adults had the highest odds of any discrimination and EDS scores (β: 1.38 (95 % CI: 1.17-1.59) and β: 1.65 (95 % CI: 1.35-1.94), respectively). The odds of perceived discrimination varied in magnitude by specific experience; for example, sexual minority adults had the highest odds of being threatened or harassed (OR: 2.93, 95 % CI: 2.52-3.42).

Conclusions: Perceived everyday discrimination is prevalent and differentially affects adults, especially members of marginalized and underserved populations. Understanding discrimination patterns will benefit public health and medical efforts aimed at mitigating exposure and deleterious health consequences.

Objective: The benefits of mobile applications in the prenatal period remain understudied. This study assessed associations between the Pregnancy Postpartum Support Program (PPSP), a digital wraparound service, and maternal and infant outcomes in a Medicaid population.

Methods: A retrospective analysis was conducted on pregnant patients with Medicaid insurance who received care and delivered in a Midwestern United States healthcare system between 8/1/2022-8/15/2023, comparing outcomes among those who did versus did not opt for PPSP enrollment. Enrolled patients were offered a mobile device app providing weekly education, "twenty-four seven" support from a clinical team, and telehealth provider visits. Adjusted multiple covariate analyses were completed using linear and logistic regressions. Patient engagement, vendor-based interaction and perception of care data were also examined.

Results: 1912 patients were evaluated: 397 in the PPSP and 1515 in the control group. PPSP cohort inclusion was associated with 4 % lower maternal length of stay (LOS) (p = 0.05), 14 % lower infant LOS (p < 0.01), higher mean infant birthweight (p < 0.01), lower odds of birthweight <2500 g (p = 0.05) and lower odds of preterm birth (p = 0.04). Nearly 85 % of all enrolled reported being "very satisfied" with the program.

Conclusions: Overall, the program was positively received by PPSP participants. Favorable outcomes associated with enrollment may be due to the program, unmeasured variables, or both. Our study shows the feasibility of offering digital support to pregnant women who voluntarily enrolled in the PPSP and adds to the evidence evaluating virtual care strategies.

Background: Electronic cigarettes, introduced as a safer tobacco alternative, have unintentionally exposed millions of youths to nicotine and harmful chemicals. Adolescence, a key period for forming lifelong habits, has seen rising e-cigarette use, particularly in developing regions like Latin America, warranting thorough investigation.

Objective: To describe the prevalence and factors associated with e-cigarette use among adolescents in Latin America.

Methods: A systematic review was conducted according to PRISMA guidelines, covering studies published between 2003 and May 2024. Database searches included PubMed/Medline, Web of Science, Scopus, Google Scholar, Scielo, and LILACS. A total of 582 studies were identified, of which 14 met the inclusion criteria. Study data were synthesized and assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute checklist.

Results: The prevalence of e-cigarette among adolescents in six Latin American countries ranged from 2.6 % to 64.2 %, with a pooled mean prevalence of 18.9 %, and lifetime use higher than current use. Key associated factors included male sex, concurrent use of tobacco and other substances, social influences, and exposure to online advertising. A widespread lack of knowledge regarding e-cigarette risks, coupled with limited regulatory oversight, may be contributing to higher usage rates.

Conclusion: This review underscores critical gaps in data on adolescent e-cigarette use in Latin America and highlights the need for expanded research and targeted public health interventions. Nearly one-fifth of adolescents reported using e-cigarettes. Comprehensive prevention programs addressing factors associated with adolescent e-cigarette use in Latin America, involving diverse stakeholders and integrating education, school-based policies, social media campaigns, and policy restrictions, are strongly recommended.

Objective: The noncompliance rate with routine or surveillance colonoscopies is high, and the underlying reasons remain unverified among Asian patients with inflammatory bowel disease (IBD). This study aimed to examine the perceptions of Asian patients with IBD regarding bowel preparation and colonoscopy and their attitudes toward the recommended intervals for colonoscopies.

Methods: Using data from one medical center between July 2020 and May 2022, we analyzed the perceptions of bowel preparation and colonoscopy and attitudes toward examination intervals among 94 patients with IBD (Crohn's disease, 41; ulcerative colitis, 53). The patients' perceptions of the four components associated with the colonoscopy procedure (embarrassment, pain, use of bowel-cleansing agents, and stress) were assessed via a questionnaire. Patients were asked to indicate the frequency at which they had scheduled colonoscopy and the frequency at which they desired to undergo the procedure.

Results: "Bowel cleansing" and "pain" received the highest dissatisfaction rate. "Drink too much" was the greatest burden in bowel preparation. Younger age and younger age at diagnosis were associated with a greater burden of bowel preparation and pain. Younger patients and those diagnosed at an earlier age tended to prefer longer examination intervals.

Conclusions: Bowel cleansing and abdominal pain were the most uncomfortable aspects associated with colonoscopy, especially when performed without sedation, among Asian patients with IBD. Younger patients and those with early diagnoses preferred longer examination intervals. Our findings can promote colonoscopy adherence and facilitate early detection of major complications in patients at high risk and those with long-term IBD.