Preventive Medicine Reports最新文献

Background: Perceptions of disease risk play an important role in adopting healthy behaviors. The main objective of this study is to examine factors associated with high perceived cancer risk among Zuni Adults in New Mexico, USA.

Methods: We used data from a survey conducted in Zuni Pueblo from October 2020 to April 2021. Our analysis included 254 adults ages 21-75 years without a reported personal cancer history. Perceived cancer risk was determined from the question: "Compared to other people your age, how likely do you think it is that you could get cancer?" and ordinal logistic regression analyses were used to identify factors associated with high perceptions of cancer risk.

Results: Overall, 35 %, 27 %, and 38 % of respondents reported perceived cancer risks that were lower than, about the same as, and higher than those of other people their age, respectively. From bivariate analysis, factors associated with high perceived cancer risk included: positive family cancer history (odds ratio [OR] = 1.95; 95 % confidence interval [CI]: 1.23-3.11), higher knowledge of cancer risk factors (OR = 1.45; CI: 1.09-1.93), higher education (OR = 1.46; CI: 1.16-1.84), and higher body mass index (OR = 1.44; CI: 1.07-1.94). In multivariable analysis, family cancer history (OR = 1.81; CI: 1.10-2.99), knowledge of risk factors (OR = 1.38; CI: 1.03-1.86), and education (OR = 1.81; CI: 1.10-2.96) remained statistically significant.

Conclusion: Our findings provide important insights on perceptions of cancer risk in this community, and have important implications for developing effective, culturally relevant interventions in this community.

Objective: To examine associations between student perceptions of school physical activity best practices and accelerometer-based physical activity during school days.

Methods: The sample was 758 students in grades 3rd-4th or 6th-7th (female-58 %; 31 % Black/African American) from 33 schools across five school districts in a Mid-Atlantic state in the U.S. Students completed the Perceptions of the Environment at School survey to assess perceived implementation of 11 school physical activity best practices and wore an Actical ankle accelerometer for 7 days between 2017 and 2019. Accelerometer cutpoints were applied for percent time in sedentary, light, and moderate-vigorous physical activity (MVPA) during school hours. Adjusted mixed effects linear regression models were used to predict percent time in each physical activity category, with separate models for elementary and middle school.

Results: More best practices were perceived by elementary versus middle schoolers (sum score = 3.3 versus 1.5, p < .01). For every additional best practice perceived, elementary schoolers spent 0.64 % less time in sedentary behavior (B = -0.62; SE = 0.27, p = .02), equivalent to ∼12 fewer minutes/week in sedentary behaviors, and 0.58 % more time in light activity (B = 0.58; SE = 0.25, p = .02; ∼10 more minutes/week). No associations observed for middle schoolers or MVPA.

Conclusions: Few best practices were perceived as being implemented in school. Elementary schoolers who perceived more best practices spent more time in light activity and less in sedentary behavior, but this relationship was not found among middle schoolers. Future research should promote implementation of school physical activity best practices and examine the linkage between implementation, student perceptions, and behavior change.Trial Registration: Clinical Trials, NCT03432715; Registered on 02/2/2018.

Objective: Assess the association between having witnessed physical violence between parents and intimate partner violence (IPV) against men in Bolivian adults according to the Encuesta de Demografia y Salud (EDSA) 2016.

Methods: A retrospective cross-sectional study was conducted using data from the EDSA 2016 in Bolivia. The variable of interest in this study was IPV in men experienced during the last 12 months (any type of violence, physical and/or sexual, and psychological). The exposure variable was having witnessed physical violence between parents. Unadjusted and adjusted generalized linear models were constructed to assess the association of interest, and prevalence ratios (PR) with 95 % confidence intervals (95 %CI) were reported.

Results: Witnessing physical aggression between parents in childhood was associated with a greater probability of suffering intimate partner violence in adulthood (adjusted PR [aPR]: 1.50; 95 %CI: 1.34-1.69). Similarly, the presence of physical aggression between parents in childhood was associated with a higher probability of physical and/or sexual violence (aPR: 1.92; 95 %CI: 1.53-2.39) and psychoverbal violence (PR: 1.48; 95 %CI: 1.32-1.67). The association identified was not modified by having suffered violence during childhood.

Conclusions: Participants who witnessed physical violence between parents were more likely to suffer intimate partner violence (IPV), psycho-verbal violence and physical and/or sexual violence by their partners.

Objective: With South Korea's population aging rapidly, the number of patients with type 2 diabetes mellitus (T2DM) is expected to rise, leading to worsened health outcomes and potentially straining healthcare financing. This study aimed to investigate how avoidable diabetes-related hospitalizations affect short- and long-term health expenditures.

Methods: Data from the National Health Insurance Service-Senior cohort from 2008 to 2019 in South Korea. A total of 27,081 participants aged 60 years and older who were diagnosed with T2DM were included in the study. The independent variable in this study was avoidable diabetes-related hospitalization according to the ICD-10 criteria "E11". The outcome measures included one- and five-year health expenditures. Regression analysis was performed using the generalized estimating equation (GEE) with a gamma distribution and log-link function. Inverse Probability of Treatment Weighting (IPTW) analysis was conducted to enhance the robustness of the results.

Results: Out of the 27,081 participants, 685 patients (2.5 %) experienced avoidable diabetes-related hospitalizations. GEE analysis with IPTW weights revealed that participants who experienced avoidable hospitalizations had a higher risk of increased health expenditures (one-year: relative risk (RR) 1.83, 95 % CI 1.76-1.91; five-year: RR 1.63, 95 % CI 1.57-1.69). Consistent patterns were observed even without weighting (one-year: RR 1.85, 95 % CI 1.68-2.04; five-year: RR 1.60, 95 % CI 1.47-1.74).

Conclusions: Our findings highlight the importance of continuous health management to prevent avoidable hospitalization, thereby promoting health and ensuring the financial stability of older patients with T2DM within the healthcare insurance system.

Objectives: Many studies have examined the impact of employment on health, but few large-scale longitudinal studies specifically investigate the impact of agricultural labor on the health of older adults. This study aims to identify the health effects of employment on older Japanese adults, focusing on agricultural workers.

Methods: This study uses longitudinal data collected by the Japan Gerontological Evaluation Study (JAGES) from 2013 to 2019. We selected 48,221 older adults out of a total of 65,751 respondents, excluding missing values. The objective variables included healthy ageing, such as dementia, functional disability, loss of healthy life expectancy, and death. Explanatory variables were used to categorize participants into four groups: non-agricultural workers, agricultural workers, retired, and those who have never worked. Seven adjustment variables, including sex, age, and socioeconomic status, were considered. Logistic and modified Poisson regression analyses were employed after imputing missing values.

Results: Incidence ranged from 2.6 % (dementia) to 17.3 % (any level of functional disability). Post-multiple imputation analysis showed significantly lower odds ratios and risk ratios for dementia, functional disability, loss of healthy life expectancy, and death among non-agricultural and agricultural workers compared to retirees. The odds and risk ratios for agricultural workers ranged from 0.45 (dementia) to 0.69 (loss of healthy life expectancy).

Conclusions: Compared with retirees, non-agricultural and agricultural workers experience significantly reduced risks for dementia, functional disability, loss of healthy life expectancy, and death. These findings showed potential health benefits associated with continued employment in older age.

Background: As primary care physician numbers continue to decline, more patients with type 2 diabetes are likely to receive care from advanced practice providers (APPs), including physician assistants and nurse practitioners. Analyzing diabetes medication prescribing trends among these provider types is essential for ensuring evidence-based diabetes care. Purpose: This retrospective, cross-sectional pilot study aimed to examine differences in type 2 diabetes medication prescribing trends by provider type (physicians vs. APPs) and geographic location, utilizing National Ambulatory Medical Care Survey (NAMCS) data.

Methods: Data from the NAMCS were collected in August 2022 for the years 2015, 2016, 2018 and analyzed using IBM SPSS, employing chi-square analysis to assess associations between provider type, geographic location, and prescribed medications. Frequency distributions were calculated for patient characteristics and provider types.

Results: Patients prescribed at least one diabetes medication (N = 1444) were included. Most received care from physicians (93.7 %) in metropolitan areas (82.8 %). Statistically significant associations were found between provider type, geographical location, and medications prescribed. Nurse practitioners were more likely to prescribe newer diabetes medications, while physician assistants frequently prescribed basal insulin. Patients in non-metropolitan statistical areas were more often prescribed older medications, whereas those in the West were less likely to receive older medications.

Conclusions: The study revealed distinct prescribing patterns by provider type and geographic location. Notably, APPs tended to prescribe newer or specific medications in certain locations, highlighting the influence of provider type and geography on diabetes care. Further studies should include larger samples of APPs to deepen insights into these trends.

Background: Smoking is the leading cause of preventable death in the United States. We interviewed Tobacco Cessation Champions, multi-sector decision makers, across the state of Michigan to assess and identify barriers and facilitators of smoking cessation and the current smoking cessation landscape.

Methods: Twenty Tobacco Cessation Champion interviews (n = 20) were completed with multi-sector decision makers to assess implementation barriers and facilitators from May 2022 to September 2023. We used rapid qualitative analysis to identify common themes across the Tobacco Cessation Champion interviews.

Results: Three key themes were identified across the Tobacco Cessation Champion interviews: 1) Facilitators and Barriers of Smoking Cessation Efforts; 2) Smoking Cessation Efforts: Underfunded, Underutilized, Not Marketable or Accessible, and 3) Need for more inclusive, person-centered smoking cessation interventions.

Conclusion: Across the themes identified in the present report, champions identified myriad areas for improvement in the tobacco cessation landscape, including: Appeal, accessibility, and the functionality of current systems. The community should strive to improve trust and relationships between providers and patients, as the trust established between these parties is imperative for promoting tobacco cessation. Lastly, cessation efforts should aim to address and improve attitudes and stigma toward smoking and tobacco cessation.

Background: Receipt of cigarette and e-cigarette coupons predicts initiation and progression of use and hinders cessation. Less is known about how coupons operate in different tobacco regulatory environments. The current study utilized longitudinal data from the Population Assessment of Tobacco and Health (PATH) Study to address this research gap.

Methods: Adults who reported past 30-day (P30D) e-cigarette use at Wave 5 (2018-2019) were included (N = 3632). The primary outcome was Wave 6 (2021) P30D any tobacco use. Wave 5 predictors were receipt of e-cigarette coupons, state e-cigarette tax, state tobacco policy context, flavored e-cigarette use, income, and education. Covariates were age, sex, race, state coupon policy, and Wave 5 use of tobacco other than e-cigarettes. Weighted logistic regression models examined effects overall and in samples stratified by state e-cigarette tax and tobacco policy context.

Results: Controlling for covariates, Wave 5 coupon receipt (AOR = 1.57; 95 % CI: 1.07, 2.31) and preference for flavored e-cigarettes (AOR = 1.70; 1.37, 2.10) were positively associated with Wave 6 tobacco use. Stronger state tobacco policy context was negatively associated with tobacco use (AOR = 0.69; 0.55, 0.88). Coupon receipt predicted tobacco use in states with an e-cigarette tax (AOR = 2.39; 1.22, 4.68) and with stronger tobacco policy contexts (AOR = 1.80; 1.07, 3.02), but not in states without an e-cigarette tax (AOR = 1.29; 0.83, 1.99) or with weaker tobacco policy contexts (AOR = 1.33; 0.78, 2.24).

Conclusions: Policies that restrict price-discounting could help discourage e-cigarette use, reinforce e-cigarette taxes and other tobacco control policies, and promote cessation of all tobacco among those reporting e-cigarette use.

Objective: Human papillomavirus (HPV) vaccine uptake remains suboptimal. Our stepped-wedge cluster randomized trial found that reminder-recall letters sent to parents of age-eligible children significantly increased vaccine uptake compared to usual care. Subsequently, we conducted a process evaluation to assess the mechanisms of the letter's effectiveness. This study evaluated who remembered the letter, use of provided resources, and child vaccination status.

Methods: This cross-sectional evaluation included data from parents (n = 1165) of adolescents ages 11-12 from six primary care practices who received letters about their child's HPV vaccination status. From 2018 to 2022, parents were mailed reminder-recall letters and then sent questionnaires 12-15 months after receiving the letter. Questionnaires asked if parents recalled the letter, whether their child received a vaccination and, if not, reasons for not vaccinating, and attitudes and beliefs about HPV vaccination.

Results: A total of 1165 of 1991 questionnaires were completed (59 %). Over half (58 %) remembered the reminder-recall letter. Compared to those not remembering the letter, those who did were significantly more likely to have had their child vaccinated (56 % versus 44 %, p < 0.05). Of those who remembered the letter but did not vaccinate, the majority reported misperceptions about their child being too young (26 %) or concerns about vaccine safety (20 %). Of those who did not remember the letter and did not vaccinate, the primary reason was not knowing the child was due for vaccination (27 %).

Conclusions: Reminder-recall letters cued the majority of parents to complete HPV vaccination; however, vaccine misperceptions remain a challenge, indicating the need for additional communication strategies.

Objective: Given the critical role of general practitioners (GPs) in the early diagnosis and management of asbestos-related diseases (ARDs), and the significant history of asbestos fibres pollution in Alessandria Local Health Authority (ASL AL), this project aimed to assess the knowledge and awareness of asbestos risks, as well as the experience in diagnosing ARDs among GPs working in Alessandria province, Northern Italy.

Methods: A questionnaire was administered to 216 GPs from all ASL AL territorial districts during 26 Territorial Assistance Equipes (EATs) meetings, held from September 2022 to January 2023. It contained 29 questions covering three main areas: 'knowledge and awareness', 'competence and experience', 'sociodemographic characteristics and workload'.

Results: Although GPs were aware of the health hazards of asbestos (94 %) and the increased risk of mesothelioma from asbestos exposure (92.6 %), significant disparities and heterogeneity of knowledge were observed among territorial districts and by comparing Casale Monferrato district with all the others, particularly regarding asbestos exposure routes, reporting of occupational diseases, and mesothelioma latency.

Conclusions: This project provides a comprehensive overview of GPs' knowledge, awareness and experience in managing ARDs, providing indications of customised training requirements. This evaluation could be extended to all areas with a history of previous asbestos exposure and provide a useful tool for policy makers to define and plan strategic actions on asbestos. This work could also be adapted to different realities with a history of environmental pollutant exposure other than asbestos, which pose a risk for the development of several diseases.