Annual Review of Public Health最新文献

Suicide rates have increased in the United States in recent years. Public policies have great potential to prevent suicide death, and well-designed quasi-experimental studies have identified policies that are effective at reducing suicide rates; however, evidence about these policies has not been synthesized. This review summarizes evidence across three domains of public policies: (a) policies that affect structural determinants of suicide risk (e.g., policies that improve economic security), (b) policies that promote access to clinical services (e.g., Medicaid expansion), and (c) policies that limit access to lethal means for completing suicide (e.g., policies that restrict access to firearms). The historical context of suicide prevention in US public policy is provided, considerations for successful suicide prevention policy implementation are discussed-such as policy awareness among key groups, enforcement, and sufficient funding-and priority areas for future research are enumerated.

We summarize the state of the evidence on the long-term services and supports infrastructure to support aging-in-place. We find an extensive literature describing the importance of affordable medical and social services delivered in the home, support for family caregivers, and the role of technology for improving communication among patients, caregivers, and health care teams to support aging-in-place. We identify gaps in access to affordable services and an inadequate workforce prepared to support aging-in-place, raising concerns about meeting the future needs of our aging population. Interventions have been directed primarily at the individual level rather than at the system or policy level. Those systems-level interventions that do exist have been primarily within the health care sector: Little attention has been directed at developing holistic interventions that address multiple sectors, which reflects the lack of a cohesive public health delivery system for long-term services and supports nationally. Our findings collectively highlight the multifaceted nature of supports to enable aging-in-place and the necessity for future research to focus on drawing connections across domains of health services infrastructure.

Vaccines are lifesaving interventions that reduce the morbidity and mortality of disease. Fortunately, serious adverse events with vaccination are uncommon, but they must promptly be recognized and evaluated to assess and clarify the safety of future administration, a process that the public must understand in order to feel safe in receiving vaccines. In this article, we provide a review of vaccine development, discuss the process by which safety is ensured, and describe key adverse events associated with their administration. We review in detail existing mechanisms for reporting these events and assessing them following recovery, as well as communication related to vaccine safety. We also describe barriers to vaccination, such as nocebo effects and antivaccination groups, and use lessons learned from the successful development of COVID-19 vaccines during the recent pandemic to define future opportunities and directions for vaccine safety.

The prevalence and harms of societal weight stigma have increased attention to its presence in public health approaches and communication. Calls to action from scholars, advocates, and health professionals emphasize the need to address weight stigma as a social justice issue and eliminate harmful narratives that perpetuate weight bias and discrimination in public health messages, practices, and policies. However, debates surrounding issues of weight stigma in public health complicate, and at times impair, efforts to effectively address this problem. Different (and sometimes opposing) perspectives include views about the health risks versus stigma effects of high body weight, the use of body mass index (BMI) as a metric of health, weight-normative (i.e., weight-centric) versus weight-inclusive treatment approaches, stigmatizing language used to describe body weight, and potential challenges when framing obesity as a disease. This review summarizes the current evidence, debates, and best practices related to weight stigma in public health efforts.

The health care safety net provides essential clinical care and social services for low-income, uninsured, and underinsured populations in the United States. Despite these important functions, the health care safety net has experienced recurrent financial instability, growing market pressures, and workforce strain. Payment reform has also introduced unique challenges for safety net providers related to measuring and reaching quality benchmarks. A common theme among these challenges is that many of them result from applying standard health policy approaches to the safety net instead of using safety net-specific approaches. This review describes progress toward strengthening the safety net, key challenges, and opportunities moving forward.

The Roe era was hardly a monolith. For more than 50 years-beginning with abortion reforms in the 1960s and continuing through the Dobbs decision in 2022-state regulations of abortion were neither uniform nor consistent. States reformed and repealed abortion bans leading up to the Roe decision in 1973. Following Roe, they enacted both demand-side regulations of people seeking abortions and supply-side regulations of people providing abortions. The resulting laboratory of state policies affords natural experiments that have yielded evidence on the effects of abortion regulations on demographic, health, economic, and other social outcomes. I present a brief history of state policy variation from 1967 through 2016 and review the empirical scholarship studying its effects. This literature demonstrates that the liberalization of abortion access in the 1960s and 1970s allowed women greater control over their fertility, resulting in increased educational attainment and earnings. Subsequent state restrictions in the 1980s through 2010s had the opposite effect, particularly when they increased the financial and logistical costs of obtaining an abortion. I conclude with a discussion of implications for the post-Dobbs era, considering to what extent evidence from the past foretells the future.

When complex public health and health services interventions are implemented in real-world settings, adaptations should be expected, embraced, and studied rather than suppressed and ignored. A substantial amount of recent research has been conducted on the assessment of some types of adaptations, and interest in guiding adaptations to both interventions and implementation strategies is growing. However, there is still a need to investigate the optimal ways to systematically and pragmatically document, analyze, and iteratively guide adaptations as well as to measure the impact of those adaptations on implementation and effectiveness outcomes. This article reviews key findings from the adaptations assessment literature, frameworks to guide classification of adaptations, and methodologies to study adaptations and their impact. We summarize research from diverse settings and populations from public health and health services research on the use of these methodologies and make recommendations for research and practice.

Achieving health equity necessitates high-quality data to address disparities that have remained stagnant or even worsened over time despite public health interventions. Data disaggregation, the breakdown of data into detailed subcategories, is crucial in health equity research. It reveals and contextualizes hidden trends and patterns about marginalized populations and guides resource allocation and program development for specific needs in these populations. Data disaggregation underpins data equity, which uses community engagement to democratize data and develop better solutions for communities. Years of research on disaggregation show that researchers must collaborate closely with communities for adequate representation. However, despite generally positive support for this approach in health disparities research, data disaggregation faces methodological and political challenges. This review offers a framework for understanding data disaggregation in the context of data equity and highlights critical aspects of implementation, including challenges, opportunities, and recent policy and community-based efforts to address hurdles.

The prevalence of burnout among health workers is alarmingly high and worsening. Many factors across the domains of culture of wellness, efficiency of practice and work demands, and personal resilience place workers at risk for burnout. Intervention research has disproportionately studied individually focused interventions to strengthen personal resilience, demonstrating small benefit from such interventions. While coping strategies may have value, we stress the need to focus interventions on mitigating work conditions that breed burnout, such as inadequate levels of staffing, and to rigorously evaluate such interventions. A conceptual framework on burnout must include critical theory interrogating the broader economic, political, and structural forces shaping health care and the relative power of workers. The concept of moral injury may be more apt than burnout for describing the effects on workers' well-being of accelerating health care consolidation by investor-owned organizations, government austerity policies, and the disempowered position of labor.

Health authorities have promoted community water fluoridation (CWF) to prevent dental caries for more than 75 years. However, growing evidence has raised questions about the safety of this public health intervention, particularly for young children who are at risk of excess fluoride intake. Divergent opinions about the risk-benefit ratio of CWF have ignited a global debate. The efficacy of topical fluoride in preventing dental caries is strong, whereas contemporary evidence for systemic administration of fluoride is weaker. Inequalities in access to dental care and topical fluorides introduce an additional layer of complexity. This review discusses evidence showing that fluoride ingestion is not essential for caries prevention, offers little benefit to the fetus and young infant, and can cause dental fluorosis and cognitive deficits. In an environment where fluoride is available from multiple sources, community-based administration of systemic fluoride may pose an unfavorable risk-benefit ratio for pregnant women and young children.