Annals of Epidemiology最新文献

{"title":"A comparison of methods for coding race in linear and logistic regression models","authors":"Melody S. Goodman ,&nbsp;Ariana Lopez ,&nbsp;Anarina L. Murillo ,&nbsp;Kristyn A. Pierce","doi":"10.1016/j.annepidem.2025.10.005","DOIUrl":"10.1016/j.annepidem.2025.10.005","url":null,"abstract":"<div><div>In many public health and clinical research studies that use regression models for analyses, race is often considered a confounder and \"controlled\" for in the regression model with simple indicators for race and non-Hispanic White as the reference group, without much introspection from the data analyst. From a health equity perspective, multiple issues exist with this approach. We examine and compare several methods for coding race in linear and logistic regression models. We compare several coding methods using a sample of 8097 participants (≥18 years old) from the 2020 New York City Community Health Survey. To illustrate the importance of coding methods for race, we conducted regression analyses to compare the results from six coding approaches: dummy, simple effect, difference (forward and backward), deviation, and analyst-defined coding. Body mass index measured continuously and diabetes status measured dichotomously were the outcome variables in the linear and logistic regression models. Results showed that selecting a coding method has implications for identifying racial health inequities. The reference group selection is critical to measuring racial inequities in health outcomes. This study emphasizes the need to consider the impact of coding techniques on research study design, particularly when racial health inequities are the research focus.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Pages 15-22"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capturing the implications of residential segregation for the dynamics of infectious disease transmission","authors":"Jon Zelner ,&nbsp;Danielle Stone ,&nbsp;Marisa C. Eisenberg ,&nbsp;Andrew F. Brouwer ,&nbsp;Krzysztof Sakrejda","doi":"10.1016/j.annepidem.2025.11.001","DOIUrl":"10.1016/j.annepidem.2025.11.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Residential segregation is linked to racial and socioeconomic inequity in outcomes for numerous infections including SARS-CoV-2, influenza, STIs, and tuberculosis. Despite the importance of segregation as a driver of infection inequity, there are few mathematical models to inform our understanding of these dynamics.</div></div><div><h3>Methods</h3><div>We developed a transmission model including mechanistic relationships between residential segregation and infection inequity. We conceptualize segregation as a fundamental social cause of infection inequity that jointly impacts contact patterns and vulnerability to infection.</div></div><div><h3>Results</h3><div>We show that the basic reproduction number, <span><math><msub><mrow><mi>R</mi></mrow><mrow><mn>0</mn></mrow></msub></math></span>, and equilibrium prevalence are sensitive to interactions between these factors. Our results show that separation alone is insufficient to explain segregation-associated differences in infection risks. Increasing separation only results in concentration of risk in segregated populations when accompanied by increasing vulnerability.</div></div><div><h3>Conclusions</h3><div>This work shows why it is important to consider causal linkages between high-level social determinants - like segregation - and more-proximal transmission mechanisms when crafting and evaluating public health policies. While the framework in this analysis is stylized, it lays the groundwork for data-driven explorations of the mechanistic impact of residential segregation on infection inequities.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Pages 102-109"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planning for the sustainability of a youth suicide prevention program in Native American contexts: A modeling study","authors":"Lauren Yan ,&nbsp;Zhixi Chen ,&nbsp;Novalene Goklish ,&nbsp;Kristin Mitchell ,&nbsp;Charity Watchman ,&nbsp;Meredith Stifter ,&nbsp;Victoria O’Keefe ,&nbsp;Allison Barlow ,&nbsp;Mary Cwik ,&nbsp;Takeru Igusa ,&nbsp;Emily E. Haroz","doi":"10.1016/j.annepidem.2025.10.020","DOIUrl":"10.1016/j.annepidem.2025.10.020","url":null,"abstract":"<div><h3>Purpose</h3><div>We aimed to identify actionable, effective sustainment strategies for a community-based suicide prevention program implemented in Tribal contexts through a participatory process of system dynamics modeling.</div></div><div><h3>Methods</h3><div>Through a series of workshops with teams implementing a suicide prevention program, we prioritized strategies for sustaining implementation and related health outcomes. We used system dynamics modeling and microsimulations to assess the impact of key strategies (<em>increased funding, enhanced program management, and leadership development</em>) on program sustainment outcomes and suicidal behavior among youth.</div></div><div><h3>Results</h3><div><em>Enhanced program management</em> impacted sustainment by increasing simulated levels of community trust by 31 % and community and external collaborators by 10 %. <em>Increased funding</em> increased simulated resource availability by 46 % and staffing levels by 13 % over the simulated time frame. Among the three simulated sustainment strategies, <em>enhanced program management</em> most improved clinical outcomes, decreasing non-suicidal self-injury by 1.4 % and suicide attempts by 1.3 %.</div></div><div><h3>Conclusions</h3><div>We collaboratively developed a simulation model that assessed the relative impact of stakeholders’ prioritized sustainment strategies. A multifaceted intervention for <em>enhanced program management</em> had the greatest impact on program sustainment outcomes. This approach can benefit Tribal communities who are considering methods to support vital community-based programs.</div></div><div><h3>Keywords</h3><div>System dynamics; Microsimulation; Community-based participatory research; Native American; Suicide prevention; Surveillance; Sustainability</div></div><div><h3>List of abbreviations and acronyms</h3><div>AI/AN, American Indian and Alaska Native; WMAT, White Mountain Apache Tribe; JHCIH, Johns Hopkins Center for Indigenous Health; C-CASA, Columbia Classification Algorithm for Suicide Assessment; GLS, Garrett Lee Smith Memorial Act; CDC, Centers for Disease Control and Prevention; NHS, National Health Service; SBIRT, Screening, Brief Intervention, Referral to Treatment; PHPCS, Public Health Program Capacity for Sustainability; PSAT, Program Sustainability Assessment Tool; SD, system dynamics; IHS, Indian Health Service</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Pages 84-93"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Availability of sexual orientation and gender identity (SOGI) information in a cohort of transgender and gender diverse people: An analysis of electronic health records","authors":"Cynthia N. Ramirez ,&nbsp;Michael Goodman ,&nbsp;Kristine Magnusson ,&nbsp;Wendy Leyden ,&nbsp;Alexandra N. Lea ,&nbsp;Darios Getahun ,&nbsp;Courtney McCracken ,&nbsp;Suma Vupputuri ,&nbsp;Lee Cromwell ,&nbsp;Timothy L. Lash ,&nbsp;Oumaima Kaabi ,&nbsp;Guneet K. Jasuja ,&nbsp;Michael J. Silverberg","doi":"10.1016/j.annepidem.2025.10.016","DOIUrl":"10.1016/j.annepidem.2025.10.016","url":null,"abstract":"<div><h3>Purpose</h3><div>Electronic health records (EHR) offer a unique opportunity to systematically collect sexual orientation and gender identity (SOGI) data. This study examined the prevalence and determinants of SOGI reporting in an EHR-based cohort of transgender and gender diverse (TGD) individuals.</div></div><div><h3>Methods</h3><div>We identified TGD people with and without SOGI documentation across four Kaiser Permanente health plans from January 1, 2022–2024. TGD status was determined through clinical notes, diagnostic codes, and SOGI data based on a previously established cohort. Factors associated with SOGI reporting were assessed using log-binomial regression, yielding prevalence ratios (PR) and the 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>Among 23,060 TGD individuals, 71 % had SOGI documentation in the EHR. Reporting varied by sociodemographic and clinical characteristics. For example, compared to those &lt; 20 years, SOGI reporting was higher for those aged 21–59 (PRs 1.10–1.21; 95 % CIs 1.06–1.24) and lower for those &gt; 60 (0.93; 0.88–0.99). Documentation was slightly lower for those assigned male at birth (0.98; 0.97–1.00) and varied by race and ethnicity (e.g., Hispanic: 0.97; 0.95–0.99; Other: 1.02; 0.98–1.05 vs. White).</div></div><div><h3>Conclusions</h3><div>KP’s EHRs captured SOGI data for over 70 % of TGD individuals, though more research is needed to understand factors associated with missing data not captured in structured fields.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Pages 23-27"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guiding artificial intelligence in public health and medicine with epidemiology: A lifecycle framework for mitigating AI misalignment","authors":"Ahmed Hassoon MD, MPH ,&nbsp;Christine Lin MPH ,&nbsp;Hyun Yi (Jacqualine) Woo MD, MPH ,&nbsp;Ruxandra Irimia MD, PHD, MPH ,&nbsp;Jill A. Marsteller PhD, MPP ,&nbsp;Anthony Li MD, PMH ,&nbsp;Antonio Banderia MD, MPH ,&nbsp;Hubert Leo BS ,&nbsp;Xiaoyi Peng ScM ,&nbsp;David Rastall MD ,&nbsp;Mark Dredze PhD","doi":"10.1016/j.annepidem.2025.11.004","DOIUrl":"10.1016/j.annepidem.2025.11.004","url":null,"abstract":"<div><div>Artificial Intelligence (AI) holds immense promise for public health, yet its potential is undermined by alignment failures where systems act contrary to human values, often exacerbating health disparities. This paper challenges the narrow view that algorithmic bias is solely a data problem, arguing instead that misalignment arises at every stage of the AI development lifecycle. We introduce a comprehensive seven-stage framework, spanning problem definition, team assembly, study design, data acquisition, model training, validation, and post-deployment implementation, viewed through an epidemiological lens. This approach systematically integrates core principles such as population representativeness, rigorous study design, bias characterization, and causal reasoning to identify and mitigate alignment risks. For each stage, we define specific alignment failures, from flawed problem formulation to post-market performance degradation, and propose actionable, evidence-based solutions. By embedding epidemiological rigor throughout the entire AI lifecycle, this framework provides a structured, proactive pathway for researchers, developers, and policymakers to create trustworthy, safe, and fair AI systems. This systemic approach is critical to harnessing AI's transformative benefits for population health while preventing the perpetuation of inequity and harm.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Pages 119-126"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piloting the novel Evidence Synthesis Equity Companion (ESEC) tool","authors":"Maria Benkhalti,&nbsp;Talia Salzman,&nbsp;Prinon Rahman,&nbsp;Ayan Hashi,&nbsp;Laura Boland,&nbsp;Mallory Drysdale","doi":"10.1016/j.annepidem.2025.11.002","DOIUrl":"10.1016/j.annepidem.2025.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The need for greater evidence on equity-denied population groups continues to be recognized across public health, epidemiology, and community medicine. Despite a number of existing frameworks and tools on the inclusion of equity considerations in evidence syntheses, there was a gap in tools providing step-wise guidance and facilitating the documentation of the process.</div></div><div><h3>Methods</h3><div>We adapted the Equity Checklist for Health Technology Assessment (ECHTA) to the more specific steps of an evidence synthesis. We complemented the guidance provided from seminal resources with articles from a comprehensive literature search and input from expert methodologists. We piloted the tool with a rapid review on substance-related mortality across racialized and ethic groups. We reported on the methodological changes following the use of the tool and the limitations we have observed.</div></div><div><h3>Results</h3><div>The Evidence Synthesis Equity Companion (ESEC) tool provides guidance and structure to considering equity and the methods to use at each step of an evidence synthesis. It allows review authors to transparently document their process and explicitly highlight its limitations. During the pilot, using the ESEC tool resulted in enhanced approaches to answer the equity-focused review question. Certain limitations remain with the tools, notably a more thorough guidance development for incorporating equity in the knowledge translation process.</div></div><div><h3>Conclusion</h3><div>The ESEC tool provides structured guidance, supporting the incorporation of equity considerations throughout the evidence synthesis process. The pilot demonstrated its benefits both for the methods used and the evidence uncovered. Additionally, the process was valuable to the review team. Using the tool in different types of evidence syntheses will allow for greater insight into its value-added.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Pages 94-101"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and cyclical patterns of dengue disease in Mexico: A 40-year time series analysis","authors":"Jaime Briseno-Ramirez ,&nbsp;Judith Carolina De Arcos-Jiménez ,&nbsp;Ana María López-Yáñez ,&nbsp;Roberto Miguel Damián-Negrete ,&nbsp;Patricia Noemi Vargas-Becerra ,&nbsp;Laura Karina Salas-Salazar ,&nbsp;Berenice Martínez-Melendres ,&nbsp;Ismael Caballero-Quirarte ,&nbsp;Pedro Martínez-Ayala","doi":"10.1016/j.annepidem.2025.10.022","DOIUrl":"10.1016/j.annepidem.2025.10.022","url":null,"abstract":"<div><h3>Purpose</h3><div>To quantify long-term trends and multi-year cycles in dengue in Mexico (1985–2025) and examine recent serotype–severity patterns.</div></div><div><h3>Methods</h3><div>We integrated open national surveillance data from the Morbidity Yearbook (1985–2024) and Open Data (2020–2025) using the official estimated-cases definition. Monthly series underwent STL decomposition, Butterworth filtering, periodogram, and autocorrelation analyses. Stationarity was assessed in prespecified windows (1985–2000; 2000–2015; 2015–2025) and by geography (coastal/high-burden vs inland). Serotype distribution and hospitalizations (2020–2025) were summarized among laboratory-confirmed cases and compared across years with χ² tests.</div></div><div><h3>Results</h3><div>Over 40 years we identified 1715,456 estimated cases; annual burden increased (Mann–Kendall z = 3.25; Sen’s slope ≈ +1275 cases/year). A recurrent multi-year oscillation overlaid the seasonal cycle, with a spectral peak near 5.8 years and an ACF secondary maximum at ∼4.3 years; the signal persisted in coastal/high-burden states and across historical windows. Since 2023, DENV-3 predominated (86 % in 2024; 94.9 % by May-2025) and coincided with higher hospitalization proportions.</div></div><div><h3>Conclusions</h3><div>Dengue in Mexico shows a significant long-term rise and a reproducible ∼5-year cycle. Cycle-aware baselines, paired with serotype surveillance, could sharpen early-warning thresholds and targeting of vector control.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Pages 53-63"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The American College of Epidemiology Annals of Epidemiology Award, 2025","authors":"","doi":"10.1016/j.annepidem.2025.11.007","DOIUrl":"10.1016/j.annepidem.2025.11.007","url":null,"abstract":"","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"112 ","pages":"Page 127"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends and source attribution of animal-contact related human nontyphoidal Salmonella enterica outbreaks across the United States, 2009–2022","authors":"Hammad Ur Rehman Bajwa ,&nbsp;Suman Bhowmick ,&nbsp;Csaba Varga","doi":"10.1016/j.annepidem.2025.10.008","DOIUrl":"10.1016/j.annepidem.2025.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Previous studies have assessed nontyphoidal <em>Salmonella enterica</em> (NTS) outbreaks associated with animal contact over short periods or single exposures. This study longitudinally evaluates the incidence, temporal trends, and all relevant exposure sources of NTS outbreaks attributed to animal contact in the United States (US) from 2009 to 2022.</div></div><div><h3>Methods</h3><div>Surveillance data on animal-contact-related NTS single-state outbreaks in the US, reported to the Centers for Disease Control and Prevention through the National Outbreak Reporting System between 2009 and 2022, were analyzed. First, yearly and state-specific NTS outbreak incidence rates (IRs) per one million population years (1 MPY) were calculated. Next, join point regression models assessed national and state-specific trends in NTS IRs over the study years. Lastly, the proportion of NTS outbreaks attributed to various animal contact sources was described.</div></div><div><h3>Results</h3><div>During the 14 years, 104 NTS outbreaks were reported (0.02 per 1 MPY). The highest outbreak IRs were observed in 2014 (0.0534 per 1 MPY), 2018 (0.0459), and 2009 (0.0389). The join point regression analysis did not identify a significant trend in the national NTS outbreak IRs; however, several states were identified with increasing and/or decreasing trends. Contact with mammals was the main exposure category (n = 37 outbreaks, 35.58 %), followed by birds (n = 31, 29.81 %) and reptiles (n = 24).</div></div><div><h3>Conclusions</h3><div>Continued public health resources to mitigate the health burden of NTS infections are needed. Differences in state-level NTS outbreak IRs call for focused NTS prevention and control programs.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 168-174"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between BMI, body size perception, and dropout from upper secondary education: A prospective cohort study of 15–19-year-old adolescents","authors":"Laura Staxen Bruun ,&nbsp;Cecilie Bladt ,&nbsp;Katrine Strandberg-Larsen ,&nbsp;Vibeke Tornhøj Christensen ,&nbsp;Jane Greve ,&nbsp;Elisabeth Reichel Hansen ,&nbsp;Janne S. Tolstrup","doi":"10.1016/j.annepidem.2025.10.010","DOIUrl":"10.1016/j.annepidem.2025.10.010","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine the independent associations of BMI and body size perception with dropout from upper secondary education.</div></div><div><h3>Methods</h3><div>Data from the Danish National Youth Study 2014, including 63,976 students aged 15–19 years, were linked to information on school dropout from the Student Register. Multilevel logistic regressions were employed to examine how BMI and body size perception were each associated with school dropout. Mediation analyses were conducted to assess the role of body size perception in the BMI-dropout association.</div></div><div><h3>Results</h3><div>Both low and high BMI were associated with higher odds of school dropout, following a U-shaped pattern across the BMI continuum. For instance, females with a BMI above 30 kg/m² had an OR of 2.37 (95 % CI: 1.74;3.27), compared to those with a BMI of 18.5–24.9 kg/m². Adjusting for body size perception, ORs attenuated for students with a BMI above the median. Body size perception mediated a substantial proportion of the BMI-dropout association. Students who perceived themselves as too thin or fat also had higher odds of dropout. For instance, females who perceived themselves as ‘much too fat’ had an OR of 2.66 (95 % CI: 2.17;3.25), compared to those who perceived themselves as ‘about right size’. Adjusting for BMI had only minor impact on ORs.</div></div><div><h3>Conclusion</h3><div>Low and high BMI, as well as the perception of not being the right size, were associated with higher odds of dropout from upper secondary education. Adjusted for body size perception, the association between BMI and dropout attenuated, suggesting that body size perception plays a crucial role in this relationship. Body size perception partly explains the BMI-dropout relationship, highlighting a need for more comprehensive approaches focusing adolescents’ perceptions of their bodies alongside actual weight to reduce school dropout.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"111 ","pages":"Pages 129-137"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}