American Journal of Preventive Medicine最新文献

Introduction: About 25% of people who currently smoke cigarettes in the United States (US) smoke non-daily, and relatively little is known about their intentions or attempts to quit. Active surveillance is essential to identify services needed to support smoking cessation efforts and reduce the burden of disease.

Methods: US population-wide estimates of quit attempts and use of cessation aids among adults who smoke cigarettes were calculated using data from the September 2022 wave of the Tobacco Use Supplement to the Current Population Survey. Statistical analyses were conducted in 2024. Weighted percentages and 95% confidence intervals (95%CI) are presented by sociodemographic characteristics and smoking pattern.

Results: In 2022, nearly 6 million adults (2.59 million women, 3.36 million men) in the US reported smoking non-daily an average of 13.4 days per month (95%CI:12.7-14.1). Compared with adults who smoke daily, the proportion of past-year quit attempts was higher among people who reported smoking on some days of the month (always some days: 41.8%; formerly daily: 58.4%; daily: 32.2%). However, those who smoke some days were less likely to report receiving medical advice to quit (always some days: 49.5%; formerly daily: 58.1%; daily: 72.7%), using pharmacotherapy such as nicotine replacement therapy or a prescribed medication (always some days: 17.9%; formerly daily: 32.4%; daily: 38.7%), or receiving counseling to quit smoking (always some days: 5.8%; formerly daily: 6.9%; daily: 12.0%).

Conclusions: Given the substantial number of adults who smoke non-daily in the US and their interest in quitting, developing targeted interventions and communication is an important public health priority.

This update, titled Providing Quality Family Planning Services^a in the United States: Recommendations of the U.S. Office of Population Affairs (Revised 2024), provides recommendations developed by the Office of Population Affairs (OPA) within the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS). These recommendations represent an update to Providing Quality Family Planning (QFP) Services: Recommendations of the Centers for Disease Control and Prevention (CDC) and the U.S. Office of Population Affairs (OPA), originally published in 2014. The updated recommendations outline how to provide quality sexual and reproductive health (SRH) services for people of reproductive age but can also be used to guide the care of people of any age when the content is relevant to their needs, including family-building services, contraception, pregnancy testing and counseling, early pregnancy management, sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) prevention and testing services, and other preventive health services. The recommendations aim to enable health care providers with the knowledge, skills, and attitudes to ensure that all people, regardless of individual characteristics such as sex, sexual orientation and gender identity, age, disability, or race, can have their SRH needs met. The primary audience for these recommendations is providers and potential providers of SRH services to people of reproductive age, such as providers working in clinical settings dedicated to SRH service delivery, including those funded by the Title X family planning program^b as well as primary care providers and other subspecialty providers who may identify SRH needs and make referrals. During the past decade, several changes have taken place in the United States that have affected SRH care delivery, including technological advances, recognition of long-standing inequities, and other legal and regulatory changes. This broader context has been considered in designing the updated recommendations. This update of the QFP aims to provide guidance on the provision of person-centered SRH care focused on individuals' needs, values, and preferences. The update offers specific recommendations for how to provide high-quality SRH care and connects users to relevant guidelines, primary research, and other resources to inform best practices. In addition to incorporating new evidence, this update incorporates newer approaches to care, including adopting a health equity lens that recognizes the impact of structural and interpersonal racism, classism, ableism, and bias based on sexual orientation and/or gender identity on health and the provision of quality SRH care. OPA will update these QFP recommendations periodically to reflect new findings in the scientific literature and revisions to the clinical guidelines referenced in this update.

Introduction: Quantifying the use of emerging tobacco products such as nicotine pouches (NPs) and heated tobacco products (HTPs) is crucial for informing public health interventions and measuring their potential effects on tobacco use morbidity, mortality and benefits from complete tobacco cessation.

Methods: Using data from the May 2019 and September 2022 cycles of the Tobacco Use Supplement to the Current Population Survey (TUS-CPS), we calculated U.S. population-wide estimates of ever and/or current use of NPs and HTPs by key socio-demographic characteristics, cigarette smoking status and preference of characterizing flavors in NPs. We present weighted frequencies, proportions and associated 95% confidence intervals. Analyses were conducted in 2024.

Results: In both survey cycles, a substantial fraction of adults who ever used HTPs had never smoked cigarettes (52.0% in 2019; 27.4% in 2022). Among those who currently used HTPs or NPs (2022 only), many reported having never smoked cigarettes (42.5% and 41.4%, respectively), while many also reported currently smoking (32.2% and 24.8%, respectively). We observed similar sociodemographic characteristics across use of both HTPs and NPs. Mint was the most common flavor choice among adults who currently used NPs (52.8%).

Conclusions: Continued surveillance of emerging tobacco products such as HTPs and NPs can inform public health approaches and support future research to better quantify the health consequences from these products.

Introduction: Food as Medicine is increasingly recognized as an important strategy for addressing the related challenges of food insecurity and nutrition-related chronic conditions. Food as Medicine refers to integration of food-based nutrition interventions into healthcare to prevent and treat disease. However, there is limited evidence to understand the effectiveness of Food as Medicine.

Methods: Recipe4Health, a comprehensive Food as Medicine program, was implemented in 4 Federally Qualified Health Centers in California for patients with food insecurity and/or nutrition-related chronic conditions. Patients were referred by a healthcare provider to a 'Food Farmacy' (16 weekly produce home deliveries) alone or in combination with a 'Behavioral Pharmacy' (16 weekly group visits). A quasi-experimental study with pre/post surveys (4 months) and propensity score matched controls for Electronic Health Record (EHR) outcomes over 12 months was conducted. Participants were 2,643 Recipe4Health patients and 2,643 controls identified from 1/2020 to 12/2022; data were analyzed from 2023-2024.

Results: There was a significant increase in produce consumption from baseline to four months (0.41 servings/day [0.11, 0.72], p=0.007) in the Food Farmacy in combination with Behavioral Pharmacy. Compared to controls, there were improvements in non-HDL cholesterol for the Food Farmacy alone (-17.1 mg/dl[-26.9, -7.2], p<0.001) and in combination with Behavioral Pharmacy (-17 mg/dl [-28.3, -5.8], p=0.003) at 12 months. Compared to controls, HbA1c significantly decreased in the Food Farmacy alone at 12 months (-0.37%, 95% CI [-0.65, -0.08]; p=0.01), but not the Food Farmacy with Behavioral Pharmacy.

Conclusions: Recipe4Health resulted in improvements in diet and multiple clinical health outcomes, such as non-HDL cholesterol and HbA1c.

Introduction: The purpose of this study was to simulate potential changes in dietary intake and food costs by replacing juice with whole fruit among children ages 1 - 5 years attending US early care and education (ECE) settings between 2008-2020.

Methods: Estimated mean changes in daily intake of calories, sugar, fiber, calcium, vitamin C and overall food costs under plausible scenarios of replacing juice with whole fruit. Researchers fit hierarchical regression with children nested within ECE nested within studies, adjusting for potential confounders.

Results: The sample consisted of 6,304 days of direct observation (90% ages 2 years or older, 51% female, 38% Black/African American) in 846 ECE facilities (73% centers, 75% Child and Adult Care Food Program (CACFP) participants). Replacing juice with whole fruit would reduce energy intake by 8.2 - 27.3 kcal/day, reduce sugar by 3.4 - 5.6 g/day, increase fiber by 0.5-1.3 g/day, and have negligible impact on vitamin C and calcium. Replacing juice with whole fruit in ECE would increase per-child daily food costs between $0.44 - 0.49, representing an increase from 3.8% for juice to approximately 9.8% - 10.7% for whole fruit as a percent of total food costs.

Conclusions: Replacing juice with whole fruit in ECE would result in increased fiber intake and decreased sugar and calories. A policy to replace juice with whole fruit in ECE would likely cause an increased daily food cost and given the potential broad benefit of this dietary intervention, there may be reason to expand funding within nutrition assistance programs in ECE.

Introduction: U.S. military personnel have a high prevalence of alcohol misuse, which can adversely affect force readiness. The objective of this study was to identify pre-service predictors of new-onset alcohol misuse among male Marines.

Methods: Data for this retrospective cohort study were collected from male U.S. Marines who completed a baseline survey at the beginning of military training from 2013 to 2021 and a standard health assessment 12-36 months later (n=28,337). An Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) score ≥4 indicated alcohol misuse. Independent predictors of alcohol misuse were evaluated using a modified Poisson regression to calculate adjusted risk ratios (aRRs) and 95% CIs. Analyses were conducted between 2022 and 2024.

Results: The incidence of new-onset alcohol misuse was 16.3% (n=4,632). In the final multivariable model, the strongest predictor of new-onset alcohol misuse was turning 21 years old during the study period (aRR 3.70, 95% CI: 3.40-4.03). Pre-service tobacco use (aRR 1.32, 95% CI: 1.22-1.43) and some pre-service alcohol use (AUDIT-C score 1-3: aRR 1.32, 95% CI: 1.24-1.40) were also associated with new-onset alcohol misuse.

Conclusions: Multiple pre-service predictors were associated with new-onset alcohol misuse in male Marines. These findings should be considered when screening for alcohol misuse and developing clinical interventions to mitigate adverse impacts of alcohol misuse in the military.