American Journal of Preventive Medicine最新文献

Introduction: In the United States (US), additional pneumococcal conjugate vaccine (PCV) with higher valency such as PCV21 is recommended for adults aged ≥65 years who have previously received pneumococcal vaccines (referred to as vaccine-experienced). This study assessed the cost-effectiveness of using PCV21 (compared to recommended options at the time-23-valent pneumococcal polysaccharide vaccine [PPSV23], PCV15, and PCV20) in adults aged ≥65 years who were previously vaccinated 5 years ago with PPSV23 or PCV13 or 2 years ago with PCV15.

Methods: A published static multi-cohort state-transition Markov model was used to estimate the lifetime clinical and economic outcomes of administering a single dose in vaccine-experienced adults from societal perspective. Quality-adjusted life years (QALYs) and costs (in 2023 USD) were discounted at an annual rate of 3%. Extensive deterministic sensitivity analysis (DSA), probabilistic sensitivity analyses (PSA), and scenario analysis with longer time since last vaccination were conducted to identify influential variables.

Results: Compared with PPSV23, PCV21 in PCV13- and PCV15-experienced adults would cost $130,700 and $173,700 per QALY gained, respectively. Administering PCV21 in PPSV23-experienced adults would cost $2,700 compared with PCV15. PCV21 would be cost-saving compared with PCV20 in all vaccine-experienced adults. Discount rates and vaccine effectiveness were the most influential inputs as shown by the DSA results. The quantitative results were robust in PSA. When vaccine history was as long as 8 (instead of 5) years for the PPSV23-, PCV13-, or PPSV23+PCV13-experienced adults aged ≥65 years in the scenario analysis, the costs per QALY of PCV21 were slightly favorable in most comparisons.

Discussion: In the US, a dose of PCV21 in adults aged ≥65 years who have previously received a pneumococcal vaccine has the potential to prevent a considerable number of pneumococcal disease cases and deaths while remaining economically reasonable over a wide range of inputs and scenarios.

Introduction: As cannabis use among older adults increases, clinicians engaging people in screening and brief interventions is central to reducing cannabis-related harms. Information is needed about cannabis or drug screening among older adults and targeted cannabis-related discussions.

Methods: The 2021-2023 National Survey on Drug Use and Health included N=14,387 U.S. adults aged ≥65 years self-reporting any past-year healthcare visit. Weighted generalized logistic models conducted in 2025 identified characteristics associated with any cannabis or illegal drug use screening. Those reporting past-year cannabis use self-reported discussions with clinicians about cannabis or other drugs. Adjusted multinomial logistic regressions estimated characteristics associated with cannabis discussions, screening only, or no screening/discussions.

Results: Among older adults encountering the healthcare system, 36.83% reported cannabis or illegal drug screening. Screening was higher in people with 2+ chronic conditions, alcohol use and higher income, but lower among Hispanic/Latine people. Among the 8.1% who self-reported past-year cannabis use (N=1,194), 19.18% discussed cannabis use with clinicians; discussions (vs. no screening/discussions) were more likely among those with 2+ chronic conditions (aRRR=1.78, 95% CI=1.15, 2.75) or mild mental illness (aRRR=2.62, 95% CI=1.18, 5.78) and less likely among Hispanic/Latine (aRRR=0.23, 95% CI=0.08, 0.66), other racial groups compared to white older adults, or reporting alcohol use.

Conclusions: One in three older adults reported any cannabis or drug screening; screening was even lower for Hispanic/Latine older adults. Fewer than one in five who used cannabis discussed their use with clinicians. Removing barriers to screening and discussions is needed to prevent negative cannabis-related consequences in older adults.

Introduction: Healthcare providers (HCPs) can address youth tobacco use through screening and counseling; however, provision remains inconsistent.

Methods: Data from the 2022 National Youth Tobacco Survey, a cross-sectional survey of U.S. middle and high school students, were analyzed to assess the prevalence and factors associated with HCP screening and counseling for youth tobacco use using descriptive statistics and logistic regression.

Results: Among 24,644 youth, 43.7% were screened, and 45.6% counseled for any tobacco use. Males had higher odds of being counseled than females (AOR: 1.37 [1.25-1.49], p <0.001). Youth aged 13-15 years and 16-18 years had higher odds of being screened (AOR: 2.44 [2.10-2.83]; 4.96 [4.03-6.06], p < 0.001), and those aged 16-18 years had higher odds of being than those aged 9-12 years (AOR: 1.32 [1.09-1.61], p = 0.005). Compared to Non-Hispanic (NH) White, NH Black (Screened: AOR: 0.71 [0.60-0.84], p <0.001; Counseled: AOR: 0.84 [0.71-0.99], p = 0.037), Hispanic (Screened: AOR: 0.77 [0.67-0.89], p <0.001; Counseled: AOR: 0.83 [0.72-0.95], p = 0.008), and NH Asian youth (Screened: AOR: 0.65 [0.48-0.87], p = 0.004; Counseled: AOR: 0.63 [0.53-0.74], p < 0.001) had lower odds of both outcomes. Youth with current sole (Screened: AOR: 1.51 [1.24-1.85]; Counseled: AOR: 1.38 [1.16-1.64], p < 0.001) or dual/poly tobacco use (Screened: AOR: 1.69 [1.27-2.24], p < 0.001; Counseled: AOR: 1.52 [1.13-2.05], p = 0.006) had higher odds of being screened and counseled than those reporting non-current use.

Conclusions: Fewer than half of U.S. youth reported receiving tobacco screening or counseling, with disparities across sociodemographic and tobacco use groups. Ongoing training for HCPs and enhancements to electronic health records may improve equitable access to tobacco prevention and cessation services for youth.

Introduction: More research is required to determine whether physical activity reduces the burden of obesity in Mexico, where it is one of the leading public health problems. Therefore, the objective of this study was to investigate whether physical activity was associated with reduced risk of mortality in adults with obesity in the Mexico City Prospective Study.

Methods: 153,060 adults aged 52 (13) years were followed for 18 (4) years [mean (SD)]. Participants were surveyed from 1998 to 2004, and data were analyzed in 2025. Trained nurses interviewed participants and measured BMI and waist circumference. Leisure-time physical activity level was derived from questions about frequency and duration of sport and exercise. Cox models were adjusted for confounders, with cardiovascular disease (CVD) and cancer mortality treated as competing risks.

Results: There were 25,317 deaths from all causes, 8,488 from CVD, and 3,368 from cancer during follow-up. Obesity was associated with increased risk of all-cause mortality. In the main analysis, compared with the reference group that reported little or no activity and had a normal BMI, the HR (95% CI) was 1.40 (1.33, 1.47) in the group that reported little or no activity and had Obesity Class II. However, physical activity attenuated the risk of all-cause mortality associated with obesity. For example, compared with the reference group, the HR (95% CI) was only 1.18 (1.06, 1.32) in the group that reported medium or high activity and had Obesity Class II. Physical activity also attenuated the risk of CVD mortality associated with Obesity Class II and the risk of cancer mortality associated with Obesity Class I and Obesity Class II. Furthermore, physical activity attenuated the risks of all-cause, CVD, and cancer mortality associated with high waist circumference.

Conclusions: This is the first study of its kind in Mexico. The results suggest that leisure-time physical activity attenuates the risks of mortality in adults with general or abdominal obesity in Mexico.

Introduction: Promotion of e-cigarettes is prolific on social media. With the emergence of disguisable e-cigarette products shaped like daily household items, miniature boba cups, and toys, detection by parents and educators is increasingly difficult. The current study utilized youth participatory action research to characterize the promotion of miniature boba cup- and toy-shaped e-cigarettes on Instagram.

Methods: With the assistance of youth researchers enrolled in a service-learning course, 199 Instagram data that promoted boba cup- and toy-shaped e-cigarettes and were posted July-December 2022 were collected July 2024 using an application programing interface. Trained coders above the tobacco minimum sales age developed a codebook and independently annotated all posts from July 2024-February 2025. After determining acceptable agreement, all discrepancies were discussed until consensus was met.

Results: Instagram images (67%) and TikTok videos reposted on Instagram (74%) displayed illegal e-cigarette products that resembled miniature boba cups (77%), small cola cans (27%), and toy animals/collectable devices (15%). Posts portrayed young people (17%) using these devices (23%), and some displayed the mass production of these illegal e-cigarettes (11%). Text and emojis suggested these products were for those over 18 years of age (17%) and shipped internationally (35%).

Conclusions: Promotion of miniature boba cup-shaped and toy-shaped e-cigarettes on Instagram may attract youth. The US Food and Drug Administration and state agencies should be aware that youth are exposed to these illegal products on social media. Platforms popular among youth need heightened surveillance and regulation to protect young audiences from pervasive marketing of nicotine and tobacco products.

Introduction: Nonfatal firearm injuries (NFFI) are increasing nationwide. NFFI survivors experience physical disability, chronic pain, psychological trauma, and mental health disorders, requiring targeted interventions. Services available in Emergency Departments (ED) may differ from those provided upon admission. This study explored differences in services and healthcare utilization between NFFI patients admitted to hospital versus discharged from the ED.

Methods: A retrospective cohort study of adults ≥18 years with NFFI was conducted at a Level 1 Trauma Center (2016-2020). Patients admitted to the hospital were compared to those discharged from the ED. Outcomes included hospital-based service use (psychology consultation, HVIP referral) and 90-day healthcare utilization (outpatient visits, ED revisits, readmissions). Multivariable logistic regression examined factors associated with admission and HVIP referral among eligible patients. Post-discharge utilization outcomes were analyzed as cumulative counts during a fixed 90-day window, with bivariate group comparisons (admitted vs. ED-discharged).

Results: Of 1,522 NFFI patients, 449 (29.50%) were discharged from the ED. Admitted patients had greater injury severity (mean 13.09 vs 5.07, p<0.0001) and were less likely to identify as racial/ethnic minorities (78.10% vs 83.07%, p=0.0282). In adjusted models, racial/ethnic minority status was not significantly associated with admission after accounting for injury severity. Admitted patients received more psychology consultations (28.80% vs 0.67%, p<0.0001) and higher HVIP referral rates when eligible (67.65% vs 54.95%, p=0.0217). In multivariable models restricted to HVIP-eligible patients, racial/ethnic minority status was associated with higher odds of HVIP referral (adjusted OR=3.127, p=0.0056). At 90-days post-discharge, admitted patients had significantly greater healthcare utilization across multiple domains, including injury-related follow-up appointments (mean 6.45 vs 1.89, p<0.0001), injury-related ED visits (mean 0.37 vs 0.20, p=0.0001), injury-related hospital readmissions (mean 0.28 vs 0.07, p<0.0001), and behavioral health visits (3.45% vs 0.89%, p=0.00549).

Conclusions: Admission status was linked to greater receipt of psychology and psychiatry consultation as well as HVIP referral, reflecting opportunities more available during inpatient stays. As expected, admitted patients also had more follow-up medical appointments; however, ED-discharged patients infrequency received psychology consultation or HVIP referral, limiting recovery potential related to mental health and overall wellbeing. These gaps highlight missed opportunities to provide early psychological support and violence prevention services in the ED setting. Standardized ED-based protocols may help address this need, although causal inference is limited by study design.

Background: Healthy behaviors and grip strength are individually associated with a lower mortality risk, but their combined effect remains unclear. The purpose of this study was to examine their joint association with all-cause mortality in European middle-aged and older adults.

Methods: A 16-year prospective cohort study (2004-2020) was conducted using data from the SHARE, including 12693 adults (≥50 years). Healthy behaviors (smoking, alcohol consumption, physical activity [PA], sleep) were self-reported. Grip strength was measured with a handheld dynamometer and categorized into age- and sex-specific groups. Cox proportional hazards models assessed the joint hazard ratio (HR) for all-cause mortality. Analysis was performed in 2025.

Results: Higher grip strength was associated with a reduced risk of all-cause mortality, regardless of smoking (HR = 0.70, 95% CI = 0.54-0.90), alcohol consumption (HR = 0.60, 95% CI = 0.46-0.77), low PA (moderate-intensity: HR = 0.51, 95% CI = 0.36-0.71; vigorous-intensity: HR = 0.55, 95% CI = 0.45-0.67) and sleeping trouble (HR = 0.60, 95% CI = 0.45-0.79). For each healthy behavior, except not smoking, the joint protective effect on mortality was comparable to the individual effect of higher grip strength. The greatest survival benefits were observed in individuals who combined higher grip strength with healthy behaviors, with risk reductions ranging from 43% to 64%.

Conclusions: Higher grip strength seems to be a protective factor against all-cause mortality, even in individuals not following healthy behaviors. Findings highlight the importance of public health strategies that promote both muscle strength and healthy behaviors to improve longevity.

Introduction: Physical inactivity is rising globally, particularly among young adults. Gamification is increasingly used to promote physical activity, but the effectiveness of different gamified elements and delivery strategies remains unclear. This study evaluated the effects of different gamification delivery strategies on increasing young adults' physical activity.

Methods: This 12-week parallel randomized controlled trial (1-week baseline, 7-week intervention, 4-week follow-up) was conducted from April 2024 to January 2025 and registered on ClinicalTrials.gov (NCT06818071, https://clinicaltrials.gov/study/NCT06818071) on January 17, 2025. Healthy university students aged 18-35 were recruited through on-campus and online advertisements and randomized to one of four conditions: (1) sequential delivery of gamified elements ("SG"), (2) cumulative delivery ("CG"), (3) explicit gamification via a commercial mobile game ("EG"), or (4) tracking-only control. Gamified elements included points, leaderboards, and social interaction. The primary outcome, daily step count (DSC), was measured in a free-living context using app-based self-reports. Secondary outcomes included changes in biometric measures. Between-group differences in DSC were analyzed using mixed-effects linear regression.

Results: Among 246 participants, all intervention groups increased DSC significantly; CG achieved the largest gain (+2,326 steps, SD 303). Increases were sustained at follow-up. Mixed-effects estimates confirmed CG's strongest effect and suggested social interaction (SG: +981 steps, p=0.080) and explicit gamification (SG: +1,304, p=0.055) were particularly effective. EG showed delayed but longer-lasting effects, suggesting sustained engagement in mobile games after initial acclimation.

Conclusions: Delivering gamified elements cumulatively, rather than overwhelming users, produced DSC increases exceeding thresholds previously associated with lower mortality risk. Such strategies should be integrated into public health efforts to address physical inactivity in young adults.

Introduction: Calorie menu labelling policies are increasingly popular worldwide; however, concerns have been raised about the potential of calorie labels to worsen disordered eating and overall psychosocial wellbeing. This study aimed to investigate the potential unintended consequences of calorie menu labelling interventions on psychosocial wellbeing among young Canadian adults.

Methods: A natural experiment was conducted using longitudinal data from three waves of the Canada Food Study (n=2,327, ages 16-30 years). Multiple imputations were performed to mitigate missing data and attrition across waves. Repeated measures logistic models with difference-in-difference analysis assessed changes over time for eleven outcomes, including disordered eating, internalized weight bias, experienced weight discrimination, and indicators of psychosocial wellbeing across four provinces: Ontario (mandatory calorie labelling), and Alberta, Quebec, and Nova Scotia (no labelling policy).

Results: At baseline, 14% of the sample were at risk of disordered eating. Approximately half reported worrying about becoming fat (48%), and nearly one-fifth experienced weight discrimination in the past year (19%). The implementation of a calorie menu labelling policy did not significantly increase the adjusted odds of disordered eating, internalized weight bias, experienced weight discrimination, nor other indicators of mental health.

Conclusions: The findings of this study contribute to the scarce literature assessing trends in disordered eating and psychosocial wellbeing in the ever-changing context of nutrition policy. The implementation of a mandatory calorie menu labelling policy in Ontario did not seem to elicit disordered eating among young adults, although the impact on people with pre-existing disordered eating and eating disorders is unknown.

Introduction: This study examined visual attention to and recognition of The Real Cost Youth E-cigarette Prevention Campaign ads in simulated, naturalistic digital media environments.

Methods: In 2024, a convenience sample of 2,040 individuals aged 18-24 years in the U.S. was exposed to a campaign ad in 1 of 4 simulated digital media environments (YouTube skippable and nonskippable, Instagram Reels and Stories). Participants' cameras captured facial coding measurements (e.g., attention), and a survey captured brand and ad recognition. Analyses included descriptive statistics and statistical testing (z-scores for categorical outcomes, independent t-tests for continuous outcomes) to compare outcomes for ad placements.

Results: Nonskippable YouTube ads captured the most attention, with participants focusing for 8.6-9.7 seconds, and 46%-54% paying attention to at least half the ad and the last 2 seconds. Instagram Stories held attention for 5-7 seconds; 25%-32% of viewers watched half the ad and the last 2 seconds. Instagram Reels and YouTube skippable ads received the least attention. Brand recognition was similar across YouTube nonskippable ads (37%-49%), Instagram Stories (45%-46%), and Instagram Reels (39%-41%), whereas fewer YouTube skippable viewers (23%-32%) recognized the brand. Ad recognition was highest for YouTube nonskippable ads (52%-73%), followed by Instagram Reels (36%-61%), Instagram Stories (32%-41%), and YouTube skippable ads (22%-48%).

Conclusions: Results show that some media platforms and placements can capture more of a viewer's attention than others. Results show that attention, brand awareness, and ad awareness can increase on several digital media platforms and ad placements.