American Journal of Preventive Medicine最新文献

Introduction: Gunshot wounds (GSWs) are typically treated in acute care settings but longer-term sequelae are likely treated by ambulatory care providers. To understand if GSW treated in acute care settings are later documented in ambulatory care electronic health records (acEHR), acute care claims and acEHR data were linked. The primary objective was to determine the percentage of patients with a GSW diagnosis in their acEHR from all patients with both an acute care GSW diagnosis and an observed follow-up ambulatory care visit. The second objective was to identify demographic and clinical factors associated with a patient having a GSW diagnosis in their acEHR.

Methods: This observational study linked Oregon Medicaid claims for acute GSW with acEHRs in OCHIN's ADVANCE Data Warehouse from 2012 - 2022 for case identification. Patients with and without an International Classification of Diseases (ICD) code for GSW in their acEHR were characterized using descriptive statistics. Multivariable logistic regression conducted between 2024-2025 modeled predictors of GSW diagnosis in follow-up acEHR controlling for patient characteristics.

Results: Only 34.3% of patients with a GSW event treated in an acute setting and with an observed ambulatory care visit had a GSW diagnosis in their acEHR. Time between acute GSW and follow-up ambulatory care, and the severity of the acute GSW injury were associated with having a GSW acEHR diagnosis. Patients identified as Black, non-Hispanic or Hispanic had higher odds of having a GSW acEHR diagnosis compared to White, non-Hispanic.

Conclusions: Most people who had a GSW treated in an acute care setting with a later ambulatory care visit did not have a GSW diagnosis in their acEHR, even though a GSW event can be relevant history for ambulatory care providers and patient care. Strategies to document prior GSW in ambulatory EHRs should be developed to support whole-person care in ambulatory settings.

Introduction: Housing is a key social determinant of health, yet research on disparities among transgender and gender diverse (TGD) people has relied on convenience or targeted samples, leaving population-representative evidence absent. To the authors' knowledge, this study provides the first population-based assessment of housing inequities for cisgender-, transgender-, and non-binary-led households in Canada.

Methods: This study utilized data from the 2021 Canadian Long Form Census, focusing on primary household maintainers aged 15 and above. Gender identity was derived from sex at birth and gender identity questions, disaggregating cisgender, transgender men, transgender women, non-binary assigned male at birth (AMAB), and non-binary assigned female at birth (AFAB) households. Outcomes included core housing need (unaffordable, inadequate, or unsuitable housing) and each component separately. Logistic regression models estimated odds ratios (ORs) and predicted probabilities, adjusting for demographic, socioeconomic, and regional covariates. Subgroup analyses examined heterogeneity by age, living arrangement, and tenure.

Results: Cisgender men-led households had the lowest probability of core housing need (8.0%), compared with higher risks among cisgender women (12.8%), transgender women (21.2%), non-binary AFAB (21.2%), non-binary AMAB (19.4%), and transgender men (16.5%). Fully adjusted models showed elevated odds for transgender women (OR = 1.32, 95% CI: 1.15-1.51), non-binary AMAB individuals (OR = 1.30, 95% CI: 1.12-1.51), and non-binary AFAB individuals (OR = 1.55, 95% CI: 1.41-1.72) households relative to cisgender men. Disparities were largest among youth, renters, and households with multiple people.

Conclusions: TGD-led households face systematic and significant housing disadvantages in Canada. Addressing these inequities requires embedding gender identity in housing policy, enforcing anti-discrimination protections, and expanding affordable and supportive housing tailored to TGD populations.

Introduction: This paper presents a systematic economic review of patient navigation (PN) services to increase colorectal cancer (CRC) screening and reduce disparities in CRC screening rates in vulnerable populations.

Methods: The literature search strategy included English-language studies conducted in high-income countries that were published from database inception to December 2022. Studies on patients with existing cancer or without healthcare system involvement were excluded. Data collection and analysis were completed in 2023. All monetary values reported are in 2022 U.S. dollars.

Results: The search yielded 17 studies with 16 studies from the U.S. and one study from France. The median intervention cost per person from 16 studies was $150 [Interquartile interval (IQI): $58, $340]. The median intervention cost per additional person screened from 17 studies was $663 (IQI: $185, $1,730). Five estimates from two studies showed a median return on investment (ROI) of 2.3% (IQI: 1.7%, 6.9%) for colonoscopy from health care providers' perspective. Two studies reported a cost per quality-adjusted life year (QALY) of -$173 and -$1,442, indicating cost savings while increasing QALYs. One study reported that the intervention had a cost per life-year (LY) gained of $3,231 or $12,293 translated to per QALY gained.

Discussion: Economic evidence demonstrates that PN services aimed at increasing CRC screenings are cost-effective based on a conservative threshold of $50,000 per QALY gained. Additionally, the ROI is favorable for PN services to increase CRC screening by colonoscopy as the estimated reimbursement values for colonoscopy exceed intervention costs.

Introduction: Clinician advice to modify health behaviors can vary by patient race/ethnicity and sex, though prior studies are mixed and show variation over time. Research examining the role of insurance type is limited.

Methods: The 2022 National Health Information Survey (NHIS) was analyzed in 2024 to estimate survey-weighted proportions of receiving clinician advice and associations with demographic factors among three at-risk groups: 1) adults who smoke cigarettes, 2) adults who engage in heavy drinking, and 3) adults with diabetes, hypertension, and/or obesity, who are insufficiently active.

Results: In each relevant population, 47.5% received advice to quit smoking, 6.8% to decrease drinking, and 35.7% to increase physical activity. The odds of receiving advice to quit smoking were lower among Non-Hispanic (NH) Black (adjusted odds ratio (aOR) 0.68 [95%CI, 0.53-0.87]) and Hispanic adults (aOR 0.46 [95%CI, 0.30-0.69]) relative to NH White adults, and adults with no insurance (aOR 0.36 [95%CI, 0.24-0.56]) and private insurance (aOR 0.55, [95%CI, 0.39-0.77]) compared to Medicare. Men had higher odds (aOR: 2.36 [95%CI, 1.84-3.02]) of being advised to decrease drinking. Hispanic adults (aOR 1.27 [95%CI, 1.05-1.54]) had higher odds of receiving advice to increase physical activity; uninsured adults (aOR 0.51 [95%CI, 0.35-0.73]), men (aOR 0.85 [95%CI, 0.76-0.96]), and adults over 64 had lower odds. Adults aged 18-34 were the least likely to receive smoking or alcohol counseling.

Conclusion: Many at-risk adults do not receive clinician advice to modify relevant health behaviors. Counseling rates vary by patient demographic factors, highlighting opportunities to improve health equity in preventive care.

Introduction: Chronic pain is linked to elevated tobacco use, but long-term trends in combustible smoking and e-cigarette use in this group remain unclear. Understanding these trajectories is vital for designing effective public health interventions. This study examined national trends in exclusive cigarette smoking (E-CS), exclusive e-cigarette use (E-EC), and dual use (2014-2023) among United States (U.S.) adults with and without chronic pain.

Methods: This was a serial cross-sectional analysis using 2014-2023 (excluding 2022) National Health Interview Survey data from 195,632 U.S. adults. Chronic pain (yes/no) was defined by self-reported pain frequency (past 3 months): "everyday" or "most days" versus "some days" or "never". Primary outcomes were E-CS, E-EC, and dual use prevalence by pain status and year, assessed via logistic regression. Secondary analyses examined pain frequency (continuous) and high-impact chronic pain (yes/no). Analyses were conducted in 2025.

Results: E-CS prevalence was significantly higher and declined more slowly among individuals with chronic pain (17.7%-2014, 13.1%-2023) versus without (12.5%-2014, 7.5%-2023; p<0.001). Adjusting for age, sex, and race/ethnicity, both E-EC and dual use prevalence were higher in the chronic pain group across all years. E-EC use increased at similar rates among individuals with (1.4%-2014, 5.6%-2023) and without (1.2%-2014, 4.5%-2023; p's<0.001) chronic pain; dual use prevalence declined at similar rates among individuals with (4.6%-2014, 2.7%-2023) and without (2.3%-2014, 1.5%-2023) chronic pain.

Conclusions: While U.S. E-CS prevalence has decreased, individuals with chronic pain remain disproportionately impacted, emphasizing the need for targeted tobacco interventions.

Introduction: The U.S. Food and Drug Administration has launched multiple large-scale youth tobacco prevention campaigns since 2014. Prior to launching campaigns, the U.S. Food and Drug Administration conducts copy-testing studies with youth aged 12-17 years using an experimental design (ad exposure versus no ad control) to evaluate potential ad effects on 4 outcome measures: attitudes toward tobacco use and beliefs about negative health consequences, harmful and potentially harmful constituents, and addiction.

Methods: A series of meta-analyses examined the difference between exposure and control groups for each of the 4 outcome measures across 10 copy-testing studies conducted from 2013 to 2020. Potential heterogeneity in these differences was explored by campaign, tobacco product, audience characteristic, and message theme. Analysis was performed in 2024.

Results: A total of 42 ads were included in the analysis. The average effect size (Hedge's g) across all ads was 0.446 (95% CI=0.312, 0.581) for attitude, 0.319 (95% CI=0.155, 0.483) for negative health consequence beliefs, 0.246 (95% CI=0.057, 0.436) for harmful and potentially harmful constituent beliefs, and 0.347 (95% CI=0.254, 0.441) for addiction beliefs. Larger effect sizes were observed for electronic cigarette ads than for ads for other products. Ads featuring harmful and potentially harmful constituent and addiction themes generated larger effect sizes on their respective targeted beliefs than ads that did not feature these themes.

Conclusions: Findings of this study provide evidence that ads from the U.S. Food and Drug Administration's tobacco prevention campaigns have the potential to positively influence relevant beliefs and attitudes among their intended youth audiences. Patterns of variation in effect sizes largely support the success of belief targeting in campaign development.

Introduction: Breast and cervical cancers are significant health concerns among Latinas, who are less likely to receive up-to-date cancer screenings. Barriers including lack of insurance contribute to this disparity. This study examined the impact of the 2021 Medicaid eligibility amendment in California and Oregon, which expanded coverage to all income-eligible adults aged 50 and older, on breast and cervical cancer screenings among Latina patients at community health centers (CHCs).

Methods: This retrospective cohort study used electronic health record data from CHCs in states that expanded eligibility (CA, OR) and those that did not (AK, CT, IN, MN, MT, NJ, OH, WA). Data included 18,209 non-pregnant Latina patients aged 50-64 who had visits both pre- (2018-2019) and post- amendment (2021-2023). Data were analyzed in 2024-2025, and a doubly robust, covariate-adjusted difference-in-differences model estimated the average treatment effect on the treated (ATT) for screening outcomes.

Results: Among previously uninsured patients, Spanish-preferring Latinas in eligibility amendment states had significantly greater increases in up-to-date breast (ATT = +9.13; 95% CI: 3.36-14.90) and cervical (ATT = +11.03; 95% CI: 5.77-16.29) cancer screenings compared to non-amendment states. English-preferring Latinas in amendment states showed a significant breast screening increase only in year three (all insurance: ATT = +11.73; 95% CI: 1.61-21.85; uninsured in pre-period: ATT = +23.42; 95% CI: 2.11-44.72). For those with any insurance, only Spanish-preferring Latinas had a significant year-three increase in cervical screening (ATT = +14.66; 95% CI: 6.11-23.21).

Conclusions: State-funded coverage expansions can increase cancer screening rates and potentially reduce cancer burden among Latinas.

Introduction: Transgender and gender diverse (TGD) adults have worse mental health than cisgender adults, yet few studies assess unmet mental health needs. This study compares frequent mental distress, access to care, and barriers among TGD and cisgender adults.

Methods: Using the 2022 KFF/Washington Post Transgender Survey of U.S. adults (n=1,338), unadjusted prevalence differences in frequent mental distress, unmet mental health need, and reasons for unmet mental health need were described. Logistic regression models assessed unmet mental health need likelihood, adjusting for sociodemographic characteristics and distress. Data were analyzed in 2024.

Results: Among TGD adults, 64% were non-binary or gender non-conforming, 22% transgender women, 12% transgender men, and 2% another gender. Compared to cisgender adults, TGD adults were more likely have Medicaid (21% vs 14%), p=0.01) or be uninsured (15% vs 10%, p=0.04), and less likely to have Medicare (6% vs. 25%, p<0.001). TGD adults reported more frequent mental distress (47% vs. 21%, p-value<0.001) and unmet mental health need (48% vs. 26%, p<0.001) than cisgender adults. In multivariable models, TGD adults had higher unmet mental health need vs. cisgender adults (OR=1.62, 95% CI: 1.08-2.43). TGD adults were more likely to report cost as the main care barrier than cisgender adults (30% vs. 15%; p=0.01).

Conclusions: TGD vs. cisgender adults reported higher rates of frequent mental distress, unmet mental health need, and cost-related barriers to mental health care. Efforts to improve the affordability and availability of mental health treatment could reduce high levels of unmet need among TGD adults.

Introduction: Current physical activity (PA) measurement methods often fail to capture domain-specific contexts. This limitation hinders the understanding of active outdoor play (AOP) in preschool-aged children (3-5 years), a critical PA domain for healthy development. The primary objective of this study was to develop a method for measuring AOP by integrating accelerometer, Global Positioning System (GPS), and time-use diary data. The secondary objective was to apply this method to quantify AOP by movement intensity and examine its contribution to total PA.

Methods: This cross-sectional study included 92 preschool-aged children and their parents from Alberta, Canada. Data were collected in August/2023-February/2024 and analyzed in May/2024-February/2025. Children wore an accelerometer and a GPS monitor for 7 days, while parents completed a time-use diary documenting their child's daily activities. Data from these 3 sources were processed and integrated to derive AOP variables. AOP was operationally defined as non-trip and non-organized PA taking place outdoors. Accelerometer data classified PA versus stationary time. GPS data classified trip versus non-trip and indoor versus outdoor location. Time-use diary data classified organized versus non-organized PA. AOP engagement was further classified into light-intensity and moderate- to vigorous-intensity using accelerometer data.

Results: Applying this method to the present sample, children spent an average of 192.9 minutes/day in AOP, with 143.1 minutes/day in light-intensity and 49.8 minutes/day in moderate- to vigorous-intensity AOP. On average, AOP accounted for 60.6% of total PA.

Conclusions: This study introduced a multi-source method for measuring AOP in preschool-aged children, addressing key limitations of traditional single-source methods. Future research could explore this method's applicability to enhance domain-specific PA knowledge, beyond overall PA, across contexts.