American Journal of Preventive Medicine最新文献

Introduction: Food and nutrition security is crucial for health, but many U.S. households experience food insecurity. This systematic review conducted in support of the Community Preventive Services Task Force examines the effectiveness of Fruit and Vegetable Incentive programs in reducing food insecurity, increasing fruit and vegetable consumption, and improving health outcomes among households with lower incomes.

Methods: Community Guide systematic review methods were applied. Studies were identified through a literature search (inception of each database to February 2023). U.S. studies were included if they evaluated programs offering participants financial incentives to purchase fruit and vegetables; were designed for or implemented among populations with lower incomes; reported health-related outcomes; and were published in English as peer-reviewed articles or government reports.

Results: This review included 30 studies. Thirteen of 14 datapoints from 12 studies indicated FVI programs reduced household food insecurity. Twenty-one of 29 datapoints from 23 studies showed increased FV consumption. Programs providing incentives to participants at risk for or with diet-related health conditions improved blood glucose levels by a median of 0.64 percentage points.

Discussion: Based on the review findings, the Community Preventive Services Task Force recommends Fruit and Vegetable Incentive programs for populations with lower incomes to reduce household food insecurity, increase household fruit and vegetable consumption, and improve blood glucose levels in participants at risk for or with diet-related health conditions. Although the review did not find direct evidence of reducing health disparities, the Community Preventive Services Task Force expects that these programs will improve health equity across the U.S. by improving the affordability and accessibility of healthier foods for households with lower incomes.

Introduction: Contraceptive care is critical piece of quality sexual reproductive healthcare. Providers directly impact client experiences and clinical outcomes; it is important to understand how providers offer contraceptive care and the factors influencing this care. This systematic review summarizes recent research on providers, their perspectives, experiences, barriers, and facilitators to offering contraceptive counseling, education, and care.

Methods: In May 2023, a systematic review was conducted in PubMed, Cochrane Database of Systematic Reviews, and Scopus to identify articles published between December 1, 2016, and May 1, 2023. Studies that explored the barriers and facilitators providers experience when offering contraceptive counseling, education, and/or care and how those differ by clinic setting, provider characteristics, and/or client demographics were included.

Results: A total of 22 studies met the inclusion criteria. Only three studies reported provider demographic characteristics. Most studies were conducted in urban locations with five delivering care to clients with low income. Care provision varied based on clinic setting, provider characteristics, and client characteristics. Care also included client-centered, efficacy-based, shared decision-making, and directive counseling approaches. Providers identified real or perceived challenges among their clients as a barrier to quality care provision, in addition to insufficient time; inability to offer same-day method insertion; and a lack of training in cultural humility, long-acting methods, and providing care to clients with intellectual disabilities.

Discussion: Despite intentions to provide client-centered care and prioritize client autonomy, providers face numerous barriers that impact their ability to offer quality care in alignment with client needs and desires.

Trial registration: Prospero-CRD42023414456 crd.york.ac.uk/PROSPERO/display_record.php?RecordID=414456.

Introduction: Contraceptive care is an opportunity for providers to help clients achieve their reproductive health goals. Client-centeredness is a core element of quality care; however, evidence suggests that the provision of client-centered contraceptive counseling needs improvement. This systematic review summarizes recent evidence on client preferences related to contraceptive care, including how client-centered approaches inform outcomes.

Methods: A systematic review was conducted in PubMed, Cochrane Database of Systematic Reviews, and Scopus to identify articles published between December 1, 2016 and May 1, 2023. Studies that explored client preferences related to contraceptive counseling, education, and/or care, and how client-centered approaches impact clients' perceived experiences with their care were included.

Results: Thirty-nine unique studies met inclusion criteria. Clients want a range of information about contraceptive methods tailored to their preferences through a variety of formats, before, during, and after their appointment. Clients desired providers with similar demographic backgrounds (gender, race, ethnicity) and life experiences (menstruation, contraceptive use, carceral system encounters) to themselves, and who are willing to offer continuous care. Clients reported greater satisfaction when providers engaged in shared decision-making, utilized decision support tools, and supported their autonomy, including prioritizing their family-building goals. When providers shared personal preferences or pressured clients to select one method over another, clients in turn, reported feeling conflicted about which method to select and some subsequently declined using any method.

Discussion: The variation in client preferences highlight the importance of offering tailored, comprehensive information that supports decision-making, prioritizes client autonomy, and recognizes positive interpersonal relationships with providers.

Trial registration: Prospero: CRD42023414456 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=414456.

Introduction: Proactively engaging patients in conversations about their needs and desires for sexual and reproductive health (SRH) is an essential part of providing client-centered care. This systematic literature identifies screening tools and approaches for assessing needs and desires for pregnancy- and STI-related services.

Methods: PubMed and the Cochrane Library were searched for articles published between July 1, 2018 and July 26, 2023. Eligible studies examined the use of screening tools for various SRH services. This manuscript focuses on evidence from 28 articles that examine findings related to pregnancy and STI screening.

Results: The evidence suggests that using these tools can increase the number of patients who receive care. The tools also facilitate clients' discussions with their providers about reproductive health goals and needs. Patients appreciate tools that are easy to use and help them have non-judgmental interactions with providers and promote shared decision-making and bodily autonomy. Providers reported a preference for screening tools that are easy to use, quick to administer, and can be integrated into existing workflows.

Conclusions: Screening tools are important for identifying clients' needs and desires as well as informing and streamlining care. More research is needed to better understand the diversity of provider and patient experiences with screening tools and whether the use of such tools promotes accessible and equitable service provision. There was insufficient evidence to recommend any specific screening tool or approach for assessing pregnancy or STI needs and desires because most tools were reported either in a single study or results were mixed.

Trial registration: Prospero - CRD420234486.

Updating the Quality Family Planning recommendations is an essential step toward offering all people evidenced-informed, person-centered, equitable, and inclusive sexual and reproductive health care. What constitutes quality sexual and reproductive health care constantly evolves as scientific research generates new evidence. In addition, the context in which people seek and receive sexual and reproductive health care has changed significantly in recent years. Today's sexual and reproductive health context is also complex and evolving against the backdrop of an increasing awareness of the impact of structural and interpersonal racism, classism, discrimination (or bias) based on sexual orientation and/or gender identity, and ableism on health and sexual and reproductive health care. The Office of Population Affairs of the HHS sought to be responsive to these complex conditions by centering equity in the update of its Quality Family Planning recommendations from start to finish, including in its approach to reviews of published literature, the creation of expert and technical workgroups to assess the literature and make recommendations, and actively engaging persons with lived experience to gather their insights so that the final product could genuinely respond to the needs of the community.

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: The worsening life expectancy of middle-aged White Americans due to suicides and substance overdoses has been hypothesized to be caused by various societal conditions. Work is a social determinant of health, but its role in this demographic shift has not been examined. This article describes the characteristics and trends of suicides and overdose fatalities occurring in U.S. workplaces among all workers between 2011 and 2022.

Methods: Data originated from the Census of Fatal Occupational Injury database. Fatality rates were calculated using the Current Population Survey. Fatality rates were calculated and compared among demographic and occupational groups. Annual rates were modeled with a first-order auto-regressive linear regression to account for serial correlation. Analyses were conducted in 2023-2024.

Results: Between 2011 and 2022, the rate of workplace overdose fatality rates increased from 0.05 per 100,000 workers to 0.33-an increase of 560%. Workplace suicide rates were relatively stable (0.19 per 100,000 to 0.17). Most industries and occupations experienced significant increases in workplace overdose rates and nonsignificant decreases in workplace suicide rates. The largest workplace overdose rates occurred in the transportation and warehousing industry (0.47, 95% CI=0.27, 0.67) and farming, fishing, and forestry occupations (0.68, 95% CI=0.27, 1.08).

Conclusions: Fatal workplace suicides and substance overdoses have different trends and impact industries, occupations, and demographic groups differently. The rise in workplace overdoses deserve immediate attention.

Introduction: Intellectual and Developmental Disabilities (IDD) have been associated with high cardiometabolic risk in adults, but there is little data on youth. This study describes the prevalence of cardiometabolic risk factors among pediatric patients with and without IDD receiving care in a large, primarily rural health system.

Methods: This was a retrospective cohort study of patients aged 6-17 years with an index visit from August 1, 2022, to July 31, 2023, at one of 44 primary care clinics in a Midwestern health system. IDD status was defined by ICD-10 diagnostic codes. Demographic and clinical characteristics were gathered from the electronic health record. The odds of having each cardiometabolic risk factor measured, and the odds of having screened positive for each risk factor, were compared in 2024 using unadjusted ORs and CIs.

Results: The prevalence of any IDD diagnosis among 33,192 eligible patients (mean age 11.6 years, 50% male) was (1,206/33,192) 3.6%, with autism being the most common (749/1,206, 62%). Though the likelihood of cardiometabolic risk factor measurement was similar, the prevalence of positive risk factors was higher in those with IDD. The odds of having obesity (OR=3.8, 95% CI=3.1, 4.8), current smoking or passive smoke exposure (OR=1.4, 95% CI=1.2, 1.6), a hypertension diagnosis (OR=6.4, 95% CI=3.8, 10.7), diabetes diagnosis (OR=2.67, 95% CI=1.2, 5.3), prediabetes diagnosis (OR=6.8, 95% CI=3.6, 12.9) or dyslipidemia (OR=3.5, 95% CI=2.9, 4.2), were all greater in patients with IDD than without IDD.

Conclusions: This study reports disparities in risk between pediatric patients with and without IDD. Future research and intervention programs should focus on young people with IDD to prevent adverse cardiometabolic outcomes later in life.

Introduction: Veterans face elevated risk of suicide and homelessness, with housing instability being a significant, independent risk factor among this population. Addressing housing instability through primary, secondary, and tertiary prevention services is crucial for improving health and mortality outcomes, though research remains limited. The objective of this study is to assess the association between receipt of primary, secondary, and tertiary homelessness prevention services and risk of suicide and all-cause mortality among Veterans within 24 months of experiencing housing instability.

Methods: Data were extracted from national U.S. Department of Veterans Affairs electronic health records, 2014-2019, and mortality data from National Death Index. Logistic regressions conducted in 2024 modeled suicide and all-cause mortality using a time-discreet survival framework with person-month as the unit of analysis. Cohort included 662,682 Veterans with indicators of housing instability in electronic health records.

Results: Veterans who received homeless services across the 3 levels of public health prevention had reduced odds of suicide compared to nonparticipants, while Veterans exiting these programs had higher odds of suicide (p-value ranges <0.001-0.05). Consistent results were found for all-cause mortality.

Conclusions: Continued receipt of services to address housing instability is associated with reduced mortality risk. Exiting programs to address housing instability may be a vulnerable period for Veterans, and investment in homelessness prevention is crucial to reduce mortality and improve outcomes among Veterans. Ongoing support is essential to mitigate risks associated with program exit.