American Journal of Preventive Medicine最新文献

Introduction: E-cigarette prevention campaigns face visibility and sustainability challenges on social media, where provaping content dominates, and coordinated opposition is common. National initiatives such as the Food and Drug Administration's The Real Cost campaign operate alongside regional efforts, yet their comparative resilience and reach in digital spaces remain understudied.

Methods: To evaluate and compare national and state/local campaigns (2018-2023) on Twitter/X, machine-learning classifiers (F1>0.90 for opposition detection) and geotagged data from Twitter's Historical PowerTrack and Academic application programming interfaces were used to analyze campaign-related content across 4 domains: volume, valence (opposition versus prevention/neutral), engagement (retweets, potential reach), and user behavior (cross-campaign participation). Tweets were algorithmically assigned to campaigns using regular expressions and filtered for relevance. Data were collected from 2018 to 2023 and analyzed in 2025.

Results: From April 2018 to April 2023, campaign-related posts declined by 61.8%, with opposition content consistently comprising >70% of posts and exceeding 90% in some months. Opposition was concentrated among a small subset of users (top 10% generated 57.9% of opposition retweets). About one fifth (20.5%) of The Real Cost campaign-related messages were classified as opposition, whereas regional campaigns, particularly Chicago's Vaping Truth, faced overwhelming opposition (99.6% of posts), with 96.2% originating outside intended campaign jurisdictions.

Conclusions: The Real Cost's relative resilience reflects the advantages of sustained investment, national scope, and constant branding. Regional campaigns were particularly vulnerable to cross-jurisdictional narrative hijacking. Future prevention efforts must proactively identify and counter coordinated opposition strategies to improve digital reach and effectiveness.

Introduction: Research using self-reported measures demonstrates that "The Real Cost" Youth Cigarette and E-Cigarette Prevention Campaigns affect tobacco-related beliefs, attitudes, behavioral intentions, and behaviors. This study provides insights by assessing attentional, affective, and cognitive responses to ads from "The Real Cost" campaigns among U.S. young adults using non-self-report measures.

Methods: Attentional, affective, and cognitive responses (eye tracking, facial electromyography, electrodermal activity, functional near-infrared spectroscopy, and heart rate, collected from 2023 to 2024 and analyzed in 2024-2025) were measured during exposure to campaign ads in a Baltimore-area convenience sample of n=25 young adults who were susceptible to or experimenting with E-cigarettes and n=25 young adults who were susceptible to or experimenting with cigarettes.

Results: Faces generally attracted the most visual attention. All ads evoked increased cognitive activity associated with self-referential processing of the messages, and 2 E-cigarette campaign ads evoked cognitive activity associated with defensive processing. Heart rate decreased while watching most ads, indicating that participants devoted cognitive resources to message processing. Affective responses varied across ads.

Conclusions: Attentional, affective, and cognitive responses indicated a favorable response to campaign ads. Decreases in heart rate and increases in cognitive activity in the medial prefrontal cortex are associated with message processing and message-consistent behavior change. Some of the E-cigarette ads but none of the cigarette ads elicited cognitive activity associated with defensive processing, potentially owing to young adult's perceptions of E-cigarettes as less harmful than cigarettes. More work will advance the understanding of the rationale for increases in activity associated with defensive processing in response to the E-cigarette ads.

Introduction: The association between social determinants of health (SDH), genetic susceptibility, and dementia risk remains unclear. This study investigates their relationship and the potential mediation by chronic conditions.

Methods: Data from 225,598 UK Biobank participants (220,847 for genetic analyses), with an average age of 55.07 years and 51.10% female, were analyzed. The data were collected during 2006-2010 and analyzed in 2025. SDH scores were weighted, combined, and categorized, and a polygenic risk score (PRS) for dementia was constructed. Associations were assessed via Cox models, with mediation and sensitivity analyses conducted.

Results: Over a median follow-up of 13.5 years, 3,232 participants developed all-cause dementia, including 1,140 Alzheimer's disease (AD), 545 vascular dementia (VaD), and 2,259 other dementias. Each one-unit increase in the SDH score was associated with a 13%, 9%, 16%, and 14% higher risk of all-cause dementia, AD, VaD, and other dementias, respectively. Compared to the favorable SDH group, the medium and unfavorable SDH groups had HRs of 1.25 (95% CI: 1.13-1.37) and 1.69 (95% CI: 1.53-1.87) for all-cause dementia. Similar trends were observed for dementia subtypes. No significant interaction was found between SDH and genetic susceptibility, but those with both unfavorable SDH and high genetic risk had the highest dementia risk. The impact of SDH on dementia was stronger in individuals under 60 years. Diabetes, CVD, and depression partially mediated this association, with depression accounting for the largest share (33.6%).

Conclusions: Unfavorable SDH was associated with an increased dementia risk, even in low genetic risk individuals, partly via chronic conditions. Modifying unfavorable SDH may help reduce dementia risk in all populations.

Introduction: Native Hawaiians/Pacific Islanders (NHPIs) face disproportionate burdens of diabetes and cardiometabolic disease. This study assessed the feasibility and effectiveness of the PILI Pasifika Program (PPP), a culturally grounded, community health worker (CHW)-led lifestyle intervention that targets social determinants of health (SDoH) to improve cardiometabolic risk factors among NHPI adults.

Study design: A parallel-group randomized controlled trial with an education material-only waitlist control was conducted. Implementation feasibility was assessed through interviews with CHWs, and participant acceptability via survey.

Setting/participants: Across four US states and two US-affiliated Pacific Islands, 24 CHWs recruited and delivered the PPP to 242 NHPI adults with ≥1 cardiometabolic risk factor (130 intervention, 112 control), and assessed cardiometabolic, behavioral, and SDoH outcomes.

Intervention: PPP consisted of 12 weekly sessions, adapted from the Diabetes Prevention Program and augmented with SDoH-focused activities.

Main outcome measures: Weight, HbA1c, blood pressure, HDL, LDL, and total cholesterol. Data collected from 2024 to 2025, analyzed in 2025.

Results: PPP participants compared with controls showed significant reductions in weight (-2.8 vs +0.5 kg), HbA1c (-0.8% vs +0.1%), systolic (-5.7 vs +2.6 mmHg) and diastolic (-3.4 vs +1.3 mmHg) blood pressure, LDL (-4.7 vs +7.6 mg/dL), and total cholesterol (-9.7 vs +9.4 mg/dL). Intervention participants also showed significant improvements in fruit/vegetable intake, physical activity, food literacy, social support, housing stability, and overall well-being. CHWs and participants found the PPP highly feasible, culturally relevant, and adaptable.

Conclusions: The PPP, delivered by culturally competent CHWs, improved cardiometabolic, behavioral, and SDoH outcomes among NHPI adults and shows promise for scalable, sustainable implementation across diverse NHPI communities.

Trial registration: ClinicalTrials.gov (NCT06471595).

Introduction: Extreme weather harms health directly by causing illnesses or injuries, and indirectly through healthcare disruptions. Understanding how adults in the U.S. are affected by extreme weather could inform preparedness efforts to prevent poor health outcomes.

Methods: Data were analyzed from the Health Information National Trends Survey 7, a cross-sectional, nationally representative survey administered to U.S. adults in 2024 (n=6,124). Weighted descriptive statistics and linear regression analyses were conducted in 2025 to examine the relationship between the level one's neighborhood was affected by extreme weather in the past year (not at all, some/a little, a lot) and health status (poor (1) to excellent (5)). Sex, age, ethnicity, education, metropolitan status, region, cigarette use status, and presence of health conditions were covariates.

Results: Nearly 9% of U.S. adults reported their neighborhood was affected "a lot" by extreme weather events in the past year (95% CI [7.1, 9.9]), 62.8% reported "some/a little" (95% CI [60.5, 65.1]), and 28.7% were not affected (95% CI [26.7, 30.6]). Being affected "a lot" (β=-0.24, p=0.002) and "some/a little" (β=-0.18, p<0.001) by extreme weather was negatively associated with health status when compared with not being affected, adjusting for covariates.

Conclusions: Experiencing extreme weather was negatively associated with health status among U.S. adults. Efforts to improve preparedness and adaptation to extreme weather are needed to protect the health of U.S. adults before, during, and after extreme weather events or natural disasters.

Introduction: California prohibited sales of flavored tobacco products in brick-and-mortar stores effective December 21, 2022. California college students were surveyed about their use and source of nicotine vapes and/or cigarettes in 2024.

Methods: A cross-sectional, online survey of California students (n=3,921, ages 18-24) clustered in community colleges (n=112) and four-year universities (n=54) was conducted April-August 2024 using Qualtrics. Data were analyzed January-May 2025. Students who reported past 30-day (i.e., current) nicotine vaping and/or cigarette smoking also reported their product flavor and source (i.e., brick-and-mortar store, online, other). Among those who reported current use of nicotine vapes (n=1,255) and cigarettes (n=935), six separate generalized linear mixed models estimated product source as a function of product flavor, adjusting for students' sociodemographics and tobacco product use characteristics.

Results: Most students reported visiting a brick-and-mortar store to get their nicotine vapes or cigarettes (75.0% and 74.0%, respectively). Compared to students who used only unflavored vapes, students who used only flavored vapes were less likely to get them from a store (63.4% vs. 81.3%, aOR=0.39, 95% CI=0.25, 0.61) and, separately, online (12.1% vs. 39.2%, aOR=0.29, 95% CI=0.20, 0.44). However, students who smoked only menthol cigarettes were more likely to get cigarettes from a store than students who smoked only non-menthol (74.8% vs. 61.3%, aOR=1.96, 95% CI=1.30, 2.94).

Conclusions: More than 15 months after California prohibited sales of flavored tobacco, brick-and-mortar stores were still the most common source for menthol cigarettes and flavored nicotine vapes among college students who used these products. Better enforcement is needed to eliminate sales of flavored tobacco.

Introduction: Job lock, when older workers cannot retire due to financial or health insurance needs, is potentially an occupational safety issue. This study explored the longitudinal effect of job lock on work-related injuries to older workers, hypothesizing that job lock increases their injury rates. It then examined how this relationship varies across work arrangements.

Methods: Analysis using 2010-2022 Health and Retirement Study (HRS) data for workers aged 55-64 years and 65 years and older compared work exposures in each wave to injuries reported in the next wave. Repeated measures negative binomial regression estimated longitudinal effects of job lock (financial, health insurance, or both) on work-related injuries, exploring effect modification by work arrangements (full-time, part-time, partly retired, self-employed). Analysis was conducted in 2025.

Results: Workers aged 55-64 years overall had 51.8 work-related injuries per 1000 person-years, compared to 44.3 work-related injuries per 1000 person-years for workers aged 65 years and older. Among those aged 55-64 years, these rates were 48% higher with job lock for financial reasons (IRR=1.48, [95% CI 1.04-2.13]), and similarly for health insurance reasons. Potentially stronger effects were observed for workers in full-time (IRR=1.57 [1.15-2.16]) and possibly part-time roles (IRR=1.72 [0.86-3.46]). After age 65 years, this data suggests that workers had a 29% higher injury rate from financial job lock (IRR=1.29 [0.66-2.51].

Conclusions: Job lock was associated with higher work-related injury rates, particularly for those in full or part-time roles before age 65 years. For self-employed, partly retired, or workers over age 65 years, job lock presented less clear injury risk, possibly from differences in job tasks or selection into safer roles. Further research should address mechanisms of job lock to elevate injury risks. Improving access to retirement resources earlier in workers' careers may help to address work-related injuries and economic challenges of aging.

Introduction: The effectiveness of warning size and format on cigar packaging in influencing youth and young adult (YYA) smoking behaviors is not well understood. This experiment tested these cigar warning characteristics among YYAs who use or are susceptible to using little cigars or cigarillos (LCCs).

Methods: The study recruited 506 US YYAs, ages 15-20 years, between April-June 2023. Participants reported ever or past 30-day use of LCCs or were susceptible to using LCCs. A 2 × 2 between-subjects online experiment was conducted where YYAs were randomized to one of four conditions, with manipulations for cigar warning size (30% or 50% of the package) and format (FDA-proposed text-only or pictorial). YYAs viewed six warnings on a mock cigarillo package. The primary outcome was perceived message effectiveness (PME). A mixed-effects regression model was fit to examine the effects of warning size and format on outcomes in September 2023.

Results: Most participants were female (50.0%), white (59.3%), and heterosexual (67.8%). Nearly half were susceptible to LCCs (47.4%), followed by past 30-day use (32%), and ever use (20.6%). Pictorial warnings significantly increased PME compared with text-only warnings. Similar effects were found for risk perceptions, cognitive and emotional reactions, and recognition. Warning size had no statistically significant effect on outcomes.

Conclusions: Pictorial cigar warnings outperformed FDA-proposed text-only warnings on PME and secondary outcomes among YYAs who use or are susceptible to LCCs. These results suggest that a pictorial format will enhance the effectiveness of cigar warnings, as has been found for cigarettes.

Introduction: Effective patient-provider communication may promote high-value services while discouraging low-value services. This study examined associations between patient-provider communication and the use of high- and low-value services among U.S. adults.

Methods: A cross-sectional study using the 2010-2021 Medical Expenditure Panel Survey was conducted in 2025. Self-reported patient-provider communication was assessed in four domains (attentive listening, clear explanation, respectfulness, time spent) and categorized as low versus moderate/high. Outcomes include 10 high-value services (appropriate cancer screenings, diagnostic and preventive tests, and diabetes care) and 12 low-value services (inappropriate cancer screenings, medication use, and imaging tests). Inverse probability of treatment weighting was applied to balance covariates, followed by weighted generalized linear models to estimate adjusted mean differences in the use of high- and low-value services across levels of patient-provider communication.

Results: Compared to adults reporting low communication, those reporting moderate/high communication had consistently greater use of all 10 high-value services, with adjusted differences ranging from +1.7 percentage points (95% CI: 1.2-2.2) for blood pressure measurement to +8.8 (6.8-10.8) for breast cancer screening. For low-value services, adults reporting moderate/high communication showed increased use of antibiotics for influenza (+3.1;1.1-5.0), but lower use of opioids for headaches (-2.3;-3.7,-0.8) and three back pain-related services: opioids (-6.7;-9.8,-3.6), MRI/CT scans (-4.2;-4.7,-3.7), and radiographs (-2.3;-4.2,-0.4).

Conclusions: Better patient-provider communication was consistently associated with greater use of high-value services, but associations with low-value services were mixed. Efforts to improve communication may help promote high-value care; however, reducing low-value care may require additional, service-specific approaches beyond communication alone.