American Journal of Preventive Medicine最新文献

Introduction: Potential public health effects of adult pneumococcal vaccines are uncertain because of observed changes in pneumococcal serotype epidemiology. Prior analyses favored the 21-valent pneumococcal conjugate vaccine but observed that serotype changes in some populations could decrease its favorability. Value of information analysis could guide further research to clarify uncertainty.

Methods: Analyses evaluated value of information in U.S. cohorts aged 65 years, comparing adult pneumococcal vaccines. Model parameters included vaccine serotype-specific pneumococcal disease and mortality risks from U.S. data, vaccination rates from published literature, and vaccine effectiveness from clinical trials and Delphi panel estimates. Analyses estimated expected value of perfect information and expected value of partial perfect information at willingness-to-pay thresholds from $0 to $200,000 per quality-adjusted life year gained. A secondary analysis examined those aged 50-64 years. Data were collected and analyzed in 2024.

Results: In those aged 65 years, value of information estimates were highest at the $100,000/quality-adjusted life year gained threshold and were markedly less at higher thresholds. At $100,000/quality-adjusted life year gained, population expected value of perfect information was $178.1 million; expected value of partial perfect information for pneumococcal disease mortality and disability parameters combined was $89.6 million and for vaccine effectiveness parameters was $73.8 million. The 21-valent pneumococcal conjugate vaccine serotype incidence expected value of partial perfect information was $19 million. In those aged 50-64 years, expected value of partial perfect information for vaccine effectiveness was $2.9 million and for 21-valent pneumococcal conjugate vaccine serotype incidence was $139,080.

Conclusions: Value of information results were more supportive of further research on selected parameters in those aged 65 years than in those aged 50 years. However, expected value of partial perfect information values for 21-valent pneumococcal conjugate vaccine serotype incidence was substantially lower in both age groups, supporting adult 21-valent pneumococcal conjugate vaccine use regardless of serotype uncertainty.

Introduction: Sedentary behavior (sitting/reclining) has been associated with depression in adults, but the relationship with dementia remains unclear. To address this, associations of mentally passive (e.g., TV-viewing) and mentally active (e.g., office work) sedentary behaviors with incident dementia were examined, including how theoretically replacing mentally passive sedentary behavior with mentally active sedentary behavior, light and moderate-to-vigorous physical activity impacts incident dementia risk.

Methods: Data originate from the Swedish National March Cohort, including 20,811 adults aged 35-64 years (baseline, 1997). Incident dementia was identified through a linkage (2016) with the Swedish National Patient Register and the Swedish Cause of Death Register. Passive and mentally active sedentary behaviors as well as light and moderate-to-vigorous physical activity were also assessed using questionnaires. Analyses included single, partition, and substitution Cox proportional hazards models, adjusting for potential confounders. Analyses were conducted in 2025.

Results: There were 569 incident cases of dementia over 393,104 person-years; median follow-up time was 19.2 years. Mentally passive sedentary behavior was associated with a higher incidence of dementia in crude (hazard ratio=1.16, 95% CI=1.11, 1.22) but not adjusted models (hazard ratio=1.04, 95% CI=0.98, 1.10). Each additional 1 hour per day of mentally active sedentary behavior was associated with a 4% lower risk for developing dementia (hazard ratio=0.96, 95% CI=0.93, 0.98). There was a significant age interaction, indicating a higher protective effect of mentally active sedentary behavior among older participants (aged 50-64 years). In the partition models accounting for all behaviors, increasing 1 hour per day of mentally active sedentary behavior, while maintaining passive sedentary behavior and light and moderate-to-vigorous physical activity constant, was associated with an 11% lower risk for incident dementia (hazard ratio=0.89, 95% CI=0.81, 0.97). Similarly, substituting 1 hour per day of passive sedentary behavior with the same amount of mentally active sedentary behavior was associated with a 7% reduction in the risk for incident dementia (hazard ratio=0.93, 95% CI=0.87, 0.99).

Conclusions: Mentally passive sedentary behavior may increase the risk of dementia. Replacing passive with mentally active sedentary behaviors or with physical activity may reduce the risk of dementia in older adults.

Introduction: E-cigarette use and obesity are often studied independently, yet emerging evidence suggests that obesity and e-cigarette use may occur together and can exacerbate health risks. The objective of this study was to examine trends in United States (U.S.) adolescent e-cigarette use by weight status and sex from 2017-2023 using data from the Monitoring the Future study, an annual nationally-representative cross-sectional study.

Methods: U.S. 8th- 10th- and 12th-grade students completed self-report measures of demographics, height, weight, and e-cigarette use at school (results pooled across grades, n=85,383). Piecewise log-binomial regression models were applied, and interactions between sex and weight status were examined within each time segment to assess subgroup differences in e-cigarette use trends.

Results: Time trends in lifetime e-cigarette use differed by sex and weight status. From 2020-2021, declines were not significant among females with overweight (ARR: 0.88; 95% CI: 0.74-1.05) or obesity (ARR: 0.87; 95% CI: 0.72-1.07), whereas females with a healthy weight and males regardless of weight status showed significant reductions. From 2021-2023, declines were observed among males with healthy weight (ARR: 0.93; 95% CI: 0.88-0.98) and obesity (ARR: 0.90; 95% CI: 0.81-0.98), but not among females across any weight category. In 2023, lifetime e-cigarette use remained highest among females with overweight or obesity compared to females with a healthy weight. Similar trends were observed for past 12-month and 30-day e-cigarette use.

Conclusions: Overall adolescent e-cigarette use declined after 2020; however, this downward trend was primarily driven by males and those with a healthy weight. Declines were not significant among female adolescents, particularly those with overweight or obesity. Findings highlight sex-specific risks for the association of obesity with e-cigarette use and underscore the need for dual prevention efforts.

Building community leadership capacity has become essential for advancing preventive health. In Florida, where Home Rule governance gives local agencies primary responsibility for health improvement, community leaders are often on the frontlines of crisis response but typically lack training in health policy, and operate within constrained systems that limit their ability to implement effective public health strategies. The Florida Health Policy Leadership Academy (FHPLA) is an applied, community-based education program that trains cross-sector leaders, including those outside traditional public health roles, to apply evidence-based preventive public health policies. Implemented annually since 2021 through the University of Florida Bob Graham Center for Public Policy, the FHPLA employs a community-based participatory framework to strengthen local capacity for preventive health action. Over a 12-week hybrid program, fellows engage in applied learning, collaboration, and community health improvement projects to translate evidence into practice. Mixed-methods evaluation across cohorts included pre- and post- surveys, free-listing exercises, and qualitative interviews. These methods examined how the program influenced participants' knowledge, confidence, and applied leadership skills. Findings revealed improved data interpretation skills, leadership confidence, and systems-level understanding of health. Participants' conceptualizations of drivers of community health shifted from individual behaviors toward structural and environmental determinants, reflecting a deeper engagement with social and policy determinants of health. Qualitative data highlight the Academy's role in fostering ongoing partnerships and applied health initiatives. The FHPLA offers an innovative model for community-based public health leadership education that bridges academia, government, and civil society. By building preventive health capacity within local systems, this approach strengthens community resilience to emerging public health challenges.