American Journal of Preventive Medicine最新文献

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.

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.