American Journal of Preventive Medicine最新文献

Introduction: Physical inactivity and sedentary behavior are recognized as independent risk factors for many diseases. However, studies investigating their associations with total and cause-specific mortality in low-income and Black populations are limited, particularly among older adults.

Methods: A prospective cohort study was conducted among 8,337 predominantly low-income and Black Americans aged ≥65 years residing in the southern United States. Participants reported their daily sitting time and leisure-time physical activity (LTPA) at baseline (2002-2009), and mortality data were collected through 2019. Analysis was conducted from September 2022 to October 2023.

Results: During a median follow-up of 12.25 years, nearly 50% (n=4,111) were deceased. A prolonged sitting time (>10 hours/day versus <4 hours/day) was associated with elevated all-cause mortality (hazard ratios [HR], 1.15; 95% confidence intervals [CI], 1.04-1.27) after adjusting for LTPA and other potential confounders. LTPA was associated with a reduced risk of all-cause mortality, with an adjusted HR of 0.75 (95% CI 0.64, 0.88) associated with 150-300 minutes per week of moderate-intensity physical activity. Individuals who were physically inactive and had a sitting time of >10 hours/day had the highest mortality risk (HR, 1.48; 95% CI, 1.23-1.78), compared with those who were physically active and had low sitting time. These associations were more pronounced for mortality due to cardiovascular diseases.

Conclusions: High sitting time is an independent risk factor for all-cause and cardiovascular disease mortality, and LTPA could partially attenuate the adverse association of prolonged sitting time with mortality.

Introduction: People with chronic pain are at increased risk of opioid misuse. Less is known about the unique risk conferred by each pain management treatment, as treatments are typically implemented together, confounding their independent effects. This study estimated the extent to which pain management treatments were associated with risk of opioid use disorder (OUD) for those with chronic pain, controlling for baseline demographic and clinical confounding variables and holding other pain management treatments at their observed levels.

Methods: Data were analyzed in 2024 from 2 chronic pain subgroups within a cohort of non-pregnant Medicaid patients aged 35-64 years, 2016-2019, from 25 states: those with (1) chronic pain and physical disability (CPPD) (N=6,133) or (2) chronic pain without disability (CP) (N=67,438). Nine pain management treatments were considered: prescription opioid (1) dose and (2) duration; (3) number of opioid prescribers; opioid co-prescription with (4) benzo- diazepines, (5) muscle relaxants, and (6) gabapentinoids; (7) nonopioid pain prescription, (8) physical therapy, and (9) other pain treatment modality. The outcome was OUD risk.

Results: Having opioids co-prescribed with gabapentin or benzodiazepine was statistically significantly associated with a 37-45% increased OUD risk for the CP subgroup. Opioid dose and duration also were significantly associated with increased OUD risk in this subgroup. Physical therapy was significantly associated with an 18% decreased risk of OUD in the CP subgroup.

Conclusions: Coprescription of opioids with either gabapentin or benzodiazepines may substantially increase OUD risk. More positively, physical therapy may be a relatively accessible and safe pain management strategy.

Introduction: Schools can support students' participation in physical activity by offering opportunities consistent with a Whole-of-School (WOS) approach; however, the extent to which physical activity opportunities are provided and how school-level characteristics associate with their use remains unclear. This study examined how elementary schools' use a WOS approach to promote physical activity, as well as associations between school-level characteristics and physical activity opportunities provided.

Methods: Survey data was collected from 162 elementary schools participating in the NFL PLAY 60 FitnessGram Project during the 2022-2023 school year. A WOS index (ranging from 0 to 12) was created from responses by school staff on questions about 6 physical activity practices (physical education, recess, before- and after-school programs, classroom-based approaches, active transport). Multivariable regression models examined associations between school characteristics and WOS index scores. Analyses were completed in Spring 2024.

Results: Fully adjusted models indicated a statistically significant difference between the percentage of economically disadvantaged students served and WOS index score. Schools serving between 20% and 39% (p<0.001), 40%-59% (p<0.01), 60%-79% (p<0.01) and ≥80% (p<0.001) economically disadvantaged students scored significantly lower on the WOS index compared to schools with 0%-19% economically disadvantaged students.

Conclusions: Studies are needed to examine disparities in physical activity practices consistent with a WOS approach to understand the implications on health, academic performance, and other key outcomes. This information can inform the development of strategies to address disparities and ensure youth have equitable access to school-based physical activity opportunities.

Introduction: Multimorbidity is associated with lower physical function in older adults. Less is known about multimorbidity and physical activity earlier in the life-course. This study examined multimorbidity trajectories across adulthood with physical activity and explores if multimorbidity accelerates age-related activity decline.

Methods: Data are from Coronary Artery Risk Development in Young Adults (CARDIA), an ongoing prospective cohort of participants recruited when they were 18-30 years old. Six multimorbidity trajectories from baseline (1985-86) through year 30 follow-up exam (2015-16; ages 48-60) were based on age of disease onset and rate of accumulating additional conditions: mid-20s-fast, mid-20s-slow, late-20s-slow, mid-30s-fast, mid-40s-fast, and early-50s-slow. Activity was device-measured at year 30 and year 35 (2021-23; ages 53-65). Multivariable linear models were used to estimate differences in activity by multimorbidity trajectory at year 30 and change (%) from year 30 to year 35. Data were collected through June 2023 and analyzed in May 2024.

Results: The sample included 1,425 CARDIA adults at year 30 (mean age 55.1 years) with 749 (mean age 61.3 years) wearing the device again at year 35. Compared with early-50s-slow, mid-20s-slow (β=-14.1, 95%CI: -24.6, -3.6) and mid-30s-fast (β=-14.2, 95%CI: -26.2, -2.2) had lower LPA and mid-20s-fast (β=-5.1, 95%CI: -9.6, -0.6) and late-20s-fast (β=-9.5, 95%CI: -14.1, -4.9) had lower MVPA. No significant differences in 5-year behavior change across multimorbidity trajectories.

Conclusions: Early onset and faster accumulation of chronic conditions was associated with lower activity in midlife. Lower intensity activity for people with multimorbidity may be a feasible target for healthy aging.

Introduction: About 25% of people who currently smoke cigarettes in the United States (US) smoke non-daily, and relatively little is known about their intentions or attempts to quit. Active surveillance is essential to identify services needed to support smoking cessation efforts and reduce the burden of disease.

Methods: US population-wide estimates of quit attempts and use of cessation aids among adults who smoke cigarettes were calculated using data from the September 2022 wave of the Tobacco Use Supplement to the Current Population Survey. Statistical analyses were conducted in 2024. Weighted percentages and 95% confidence intervals (95%CI) are presented by sociodemographic characteristics and smoking pattern.

Results: In 2022, nearly 6 million adults (2.59 million women, 3.36 million men) in the US reported smoking non-daily an average of 13.4 days per month (95%CI:12.7-14.1). Compared with adults who smoke daily, the proportion of past-year quit attempts was higher among people who reported smoking on some days of the month (always some days: 41.8%; formerly daily: 58.4%; daily: 32.2%). However, those who smoke some days were less likely to report receiving medical advice to quit (always some days: 49.5%; formerly daily: 58.1%; daily: 72.7%), using pharmacotherapy such as nicotine replacement therapy or a prescribed medication (always some days: 17.9%; formerly daily: 32.4%; daily: 38.7%), or receiving counseling to quit smoking (always some days: 5.8%; formerly daily: 6.9%; daily: 12.0%).

Conclusions: Given the substantial number of adults who smoke non-daily in the US and their interest in quitting, developing targeted interventions and communication is an important public health priority.

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: Quantifying the use of emerging tobacco products such as nicotine pouches (NPs) and heated tobacco products (HTPs) is crucial for informing public health interventions and measuring their potential effects on tobacco use morbidity, mortality and benefits from complete tobacco cessation.

Methods: Using data from the May 2019 and September 2022 cycles of the Tobacco Use Supplement to the Current Population Survey (TUS-CPS), we calculated U.S. population-wide estimates of ever and/or current use of NPs and HTPs by key socio-demographic characteristics, cigarette smoking status and preference of characterizing flavors in NPs. We present weighted frequencies, proportions and associated 95% confidence intervals. Analyses were conducted in 2024.

Results: In both survey cycles, a substantial fraction of adults who ever used HTPs had never smoked cigarettes (52.0% in 2019; 27.4% in 2022). Among those who currently used HTPs or NPs (2022 only), many reported having never smoked cigarettes (42.5% and 41.4%, respectively), while many also reported currently smoking (32.2% and 24.8%, respectively). We observed similar sociodemographic characteristics across use of both HTPs and NPs. Mint was the most common flavor choice among adults who currently used NPs (52.8%).

Conclusions: Continued surveillance of emerging tobacco products such as HTPs and NPs can inform public health approaches and support future research to better quantify the health consequences from these products.

Introduction: Food as Medicine is increasingly recognized as an important strategy for addressing the related challenges of food insecurity and nutrition-related chronic conditions. Food as Medicine refers to integration of food-based nutrition interventions into healthcare to prevent and treat disease. However, there is limited evidence to understand the effectiveness of Food as Medicine.

Methods: Recipe4Health, a comprehensive Food as Medicine program, was implemented in 4 Federally Qualified Health Centers in California for patients with food insecurity and/or nutrition-related chronic conditions. Patients were referred by a healthcare provider to a 'Food Farmacy' (16 weekly produce home deliveries) alone or in combination with a 'Behavioral Pharmacy' (16 weekly group visits). A quasi-experimental study with pre/post surveys (4 months) and propensity score matched controls for Electronic Health Record (EHR) outcomes over 12 months was conducted. Participants were 2,643 Recipe4Health patients and 2,643 controls identified from 1/2020 to 12/2022; data were analyzed from 2023-2024.

Results: There was a significant increase in produce consumption from baseline to four months (0.41 servings/day [0.11, 0.72], p=0.007) in the Food Farmacy in combination with Behavioral Pharmacy. Compared to controls, there were improvements in non-HDL cholesterol for the Food Farmacy alone (-17.1 mg/dl[-26.9, -7.2], p<0.001) and in combination with Behavioral Pharmacy (-17 mg/dl [-28.3, -5.8], p=0.003) at 12 months. Compared to controls, HbA1c significantly decreased in the Food Farmacy alone at 12 months (-0.37%, 95% CI [-0.65, -0.08]; p=0.01), but not the Food Farmacy with Behavioral Pharmacy.

Conclusions: Recipe4Health resulted in improvements in diet and multiple clinical health outcomes, such as non-HDL cholesterol and HbA1c.