American Journal of Preventive Medicine最新文献

Interest is rapidly growing around screening for health-related social needs (HRSN) in direct patient care settings. The screening and provision of HRSN is often done in the context of trying to address social determinants of health (SDOH). While there is emerging evidence that screening and referral for HRSN can improve health outcomes, there are educational, operational, and systemic gaps that need to be filled in order for HRSN screening and referral to be implemented system-wide and result in meaningful improvement in population health outcomes. The American College of Preventive Medicine recommends HRSN screening and referral in patient care settings only when there are sufficient systems in place to support addressing those needs. This paper identifies key considerations to take into account when implementing HRSN screening and referral in health care settings and makes recommendations to address those key considerations. The recommendations also frame the broader need to address SDOH at a population level. Finally, the paper identifies several knowledge and evidence gaps in the existing literature on the topic of HRSN, which will hopefully drive future research in this area, and result in an evidence-based, population approach to the issue.

Individuals with intellectual and/or developmental disabilities (I/DDs) encounter barriers to vaccine access, uptake, and confidence, leading to health inequities. These include barriers related to healthcare provider capacity to effectively address the social determinants of health, provide accessible needle procedures, and translate and disseminate inclusive public health information. The current study aimed to test the preliminary effectiveness of a virtual continuing medical education (CME) course on enhancing healthcare provider capacity to address these barriers. This CME was available free-of-charge online. Participants included 120 healthcare providers (physicians: 45%; nurses: 37%; and other learners: 18%) in internal medicine, family practice, and related disciplines. The CME-created based on video interviews with patients and providers-focused on factors that affect vaccine uptake/access/confidence (Module 1); strategies to increase vaccine receipt (Module 2); and inclusive public health communication (Module 3). The pre-post survey assessed self-reported understanding, confidence, and abilities. Following CME completion, learners were significantly more likely to report higher understanding, confidence, and abilities in responding to the social determinants of health (Module 1); addressing barriers to vaccine access/uptake/confidence (Module 2); and engaging in effective public health communication (Module 3). Findings support the utility of short-term healthcare provider trainings on this topic. Future research should evaluate longer-term impacts and identify opportunities to create standardized medical curricula for this population.

Introduction: Pubic hair removal (PHR) is a common practice, and many seek PHR from a skincare professional, or esthetician. Estheticians occupy a unique role in which they often have deep, trusting relationships and well-established rapport with their clientele, whereby they could serve as trusted providers of skin and beauty expertise, but also health promotion partners/facilitators. The purpose of this study is to explore the frequency of esthetician involvement regarding 7 potentially concerning health-related symptoms on their clients' skin and examine estheticians' comfort engaging in discussions about health, knowledge regarding these health issues, and interest in being more formally involved in their clients' health.

Methods: A cross-sectional survey was administered between March-August 2023. Potential participants were identified using purposive sampling of Yelp listings (of hair removal/waxing salons), supplemented by snowball sampling, in 11 pre-selected U.S. metropolitan areas. N=359 estheticians who provide PHR services completed an online Qualtrics survey (97.5% women; 36.2% White, 24.0% Black, 20.1% Hispanic).

Results: The most noticed, discussed, and referred issue among the sample was general skin health (90.3% noticed, 82.2% discussed/referred), followed by sexually transmitted infections (STIs; 39.2% noticed, 36% discussed, and 26% referred). More respondents acknowledged discussing (26.6%) compared with noticing (19.8%) skin cancer. Most of the sample indicated high acceptability regarding improving the health of their clientele, and 72.7% expressed support for partnering with health professionals in such efforts.

Conclusions: This is a prime opportunity to aid in the facilitation of estheticians directly improving health and well-being beyond the skin of their clients.

Introduction: Chronic diseases are primary causes of mortality and disability in the U.S. Although individual-level indices to assess the burden of multiple chronic diseases exist, there is a lack of quantitative tools at the population level. This gap hinders the understanding of the geographical distribution and impact of chronic diseases, crucial for effective public health strategies. This study aims to construct a Chronic Disease Burden Index (CDBI) for evaluating county-level disease burden, to identify geographic and temporal patterns, and investigate the association between CDBI and social vulnerability.

Methods: A total of 20 health measures from CDC's PLACES database (2018-2021) were used to construct annual county-level CDBIs through principal component analysis. Geographic hotspots of chronic disease burden were identified using Getis-Ord Gi*. Multinomial logistic regression models and bivariate maps were used to assess the association between CDBI and CDC's social vulnerability index. Analyses were conducted in 2023-2024.

Results: Counties with high chronic disease burden were predominantly clustered in the southern U.S. High persistent chronic disease burden was prevalent in Kentucky and West Virginia, while increased burden was observed in Ohio and Texas. Chronic disease burden was highly associated with social vulnerability index (OR_{Q5 vs Q1}=7.6, 95% CI: [6.6, 8.8]), with nonmetro-urban counties experiencing elevated CDBI (OR=14.6, 95% CI: [9.7, 21.9]).

Conclusions: The CDBI offers an effective tool for assessing chronic disease burden at the population level. Identifying high-burden and vulnerable communities is a crucial first step toward facilitating resource allocation to enhance equitable healthcare access and advancing understanding of health disparities.

Introduction: Varicella has not yet been included in the National Immunization Program (NIP) in China, and varicella vaccination strategies vary by region. To determine the optimal varicella vaccination strategy in Shanghai, China, the cost-effectiveness and 5-year costs of 5 immunization scenarios were analyzed.

Methods: A static decision tree-Markov model was developed in 2022 to assess the cost-effectiveness and 5-year costs of voluntary and routine varicella vaccination programs in the 2019 birth cohort in Shanghai from a societal perspective. Parameters were collected in 2022 from the varicella surveillance system, a questionnaire survey of 414 guardians of patients with childhood varicella, and semi-structured interviews with 20 experts on varicella outbreaks from different institutions in Shanghai. The outcomes included varicella cases avoided, quality-adjusted life year (QALY) loss, and incremental costs per QALY (ICER). The 5-year costs were compared with local medical expenditures.

Results: Among the 5 scenarios, one dose of routine varicella vaccination was the most cost-saving (USD 70.2) and cost-effective (Dominant) with a 5-year immunization expenditure of USD 9.9 million. Two doses of routine varicella vaccination had the highest QALY (29.9), and its ICER (USD 791.9/QALY) was below the willingness-to-pay threshold (USD 5,203-23,767/QALY). The 5-year immunization expenditure was USD 19.8 million. The effectiveness and price of vaccines, vaccination coverage, and per capita income are the 4 main factors that affect ICERs.

Conclusions: In Shanghai, the 2 doses of routine varicella vaccination strategy for 1- and 4-year-olds with a 95% coverage rate was found to be the optimal varicella immunization strategy.

Introduction: This is a retrospective study that examines the risk of non-COVID-19 respiratory infection (RI)-related emergency department (ED) visits and hospitalizations among autistic adults. The study compares these findings to non-autistic adults using the 2018 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample.

Methods: The data were analyzed in 2022 using the ICD-10-CM codes to extract 46,996 case records that included an autism diagonosis matched by age and sex (140,997) records that did not include an autism diagnosis in a 1:3 case-control ratio. Respiratory infections were also identified using the ICD-10-CM codes and classified by type. Logistic regression models were conducted for the likelihood of presenting with respiratory infections to the emergency department and subsequent hospitalization. All models were adjusted for covariates.

Results: Autistic adults were more likely to present with any type of respiratory infection at the emergency department (AOR=1.83, CI=1.69-2.42), lower respiratory infections (AOR=1.37, CI=1.09-1.50), and pneumonia (AOR=2.42, CI=1.98-2.47) compared to non-autistic adults.. They were also more likely to be hospitalized from respiratory infection during emergency department visits (AOR=3.87, CI=3.21-4.30), including upper respiratory infections and lower respiratory infections, pneumonia, and bronchitis.

Conclusions: Individuals with autism were more likely to experience emergency department visits and hospitalizations because of respiratory infections than individuals without autism. Amid growing evidence of the disproportionate impact of COVID-19 on the autistic population, the study findings highlight a broader, pre-existing burden of respiratory infections among adults with autism in the U.S. that extend beyond the recent pandemic.

Introduction: Ignition interlock devices installed after conviction for driving under the influence of alcohol (DUI) have been shown to reduce subsequent DUI arrests (specific deterrence). However, there is little evidence on how interlock-device penalties might affect general deterrence, that is, deterring people from driving after consuming alcohol prior to a DUI conviction.

Methods: A discrete choice experiment was conducted and data were analyzed in 2023 with 583 U.S.-based adults who consume alcohol at least once in the past week to assess the deterrent effects of five different penalties (fine, jail time, interlock device, license suspension, alcohol treatment) for alcohol-impaired driving under randomized sequential scenarios of high (20% chance of being caught) and low (1%) police enforcement. Participants resided in 46 states.

Results: Deterrent effects of an interlock penalty, operationalized as having to install an interlock device for 1 year, are large and on par with a 20-fold increase in police enforcement activity (from 1% chance of being caught to 20%), or a $2,000 increase in the DUI fine under the status quo enforcement regime. On average, a 1-year interlock penalty had the same deterrent effect as a 10-day increase in jail time.

Conclusions: Wider use of interlock devices as a DUI penalty could have large deterrent effects, independent of their ability to physically prevent the motor vehicle of an intoxicated driver from starting. The deterrent effect documented here adds to evidence on interlock devices' overall effectiveness as well as their potential to shift DUI penalties away from criminalization (jail time) and toward immobilization and rehabilitation.