American Journal of Preventive Medicine最新文献

Introduction: Sugar-sweetened beverage (SSB) warning label and excise tax policies hold promise for preventing type 2 diabetes. Population-level impacts of SSB policies have been projected using simulation models, but the authors are unaware of any assessing the effect of warning labels on type 2 diabetes (T2D), or the effects of warning label and tax effects using the same modeling assumptions. Simulation models have also rarely considered how policy implementation factors such as design and sustainment affect policy outcomes.

Methods: Microsimulation model of T2D development in a closed cohort of US adults aged 18-64 over 10 years with 1200 replications. The model was developed using the National Health and Nutrition Examination Survey 2017-18, US Diabetes Surveillance System, and published literature. Policy implementation scenarios were modeled in 2025 for warning label (design: graphic or text warning label) and tax (sustainment: $0.02/fluid ounce excise tax sustained or repealed) policies, compared to the status quo.

Results: Relative to the status quo, a graphic warning label was estimated to avert 945,000 cases of T2D over 10 years (95% UI=442,000, 1,820,000) as compared to 480,000 (147,000, 1,140,000) cases averted under a text warning label. A $0.02/fluid ounce excise tax was estimated to avert 1,260,000 (646,000, 2,160,000) cases of T2D over 10 years. If repealed after 1 year, the policy would only avert 78,000 (0, 469,000) cases of T2D.

Conclusions: SSB policies may be an approach to meaningfully decrease the number of individuals with T2D. Policy design and sustainment drive the magnitude of effects.

Introduction: Socioeconomic determinants such as education have been shown to be vital factors in multimorbidity progression among middle-aged and older adults. However, whether cumulative disadvantage in education is associated with multimorbidity progression remains unclear, particularly in cross-cultural contexts. This study aimed to investigate the progression of physical-mental-cognitive multimorbidity (PMC), and to evaluate how cumulative disadvantage in education influenced its progression among Chinese and English populations.

Methods: Data were extracted from China Health and Retirement Longitudinal Study (2011-2020) and English Longitudinal Study of Ageing (2011-2019). Cumulative disadvantage in education was measured by classification of educational years among core family members (participants, their parents and spouse). Multimorbidity involved chronic conditions in physical-mental-cognitive domains, and its quantitative changes were identified through group-based trajectory modeling. Logistic regressions and competing risk models were used to examine associations of educational disadvantages and multimorbidity trajectories.

Results: A total of 13,278 participants aged ≥45 were included. Four multimorbidity trajectories were identified: steady, slow growth, medium growth, and fast growth. Most individuals had severe educational disadvantage (45.46%) and physical-mental multimorbidity pattern (23.26%). Educational disadvantage was significantly associated with faster multimorbidity trajectories (P <0.001) and higher risks of complex multimorbidity patterns, particularly PMC multimorbidity (P <0.001). Maternal education significantly influenced multimorbidity progressions in England (P <0.001), but not in China (P = 0.100).

Conclusions: It is important to monitor quantitative and pattern changes in multimorbidity among middle-aged and older adults holistically. Public health should prioritize individuals with educational disadvantages as well as their families to more effectively address multimorbidity management.

Introduction: To evaluate the impact of firearm injury prevention programs and policies, it is important to characterize firearm injury costs. A prior review evaluated medical-specific firearm injury costs, but non-medical societal costs have not been previously reviewed. This study explicitly reviews the non-medical costs of both fatal and nonfatal firearm injury.

Methods: A systematic review of studies conducted from 2000-2023 in English reporting non-medical costs of U.S. firearm injury in Embase, PubMed, the Cochrane Library, EconLit, JSTOR as well as grey literature. The methods, data quality, types of non-medical costs, and the relationship between non-medical and medical costs were extracted. Bias was assessed using a modified Newcastle-Ottawa Scale and synthesized based on the SWiM (Synthesis without meta-analysis) guidelines.

Results: Nineteen studies analyzing national, state, city, and individual costs were identified. Studies generally used modeling approaches (13 studies) to calculate costs, but four used a cohort approach and two used a willingness-to-pay approach. Studies evaluated wide ranges of costs: medical, productivity, intangible (quality-of-life), criminal justice, and other costs. In studies evaluating both medical and non-medical costs, non-medical costs were much higher, with criminal justice costs being 1.5 to 3.9 times larger, productivity costs being 14 to 25 times larger, and intangible costs being 29 to 175 times larger than medical costs.

Discussion: The literature on non-medical costs is relatively under-developed, leading to wide ranges in results. Studies consistently show non-medical costs are orders of magnitude larger than medical costs of firearm injury with total costs potentially in the millions of dollars per injury. More research on non-medical costs of firearm injury will help quantify and clarify the magnitude of these costs, as well as be used to understand the cost-savings of specific prevention policies or programs.

Introduction: Extreme Risk Protection Order (ERPO) statutes allow temporary firearm removal and possession prohibition during periods of extreme risk of self- or other-directed harm. Prior research suggests most frequent use for White men, but population rates are underexamined. This study's objective was to describe county-specific frequency and rate of ERPO petitioning by respondent demographics across Florida's first 3.8 years of policy implementation.

Methods: ERPO petitions filed from 3/9/2018-12/31/2021 were obtained directly from court records or through public records requests from 65 of 67 Florida counties. Age, gender, and race or ethnicity of ERPO respondents were identified from petitions and aggregated by county-year. Petitioning rates per 100,000 resident-years were calculated and mapped to visualize incidence by county tertiles (no-/low-, moderate-, and high-use). Total petitioning incidence and incidence by respondent demographics were compared between tertiles and within tertiles over time.

Results: In total, 8,611 petitions were filed. ERPO petitioning generally increased over time, with greatest variability in moderate-use counties. Statewide, petitioning rates were higher for White residents than other race and ethnicity groups. Yet, in low-use counties, Black residents were subject to ERPOs at comparable rates to White residents, and in 2021, petitioning for Black residents was comparable or higher than for White residents in moderate- and high-use counties. Women, older adults, and residents of one-third of Florida's counties rarely received ERPOs.

Conclusions: Despite overall increased use, the relative rareness per capita and unevenness of ERPO petitioning statewide implies disparate policy implementation experiences among residents, potentially complicating attainment of intended policy effects.

Introduction: California enacted a statewide restriction on flavored tobacco product sales on December 21, 2022. Policy efforts to eliminate flavored tobacco products from retail environments are designed to restrict consumer access, with the goal of reducing initiation and experimentation, and supporting cessation.

Methods: This study used NielsenIQ retail scanner data to study cigarette pack sales and availability (i.e., the weekly number of universal product codes (UPCs) with positive sales), pre-intervention (1/1/2021 to 12/17/2022) to post-intervention (12/18/2022 to 12/30/2023) overall and by flavor category: tobacco/unflavored, menthol, and "nonmenthol" labeled. A control method was employed to create a synthetic California, based on pre-intervention-period data, to compare to California, post-intervention.

Results: From pre- to post-intervention, average weekly availability of menthol cigarettes decreased 44% in California, with ∼175 products still available in December 2023; sales decreased by 90%. "Non-menthol" labeled cigarette availability increased 194% and sales increased 708%. Total cigarette availability in California decreased, but total sales were unchanged. Changes in California were distinct from synthetic California.

Conclusions: California's statewide flavored tobacco sales restriction was effective at reducing the availability and sale of menthol cigarettes despite the increase in availability and sales of "non-menthol" labeled cigarettes. Total cigarette sales remain unchanged in the oneyear post-intervention due to the increase in sales of "non-menthol" labeled cigarettes.

Medical students often lack sufficient awareness and understanding of preventive medicine. Students acknowledge the importance of training in prevention and public health, but there is low awareness of the specialty, with few medical students considering it as a career path. This study aimed to assess the lack of awareness and understanding of the specialty of Public Health and General PH/GPM (PH/GPM) among medical students as well as increase the number of students considering a career in the specialty. Participants completed a pre-survey that assessed their current awareness, knowledge, and interest of the PH/GPM specialty. The intervention consisted of distributing the American College Prevention Medicine (ACPM) toolkit, video, and flyers, and a Q&A. A post-survey assessed changes and elicited the most appealing learning method. The study population included all medical students at the University of Maryland. The data was collected and analyzed in 2024. Pre- and post-survey responses were compared using chi-square tests. All three outcomes (awareness, knowledge, and interest) improved significantly from pre (n=430) to post-survey (n=390). Awareness increased from 48% to 100% (p<0.0001), knowledge increased from 18% to 96% (p<0.0001) and interest increased from 10% to 67% (p<0.0001). Flyers were identified as the most appealing method (see Figure 1.) of information delivery (71% of respondents), followed by the ACPM toolkit (25%), and ACPM video (4%). There is an opportunity in medical schools to provide targeted education to increase medical students' awareness, understanding, and interest in the specialty. PH/GPM remains under-recognized and under-promoted in medical schools. Educational outreach in medical schools may increase the number of future doctors pursuing careers in PH/GPM.

Introduction: Cannabis policies differ between states that have legalized cannabis use, and within states over time following legalization milestones. A continuous measure of state cannabis policy environments was examined in relation to college students' cannabis and alcohol use, accounting for concurrent state alcohol policies.

Methods: Undergraduates (n=902,486) ages 18-24 years from 591 four-year institutions in 47 states completed a cross-sectional survey between 2008 and 2019. Time-varying, state-level Cannabis Policy Scale (CPS) and Alcohol Policy Scale (APS) scores were sums of 17 and 29 policies, respectively, weighted by efficacy and state-level implementation. Outcomes were any 30-day use and frequent use (20+ days) of cannabis and alcohol, 2-week binge drinking (5+ drinks in a sitting), and co-use (binge drinking and frequent cannabis use). Data were analyzed in 2024-2025.

Results: Higher CPS scores (greater restrictiveness) were associated with significantly lower odds of cannabis use, frequent cannabis use, and co-use [OR=0.97 (0.96-0.98); 0.93 (0.91-0.94); and 0.94 (0.92-0.96), respectively], but not significantly associated with alcohol use outcomes. Higher APS scores were significantly associated with lower odds of every cannabis, alcohol, and co-use outcome. CPS and APS effects generally were significant for underage students (ages 18-20), but stronger for older students (ages 21-24).

Conclusions: Under less restrictive state cannabis and alcohol policy regimes college students were more apt to use cannabis and alcohol frequently and concurrently. To improve students' well-being, campus- and community-level policymakers can build on strong state policy environments or compensate for weak ones, using APS and CPS as tools to identify these needs.

Introduction: Food systems account for ∼30% of the greenhouse gas emissions (GHGE) that contribute to climate change. Climate labels on restaurant menus may help consumers decrease their food-related climate impact and improve meal nutrition given that environmentally sustainable diets are also healthier. This study evaluated the degree to which different climate labels promoted healthier and lower climate impact food choices.

Study design: Online RCT conducted in 2024, analyzed in 2025.

Setting/participants: A national sample of 6,221 adults benchmarked to the US Census on sex, race, ethnicity, and age.

Intervention: Participants were randomized to view a fast-food menu with either a control label or one of four climate label designs: (1) Numeric; (2) Climate Grade; (3) Traffic Light; or (4) Warning. Labels appeared alongside main menu items and were based on total supply chain GHGE associated with each item. Participants were instructed to select a hypothetical lunch meal order.

Main outcome measures: The main outcomes of this study were the selected meals' nutritional quality (measured using a modified Nutrient Profile Index [NPI] score) and GHGE in kgCO2e per meal.

Results: Compared with participants in the control condition (mean NPI score=50.6, SE(0.28)), those in the Traffic Light (mean NPI score=51.3, SE(0.28); p=0.013) and Warning (mean NPI score=51.3, SE(0.28); p=0.015) label groups chose significantly healthier meals (i.e., higher NPI score). Compared to the control (mean GHGE=27.5, SE(0.97)), all climate labels resulted in meals with significantly lower GHGE. Participants in the Traffic Light condition selected meals with the lowest GHGE (mean GHGE=22.6, SE(0.97); p<0.001), followed by Warning (mean GHGE=23.9, SE(0.97); p<0.001), Grade (mean GHGE=24.6, SE(0.97); p=0.004), and Numeric (mean GHGE=24.7, SE(0.98); p=0.005).

Conclusions: Interpretive climate labels, particularly Traffic Light and Warning label designs, are a promising way of improving the nutritional quality while reducing the climate impact of restaurant meal orders.

Trial registration: (https://clinicaltrials.gov/study/NCT06909019).