American Journal of Preventive Medicine最新文献

Introduction: Reducing meat intake could improve planetary and human health, but high sodium in commercially prepared meat-free foods may undermine some health benefits of reducing meat intake. This study characterized trends in sodium content of meat-based versus meat-free foods in large chain U.S. restaurants, and examined mean sodium differences and portions of items qualifying for a "high in sodium" warning label.

Methods: Data came from MenuStat.org, a longitudinal database of menu items from U.S. restaurants collected annually from 2013-2021. The analytic sample included 24,147 items from 75 restaurants. Linear regression for panel data assessed trends in mean per-item sodium overall and by meat category (meat-based/meat-free), adjusted for restaurant type, menu category, children's item, and energy. Post-estimation margins estimated mean sodium. Analyses were conducted in 2025.

Results: From 2013-2021, mean sodium content was high, with no significant changes among meat-based or meat-free items. Meat-free items accounted for 22.1% of items and had lower mean sodium than meat-based items (-301 mg; 95% CI: -365, -238), consistent over time, across restaurant types and nearly all menu categories. Across all years, 13.4-17.2% meat-based and 3.7-5.9% of meat-free items would qualify for a "high in sodium" warning label by exceeding 100% of the sodium Daily Value.

Conclusions: Across 75 large chain restaurants, the sodium content of menu items did not change from 2013-2021. Meat-free items were lower in mean sodium than meat-based items, but were still high in sodium. Efforts to shift toward plant-forward diets should be paired with stronger sodium reduction policies.

System-level interventions are needed to improve early breast cancer detection and prevent colon and cervical cancers due to suboptimal adherence to screening guidelines in the U.S. A student-led outreach initiative was conducted at a New Jersey family medicine practice to improve screening rates among overdue patients. From January 1, 2023, to February 1, 2025, an interventional cohort study identified 911 patients aged 21-80 via electronic health record review, of whom 822 were confirmed to be overdue and eligible for outreach. The primary outcome was completion of guideline-recommended screenings within two years. Thirty-three students contacted 822 patients who were overdue for cancer screening (mean age 61; 74% female; 63% White, 16% Black, 3% Hispanic, 3% Asian), representing 1,365 overdue tests. Successful contact was made with 386 patients (47%), of whom 53 (13.7%) reported being up to date, verified when possible. The screening status of the 436 uncontacted patients was unknown, so all 822 were retained in the denominator to avoid overestimating intervention effects. Outreach generated an 11.4% referral rate (156 of 1,365), including 47 colonoscopies, 39 Cologuard®, 48 mammograms, and 22 Pap smears. Completion rates were 5.5% for colon cancer (35/636), 6.7% for breast cancer (27/402), and 3.1% for cervical cancer (10/327). Abnormal findings occurred in 57.9% of colonoscopies, 18.7% of Cologuard tests, 33.3% of mammograms, and 0% of Pap smears. This student-led outreach to patients overdue for cancer screenings facilitated referrals for colorectal, breast, and cervical cancer, supported early detection of abnormalities, and provided students with hands-on experience in preventive medicine, fostering development as community-focused physicians.

Introduction: Osteoporosis widely affects the aging population and often leads to debilitating fragility fractures. Dual-energy X-ray absorptiometry (DXA) scans are important for osteoporosis screening and treatment among aging women to prevent fragility fractures; however, disparities exist across populations. This study analyzed these disparities to help reduce screening inequalities to prevent complications of osteoporosis.

Methods: A sample was used from the 2018, 2020, and 2022 U.S. Medical Expenditure Panel Survey of women who responded about screening DXA utilization. Logistic regression modeling was used to determine associations between social determinants of health (SDOH), particularly between limited English proficiency (LEP), and screening DXA utilization. Two models, SDOH and SDOH+LEP, were generated utilizing these variables modified by the addition of the variable of English proficiency.

Results: Half of the 10,079 respondents without osteoporosis (48%, N=4,851) reported undergoing a DXA scan with a median age of 69 years (50-85). Low income; lower education; Black, Asian, Hispanic race/ethnicity; and LEP were significantly associated with not receiving a screening DXA scan. Hispanic women had a 55% decreased likelihood of receiving a screening DXA scan (OR=0.450, 95%CI: 0.365-0.554, p<0.001) compared to non-Hispanic White women, though this lost statistical significance when accounting for LEP (OR=0.732, 95%CI: 0.521-1.029, p=0.073).

Conclusions: The results demonstrate significant SDOH disparities in DXA screening for osteoporosis. The effect is modified, specifically the association of race/ethnicity, when LEP is included as a risk factor. Awareness of these disparities is important for primary care and other providers to deliver equitable prevention and treatment opportunities for osteoporosis.

Introduction: Although cannabis use has increased during a time of expanding cannabis legalization, there is limited evidence on how use has shifted in response to legalization across at-risk groups. This study examined the impact of recreational cannabis legalization on adult cannabis use overall and by demographic and higher-risk strata.

Methods: Behavioral Risk Factor Surveillance System 2016-2023 surveys (N=859,600 adults from 38 states) were linked to state recreational cannabis legalization. Using quasi-experimental difference-in-differences zero-inflated negative binomial and probit regressions, the impact of legalization on cannabis use was examined overall and by demographic (age, sex, education, race/ethnicity) and higher-risk (mental health, cigarette smoking, alcohol use) strata, adjusting for demographic and policy controls, state, and year. Data were compiled in 2024-2025 and analyzed in 2025.

Results: Recreational cannabis legalization was associated with 44% lower odds of zero cannabis use (95% CI=40%, 48%), indicating higher likelihood of any use, not with a greater frequency of use among users, and a significant total effect estimate, indicating higher cannabis use after legalization. When cannabis use was dichotomized, legalization was associated with a 0.94 percentage point increase in the likelihood of use (95% CI=0.04, 1.84), a 9.8% relative increase compared with 2016 levels. Adults aged ≥60 years, female, White, or college educated had generally lower cannabis use, yet significant interactions (all p<0.1) revealed that they were the most responsive to legalization, with 1-2 percentage point increases in use.

Conclusions: Recreational cannabis legalization is driving increases in cannabis use among groups with historically lower use rather than increasing use among those who already used cannabis.

Introduction: Ultra-processed dietary patterns have been associated with higher risk of weight gain. Previous studies were conducted in high-income countries using dietary assessment tools not specifically designed to identify ultra-processed foods (UPF). The purpose of this study was to examine the prospective association between ultra-processed dietary pattern and risk of weight gain in Brazilian adults.

Methods: Data from 24,453 participants from NutriNet-Brasil cohort study who responded to two Nova24h dietary recalls at baseline and were followed for a median of 43.6 months were analyzed. Ultra-processed dietary pattern was assessed based on the contribution of UPF to total energy intake. Weight gain was defined as ≥5% and ≥10% increase from baseline body weight, based on self-reported measurements. Cox proportional hazards models and stratified analyses were performed.

Results: A linear dose-response association was observed: for each 10% increase in UPF contribution, the risk of ≥5% weight gain increased by 5% [10,092 cases, hazard ratio (HR) 1.05; 95% confidence interval (CI) 1.04 to 1.07] and the risk of ≥10% weight gain increased by 8% (4,865 cases, HR 1.08; 95% CI 1.06 to 1.10). Compared with participants in the lowest quintile (<11.8% of UPF), those in the highest quintile (≥34.0%) had higher risk of weight gain (≥5%: HR 1.23; 95% CI 1.15 to 1.31; ≥10%: HR 1.35; 95% CI 1.23 to 1.48). These associations persisted, although attenuated, after adjustment for diet nutritional profile.

Conclusions: Higher exposure to ultra-processed dietary pattern was associated with an increased risk of weight gain in Brazilian adults.

Introduction: Gunshot wounds (GSWs) are typically treated in acute care settings but longer-term sequelae are likely treated by ambulatory care providers. To understand if GSW treated in acute care settings are later documented in ambulatory care electronic health records (acEHR), acute care claims and acEHR data were linked. The primary objective was to determine the percentage of patients with a GSW diagnosis in their acEHR from all patients with both an acute care GSW diagnosis and an observed follow-up ambulatory care visit. The second objective was to identify demographic and clinical factors associated with a patient having a GSW diagnosis in their acEHR.

Methods: This observational study linked Oregon Medicaid claims for acute GSW with acEHRs in OCHIN's ADVANCE Data Warehouse from 2012 - 2022 for case identification. Patients with and without an International Classification of Diseases (ICD) code for GSW in their acEHR were characterized using descriptive statistics. Multivariable logistic regression conducted between 2024-2025 modeled predictors of GSW diagnosis in follow-up acEHR controlling for patient characteristics.

Results: Only 34.3% of patients with a GSW event treated in an acute setting and with an observed ambulatory care visit had a GSW diagnosis in their acEHR. Time between acute GSW and follow-up ambulatory care, and the severity of the acute GSW injury were associated with having a GSW acEHR diagnosis. Patients identified as Black, non-Hispanic or Hispanic had higher odds of having a GSW acEHR diagnosis compared to White, non-Hispanic.

Conclusions: Most people who had a GSW treated in an acute care setting with a later ambulatory care visit did not have a GSW diagnosis in their acEHR, even though a GSW event can be relevant history for ambulatory care providers and patient care. Strategies to document prior GSW in ambulatory EHRs should be developed to support whole-person care in ambulatory settings.

Introduction: Housing is a key social determinant of health, yet research on disparities among transgender and gender diverse (TGD) people has relied on convenience or targeted samples, leaving population-representative evidence absent. To the authors' knowledge, this study provides the first population-based assessment of housing inequities for cisgender-, transgender-, and non-binary-led households in Canada.

Methods: This study utilized data from the 2021 Canadian Long Form Census, focusing on primary household maintainers aged 15 and above. Gender identity was derived from sex at birth and gender identity questions, disaggregating cisgender, transgender men, transgender women, non-binary assigned male at birth (AMAB), and non-binary assigned female at birth (AFAB) households. Outcomes included core housing need (unaffordable, inadequate, or unsuitable housing) and each component separately. Logistic regression models estimated odds ratios (ORs) and predicted probabilities, adjusting for demographic, socioeconomic, and regional covariates. Subgroup analyses examined heterogeneity by age, living arrangement, and tenure.

Results: Cisgender men-led households had the lowest probability of core housing need (8.0%), compared with higher risks among cisgender women (12.8%), transgender women (21.2%), non-binary AFAB (21.2%), non-binary AMAB (19.4%), and transgender men (16.5%). Fully adjusted models showed elevated odds for transgender women (OR = 1.32, 95% CI: 1.15-1.51), non-binary AMAB individuals (OR = 1.30, 95% CI: 1.12-1.51), and non-binary AFAB individuals (OR = 1.55, 95% CI: 1.41-1.72) households relative to cisgender men. Disparities were largest among youth, renters, and households with multiple people.

Conclusions: TGD-led households face systematic and significant housing disadvantages in Canada. Addressing these inequities requires embedding gender identity in housing policy, enforcing anti-discrimination protections, and expanding affordable and supportive housing tailored to TGD populations.

Introduction: This paper presents a systematic economic review of patient navigation (PN) services to increase colorectal cancer (CRC) screening and reduce disparities in CRC screening rates in vulnerable populations.

Methods: The literature search strategy included English-language studies conducted in high-income countries that were published from database inception to December 2022. Studies on patients with existing cancer or without healthcare system involvement were excluded. Data collection and analysis were completed in 2023. All monetary values reported are in 2022 U.S. dollars.

Results: The search yielded 17 studies with 16 studies from the U.S. and one study from France. The median intervention cost per person from 16 studies was $150 [Interquartile interval (IQI): $58, $340]. The median intervention cost per additional person screened from 17 studies was $663 (IQI: $185, $1,730). Five estimates from two studies showed a median return on investment (ROI) of 2.3% (IQI: 1.7%, 6.9%) for colonoscopy from health care providers' perspective. Two studies reported a cost per quality-adjusted life year (QALY) of -$173 and -$1,442, indicating cost savings while increasing QALYs. One study reported that the intervention had a cost per life-year (LY) gained of $3,231 or $12,293 translated to per QALY gained.

Discussion: Economic evidence demonstrates that PN services aimed at increasing CRC screenings are cost-effective based on a conservative threshold of $50,000 per QALY gained. Additionally, the ROI is favorable for PN services to increase CRC screening by colonoscopy as the estimated reimbursement values for colonoscopy exceed intervention costs.