American Journal of Preventive Medicine最新文献

Introduction: Cardiovascular disease (CVD) is a leading cause of death among transgender women and people with HIV. Exogenous estrogen and psychosocial stressors are known risk factors for CVD. Yet, few studies have used biomarkers to examine the role of stress in CVD risk among transgender women with HIV (TWHIV). This analysis examined whether stress moderates relationships between gender-affirming hormone therapy (GAHT) duration and CVD risk among TWHIV.

Methods: This cross-sectional analysis of baseline data from an observational cohort of 108 Black and Latina TWHIV in Boston, New York, and Washington, DC, enrolled December 2020 to June 2022, measured sociodemographics, medical diagnoses, medications, smoking history, and perceived stress via interviewer-administered surveys. Physiological stress was measured with 14 biomarkers to calculate allostatic load indices (ALI). Forty participants provided saliva samples used to calculate cortisol awakening response and cortisol daily decline. The 2018 American College of Cardiology Revised Pooled Cohort Equation estimated 10-year CVD risk. Data were analyzed in 2024.

Results: GAHT duration was positively associated with CVD risk scores in bivariate regression. In multivariable linear regression models (adjusting for age, income, education), only age and ALI remained significantly associated with CVD risk scores (β 1.13, CI: 1.05, 1.21). No stress measure significantly interacted with GAHT duration to affect CVD risk scores. In visual plots, GAHT duration increased CVD risk scores only for TWHIV experiencing the highest ALI.

Conclusions: Stress plays an important role in CVD in TWHIV. More research is needed on non-GAHT factors, which influence CVD health among transgender women.

Introduction: Contraceptive care is critical piece of quality sexual reproductive healthcare. Providers directly impact client experiences and clinical outcomes; it is important to understand how providers offer contraceptive care and the factors influencing this care. This systematic review summarizes recent research on providers, their perspectives, experiences, barriers, and facilitators to offering contraceptive counseling, education, and care.

Methods: In May 2023, a systematic review was conducted in PubMed, Cochrane Database of Systematic Reviews, and Scopus to identify articles published between December 1, 2016, and May 1, 2023. Studies that explored the barriers and facilitators providers experience when offering contraceptive counseling, education, and/or care and how those differ by clinic setting, provider characteristics, and/or client demographics were included.

Results: A total of 22 studies met the inclusion criteria. Only three studies reported provider demographic characteristics. Most studies were conducted in urban locations with five delivering care to clients with low income. Care provision varied based on clinic setting, provider characteristics, and client characteristics. Care also included client-centered, efficacy-based, shared decision-making, and directive counseling approaches. Providers identified real or perceived challenges among their clients as a barrier to quality care provision, in addition to insufficient time; inability to offer same-day method insertion; and a lack of training in cultural humility, long-acting methods, and providing care to clients with intellectual disabilities.

Discussion: Despite intentions to provide client-centered care and prioritize client autonomy, providers face numerous barriers that impact their ability to offer quality care in alignment with client needs and desires.

Trial registration: Prospero-CRD42023414456 crd.york.ac.uk/PROSPERO/display_record.php?RecordID=414456.

Introduction: In guidance published in February 2020, the FDA described their intent to prioritize enforcement against the sale of flavored cartridge-based Electronic Nicotine Delivery Systems (ENDS) except tobacco and menthol flavors. This guidance was specific to cartridge-based ENDS and did not apply to other ENDS types or e-liquids sold in the U.S.. It remains unknown if use of certain types of ENDS devices and flavors changed following the publication of this guidance.

Methods: This analysis includes PATH Study data from Wave 5 (W5, 2018-2019) and Wave 6 (W6, 2021) and examines cross-sectional estimates of (1) use of flavored ENDS and (2) use of different device types. All analyses in this study were stratified by self-reported age (youth-aged 12-17 years at W5 and aged 14-17 years at W6, and adults-aged 18-20, 21-24, and 25+ years). Analyses were conducted in 2023-2024.

Results: Among adults aged 21 years and over, there were significant increases in the use of menthol or mint flavored ENDS. There were no substantial changes in flavors of ENDS used among youth or adults aged 18-20 years. Among all age groups, the use of cartridge-based ENDS was lower in 2021 than 2018-2019, with a notable shift to disposable-style ENDS.

Conclusions: Federal-level tobacco control actions taken in the U.S. in early 2020 prioritized enforcement against "any flavored, cartridge-based ENDS product (other than a tobacco- or menthol-flavored ENDS product)." Based on this analysis, there was a shift following the policy to menthol or mint-flavored ENDS and disposable-style ENDS.

Background: The objective of this study is to investigate the effect of allergies on complications following total shoulder arthroplasty (TSA).

Materials and methods: All data were collected by using the PearlDiver national database to identify patients who had undergone TSA (anatomic or reverse) between 1 January 2010 and 31 October 2021. Patients were stratified into two groups: allergies and no allergies. Comparisons were made regarding complications and revision surgeries. Complications were compared at 30 and 90 days. Revisions were compared at 1, 5 and 10 years postoperatively.

Results: This study identified 28,182 patients with allergies and 126,296 patients without allergies. Patients with allergies were more likely to require revision surgery at all time points analyzed (p < 0.001). Patients with allergies were more likely to have sepsis within 30 (OR 1.53 [1.30-1.80], p < 0.001) and 90 days (1.71 [1.51-1.94], p < 0.001) postoperatively. Patients with allergies were more likely to experience a wound complication within 30 (1.89 [1.58-2.26], p < 0.001) and 90 days (1.81 [1.58-2.08], p < 0.001). The allergy group experienced higher rates of prosthetic joint infections (PJI) (2.14 [1.81-2.54], p < 0.001) and implant complications at 90 days (1.52 [1.42-1.62], p < 0.001).

Discussion: Patients with allergies were more likely to require revision surgery, experience wound complications, sepsis and PJI following TSA.

Introduction: The aim of this study was to determine the associations between type 2 diabetes or prediabetes and loneliness and related social experiences in young adults, a population at increasingly high risk of type 2 diabetes.

Methods: This was a cross-sectional analysis using data from adults aged 18-35 years enrolled in the All of Us Research Program. Exposures included loneliness, social support, discrimination, neighborhood social cohesion, and stress, measured by standardized surveys. The main outcome was type 2 diabetes or prediabetes by self-report or linked health record. Logistic regression determined the odds of type 2 diabetes/prediabetes for each survey measure, adjusting for age, sex, race or ethnicity, income, and family history. Latent class analysis evaluated clustering of social experiences. Data were collected from 2018 to 2022 and analyzed in May 2023-June 2024.

Results: The cohort included 14,217 young adults (aged 28.2 ± 4.4 years, 73.1% [n=10,391] women, 64.1% [n=9,111] White, 10.6% [n=1,506] Hispanic, 5.7% [n=806] Black, and 9.1% [n=1,299] multiracial). Overall, 5.5% (n=777) had either prediabetes or type 2 diabetes. The 2 highest loneliness quartiles were associated with increased odds of prediabetes/type 2 diabetes (Q3: OR=1.42 [95% CI=1.15, 1.76] and Q4: OR=1.78 [95% CI=1.45, 2.19]). Greater stress and discrimination and lower social support and neighborhood social cohesion were also associated with increased odds of prediabetes/type 2 diabetes. Latent class analysis revealed 3 distinct phenotypes, with elevated odds of prediabetes/type 2 diabetes in the 2 with the most adverse social profiles (OR=2.32 [95% CI=1.89, 2.84] and OR=1.28 [95% CI=1.04, 1.58]).

Conclusions: Loneliness and related experiences are strongly associated with type 2 diabetes and prediabetes in young adults. Whether these factors could be leveraged to reduce type 2 diabetes risk should be investigated.

Introduction: Social risk factors are associated with worse access to care. This study measured the prevalence of social risk factors among low-income adults, assessed the relationship between number of social risk factors and access to care, and examined heterogeneity by health insurance type.

Methods: Using 2022 Behavioral Risk Factor Surveillance Survey data from 39 states, the association between number of SRFs (0, 1, 2-3, 4, or more) and three access to care measures (having a personal doctor, having a routine checkup, and inability to see doctor because of cost) were measured using multivariable linear probability models. The analysis was stratified by health insurance coverage type (private, Medicare, Medicaid, or uninsured) to assess whether effects were differential. Analyses were conducted in 2024.

Results: Among 90,208 low-income adults, 46.6% reported at least one SRF. Compared to people who reported no SRFs, those who reported four or more were more likely to report being unable to afford care (28.21 percentage points [PP], p<0.001) and less likely to have a personal doctor (-4.98 PP, p<0.001) or routine checkup in the last two years (-4.29 PP, p<0.001). The magnitude of disparity by number of SRFs in inability to afford care was larger among privately insured and uninsured people compared to those with Medicare or Medicaid coverage.

Conclusions: Higher levels of SRFs were associated with worse access to care among low-income adults. Policies that minimize cost-related barriers to care, coupled with care delivery reforms and social policies that address SRFs, may improve access to care.

Introduction: A lung cancer screening program using low dose CT (LDCT) in a Federally Qualified Health Center (FQHC) in Central Texas was developed and assessed for equitable implementation.

Methods: From 11/2020-8/2023, patients aged 55-77 years who currently smoked or quit within 15 years with ≥20 pack-years of exposure were identified through EHR query and mailed outreach, or through direct provider referrals. A bilingual social worker confirmed eligibility, provided telecare shared decision-making (SDM), coordinated screening, and offered smoking cessation. To assess equity, LDCT completion across demographics was compared, in 2023.

Results: A total of 6,486 patients were mailed outreach materials; 479 patients responded, of whom 108 (22.5%) were eligible and 71 (65.7%) participated in SDM. 629 eligible patients were referred internally; 579 (92.0%) completed SDM. Of the 650 patients who completed SDM, 636 (97.8%) agreed to screening. Mean age was 61.7 years; 38.1% were female. The population was diverse: 35.8% identified as Latino, 17.8% as African-American, 26.8% had Medicare or Medicaid, 48.0% used the county medical assistance program, 14.2% were uninsured, and 76.7% currently smoked. Overall, 528 (83.0%) patients completed LDCT. There were no statistically significant differences in completion by age, gender, race/ethnicity, or insurance status. Spanish-speaking patients were more likely to complete the CT than English speakers (OR 2.22, 95% CI=1.22, 4.41) and those who formerly smoked were more likely to complete the CT than patients who currently smoked (OR 1.93, 95% CI=1.12, 3.51).

Conclusions: The navigator-centered program achieved equitable implementation of lung cancer screening in a diverse FQHC system.

Introduction: Healthcare providers should facilitate smoking cessation, and primary care is an ideal setting for delivering this evidence-based care. This study's objective was to describe readiness to quit smoking combustible cigarettes among adult Appalachian primary care patients and determine their providers' implementation of an established tobacco treatment model.

Methods: As part of a randomized clinical trial, 298 providers in 10 health systems across 4 states received tobacco treatment training. Periodically between January 2022 and June 2023, anonymous surveys were distributed to patients after primary care visits. The survey included questions about demographics, visit type, smoking status, readiness to quit, and provider behavior related to tobacco treatment implementation. In 2023, descriptive statistics, bivariate tests and logistic regression models were conducted.

Results: Among 1,242 survey respondents, 34.1% reported current smoking. Among those who reported current smoking, 13.9% expressed readiness to quit within the next 30 days and 15.3% reported readiness in 1-6 months while 36.7% indicated "never" wanting to quit. Nearly all providers asked respondents about smoking status (96.9%) and advised them to quit (89.8%); fewer providers engaged in cessation assistance by discussing behavioral counseling, discussing medication options, and/or prescribing medication (25.1%-64.6% across behaviors). Provider behavior was most consistently associated with patient age and visit type.

Conclusions: Nearly one third of Appalachian patients who smoke reported readiness to quit within 6 months and nearly all received advice to quit from their provider. Patients would benefit from more intensive tobacco treatment delivery in primary care settings, with a focus on assisting with quit attempts.

Introduction: Proactively engaging patients in conversations about their needs and desires for sexual and reproductive health (SRH) is an essential part of providing client-centered care. This systematic literature identifies screening tools and approaches for assessing needs and desires for pregnancy- and STI-related services.

Methods: PubMed and the Cochrane Library were searched for articles published between July 1, 2018 and July 26, 2023. Eligible studies examined the use of screening tools for various SRH services. This manuscript focuses on evidence from 28 articles that examine findings related to pregnancy and STI screening.

Results: The evidence suggests that using these tools can increase the number of patients who receive care. The tools also facilitate clients' discussions with their providers about reproductive health goals and needs. Patients appreciate tools that are easy to use and help them have non-judgmental interactions with providers and promote shared decision-making and bodily autonomy. Providers reported a preference for screening tools that are easy to use, quick to administer, and can be integrated into existing workflows.

Conclusions: Screening tools are important for identifying clients' needs and desires as well as informing and streamlining care. More research is needed to better understand the diversity of provider and patient experiences with screening tools and whether the use of such tools promotes accessible and equitable service provision. There was insufficient evidence to recommend any specific screening tool or approach for assessing pregnancy or STI needs and desires because most tools were reported either in a single study or results were mixed.

Trial registration: Prospero - CRD420234486.

Introduction: Age-adjusted mortality rates (AAMR) for cardiovascular diseases (CVD) increased in 2020 and 2021, and provisional data indicated an increase in 2022, resulting in substantial excess CVD deaths during the COVID-19 pandemic. Updated estimates using final data for 2022 are needed.

Methods: The National Vital Statistics System's final Multiple Cause of Death files were analyzed in 2024 to calculate AAMR from 2010 to 2022 and excess deaths from 2020 to 2022 for U.S. adults aged ≥35 years, with CVD as the underlying cause of death.

Results: The CVD AAMR among adults aged ≥35 years in 2022 was 434.6 deaths per 100,000 (95% CI=433.8, 435.5), which was lower than in 2021 (451.8 deaths per 100,000; 95% CI=450.9, 452.7). The most recent year with a similarly high CVD AAMR as in 2022 was 2012 (434.7 deaths per 100,000 population, 95% CI=433.8, 435.7). The CVD AAMR for 2022 calculated using provisional data overestimated the AAMR calculated using final data by 4.6% (95% CI=4.3%, 4.9%) or 19.9 (95% CI=18.6, 21.2) deaths per 100,000 population. From 2020 to 2022, an estimated 190,661 (95% CI=158,139, 223,325) excess CVD deaths occurred.

Conclusions: In 2022, the CVD AAMR among adults aged ≥35 years did not increase, but rather declined from a peak in 2021, signaling improvements in adverse mortality trends that began in 2020, amid the COVID-19 pandemic. However, the 2022 CVD AAMR remains higher than observed before the COVID-19 pandemic, indicating an ongoing need for CVD prevention, detection, and management.