American Journal of Preventive Medicine最新文献

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).

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 to 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. Postestimation margins estimated mean sodium. Analyses were conducted in 2025.

Results: From 2013 to 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 to 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 owing 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 years through 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 2 years. Thirty-three students contacted 822 patients who were overdue for cancer screening (mean age of 61 years; 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 of 636), 6.7% for breast cancer (27 of 402), and 3.1% for cervical cancer (10 of 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.