American Journal of Preventive Medicine最新文献

Introduction: Electronic nicotine delivery systems (ENDS) have become widely popular, inadvertently increasing the risk of pediatric liquid nicotine exposures. Even small amounts of concentrated nicotine can result in severe toxicity in young children. This study aimed to quantify emergency department visits for liquid nicotine poisoning among children under five years of age from 2019 to 2024.

Methods: Data from the National Electronic Injury Surveillance System (NEISS) from 2019 to 2024 were analyzed using a cross-sectional approach. Cases were identified by extracting records with poisoning diagnoses and filtering narratives using keywords associated with ENDS poisonings. Two independent reviewers confirmed each case involved exposure to ENDS liquid nicotine. NEISS sample weights were applied to produce national estimates with 95% confidence intervals.

Results: An estimated 3,952 emergency department visits nationally (95% CI: 2,600-5,305) were attributed to liquid nicotine poisoning among children under five years of age from 2019-2024. Children under two years accounted for 2,921 cases (73.9%). Males represented 2,345 cases (59.3%) and females 1,607 cases (40.7%). White children comprised 2,345 cases (59.3%). Most children (88.3%) were treated and released, while 165 cases (4.2%) required hospital admission. No fatalities were reported.

Conclusion: Liquid nicotine poisoning remains a significant pediatric health concern, with over 3,900 emergency department visits nationally during 2019-2024. Children under two years of age are at highest risk due to developmental factors and exploratory behaviors. While most cases did not require hospitalization, the potential for serious outcomes underscores the need for enhanced prevention strategies, including improved product packaging and public education about safe storage practices.

Introduction: Mailed stool testing is effective for increasing colorectal cancer (CRC) screening, which reduces CRC incidence and mortality. To scale up mailed programs efficiently, this study examines tradeoffs between total reach, program intensity, and budget impact.

Methods: A population-based simulation model was adapted to reflect 215,000 under-screened individuals in Federally Qualified Health Centers across a large US state (Texas) over five years. Base case parameters and uncertainty ranges for impact and costs across alternative strategies were derived from local program data and literature review conducted in 2025. Comparisons included reminder intensity (a) no reminders (initial mailing only), (b) low intensity (reminders by letters, texts, or automated calls), and (c) high intensity (staff outreach by phone) as well as adding patient navigator outreach for participants with positive stool tests. Program designs were compared across 200 probabilistic scenarios under traditional and budget-constrained frameworks.

Results: Scenarios incorporating navigation were always preferred over those without navigation. Relative to no reminders, low-intensity reminders cost an incremental $108,000 per CRC case prevented. Adding high-intensity reminders cost a further $193,000 per case prevented. At a fixed budget lower than $13 million over five years, a combination of navigation and low-intensity reminders would generally maximize total program impact, although this inflection point varies with the size of the target unscreened population.

Conclusions: Policymakers facing economic tradeoffs in program design should prioritize patient navigation after positive primary tests, which is cost-efficient, and should consider patient reminders, with the optimal reminder strategy dependent on the target population size and budget.

Introduction: Consumer interest in cannabis-derived products (CDPs) remains high, including among women, a growing demographic group. This study examined women's reproductive health claims in CDP e-commerce listings to better understand their potential consumer risk.

Methods: This study involved three phases: (1) data mining U.S. product listings from cannabis e-commerce websites Leafly and Weedmaps; (2) keyword filtering related to women's health and reproductive topics; and (3) content coding of CDP listings for women's health benefits, including product characteristics, such as route of administration (RoA), and any accompanying health warnings and user-generated reviews all conducted September-November 2023.

Results: A total of 1,463,510 unique CDP listings were collected from Leafly and Weedmaps. After keyword filtering and content coding, 408 listings mapped to 465 health benefit claims across five major women's health areas: menstrual cycle (57.2%, n=266), fertility (14.0%, n=65), women's health conditions (13.1%, n=61), menopausal transition (15.0%, n=70), and maternal health (0.7%, n=3). Among these 408 CDP listings, only 6.6% (n=27) contained disclaimers with health warning language. For products making women's health claims, the top product RoA was topical/transdermal application (e.g., dermatological agents, transdermal products, n=135). Product reviews contained 14 comments with thematic relevance to stated health benefit claim(s), including with 12 (85.7%) positive and 2 (14.3%) negative.

Conclusion: This study found >400 unique CDPs promoting various women-focused health benefits on two cannabis e-commerce sites, despite known reproductive and maternal health risks. Additional research is needed to understand how women perceive these marketed benefits and how they influence product use and behavior.

The National Diabetes Prevention Program (NDPP) is a yearlong lifestyle intervention for adults at high risk of developing type 2 diabetes. The program is based on the highly efficacious yet resource-intensive intervention from the landmark Diabetes Prevention Program trial. This Current Issues article examines the successes and challenges in achieving financial sustainability for the NDPP, focusing on strengthening Medicare coverage, which is a key indicator of the program's long-term potential success. A major barrier is that Medicare reimbursement rates were initially based on incomplete cost estimates that excluded critical components such as participant recruitment and administrative support. Combined with performance-based payment models and frequent claim denials, these low rates have resulted in average payments of only $225 dollars per Medicare participant, leaving a considerable financial shortfall to program suppliers. Low payments have discouraged suppliers from offering the NDPP and may explain its limited uptake, with approximately 0.03% of eligible Medicare beneficiaries participating to date. In this research letter, we identify four strategies to improve sustainability. First, define the minimum cost of effective delivery using rigorous and comprehensive costing studies. Second, systematically reduce administrative burdens to lower indirect costs. Third, set reimbursement rates that reflect actual costs and consider hybrid payment models that both support access and reward outcomes. Fourth, plan for future scale-up by setting delivery targets that are aligned with available resources, while prioritizing the highest-risk populations. Firmly establishing a sustainable delivery model for the NDPP may be key to ensuring widespread uptake and preventing diabetes across the US.