American Journal of Preventive Medicine最新文献

Introduction: The federal Supplemental Nutrition Assistance Program (SNAP) seeks to improve food and nutritional security, but pre-pandemic evidence suggests benefit amounts are insufficient. Pandemic-related Emergency Allotments (EA) and Thrifty Food Plan Modernization (TFPM) increased SNAP benefit amounts. This study uses transaction data from shoppers at a large supermarket chain in North Carolina to understand if these changes were associated with shifts in grocery food purchase composition.

Methods: Data was collected from October 2019-February 2022 and analyzed from October-November 2023. A difference-in-differences approach was applied to assess purchase changes among a matched panel of SNAP and non-SNAP shoppers before and after the EA and TFPM and compared to the pre-pandemic period.

Results: Higher increases in fruits, vegetables, nuts, legumes, and other non-processed foods and beverages purchases were observed among SNAP shoppers (vs. non-SNAP shoppers) after the implementation of both the EA and TFPM. Decreases in sugar-sweetened beverages purchased and sugar from purchases after the EA were also observed. Purchase improvements were more notable when both EA and TFPM benefits were applied.

Conclusions: Even modest SNAP benefit increases were associated with purchase changes, suggesting benefit amounts have a key role in improving purchase composition. With the expiration of emergency allotments in 2023 and upcoming debates around the SNAP program, understanding the implications of benefit adequacy on food purchasing remains critical for policy planning. These findings provide timely evidence on how SNAP enhancements may improve nutritional quality, underscoring the need to sustain or expand benefit levels to support healthy eating among low-income households.

Introduction: Studies assessing the risk of dementia associated with excess weight have found mixed results due to methodological challenges. This study sought to quantify this relationship while avoiding the confounding that is attributable to reverse causality.

Methods: This cohort study used data from the Health and Retirement Study (1992-2018) analyzed in 2024-2025. The exposure was maximum BMI over 10 years of weight history before the start of follow-up. Participants were followed for 16 years for incident dementia, death, or censoring. Population attributable fractions for dementia were calculated using hazard ratios (HRs) from multivariable Cox proportional hazards models and prevalence of overweight and obesity.

Results: The final sample comprised 3,734 individuals (57.1% female, mean age 64.7 [SD 4.4]) and 395 incident dementia cases. Compared to those with a maximum BMI in the normal weight range (18.5-24.9 kg/m²), the class II/III obesity group (35+ kg/m²) had almost double the hazard of dementia over follow-up (adjusted [a]HR 1.89, CI 1.31, 2.73), the class I obesity group (30-34.9 kg/m²) had 42% increased hazard (CI 1.01, 2.00) and the overweight group (25-29.9 kg/m²) had 22% increased hazard (CI 0.89, 1.67). If all individuals with a maximum BMI in the overweight or obesity range had been in the normal weight group, 22.1% (CI 1.8, 38.2) of dementia cases could have potentially been averted.

Conclusions: The contribution of obesity to the burden of dementia is larger than current evidence suggests. Investigating this association without accounting for the complexity of the temporal relationship between obesity and dementia can result in erroneous conclusions.

Introduction: As of 2025, nine states have adopted Universal Free School Meal programs. The success of these programs depends in part on high participation. This study tested whether a social media campaign promoting school meal participation increases school lunch and breakfast participation in states with Universal Free School Meal programs.

Study design: Randomized controlled trial.

Setting/participations: 832 parents of elementary-aged children living in states with Universal Free School Meal programs.

Intervention: Parents were randomized to a school meal promotion campaign or a control campaign about reading. Campaigns were delivered via private Facebook groups for 6 weeks between October-December 2024.

Main outcome measures: The co-primary outcomes were children's school lunch and school breakfast participation as reported by parents in baseline and follow-up surveys. Secondary outcomes included engagement with the campaigns (e.g., noticing, reading, and talking about campaign messages) and perceived barriers to participation in school meals. Data were collected in September-December 2024 and analyzed in 2025.

Results: The school meal promotion campaign elicited more noticing of the campaign messages (difference vs. control, 37 percentage points), reading the campaign messages (difference=0.16 on a 1-5 scale), and talking with others about the campaign messages, school meals, and the benefits of school meals (differences=0.14 to 0.21 on 1-5 scales) (all ps<.05). The campaign did not increase participation either in school lunch (difference-in-differences=0.08 meals/week, 95%CI: -0.08,0.25, p=.30) or breakfast (difference-in-differences=0.02 meals/week, 95%CI: -0.16,0.20, p=.81). Parents reported several barriers to their child's participating in school lunch and breakfast, including that the child does not like the meals (38-63% of parents reported), the meals appear to be low quality (17-27%), and there is not enough time to eat (25-30%).

Conclusions: Delivering school meal promotion campaigns to parents via Facebook is feasible and acceptable but may not be sufficient to increase children's school meal participation.

Trial registration: ClinicalTrials.gov (NCT#06419218).

Introduction: Vaping products are the most widely used tobacco products among young adults in the U.S., driven partly by added flavors that are palatable and misperceived as safe. Vaping prevention public service announcements often use cognitive, emotional, and social appeals, yet little is known about the neurobehavioral mechanisms driving their effectiveness. This study employed functional magnetic resonance imaging to determine whether neural responses to vaping prevention public service announcements in the salience, emotional, cognitive control, and default mode networks predict subsequent vaping and whether these effects vary by message type.

Methods: Forty-six young adult nonsmokers who vaped ≥15 days during the past month viewed vaping prevention public service announcements during functional magnetic resonance imaging. Public service announcements were adapted from existing campaigns with cognitive, emotional, and social appeals. Subsequent vaping behavior was tracked weekly for 1 month. Data were collected between 2019 and 2022, with formal analyses conducted in 2024.

Results: Greater reactivity in the emotional network during public service announcement exposure predicted reduced vaping 1 month later, especially when viewing cognitive and social public service announcement. In contrast, heightened cognitive control network reactivity was linked to increased vaping, driven primarily by responses to emotional public service announcements.

Conclusions: Emotional network responses to cognitive and social public service announcements and cognitive control responses to emotional public service announcements may serve as useful and possibly differential neuromarkers of future vaping behavior. Specifically, public service announcements that elicit reflective emotional processing may be more effective than those relying on overt emotional intensity. These findings suggest the utility of functional magnetic resonance imaging in informing optimization of health message design in the evolving nicotine product landscape.

Introduction: Chronic conditions associated with COVID-19 hospitalization were identified early in the pandemic when underlying population immunity was low. Updated information on risk factors for COVID-19 hospitalization is needed.

Methods: Surveillance and cross-sectional survey data were combined to compare COVID-19 hospitalization rates in adults aged ≥18 years with and without nine chronic conditions in 98 counties across 13 states. Hospitalization counts were obtained from the COVID-19-associated Hospitalization Surveillance Network. The adult population with and without chronic conditions was estimated from U.S. Census data and the Behavioral Risk Factor Surveillance System. Adjusted rate ratios (aRRs) were estimated using Poisson regression with Monte Carlo simulation, adjusting for age group, sex, and race and ethnicity.

Results: From October 2022 through September 2023 (2022-2023), compared to adults without a given condition, COVID-19 hospitalization rates were greater among adults with chronic kidney disease (aRR [95% uncertainty interval]: 4.5 [3.4-5.9]), diabetes (2.2 [1.7-2.8]), stroke (2.1 [1.5-2.9]), severe obesity (2.0 [1.5-2.8]), coronary artery disease (2.0 [1.5-2.5]), COPD (1.9 [1.5-2.5]), smoking (1.5 [1.2-2.0]) and asthma (1.5 [1.1-2.0]). Non-severe obesity was not associated with increased risk. Hospitalization rates were 18.0 times higher among adults aged ≥75 years vs 18-49 years. Compared to earlier seasons (2020-2022), more hospitalized adults in 2022-2023 had ≥3 chronic conditions and were aged ≥75 years.

Conclusions: Eight of nine chronic conditions assessed were associated with increased risk of COVID-19 hospitalization; risk varied by condition and age. Older age was the strongest risk factor. Findings can guide prevention and treatment by identifying populations at greatest risk of COVID-19 hospitalization.

Introduction: The aim of this study was to examine severe maternal morbidity at the intersection of race and physical disability status using nationally representative data.

Methods: This study conducted a pooled cross-sectional analysis of delivery hospitalizations in 2025 using 2004-2022 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Delivery hospitalizations and physical disabilities were identified using validated International Classification of Diseases, Ninth/ICD-10 Revisions-based algorithms. The primary outcome was severe maternal morbidity excluding blood transfusion-only cases. Secondary outcomes included severe maternal morbidity severity measured by the number of severe maternal morbidity indicators (≥2 or ≥3) and specific severe maternal morbidity categories. Risk ratios were calculated using modified Poisson regression and evaluated additive interaction using the Relative Excess Risk due to Interaction and Attributable Proportion.

Results: Among 8,584,800 delivery hospitalizations, 88,389 (1.0%) were to women with physical disabilities. Black disabled women with 528 per 10,000 deliveries (528.0; 95% CI=492.8, 565.5) had the highest rates of severe maternal morbidity, followed by White women with physical disabilities (213.9; 95% CI=203.6, 224.7) and Black women without physical disabilities (107.7; 95% CI=105.3, 110.1). White women without physical disabilities with 61 per 10,000 deliveries (60.7; 95% CI=59.4, 62.1) had the lowest rate of severe maternal morbidity. After adjustment, Black women with physical disabilities had 6.92 times the risk of severe maternal morbidity (95% CI=6.45, 7.44) compared with White women without disabilities. The adjusted Relative Excess Risk due to Interaction for severe maternal morbidity was 2.07 (95% CI=1.67, 2.47), and the Attributable Proportion due to interaction was 0.38 (95% CI=0.33, 0.43), suggesting that 38% of excess risk among Black women with physical disabilities was attributable to the interaction between race and physical disability.

Conclusions: Black women with physical disabilities experience compounded risks of severe maternal morbidity that exceed the sum of risks associated with race or physical disability alone. These findings underscore the need for intersectional approach to develop effective interventions to improve maternal care quality and outcomes in this high-risk population.

Introduction: Adverse childhood experiences (ACEs) are associated with increased health risks, including cancer, but their impact on cancer screening behaviors remains inconsistently documented. This study examines associations between ACEs and guideline-recommended breast, prostate, cervical and colorectal cancer screening behaviors using data from 28 U.S. states.

Methods: A cross-sectional analysis of 134,174 respondents from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) was conducted, representing 80.1 million adults. Cancer screening adherence was assessed according to U.S. Preventive Services Task Force recommendations. Multivariable logistic regression was used to analyze associations between ACE exposure (0, 1, 2, 3, or ≥4 ACEs) and screening adherence, adjusting for sociodemographic and healthcare access factors.

Results: Women with two ACEs (aPR 0.95, 95% CI: 0.91-1.00) or ≥4 ACEs (aPR 0.95, 95% CI: 0.92-0.98) were significantly less likely to adhere to breast cancer screening guidelines. Men with one ACE (aPR 0.88, 95% CI: 0.81-0.96), two ACEs (aPR 0.86, 95% CI: 0.77-0.94), and three ACEs (aPR 0.87, 95% CI: 0.78-0.98) had lower rates of prostate cancer screening adherence. No significant associations were found between ACEs and cervical or colorectal cancer screening. Insurance coverage and having a personal doctor were the strongest independent predictors of screening adherence.

Conclusions: Exposure to ACEs is associated with reduced adherence to breast and prostate cancer screening, potentially compounding cancer risks in individuals with ACE exposure. These findings highlight the importance of addressing barriers to cancer screening among individuals with histories of childhood adversity.

Introduction: With expanding cannabis legalization, sometimes motivated by an interest in improving social justice, some states have enacted different initiatives to support social equity (SE) goals. This study described state SE initiatives related to equitable industry entrepreneurship opportunities among disproportionately-impacted communities and areas (DICAs), community reinvestment, and criminal justice reform.

Methods: Two coders independently identified these 3 state-level cannabis-related initiatives among the 22 states with legal and active non-medical ('recreational') cannabis retail as of December 2024 using NexisUni and state-specific legislative websites. Themes were synthesized using iterative content and thematic analysis.

Results: SE initiatives related to cannabis licensure were present in 17/22 states; of these, 13 reserved a number/percent of licenses for SE entrepreneurs. Regarding SE licensure eligibility, all states required majority business ownership and had criteria considering: cannabis-related arrests/convictions of applicants and/or family members (n=14/17), residence in DICA residence (n=15/17), and/or applicants' income/wealth (n=9/17). Most states with SE entrepreneurship initiatives provided SE entrepreneurs with technical assistance/training (n=14/17) and opportunities for reduced application/licensing fees (n=10/17). Most states imposed cannabis sales taxes (n=15/22) and/or excise taxes (n=20/22). Ten states (n=10/22) distributed cannabis program revenues to substance use education/prevention/treatment; approximately one-fifth (n=4/22) distributed funds to SE entrepreneurship initiatives. Over two-thirds of states (n=15/22) had cannabis-related expungements.

Conclusions: Most states had cannabis-related SE initiatives (e.g., equitable entrepreneurship support, allocation of tax revenue, expungements), which varied in terms of their licensure, resources, and participation. Future research is needed to monitor and evaluate these SE initiatives.