American Journal of Preventive Medicine最新文献

Introduction: Clinician advice to modify health behaviors can vary by patient race/ethnicity and sex, though prior studies are mixed and show variation over time. Research examining the role of insurance type is limited.

Methods: The 2022 National Health Information Survey (NHIS) was analyzed in 2024 to estimate survey-weighted proportions of receiving clinician advice and associations with demographic factors among three at-risk groups: 1) adults who smoke cigarettes, 2) adults who engage in heavy drinking, and 3) adults with diabetes, hypertension, and/or obesity, who are insufficiently active.

Results: In each relevant population, 47.5% received advice to quit smoking, 6.8% to decrease drinking, and 35.7% to increase physical activity. The odds of receiving advice to quit smoking were lower among Non-Hispanic (NH) Black (adjusted odds ratio (aOR) 0.68 [95%CI, 0.53-0.87]) and Hispanic adults (aOR 0.46 [95%CI, 0.30-0.69]) relative to NH White adults, and adults with no insurance (aOR 0.36 [95%CI, 0.24-0.56]) and private insurance (aOR 0.55, [95%CI, 0.39-0.77]) compared to Medicare. Men had higher odds (aOR: 2.36 [95%CI, 1.84-3.02]) of being advised to decrease drinking. Hispanic adults (aOR 1.27 [95%CI, 1.05-1.54]) had higher odds of receiving advice to increase physical activity; uninsured adults (aOR 0.51 [95%CI, 0.35-0.73]), men (aOR 0.85 [95%CI, 0.76-0.96]), and adults over 64 had lower odds. Adults aged 18-34 were the least likely to receive smoking or alcohol counseling.

Conclusion: Many at-risk adults do not receive clinician advice to modify relevant health behaviors. Counseling rates vary by patient demographic factors, highlighting opportunities to improve health equity in preventive care.

Introduction: Chronic pain is linked to elevated tobacco use, but long-term trends in combustible smoking and e-cigarette use in this group remain unclear. Understanding these trajectories is vital for designing effective public health interventions. This study examined national trends in exclusive cigarette smoking (E-CS), exclusive e-cigarette use (E-EC), and dual use (2014-2023) among United States (U.S.) adults with and without chronic pain.

Methods: This was a serial cross-sectional analysis using 2014-2023 (excluding 2022) National Health Interview Survey data from 195,632 U.S. adults. Chronic pain (yes/no) was defined by self-reported pain frequency (past 3 months): "everyday" or "most days" versus "some days" or "never". Primary outcomes were E-CS, E-EC, and dual use prevalence by pain status and year, assessed via logistic regression. Secondary analyses examined pain frequency (continuous) and high-impact chronic pain (yes/no). Analyses were conducted in 2025.

Results: E-CS prevalence was significantly higher and declined more slowly among individuals with chronic pain (17.7%-2014, 13.1%-2023) versus without (12.5%-2014, 7.5%-2023; p<0.001). Adjusting for age, sex, and race/ethnicity, both E-EC and dual use prevalence were higher in the chronic pain group across all years. E-EC use increased at similar rates among individuals with (1.4%-2014, 5.6%-2023) and without (1.2%-2014, 4.5%-2023; p's<0.001) chronic pain; dual use prevalence declined at similar rates among individuals with (4.6%-2014, 2.7%-2023) and without (2.3%-2014, 1.5%-2023) chronic pain.

Conclusions: While U.S. E-CS prevalence has decreased, individuals with chronic pain remain disproportionately impacted, emphasizing the need for targeted tobacco interventions.

Introduction: The U.S. Food and Drug Administration has launched multiple large-scale youth tobacco prevention campaigns since 2014. Prior to launching campaigns, the U.S. Food and Drug Administration conducts copy-testing studies with youth aged 12-17 years using an experimental design (ad exposure versus no ad control) to evaluate potential ad effects on 4 outcome measures: attitudes toward tobacco use and beliefs about negative health consequences, harmful and potentially harmful constituents, and addiction.

Methods: A series of meta-analyses examined the difference between exposure and control groups for each of the 4 outcome measures across 10 copy-testing studies conducted from 2013 to 2020. Potential heterogeneity in these differences was explored by campaign, tobacco product, audience characteristic, and message theme. Analysis was performed in 2024.

Results: A total of 42 ads were included in the analysis. The average effect size (Hedge's g) across all ads was 0.446 (95% CI=0.312, 0.581) for attitude, 0.319 (95% CI=0.155, 0.483) for negative health consequence beliefs, 0.246 (95% CI=0.057, 0.436) for harmful and potentially harmful constituent beliefs, and 0.347 (95% CI=0.254, 0.441) for addiction beliefs. Larger effect sizes were observed for electronic cigarette ads than for ads for other products. Ads featuring harmful and potentially harmful constituent and addiction themes generated larger effect sizes on their respective targeted beliefs than ads that did not feature these themes.

Conclusions: Findings of this study provide evidence that ads from the U.S. Food and Drug Administration's tobacco prevention campaigns have the potential to positively influence relevant beliefs and attitudes among their intended youth audiences. Patterns of variation in effect sizes largely support the success of belief targeting in campaign development.

Introduction: Breast and cervical cancers are significant health concerns among Latinas, who are less likely to receive up-to-date cancer screenings. Barriers including lack of insurance contribute to this disparity. This study examined the impact of the 2021 Medicaid eligibility amendment in California and Oregon, which expanded coverage to all income-eligible adults aged 50 and older, on breast and cervical cancer screenings among Latina patients at community health centers (CHCs).

Methods: This retrospective cohort study used electronic health record data from CHCs in states that expanded eligibility (CA, OR) and those that did not (AK, CT, IN, MN, MT, NJ, OH, WA). Data included 18,209 non-pregnant Latina patients aged 50-64 who had visits both pre- (2018-2019) and post- amendment (2021-2023). Data were analyzed in 2024-2025, and a doubly robust, covariate-adjusted difference-in-differences model estimated the average treatment effect on the treated (ATT) for screening outcomes.

Results: Among previously uninsured patients, Spanish-preferring Latinas in eligibility amendment states had significantly greater increases in up-to-date breast (ATT = +9.13; 95% CI: 3.36-14.90) and cervical (ATT = +11.03; 95% CI: 5.77-16.29) cancer screenings compared to non-amendment states. English-preferring Latinas in amendment states showed a significant breast screening increase only in year three (all insurance: ATT = +11.73; 95% CI: 1.61-21.85; uninsured in pre-period: ATT = +23.42; 95% CI: 2.11-44.72). For those with any insurance, only Spanish-preferring Latinas had a significant year-three increase in cervical screening (ATT = +14.66; 95% CI: 6.11-23.21).

Conclusions: State-funded coverage expansions can increase cancer screening rates and potentially reduce cancer burden among Latinas.

Introduction: Transgender and gender diverse (TGD) adults have worse mental health than cisgender adults, yet few studies assess unmet mental health needs. This study compares frequent mental distress, access to care, and barriers among TGD and cisgender adults.

Methods: Using the 2022 KFF/Washington Post Transgender Survey of U.S. adults (n=1,338), unadjusted prevalence differences in frequent mental distress, unmet mental health need, and reasons for unmet mental health need were described. Logistic regression models assessed unmet mental health need likelihood, adjusting for sociodemographic characteristics and distress. Data were analyzed in 2024.

Results: Among TGD adults, 64% were non-binary or gender non-conforming, 22% transgender women, 12% transgender men, and 2% another gender. Compared to cisgender adults, TGD adults were more likely have Medicaid (21% vs 14%), p=0.01) or be uninsured (15% vs 10%, p=0.04), and less likely to have Medicare (6% vs. 25%, p<0.001). TGD adults reported more frequent mental distress (47% vs. 21%, p-value<0.001) and unmet mental health need (48% vs. 26%, p<0.001) than cisgender adults. In multivariable models, TGD adults had higher unmet mental health need vs. cisgender adults (OR=1.62, 95% CI: 1.08-2.43). TGD adults were more likely to report cost as the main care barrier than cisgender adults (30% vs. 15%; p=0.01).

Conclusions: TGD vs. cisgender adults reported higher rates of frequent mental distress, unmet mental health need, and cost-related barriers to mental health care. Efforts to improve the affordability and availability of mental health treatment could reduce high levels of unmet need among TGD adults.

Introduction: Socioeconomic disparities in dental caries remain a substantial public health concern in the U.S. This study examined associations between socioeconomic status (SES) indicators and dental caries experience in U.S. adults and assessed trends in SES-related disparities over time.

Methods: A cross-sectional study was conducted using data on adults aged ≥ 25 from the National Health and Nutrition Examination Survey (NHANES) between 2011 and March 2020. Data were analyzed between 2024 and 2025. Caries experience was defined using the Decayed, Missing, Filled Teeth (DMFT) score from a standardized dental examination. SES indicators were operationalized using participants' self-reported responses. Multiple Imputation by Chained Equations was employed to address missing data. Poisson models with a dispersion parameter were used to examine associations between SES indicators and DMFT and to explore temporal trends in SES-related disparities in caries experience across four survey cycles.

Results: After adjusting for age, sex, and race/ethnicity, all SES indicators were significantly associated with caries experience. Individuals with lower income (RR=1.27, 95% CI: 1.24 - 1.30), lower education (RR=1.31, 95% CI: 1.28 - 1.33), unemployment (RR=1.17, 95% CI: 1.14 - 1.19), food insecurity (RR=1.13, 95% CI: 1.11 - 1.15), and no health insurance (RR=1.09, 95% CI: 1.06 - 1.11) had higher DMFT scores compared to more advantaged counterparts. Dose-response relationships for income, education, and employment were observed, with progressively higher caries experience in lower SES categories. Analyses across NHANES cycles showed persistent SES-related disparities in caries experience, with no large changes in magnitude over time.

Conclusion: Socioeconomic disparities in caries among U.S. adults persisted from 2011 to 2020, with consistently higher caries experience in disadvantaged groups. These findings highlight the need for targeted policies to reduce financial and structural barriers to dental care and address broader socioeconomic determinants of oral health.

Introduction: Current physical activity (PA) measurement methods often fail to capture domain-specific contexts. This limitation hinders the understanding of active outdoor play (AOP) in preschool-aged children (3-5 years), a critical PA domain for healthy development. The primary objective of this study was to develop a method for measuring AOP by integrating accelerometer, Global Positioning System (GPS), and time-use diary data. The secondary objective was to apply this method to quantify AOP by movement intensity and examine its contribution to total PA.

Methods: This cross-sectional study included 92 preschool-aged children and their parents from Alberta, Canada. Data were collected in August/2023-February/2024 and analyzed in May/2024-February/2025. Children wore an accelerometer and a GPS monitor for 7 days, while parents completed a time-use diary documenting their child's daily activities. Data from these 3 sources were processed and integrated to derive AOP variables. AOP was operationally defined as non-trip and non-organized PA taking place outdoors. Accelerometer data classified PA versus stationary time. GPS data classified trip versus non-trip and indoor versus outdoor location. Time-use diary data classified organized versus non-organized PA. AOP engagement was further classified into light-intensity and moderate- to vigorous-intensity using accelerometer data.

Results: Applying this method to the present sample, children spent an average of 192.9 minutes/day in AOP, with 143.1 minutes/day in light-intensity and 49.8 minutes/day in moderate- to vigorous-intensity AOP. On average, AOP accounted for 60.6% of total PA.

Conclusions: This study introduced a multi-source method for measuring AOP in preschool-aged children, addressing key limitations of traditional single-source methods. Future research could explore this method's applicability to enhance domain-specific PA knowledge, beyond overall PA, across contexts.

Introduction: This study aimed to determine the prevalence of colorectal cancer (CRC) screening among cancer survivors and compare the likelihood of CRC screening among cancer survivors to that of the cancer-free general population.

Methods: A systematic search of MEDLINE (Ovid), EMBASE, PubMed, and CINAHL databases from inception through September 16, 2024 was conducted. Studies reporting CRC screening among cancer survivors or in both cancer survivors and cancer-free controls were included. Random effects meta-analyses were conducted to pool estimates. Analyses were performed across primary cancer sites where at least three studies were identified.

Results: Of the 2497 articles identified, 59 fulfilled the inclusion criteria. The overall pooled prevalence of CRC screening (up-to-date for screening or had been screened during a specific time period after non-CRC diagnosis) was 0.53 (95% CI: 0.46, 0.61), with estimates ranging from 0.72 (prostate) to 0.51 (breast) across primary cancer sites. Cancer survivors were more likely to participate in CRC screening than cancer-free controls (Odds Ratio: 1.39, 95%CI: 1.26, 1.52), but there was some evidence of publication bias (Egger's test p-value = 0.092). Study design, method of CRC screening ascertainment (self-report vs. medical records), and first primary cancer site were significant sources of heterogeneity.

Discussion: Cancer survivors were more likely to undergo CRC screening compared to cancer-free controls, but overall rates were well below generally recommended levels for population-based screening. Future studies should evaluate the predictors of non-adherence to CRC screening among cancer survivors to inform policymakers in targeting populations with lower screening rates.

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.