American Journal of Preventive Medicine最新文献

Introduction: Socioeconomic disparities in dental caries remain a substantial public health concern in the U.S. This study examined the associations between socioeconomic status 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 years 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 the associations between SES indicators and DMFT and to explore temporal trends in SES-related disparities in caries experience across 4 survey cycles.

Results: After adjusting for age, sex, and race/ethnicity, all SES indicators were significantly associated with caries experience. Individuals with lower income (risk ratio=1.27, 95% CI=1.24, 1.30), lower education (risk ratio=1.31, 95% CI=1.28, 1.33), unemployment (risk ratio=1.17, 95% CI=1.14, 1.19), food insecurity (risk ratio=1.13, 95% CI=1.11, 1.15), and no health insurance (risk ratio=1.09, 95% CI=1.06, 1.11) had higher DMFT scores than 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.

Conclusions: 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: 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 prepandemic evidence suggests that benefit amounts are insufficient. Pandemic-related emergency allotments and Thrifty Food Plan Modernization increased SNAP benefit amounts. This study uses transaction data from shoppers at a large supermarket chain in North Carolina to understand whether these changes were associated with shifts in grocery food purchase composition.

Methods: Data were collected from October 2019 to February 2022 and analyzed from October to 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 emergency allotments and Thrifty Food Plan Modernization and compared with the prepandemic period.

Results: Higher increases in fruits, vegetables, nuts, legumes, and other nonprocessed foods and beverages purchases were observed among SNAP shoppers (than among nonSNAP shoppers) after the implementation of both the emergency allotments and Thrifty Food Plan Modernization. Decreases in sugar-sweetened beverages purchased and sugar from purchases after the emergency allotments were also observed. Purchase improvements were more notable when both emergency allotments and Thrifty Food Plan Modernization benefits were applied.

Conclusions: Even modest SNAP benefit increases were associated with purchase changes, suggesting that benefit amounts have a key role in improving purchase composition. With the expiration of emergency allotments in 2023 and upcoming debates around the SNAP, 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 owing to methodologic 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 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]) years, and 395 incident dementia cases). Compared with 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 hazard ratio=1.89, 95% CI=1.31, 2.73), the Class I obesity group (30-34.9 kg/m²) had 42% increased hazard (95% CI=1.01, 2.00), and the overweight group (25-29.9 kg/m²) had 22% increased hazard (95% 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% (95% 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, 9 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: This was an RCT.

Setting/participants: A total of 832 parents of elementary-aged children living in states with Universal Free School Meal programs were included.

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

Main outcome measures: The coprimary 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 versus 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=0.14-0.21 on 1-5 scales) (all ps<0.05). The campaign did not increase participation either in school lunch (difference-in-differences=0.08 meals/week, 95% CI= -0.08, 0.25, p=0.30) or breakfast (difference-in-differences=0.02 meals/week, 95% CI= -0.16, 0.20, p=0.81). 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 through Facebook is feasible and acceptable but may not be sufficient to increase children's school meal participation.

Trial registration: This study is registered at 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.