American Journal of Preventive Medicine最新文献

Introduction: To address youth and young adult vaping, the Food and Drug Administration and other organizations have launched vaping prevention video ads. However, limited research exists on the objective features of these ads (i.e., observable and systematically codable elements). This study identified and described these features through a content analysis.

Methods: A total of 302 video ads, released between 2015 and 2024, were collected on the basis of the following criteria: focused on vaping prevention, targeted youth or young adults, 35 seconds or shorter, and in English. Twenty-nine codes were developed to capture objective features in 5 categories: (1) message themes; (2) structural features (genre, visual, audio, and format); (3) tobacco product depictions; (4) audience targeting; and (5) other features, such as source and length. Data were analyzed in 2024.

Results: Most ads (49.3%) were from U.S. national organizations, followed by U.S. state governments (43.7%) and international sources (7.0%). Nearly half (46.0%) were 11-20 seconds. Nicotine addiction was the most common primary theme (34.4%), followed by harmful chemicals/metals (16.2%) and mental health (13.9%). Ads predominantly used live action (68.2%), visual effects (54.0%), background music (78.5%), and an acted-out format (57.3%). Vaping imagery appeared in most ads (68.5%). Few ads were explicitly designed for specific racial/ethnic (3.6%) or lesbian, gay, or bisexual (0.3%) communities.

Conclusions: This study provides the groundwork for future research to identify which objective ad features most effectively influence vaping-related outcomes. Findings also serve as a practical resource for campaign developers who design ads on the basis of objective features.

Introduction: In January 2025, the Food and Drug Administration proposed mandating Nutrition Info front-of-package labels, which would indicate whether packaged foods are low, medium, or high in saturated fat, sodium, and added sugars. This study examined whether a label similar to the Food and Drug Administration's proposal improves consumer understanding compared with positive endorsement and other proposed or adopted front-of-package labels and whether effects vary by income, education, race/ethnicity, and nutrition literacy.

Study design: This was an online RCT conducted in October-November 2024.

Setting/participants: National sample of 5,636 U.S. adults who were primary grocery shoppers.

Intervention: Participants were randomized to 1 of 6 front-of-package labeling systems: (1) positive (reference group), (2) Nutrition Info (the Food and Drug Administration proposal), (3) high-in nutrient (warnings for high levels of nutrients of concern), (4) positive + Nutrition Info, (5) positive + high-in, and (6) spectrum (rates products from least to most healthy).

Main outcome measures: Participants viewed 6 pairs of products with their assigned labels and indicated which product they thought was healthier in each pair. Consumer understanding was measured by correct identification of the healthier product across product pairs. Analyses were conducted in 2025.

Results: Across product pairs, participants correctly identified the healthier option 56%-90% of the time. Compared with positive labels, Nutrition Info labels led to the greatest improvements in consumer understanding (difference: 18.4 percentage points), followed by positive + Nutrition Info (17.9 percentage points), positive + high-in (11.8 percentage points), spectrum (10.8 percentage points), and high-in (5.3 percentage points) (ps<0.001). Effects did not differ by income, education, or race/ethnicity but differed by nutrition literacy (p-interaction<0.01). Labels improved understanding more for higher-literacy than for lower-literacy participants, with the largest differences for Nutrition Info and positive + Nutrition Info labels.

Conclusions: Findings support the Food and Drug Administration's initiative to implement mandatory front-of-package labels. Nutrition Info labels improved consumer understanding the most but may not serve all nutrition literacy groups equally.

Trial registration: NCT06516627.

Introduction: Many Americans are overdue for their colorectal cancer screening. Behavioral scientists have proposed two types of interventions to increase screening uptake. First, well-known nudging interventions aim to steer patients towards screening, by, for example, providing default appointments or emphasizing social norms. Second, de-sludging interventions remove sludge or frictions that make it unnecessarily difficult for patients to screen. Nudging has attracted controversy but little is known about public attitudes towards de-sludging. We therefore examined whether opposition and negative perceptions were more common for nudging or de-sludging, and whether these responses varied by political affiliation.

Methods: A randomized cross-sectional survey included 8,735 U.S. residents randomized to one of ten descriptions of interventions intended to increase uptake of colorectal screening, including five nudging and five de-sludging interventions. (Data were collected and analyzed in 2023-2024) RESULTS: Nudging was more likely than de-sludging to elicit opposition, perceived ineffectiveness, and perceived threats to freedom, with findings holding across political affiliations.

Conclusions: Findings suggest widespread support for prioritizing de-sludging over nudging.

The supply of board-certified specialists in Preventive Medicine has never been adequate to meet current or projected future workforce needs. One consistent recommendation to increase the number of trainees has been for greater levels of funding for existing residency programs. However, positions funded at current levels remain unfilled, which has also been the case historically. Such data, together with the results from surveys, support the notion that the rate limiting step is actually the low appeal of a career in Preventive Medicine among medical students. In spite of repeated calls to raise the visibility of the profession among medical students, this has never been implemented on a wide scale and there is likely no practical way to do so. Paradoxically, Preventive Medicine does become attractive as a career to many physicians after they enter practice. It is time to abandon a traditional model of Graduate Medical Education designed to matriculate medical students and modernize the training to reach candidates in practice. Recently, new pathways which address these obstacles have been developed by other specialties that can be adapted for Preventive Medicine. More than one pathway to a qualification is desirable, reflective of the diverse roles in this field.

Introduction: ICD-10 Z codes allow for systematic documentation of people experiencing housing instability (PEHI) within healthcare settings, but little is known about Z code usage patterns in PEHI populations. This analysis performed in 2025 identifies healthcare utilization patterns and clinical and sociodemographic characteristics associated with documented housing instability in a large urban PEHI cohort from 2016-2022.

Methods: A reference standard for housing instability was created using detailed data from a clinic network serving PEHI. Linking this with electronic health record (EHR) data from 6 other health systems throughout the city of Chicago created a retrospective cohort of housing insecure patients with ≥1 visit at another participating health system. In addition to descriptive statistics, the assignment (yes/no) of Z59 diagnosis codes is analyzed using a modified Poisson model to estimate rate ratios (RRs), controlling for relevant patient-level sociodemographic and clinical factors.

Results: PEHI with Z59 diagnosis codes had more emergency department (ED) and inpatient encounters than those without Z59 codes. Multivariable findings indicated Z59 code recipients were more likely to be male (RR 1.35 [1.25-1.46]) and to experience serious medical and mental health comorbidities. Z59 code recipients were more likely to report living in a shelter (RR 1.31 [1.21-1.42]), living on the street (RR 1.88 [1.61-2.20]), or receiving outreach care in these settings (RR 1.61 [1.49-1.74]). Rates of Z59 code assignment varied among participating sites.

Conclusions: Although Z59 codes for housing instability are infrequently used in healthcare settings, they may help identify PEHI in greatest need of medical and social interventions.

Introduction: Medication adherence is critical for hypertension management but remains suboptimal. Most interventions target patient-level barriers, while routine care factors, such as the timing of clinic visits, remain underexamined. Time-of-day effects on clinical decision-making are documented in acute care, but implications for chronic disease management are less understood.

Methods: A longitudinal analysis of 936,502 U.S. adults with hypertension receiving 4,027,607 antihypertensive prescriptions (2016-2024) linked electronic health records with pharmacy dispensing data. Associations between appointment hour and prescription filling and 90-day medication adherence (proportion of days covered ≥80%) were estimated. Secondary outcomes included visit duration, days' supply, and fixed-dose combination prescribing. Models adjusted for patient, clinician, and visit characteristics with month and year fixed effects. Analyses were conducted in 2025.

Results: Compared with 7 AM visits, 5 PM visits had 10.6% lower odds of adherence (adjusted odds ratio [AOR]: 0.894; 95% CI: 0.854-0.935) and 8.8% lower odds of prescription filling (AOR: 0.912; 95% CI: 0.871-0.954). Each hour later was associated with 1.0% lower odds of adherence (AOR: 0.990; 95% CI: 0.988-0.992) and 0.9% lower odds of filling (AOR: 0.991; 95% CI: 0.989-0.993). Later visits were associated with shorter visit durations, fewer days' supply per fill, and less fixed-dose combination prescribing. Time-of-day patterns appeared only for filled prescriptions, consistent with an association linked to prescribing-dispensing processes rather than patient characteristics.

Conclusions: Later visit times were associated with lower prescription filling and adherence, as well as shorter visits, reduced medication supply, and less fixed-dose combination prescribing. These patterns suggest prescribing and dispensing processes vary by time-of-day. Attention to consistent medication management practices throughout the clinic day may help reduce this variation.