American Journal of Preventive Medicine最新文献

Introduction: This study examined prospective associations of perceived discrimination experience and past-week alcohol use among U.S. adults.

Methods: This longitudinal study analyzed 22 biweekly surveys from the Understanding America Study during June 2020-July 2021, a nationally representative U.S. adult panel. Multivariable regressions were conducted to examine prospective associations of perceived discrimination experiences (any versus none) or mean levels of discrimination (never [0] to almost every day [4]) and past-week alcohol use frequency [days: 0-7]) or binge drinking (yes/no) 2 weeks later, after disaggregating within-person and between-person effects of discrimination regressor and adjusting for covariates. Analyses were conducted in 2024.

Results: Among 8,026 participants, 18.9% reported perceived discrimination experiences. The mean of past-week alcohol drinking was 1.27 days and 9.3% reported past-week binge drinking. Within-person discrimination prevalence and levels of discrimination were associated with higher drinking frequency (IRR [95% CI]=1.05 [1.02,1.08], p=0.0003 and IRR [95% CI]=1.06 [1.02, 1.10], p=0.002, respectively), and between-person discrimination prevalence was associated with higher drinking frequency (IRR [95% CI]=1.16 [1.05, 1.30], p=0.005) and higher likelihood of binge drinking (AOR [95% CI]=1.90 [1.49, 2.42], p<0.0001). The associations of discrimination prevalence and drinking frequency differed by sex (interaction effect, p=0.02) and race/ethnicity (interaction effect of Whites versus Blacks, p=0.006), with significantly higher numbers of past-week drinking among females (AOR [95% CI]=1.10 [1.05, 1.15] and Black adults (AOR [95% CI]=1.17 [1.07, 1.28]) but not among males and Hispanic/other race adults.

Conclusions: Discrimination experiences were prospectively associated with an increased risk of alcohol-drinking outcomes, and the effect was more pronounced among certain demographic groups. Efforts to mitigate the adverse effects of recurrent exposure to discrimination are critical to advance health equity.

Introduction: Millions of U.S. families rely on the Supplemental Nutrition Assistance Program (SNAP) to afford food. Congress has proposed changing the items eligible for purchase with SNAP, which could influence participants' diets. Understanding attitudes towards these changes overall, by political party, and by SNAP participation can identify proposals with bipartisan support and center SNAP participant preferences.

Methods: This cross-sectional survey of U.S. adults (n=4,470) from November 3-14, 2023, evaluated support for 4 changes to SNAP purchases. In 2024, descriptive statistics and logistic regression were used to evaluate overall support for these 4 policies and to test for differences by political party and SNAP participation.

Results: A majority of U.S. adults (68.1%) across political parties supported allowing the purchase of hot and prepared foods under SNAP. A slim majority (51.6%) supported creating nutrition guidelines to guide allowable items. Policies to exclude sugary drinks (38.7%) and unhealthy items generally (46.2%) were less popular.

Conclusions: Policies to expand SNAP were more popular than restrictions, both overall and across political parties, and restrictions were particularly unpopular among SNAP participants. Bipartisan support for policies to expand SNAP may help these proposals advance during Farm Bill negotiations and would align with the preferences of SNAP participants.

Introduction: Research is needed to demonstrate the impact of child-directed advertising on household purchases of nutrient-poor children's foods to support mandatory government regulations. This study examines the relationship between total TV advertising to children versus adults and U.S. household purchases of high-sugar children's cereals. Post-hoc analyses examine potential differential marginal effects of advertising on households experiencing health disparities.

Methods: Longitudinal Nielsen U.S. household panel data (2009-2017) provided monthly volume (oz) of ready-to-eat cereal purchases by households with children (<12 years) (N=76,926). Nielsen gross ratings point data measured monthly TV advertising to children (6-11 years) and adults (18-49 years) (2008-2017). A two-part Cragg hurdle model assessed associations between child versus adult advertising for children's cereal brands (n=9) and subsequent household cereal purchases, including differences by household sociodemographic characteristics. Data were collected in 2021 and analyzed in 2023.

Results: Advertising to children, but not adults, was positively related to household purchases of children's cereals (p<0.01) across all sample households. Lower price (p<0.05) and greater household size (p<0.01) also predicted higher purchases. Marginal effects of advertising to children were higher for Black versus non-Black households (p<0.01), and positively related to purchases by middle/high-income (p<0.01) but not low-income households. Advertising to adults only predicted greater children's cereal purchases by low-income households (p<0.01).

Conclusions: Advertising children's cereals directly to children may increase household purchases and children's consumption of these high-sugar products. Child-directed advertising may also disproportionately influence purchases by Black households. This study supports further restrictions on advertising of nutrient-poor foods directly to children.

Introduction: Persons with mental disorders are at increased risk for physical illness. Individuals who seek help for psychological problems might benefit from timely support and interventional approaches. This study aimed to explore the associations between psychological problems for which help was sought and physical illness.

Methods: The 7th survey of the Tromsø Study, which included 21,083 participants aged ≥40 years, was used in the study. The main exposure was psychological problems for which help was sought. Main outcomes were lifetime prevalence and time to onset of physical illness. Associations between psychological problems and physical illness were analyzed using logistic regression and survival analysis and adjusted for sex, birth year, smoking, education, and income. Data were collected in 2015-2016 and analyzed in 2023-2024.

Results: Psychological problems were associated with smoking and having lower income but higher educational attainment. Psychological problems were associated with lifetime prevalence of hypertension, coronary artery disease, heart failure, atrial fibrillation, stroke, kidney disease, chronic obstructive pulmonary disease, asthma, arthrosis, migraine, chronic pain, and cancer; ORs ranged from 1.15 (95% CI=1.04, 1.27) to 2.15 (95% CI=1.76, 2.62). Survival analysis demonstrated that individuals with psychological problems are at increased risk for subsequent physical illness; hazard ratios ranged from 1.18 (95% CI=1.06, 1.32) to 2.74 (95% CI=2.06, 3.65).

Conclusions: This study found that psychological problems with or without a diagnosis of mental disorder might be an important marker of increased risk for physical illness.

Introduction: The aim of this study is to assess the individual and joint associations of variability in multiple cardiometabolic parameters with mortality risk across older populations.

Methods: A total of 51,551 Chinese elderly participants (aged ≥60 years) with ≥3 measurements of systolic blood pressure, visceral adiposity index, fasting blood glucose, and low-density lipoprotein cholesterol during 2018-2022 were included. Variability metrics included SD, coefficient of variation, average real variability, and variability independent of the mean (used in primary analysis). Participants were classified on the basis of the number of high-variability (highest quartile of variability) parameters into 4 categories: with 0, 1, 2, and 3-4 high-variability cardiometabolic parameters. Cox regression analyses were performed in 2024. Findings were then externally validated using the Health and Retirement Study (Waves 8-15).

Results: Higher systolic blood pressure, visceral adiposity index, fasting plasma glucose, and low-density lipoprotein cholesterol variability were associated with greater all-, cardiovascular-, and other-cause mortality risk. Compared with those of subjects with no high-variability parameters measured as the variability independent of the mean, the hazard ratios (95% CI) of all-cause mortality were 1.30 (1.16, 1.44) for 1 parameter, 1.86 (1.66, 2.09) for 2 parameters, and 2.02 (1.75, 2.32) for 3-4 parameters. Consistent results were noted for cardiovascular-, cancer-, and other-cause mortality using other variability indices and in various sensitivity and subgroup analyses. These associations were validated in the Health and Retirement Study (n=1,991).

Conclusions: Increased variability in cardiometabolic parameters is associated with elevated risks of all-cause and cause-specific mortality among older adults in China. Reducing variability of these parameters could serve as a target to increase life expectancy in older populations.

Introduction: Opioid prescription policies may reduce availability of prescription opioids and decrease initiation of opioid analgesic misuse and possible opioid use disorder (OUD). OUD prevalence may have decreased in recent years, but there are few studies on trends of OUD incidence. The objective of this study was to examine OUD incidence rates to detect population changes overall and within demographic subgroups over time.

Methods: In 2023, a longitudinal analysis of incident OUD diagnoses was conducted after implementation of Vermont's July 2017 policy limiting opioid analgesic prescriptions for acute pain. Included were individuals 16+ years with medical claims in Vermont's all-payer claims database between July 1, 2017 and December 31, 2021. Multiple Poisson regression models assessed changes in OUD incidence rates per month overall, controlling for age, sex, rurality, and insurance type, and separately, testing age, rurality, and insurance as moderators.

Results: Among 537,707 individuals, there was a 0.8% decrease per month in the OUD incidence rate (95% CI: 0.991, 0.993) from July 2017 through December 2021. Age moderated the association between OUD incidence and time, with the largest decrease per month (1.6%) among 16-29 year-olds (95% CI: 0.981, 0.986). There were smaller decreases in OUD incidence rate per month among 30-44 year-olds (0.6%), 45-59 year-olds (0.5%), and 60+ year-olds (0.6%).

Conclusions: This study found that the OUD incidence rate in Vermont decreased overall between July 2017 (policy start limiting opioid analgesic prescriptions) - December 2021, including during the COVID-19 pandemic, with the most pronounced decrease among adolescents and young adults.

Introduction: As perinatal drug overdoses continue to rise, reliable approaches are needed to monitor overdose trends during pregnancy and postpartum. This analysis aimed to determine the sensitivity, specificity, positive predictive value, and negative predictive value of ICD-9/10-CM codes for drug overdose events among people in the MATernaL and Infant clinical NetworK (MAT-LINK) with medication for opioid use disorder during pregnancy.

Methods: People included in this analysis had electronic health record documentation of medication for opioid use disorder and a known pregnancy outcome from January 1, 2014, through August 31, 2021. Data were analyzed during pregnancy through 1 year postpartum. The Centers for Disease Control and Prevention's drug overdose case definitions were used to categorize overdose based on ICD-9/10-CM codes. These codes were compared to abstracted electronic health record data of any drug overdose. Analyses were conducted between May 2023 and May 2024.

Results: Among 3,911 pregnancies with electronic health record-documented medication for opioid use disorder, the sensitivity of ICD-9/10-CM codes for capturing drug overdose during pregnancy was 32.7%, while specificity was 98.5%, positive predictive value was 23.4%, and negative predictive value was 99.0%. The sensitivity of ICD-9/10-CM codes for capturing drug overdose postpartum was 30.9%, while specificity was 98.4%, positive predictive value was 25.9%, and negative predictive value was 98.8%.

Conclusions: The sensitivity and positive predictive value of ICD-9/10-CM codes for capturing drug overdose compared with abstracted electronic health record data during the perinatal period was low in this cohort of people with medication for opioid use disorder during pregnancy, though the specificity and negative predictive value were high. Incorporating other data from electronic health records and outside the healthcare system might provide more comprehensive insights on nonfatal drug overdose in this population.

Introduction: Age at diagnosis of diabetes is important for informing public health planning and treatment strategies. This study aimed to estimate trends and racial/ethnic differences in age at diagnosis of adult-onset diabetes by type in the United States.

Methods: This serial nationwide cross-sectional study used data from the National Health Interview Survey in 2016-2022. Adults aged ≥18 years with self-reported age at diagnosis of adult-onset type 1 diabetes (T1D) or type 2 diabetes (T2D) were included. Trends in mean age at diagnosis of T1D and T2D and in proportions of people with T1D or T2D diagnosed at different ages were assessed by linear and logistic regressions. Racial/ethnic differences in mean age at diagnosis of T1D and T2D were determined.

Results: Included were 1224 T1D cases and 14,221 T2D cases. From 2016 to 2022, the mean age at diagnosis of T2D increased by 0.18 years annually (95% CI, 0.05-0.30 years, P =0.005), but no significant trend was observed for T1D. The proportion of T2D cases with diagnosis age ≥60 years increased by 3.17% and with diagnosis age in 18-29 years decreased by 5.62% annually (P ≤0.01). On average, Hispanic individuals had T1D diagnosed 3.2 years older and minority groups had T2D diagnosed 2.0-6.1 years younger than non-Hispanic White individuals (P ≤0.02).

Conclusions: Among US adults, the mean age at diagnosis of adult-onset T1D remained stable and of adult-onset T2D increased significantly from 2016 to 2022. Substantial and opposite differences in mean diagnosis age of T1D and T2D by race/ethnicity were identified.

Introduction: Primary care delivery in the United States, including tobacco treatment, was negatively impacted by the COVID-19 public health emergency (PHE), leading to pandemic-related cessation disparities. Early in the PHE, rates of tobacco assessment during telehealth visits were substantially lower than during in-person visits. It is unknown if these changes persisted.

Methods: Electronic health record data were extracted and analyzed in 2024 from adult patients with ≥1 primary care visit to a primary care community-based health clinic between 01/01/2019-05/31/2023 (N=1,792,934 patients from 541 clinics in 17 states). The monthly percentage of visits with smoking assessment (yes/no) were examined overall and by visit modality.

Results: Prior to March 2020, <1% of visits were via telehealth. In the months following, >50% were via telehealth, leveling to 25% in the later study months. Prior to the PHE, >95% of all visits included smoking assessment; the highest monthly percentage after the PHE declaration was 77%. For in-person visits, assessments occurred at >95% of visits in each study month prior to March 2020, with subsequent percentages ranging from 46% (April 2020) to 95% (May 2023). In contrast, assessment during telehealth visits reached a maximum of 9% in late 2022.

Conclusions: Smoking assessment remained consistently lower during the PHE compared to the months prior, primarily driven by lack of assessment during telehealth visits. Concerted efforts are needed to ensure that telehealth visits are leveraged to promote equitable smoking assessment and delivery of evidence-based tobacco treatment among a patient population with high rates of tobacco use.

Introduction: Intimate partner violence accounts for up to one half of all homicides of women in the U.S. Rates of intimate partner homicide are associated with both race/ethnicity and social determinants of health, but their relative contribution is incompletely understood.

Methods: The authors used negative binomial regression to model the relationship between counties' racial/ethnic composition and their rates of intimate partner homicide of women, controlling for urbanicity, median income, gender pay gap, unemployment, school funding, and violent crime rate. Data from 49 states and the District of Columbia between 2016 and 2021 were used. Analyses were conducted in 2024.

Results: In unadjusted analysis, counties with a lower proportion of White residents experienced higher rates of intimate partner homicide (incidence rate ratios [IRR]=1.11; 95% CIs=1.08, 1.13). When controlling for social determinants of health, this association was not observed (IRR=1.01; 95% CI=0.97, 1.04). Median income, school funding, and violent crime rate were independent predictors of intimate partner homicide in the multivariate model.

Conclusions: Racial/ethnic composition of a population does not independently predict its rate of intimate partner homicide when controlling for social determinants of health. Racial/ethnic inequities in intimate partner homicide are largely attributable to structural factors, which may be modifiable through policy changes.