American Journal of Preventive Medicine最新文献

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.

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.

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

Methods: A reference standard for housing instability was created using detailed data from a clinic network serving people experiencing housing instability. Linking this with electronic health record 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, controlling for relevant patient-level sociodemographic and clinical factors.

Results: People experiencing housing instability with Z59 diagnosis codes had more emergency department and inpatient encounters than those without Z59 codes. Multivariable findings indicated that Z59 code recipients were more likely to be male (rate ratio=1.35; 95% CI=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 (rate ratio=1.31; 95% CI=1.21, 1.42), living on the street (rate ratio=1.88; 95% CI=1.61, 2.20), or receiving outreach care in these settings (rate ratio=1.61; 95% CI=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 people experiencing housing instability in greatest need of medical and social interventions.