Preventing Chronic Disease最新文献

Introduction: An estimated 6,000 preventable cancer deaths - including from colorectal cancer (CRC) - occurred in rural America in 2022. Screening can prevent CRC or identify disease at earlier stages when it is more treatable. However, national estimates for CRC screening lag behind Healthy People 2030 objectives. In rural settings, barriers to screening are unique and persistent.

Methods: We performed a scoping review to describe the types and effectiveness of interventions to increase CRC screening in primarily rural settings. We included US-based studies published during January 2010 through May 2024. Interventions were categorized according to US Community Preventive Services Task Force-recommended strategies for multicomponent interventions.

Results: Of 508 unique publications identified, 36 met inclusion criteria. Most studies were multicomponent interventions (n = 34). Most studies were associated with an increase in CRC screening uptake. The most common intervention approaches were client reminders (eg, telephone reminders about screening) (n = 25), small media (eg, pamphlets) (n = 25), and reducing structural barriers to screening (eg, patient navigation) (n = 24). Over half (n = 21) of studies reported using a theory, framework, or research approach to inform intervention development, implementation, or evaluation. Six studies (17%) included cost evaluations. The studies included in this review represented less than half of all US states.

Conclusion: This scoping review provides insight into CRC screening intervention implementation in rural settings. The limited geographic representation of the interventions included in our review may highlight an opportunity to improve implementation and dissemination of effective CRC screening interventions in rural settings to reduce CRC incidence and death.

Introduction: Associations between screen time and health outcomes among teenagers are well established. However, most studies use parent-reported information, which may misrepresent the magnitude or nature of these associations. In addition, timely nationally representative estimates are needed to correspond with evolving screen use. This study aimed to address these gaps by using data from a nationally representative survey of teenagers.

Methods: Data came from the 2021-2023 National Health Interview Survey-Teen (NHIS-Teen), a follow-back web-based survey designed to collect health information directly from teenagers aged 12 to 17 years. NHIS-Teen provides a unique opportunity to assess teenagers' self-reported health in conjunction with a rich set of parent-reported covariates, including family income, from the National Health Interview Survey. This study examines associations between high daily non-schoolwork screen time, defined as 4 or more hours of daily screen time, and adverse health outcomes across the domains of physical activity, sleep, weight, mental health, and perceived support.

Results: Teenagers with higher non-schoolwork screen use were more likely to experience a series of adverse health outcomes, including infrequent physical activity, infrequent strength training, being infrequently well-rested, having an irregular sleep routine, weight concerns, depression symptoms, anxiety symptoms, infrequent social and emotional support, and insufficient peer support.

Conclusion: Results of this study include associations between high screen time and poor health among teenagers using self-reported data. Future work may further investigate these associations and their underlying mechanisms, including the content viewed on screens and the interactions taking place across screens.

Introduction: Nationally representative estimates of mental health symptoms and services in adults with kidney disease are limited. The objective of this study was to examine the mental health status and use of health care among adults with and without kidney disease.

Methods: We used data from the 2021 National Health Interview Survey. Diagnosed kidney disease is based on adults who reported ever being told by a doctor or other health professional that they had weak or failing kidneys. The survey question captures data on adults who are aware of having kidney disease and most likely have advanced kidney disease. Mental health measures examined were serious psychological distress (SPD), current symptoms of anxiety and depression, diagnosed anxiety and depressive disorder, prescription medication use for these disorders, and receipt of counseling. We used logistic regression models, with predicted marginal proportions, to calculate unadjusted and adjusted prevalence ratios, controlling for sociodemographic and health characteristics.

Results: About 2.9% of adults reported having a diagnosis of kidney disease; prevalence varied by sociodemographic and health characteristics. The prevalence of SPD; current symptoms of anxiety or depression or both; history of diagnosed anxiety or depression or both; and receiving counseling and prescription use for these disorders were higher among adults with kidney disease than among adults without kidney disease. In multivariable models adjusted for sociodemographic and health characteristics, adults with diagnosed kidney disease remained more likely than adults not diagnosed with kidney disease to experience mental health conditions and receive counseling.

Conclusion: A survey of the US population found a higher prevalence of poor mental health and receipt of mental health care among people diagnosed with kidney disease than among people not diagnosed with kidney disease.

[This corrects the article DOI: 10.5888/pcd21.230444.].

Introduction: Timely access to stroke care reduces death and disability due to stroke. Studies have investigated disparities in access by sociodemographic characteristics but not comorbidity prevalence. We used updated data to assess both types of disparities in drive times to certified stroke centers nationwide.

Methods: We conducted a cross-sectional spatial analysis of drive time from each contiguous US census tract (N = 72,517), using population-weighted centroids, to any certified stroke care (n = 1,825) or advanced (ie, endovascular-capable) stroke care (n = 426), using 2022 data from multiple state and nationwide databases. We compared median comorbidity prevalence and sociodemographic characteristics for census tracts within versus beyond a 60-minute drive time, using US Centers for Disease Control and Prevention PLACES 2020 data.

Results: Median (interquartile range) drive time was 11.8 (7.6-21.6) minutes to any certified stroke care, and 23.0 (12.6-53.9) minutes to advanced stroke care. Approximately 20% of the US adult population (n = 49 million) resided in census tracts beyond a 60-minute drive from advanced stroke care; most (65%) were rural. Census tracts more than 60 minutes from advanced stroke care had significantly higher prevalence of stroke, high blood pressure, coronary heart disease, high cholesterol, diabetes, chronic kidney disease, fair or poor self-rated health status, smoking, and obesity. They also had higher poverty rates, lower educational attainment, lower median income, and higher proportions of non-Hispanic White people and people older than 65 years.

Conclusion: Residents in census tracts lacking timely access to stroke care have higher prevalence of health risk factors. The results highlight areas where education, telehealth infrastructure, and facility placement could improve stroke systems of care.