Preventing Chronic Disease最新文献

Introduction: Early childhood caries (ECC), dental cavities in children younger than 6 years, is common, consequential, and inequitably concentrated among socially disadvantaged children. The World Health Organization and authoritative clinical and public health agencies promote 4 chronic disease management (CDM) approaches that are low-cost and can be delivered in home and community sites: pharmacologic, behavioral, monitoring, and minimally invasive dentistry (MID). The extent of adoption of these approaches among US pediatric dentists is unknown.

Methods: From November 2021 through July 2023, trained research staff members administered and videorecorded via Zoom a semistructured survey on ECC management to 1,639 clinically active pediatric dentists in the US, including 170 thought leaders (organizational and academic leaders). Data collected included treatment approaches, time allocated to counseling, and personal, practice, and patient population characteristics.

Results: The survey response rate was 27.7%. Among CDM approaches, 88.7% cited pharmacologic approaches, 43.4% behavioral, 41.1% monitoring, and 39.3% MID approaches. MID was significantly associated with thought leaders and with more recent graduates engaged as associates in larger practices or in safety-net settings serving high volumes of low-income children and children with a history of caries. We noted fewer significant associations between other CDM approaches and the characteristics of dentists, practices, and populations served. CDM was not associated with the race or ethnicity of dentists or patients, the numbers of ancillary personnel in practice, or dental management organizations. One-third (32.4%) of respondents reported scheduling 5 or fewer minutes for counseling on caries.

Conclusion: Except for pharmacologic treatments and despite professional guidelines, CDM approaches are underused. We posit that CDM approaches hold strong promise to enhance oral health equity as value-based care arrangements expand in dentistry.

Introduction: Kentucky has the highest all-site cancer incidence and death rate in the US. In 2021, the University of Kentucky Markey Cancer Center convened a steering committee to conduct a statewide community cancer needs assessment (CNA). The goal of the final CNA phase was to gather community input on prioritizing Kentucky's cancer-related needs and ways to address them.

Methods: In 2021, we recruited 162 people to participate in online concept mapping, a participatory mixed method, to explore connections and identify priority areas. Fifty-one community members and 111 organizational partners participated in survey-based activities to prioritize 80 items representing key CNA findings and discussion groups to explore key focus areas and strategies for Kentucky communities.

Results: Concept maps display perceived similarity of the 80 items and a 6-cluster solution. High-priority focus areas included lung cancer screening, smoking, human papillomavirus (HPV) vaccination, and disparities driven by social determinants among rural, Appalachian, Black, and Hispanic residents. High-priority strategies to address needs included expanding health communication on risks, screening guidelines, and insurance benefits; patient navigation; accessible, culturally appropriate treatment information and self-efficacy in treatment decisions; access to care through financial assistance, mobile clinics, and at-home screening; and patient-provider trust and communication.

Conclusion: Our findings indicate the utility of the concept mapping process to facilitate the prioritization of wide-ranging catchment area needs and ways to address them. Moving forward, the prioritized focus areas and strategies can inform Kentucky's new state cancer plan and future research to reduce the state's cancer burden and disparities.

While it is known that epilepsy often co-occurs with psychiatric disorders, few studies have examined nonpsychiatric comorbidity. We analyzed 2021 and 2022 National Health Interview Survey Sample Adult data. Compared with adults with no epilepsy, the 1.2% of US adults (about 3.0 million) with active epilepsy had a higher prevalence of nearly all 21 conditions examined and were more likely to have 4 or more co-occurring chronic conditions. Health care and social service providers can promote healthy behaviors and preventive screening for common comorbidities, improve access to care, and refer people with epilepsy to evidence-based self-management programs.

Introduction: Little is known about the recency, correlates, and content of health care provider (HCP) counseling about physical activity (PA) among adults with arthritis.

Methods: We analyzed data from the Porter Novelli FallStyles cross-sectional survey of noninstitutionalized US adults. Among adults with arthritis, we assessed the recency of HCP counseling about PA; counseling content, including PA assessment/screening and advice/counseling; and recommendations. Data were weighted by sex, age, household income, race and ethnicity, household size, education, census region, and metropolitan status.

Results: Among adults with arthritis (n = 1,113), 16.8% received HCP counseling within the past 6 months, 9.6% received counseling between 6 months and a year ago; 27.7% received HCP counseling more than a year ago; 30.4% never received HCP counseling; and 15.5% did not recall. Prevalence of HCP counseling about PA was higher for those reporting obesity (prevalence ratio [PR] = 1.3) and chronic pain (PR = 1.2), compared with those without these conditions. The most and least common content of HCP counseling were assessment of PA level (74.7%) and receiving a physical activity prescription (6.1%), respectively. The most frequent recommendations for PA type were flexibility exercises (40.1%), aerobic activities (39.8%), specific modalities of PA (eg, swimming, walking, dancing; 38.1%), and muscle-strengthening exercises (36.6%). Only 4.4% received a recommendation for arthritis-appropriate PA programs.

Conclusion: HCP counseling about PA among adults with arthritis for arthritis symptom management is lacking in frequency, actionable content, and recommendations to engage in evidence-based PA interventions. Dissemination and implementation of policies and programs facilitating frequent high-quality HCP counseling and recommendation to PA programs for arthritis remains a public health priority.

Introduction: Childhood mental, behavioral, and developmental disorders (MBDD) are common and are associated with poor health and well-being. Monitoring the prevalence of MBDDs among children and factors that may influence health outcomes is important to understanding risk and promoting population health.

Method: We examined trends in parent-reported lifetime MBDDs among children and associated health promotion and risk indicators from 2016 through 2021 by using data from the National Survey of Children's Health. Estimates of prevalence and average annual percentage change were stratified by specific MBDDs and demographic characteristics (eg, sex, age, race and ethnicity). Children with any MBDDs versus none were compared overall and by MBDD subgroup on health care, family, and community indicators.

Results: From 2016 through 2021, MBDD prevalence among children aged 3 to 17 years increased from 25.3% to 27.7%; increases were specific to anxiety, depression, learning disability, developmental delay, and speech or language disorder. Unmet health care needs increased annually by an average of approximately 5% among children with MBDDs. Each year from 2016 to 2021, approximately 60% of children with MBDDs received mental or developmental services in the past 12 months. Each year, a higher percentage of parents of children with MBDDs compared with children without MBDDs reported poor mental health (14.7% MBDD, 5.7% no MBDD) and economic stress (21.6% MBDD, 11.5% no MBDD).

Conclusion: Increasing prevalence of certain MBDDs and MBDD-associated indicators, before and during the COVID-19 pandemic, highlights the need for improved pediatric mental health training for health care providers, for prevention and intervention efforts, and for policies addressing economic stability and equitable access to mental health services.

Introduction: We examined trends in prepregnancy obesity and gestational weight gain, with a focus on racial and ethnic differences, before and during the COVID-19 pandemic in South Carolina.

Methods: Hospital and emergency department discharge codes were linked to birth certificates. Prepregnancy obesity was defined as a body mass index (kg/m²) of 30 or higher. Gestational weight gain was defined as inadequate, adequate, or excessive based on the 2009 Institute of Medicine guidelines. A generalized linear model with a multinomial distribution and glogit link estimated the risk of inadequate weight gain and excessive weight gain with adequate weight gain as the reference group. The generalized linear model with a modified Poisson distribution and log link estimated prepregnancy obesity risk with nonobese as the reference group.

Results: Our study included 306,344 full-term, singleton live births among 239,597 mothers from 2015 through 2021. The prevalence of inadequate weight gain increased across all racial and ethnic groups prepandemic (relative risk [RR] = 1.02; 95% CI, 1.01-1.02) and attenuated during the pandemic (RR = 0.99; 95% CI, 0.96-1.01). The prevalence of excessive weight gain was high and remained stable across all races and ethnicities before and during the pandemic. The prevalence of prepregnancy obesity increased across all racial and ethnic groups prepandemic; the prevalence after the start of the pandemic increased only among women of "other" races and ethnicities (RR = 1.12; 95% CI, 1.05-1.19) while attenuating among Hispanic, non-Hispanic Black, and non-Hispanic White women.

Conclusion: The COVID-19 pandemic did not alter trends of gestational weight gain; however, it did have a small effect on trends in prepregnancy obesity, with differential effects across racial and ethnic groups. The prevalence of prepregnancy obesity, inadequate weight gain, and excessive weight gain remains high among pregnant women in South Carolina. Obesity and weight gain are risk factors for many adverse maternal and infant pregnancy outcomes. Their high prevalence indicates the importance of developing effective weight management programs for women of childbearing age and pregnant women.