JAMA Health Forum最新文献

Importance: Rates of congenital syphilis in the US have surged over the past decade, despite most states having long-standing mandates requiring clinicians to offer syphilis screening early in pregnancy. Gaps in screening coverage remain, and first-trimester screening alone may miss cases. Several professional bodies now recommend repeat screening in the third trimester and at delivery. Evidence on the impact of expanded prenatal syphilis screening mandates on case detection is limited.

Objective: To evaluate the effectiveness of expanding prenatal syphilis screening mandates on syphilis case detection during pregnancy.

Design, setting, and participants: Birth certificate data from 33 US states between 2012 and 2022 were analyzed using a staggered difference-in-differences design. Maternal syphilis case detection in 4 states that enacted mandates for third-trimester and delivery screening (Arizona, Georgia, Louisiana, and Michigan) were compared with 29 control states without such mandates during this period. The new mandates required all pregnant people be offered third-trimester screening. Three of the states further required that individuals at high risk of syphilis infection be offered screening again at delivery, and 1 state required universal delivery screening. To ascertain whether expanded mandates were associated with changes in screening coverage, inpatient discharge records from 1 mandate expansion state (Georgia) were analyzed. Data were analyzed from December 2024 to September 2025.

Exposures: Passage of a universal syphilis screening mandate in the third trimester and a high-risk or universal mandate at delivery between 2012 and 2022.

Main outcomes and measures: Maternal syphilis case detection (cases per 100 000 live births) and the share of deliveries receiving syphilis screening.

Results: The study sample included 16.3 million live births and 20 961 reported syphilis cases between 2012 and 2022 in 4 mandate expansion states and 29 control states. Expanded screening mandates were associated with a 26% (95% CI, 3-53) increase in maternal syphilis case detection in the first quarter after enactment. The increase in case detection attenuated thereafter and was no longer significant within 1 year (11%; 95% CI, -17 to 48; P = .48).

Conclusions and relevance: In this study, expanded prenatal syphilis screening mandates may improve syphilis case detection in the near-term but are unlikely to have sustained impact without complementary efforts, such as those that facilitate clinician adherence and ensure patient access to and completion of treatment.

Importance: Many US cities track firearm violence with annual homicide counts, which may not capture prevention gains, nonfatal injury trends, and stretches of peace. Metrics that quantify days without shootings provide an opportunity to communicate resilience and guide action. To provide a fuller picture, we introduce 4 novel metrics-shooting-free days (SFDs), shooting death-free days (SDFDs), consecutive shooting-free days (CSFDs), and multiple shooting-free days (MSFDs)-that, to our knowledge, have not previously been calculated across major US cities.

Objectives: To introduce, compute, and compare the 4 novel metrics across the 10 largest US cities from 2015 through 2024 and to test temporal trends.

Design, setting, and participants: Repeated cross-sectional, time-series analyses of daily gun violence incidents measured in 10 US cities with populations exceeding 1 million using Gun Violence Archive data to construct city-day observations from all fatal and nonfatal shooting incidents recorded between January 1, 2015, through December 31, 2024. Linear regressions were used to estimate annual trends. Data were analyzed from June 2025 through January 2026.

Exposures: Calendar year and city, operationalized as city-year panels derived from daily counts of persons shot (killed or injured).

Main outcomes and measures: SFDs are defined as days per year with no shooting incidents; SDFDs, days with no shooting deaths; CSFDs, maximum number of consecutive days per year with no shooting incidents; and MSFDs, days with fewer than 2 people shot. Outcomes were computed per city per year and calculating the mean across years.

Results: Of the 10 cities, Chicago had the lowest means (1.6 SFDs, 86.9 SDFDs, 0.6 CSFD, and 9.6 MSFDs per year) whereas San Diego had the highest (291.5 SFDs, 337.6 SDFDs, 24.2 CSFDs, and 347.3 MSFDs). A pronounced pullback occurred from 2019 through 2021. Phoenix and Dallas-Fort Worth had significant declines in all 4 metrics. Overall trends were significantly downward: -4.79 SFDs per year (P < .05), -4.50 SDFDs per year (P < .05), -0.30 CSFDs per year (P < .05), and -8.37 MSFDs per year (P < .01). Jacksonville, was the only city to show a significantly improved metric, in MSFDs (0.84 days per year; P < .05).

Conclusions and relevance: These novel metrics highlight periods of success and safety rather than focusing on negative outcomes. Metrics varied widely, worsened overall during the study decade, and highlighted cities with policies and practices that could be replicated. Incorporating shooting-free metrics into public dashboards can motivate communities, sharpen accountability, and guide interventions in US cities.