Pub Date : 2025-12-01DOI: 10.1016/j.focus.2025.100461
Yuri T. Jadotte MD, PhD, MPH
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Pub Date : 2025-10-27DOI: 10.1016/j.focus.2025.100460
Jason Hoppe DO , Heather Tolle PhD , Katherine J. Sullivan PhD , Katherine Ziegler MPH , Zachary Giano PhD , Barbara Gabella MSPH
Introduction
In response to the opioid crisis, Colorado enacted Senate Bill 18-022, which limits initial opioid prescriptions to 7 days for opioid-naïve patients and mandates prescription drug monitoring program review before a second prescription. This study evaluates provider adherence to these mandates and associated patient outcomes.
Methods
A retrospective cohort study was conducted using linked electronic health record and prescription drug monitoring program data from a large academic-affiliated healthcare system in Colorado. Adult opioid-naïve patients (aged 18–89 years) who received an initial opioid prescription between May 2018 and May 2019 were included. Provider adherence to the 7-day prescribing limit for the first and second prescriptions and prescription drug monitoring program review mandate with the second opioid prescription were assessed. Patient outcomes included chronic opioid use, aberrant opioid use, and healthcare utilization within 6 months after the prescription.
Results
Among 35,461 opioid-naïve patients prescribed an opioid, 78.5% received an initial prescription consistent with the 7-day statutory limit. Of the 9,423 patients with a second opioid prescription, 58.4% received a 7-day supply or less, and 13.1% had a documented prescription drug monitoring program review. Prescriptions exceeding 7 days were significantly associated with increased chronic opioid use (31.9% vs 0.2%), aberrant use (4.0% vs 2.1%), and higher healthcare utilization (mean 5.44 vs 1.95 visits). Prescription drug monitoring program review was not associated with reduced chronic opioid use or healthcare visits and was more common among patients with worse outcomes, suggesting potential confounding by patient complexity.
Conclusions
Providers largely adhered to the 7-day opioid prescribing limit, which was associated with improved patient outcomes. However, mandated prescription drug monitoring program checks were infrequent and not associated with reduced risk, highlighting the need to reassess the effectiveness of prescription drug monitoring program–related policies.
{"title":"Examining Statewide Opioid Prescribing Limits and Prescription Drug Monitoring Program Mandates: Provider Compliance and Patient Outcomes","authors":"Jason Hoppe DO , Heather Tolle PhD , Katherine J. Sullivan PhD , Katherine Ziegler MPH , Zachary Giano PhD , Barbara Gabella MSPH","doi":"10.1016/j.focus.2025.100460","DOIUrl":"10.1016/j.focus.2025.100460","url":null,"abstract":"<div><h3>Introduction</h3><div>In response to the opioid crisis, Colorado enacted Senate Bill 18-022, which limits initial opioid prescriptions to 7 days for opioid-naïve patients and mandates prescription drug monitoring program review before a second prescription. This study evaluates provider adherence to these mandates and associated patient outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using linked electronic health record and prescription drug monitoring program data from a large academic-affiliated healthcare system in Colorado. Adult opioid-naïve patients (aged 18–89 years) who received an initial opioid prescription between May 2018 and May 2019 were included. Provider adherence to the 7-day prescribing limit for the first and second prescriptions and prescription drug monitoring program review mandate with the second opioid prescription were assessed. Patient outcomes included chronic opioid use, aberrant opioid use, and healthcare utilization within 6 months after the prescription.</div></div><div><h3>Results</h3><div>Among 35,461 opioid-naïve patients prescribed an opioid, 78.5% received an initial prescription consistent with the 7-day statutory limit. Of the 9,423 patients with a second opioid prescription, 58.4% received a 7-day supply or less, and 13.1% had a documented prescription drug monitoring program review. Prescriptions exceeding 7 days were significantly associated with increased chronic opioid use (31.9% vs 0.2%), aberrant use (4.0% vs 2.1%), and higher healthcare utilization (mean 5.44 vs 1.95 visits). Prescription drug monitoring program review was not associated with reduced chronic opioid use or healthcare visits and was more common among patients with worse outcomes, suggesting potential confounding by patient complexity.</div></div><div><h3>Conclusions</h3><div>Providers largely adhered to the 7-day opioid prescribing limit, which was associated with improved patient outcomes. However, mandated prescription drug monitoring program checks were infrequent and not associated with reduced risk, highlighting the need to reassess the effectiveness of prescription drug monitoring program–related policies.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 2","pages":"Article 100460"},"PeriodicalIF":0.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.focus.2025.100459
Luis A. Rodríguez PhD, MPH, RD , Patrick T. Bradshaw PhD, MS , Alka M. Kanaya MD , Alex Akushevich MS , Anna Maria Siega-Riz PhD, MS , Leonor Corsino MD, MHS , Sandra S. Albrecht PhD, MPH , Carmen R. Isasi MD, PhD , Yasmin Mossavar-Rahmani PhD, RD, CDN , Martha Daviglus MD, PhD, MPH , Linda Van Horn PhD, RDN , Linda C. Gallo PhD , Daniela Sotres-Alvarez DrPH, MS
<div><h3>Introduction</h3><div>Excessive sugar-sweetened beverage consumption is associated with metabolic syndrome, but few studies have evaluated the associations with added sugars from all dietary sources. The authors evaluated cross-sectional and longitudinal associations between added sugars intake and metabolic syndrome and its components in a cohort of U.S. Hispanic/Latino adults. In addition, the authors conducted a secondary analysis to evaluate whether sugar-sweetened beverages were independently associated with metabolic syndrome and its components.</div></div><div><h3>Methods</h3><div>The authors used baseline (<em>n</em>=12,484) and 6.2-year follow-up (<em>n</em>=5,576) data from adults aged 18–74 years without diabetes from the Hispanic Community Health Study/Study of Latinos. The authors derived added sugars and sugar-sweetened beverage intake at baseline from two 24-hour dietary recalls using the National Cancer Institute methodology and categorized participants using quintiles of added sugars percentage per day for added sugars or 8 fl oz servings per day for sugar-sweetened beverages. The authors used the National Cholesterol Education Program—Third Adult Treatment Panel definition of metabolic syndrome and metabolic syndrome components. In cross-sectional analyses, the authors used multivariate logistic and linear regression to estimate the ORs for binary outcomes and mean differences for continuous outcomes. In longitudinal analyses, the authors used Poisson regression to estimate incidence rate ratios.</div></div><div><h3>Results</h3><div>Metabolic syndrome prevalence was 24.8% at baseline, and average added sugars was 14.4%. In the cross-sectional analysis, those in the fifth quintile of added sugars had odds of metabolic syndrome (OR=1.01, 95% CI=0.74, 1.39; <em>p</em>-trend=0.622) similar to the odds for those in the lowest quintile. In the longitudinal analyses, there was no significant association between added sugars and metabolic syndrome incidence in minimally or fully adjusted models (overall <em>p</em>-trend=0.84 and 0.93, respectively). In secondary analyses, cross-sectionally, sugar-sweetened beverage intake was significantly associated with waist circumference (<em>p</em>-trend=0.003), high-density lipoprotein cholesterol (<em>p</em>-trend<0.001), and fasting glucose (<em>p</em>-trend<0.001). Longitudinally, among individual components, those consuming more than two 8 fl oz servings per day had a 35% higher rate of reduced high-density lipoprotein cholesterol (incidence rate ratio=1.35, 95% CI=1.02, 1.79; <em>p</em>-trend=0.009).</div></div><div><h3>Conclusions</h3><div>Added sugars were not associated with prevalent or incident metabolic syndrome among U.S. Hispanic/Latino adults. However, findings from secondary analyses suggest that sugar-sweetened beverages may have a distinct metabolic impact, particularly on waist circumference, high-density lipoprotein cholesterol, and fasting glucose, warranting fur
{"title":"Added Sugars Intake and Metabolic Syndrome in U.S. Hispanic/Latino Adults: Longitudinal Results From the Hispanic Community Health Study/Study of Latinos","authors":"Luis A. Rodríguez PhD, MPH, RD , Patrick T. Bradshaw PhD, MS , Alka M. Kanaya MD , Alex Akushevich MS , Anna Maria Siega-Riz PhD, MS , Leonor Corsino MD, MHS , Sandra S. Albrecht PhD, MPH , Carmen R. Isasi MD, PhD , Yasmin Mossavar-Rahmani PhD, RD, CDN , Martha Daviglus MD, PhD, MPH , Linda Van Horn PhD, RDN , Linda C. Gallo PhD , Daniela Sotres-Alvarez DrPH, MS","doi":"10.1016/j.focus.2025.100459","DOIUrl":"10.1016/j.focus.2025.100459","url":null,"abstract":"<div><h3>Introduction</h3><div>Excessive sugar-sweetened beverage consumption is associated with metabolic syndrome, but few studies have evaluated the associations with added sugars from all dietary sources. The authors evaluated cross-sectional and longitudinal associations between added sugars intake and metabolic syndrome and its components in a cohort of U.S. Hispanic/Latino adults. In addition, the authors conducted a secondary analysis to evaluate whether sugar-sweetened beverages were independently associated with metabolic syndrome and its components.</div></div><div><h3>Methods</h3><div>The authors used baseline (<em>n</em>=12,484) and 6.2-year follow-up (<em>n</em>=5,576) data from adults aged 18–74 years without diabetes from the Hispanic Community Health Study/Study of Latinos. The authors derived added sugars and sugar-sweetened beverage intake at baseline from two 24-hour dietary recalls using the National Cancer Institute methodology and categorized participants using quintiles of added sugars percentage per day for added sugars or 8 fl oz servings per day for sugar-sweetened beverages. The authors used the National Cholesterol Education Program—Third Adult Treatment Panel definition of metabolic syndrome and metabolic syndrome components. In cross-sectional analyses, the authors used multivariate logistic and linear regression to estimate the ORs for binary outcomes and mean differences for continuous outcomes. In longitudinal analyses, the authors used Poisson regression to estimate incidence rate ratios.</div></div><div><h3>Results</h3><div>Metabolic syndrome prevalence was 24.8% at baseline, and average added sugars was 14.4%. In the cross-sectional analysis, those in the fifth quintile of added sugars had odds of metabolic syndrome (OR=1.01, 95% CI=0.74, 1.39; <em>p</em>-trend=0.622) similar to the odds for those in the lowest quintile. In the longitudinal analyses, there was no significant association between added sugars and metabolic syndrome incidence in minimally or fully adjusted models (overall <em>p</em>-trend=0.84 and 0.93, respectively). In secondary analyses, cross-sectionally, sugar-sweetened beverage intake was significantly associated with waist circumference (<em>p</em>-trend=0.003), high-density lipoprotein cholesterol (<em>p</em>-trend<0.001), and fasting glucose (<em>p</em>-trend<0.001). Longitudinally, among individual components, those consuming more than two 8 fl oz servings per day had a 35% higher rate of reduced high-density lipoprotein cholesterol (incidence rate ratio=1.35, 95% CI=1.02, 1.79; <em>p</em>-trend=0.009).</div></div><div><h3>Conclusions</h3><div>Added sugars were not associated with prevalent or incident metabolic syndrome among U.S. Hispanic/Latino adults. However, findings from secondary analyses suggest that sugar-sweetened beverages may have a distinct metabolic impact, particularly on waist circumference, high-density lipoprotein cholesterol, and fasting glucose, warranting fur","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 1","pages":"Article 100459"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-06DOI: 10.1016/j.focus.2025.100456
Keisuke Kokubun PhD
Introduction
There are important workplace health lessons to be learned from the pandemic.
Methods
This study summarizes the relationships between workplace safety practices, fear, resources, and employee engagement during the COVID-19 pandemic through a narrative review on articles published between January 2020 and June 2025 using a primary literature search base.
Results
Organizations have had to implement workplace safety management practices aligned with their occupational safety and health management systems in response to COVID-19. Safety management practices include safety initiatives and training as well as employee involvement. Methods to increase employee involvement include fear and anxiety. However, although fear and anxiety promote safety compliance and safe behavior, they also wear down employees and increase their work distraction and turnover intentions. Therefore, social and psychological resources need to be strengthened to overcome this dilemma. These resources can also help safety management practices today as the pandemic begins to wind down.
Conclusions
Future research should focus on identifying ways to strengthen employees' social and psychological resources without relying on disasters. To this end, an integration of conservation of resource theory and behavioral theory may be useful.
{"title":"Workplace Safety Management Practices, Fear, Resources, and Employee Involvement During the COVID-19 Pandemic: A Narrative Review","authors":"Keisuke Kokubun PhD","doi":"10.1016/j.focus.2025.100456","DOIUrl":"10.1016/j.focus.2025.100456","url":null,"abstract":"<div><h3>Introduction</h3><div>There are important workplace health lessons to be learned from the pandemic.</div></div><div><h3>Methods</h3><div>This study summarizes the relationships between workplace safety practices, fear, resources, and employee engagement during the COVID-19 pandemic through a narrative review on articles published between January 2020 and June 2025 using a primary literature search base.</div></div><div><h3>Results</h3><div>Organizations have had to implement workplace safety management practices aligned with their occupational safety and health management systems in response to COVID-19. Safety management practices include safety initiatives and training as well as employee involvement. Methods to increase employee involvement include fear and anxiety. However, although fear and anxiety promote safety compliance and safe behavior, they also wear down employees and increase their work distraction and turnover intentions. Therefore, social and psychological resources need to be strengthened to overcome this dilemma. These resources can also help safety management practices today as the pandemic begins to wind down.</div></div><div><h3>Conclusions</h3><div>Future research should focus on identifying ways to strengthen employees' social and psychological resources without relying on disasters. To this end, an integration of conservation of resource theory and behavioral theory may be useful.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 2","pages":"Article 100456"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-04DOI: 10.1016/j.focus.2025.100455
Michael K.D. Amponsah MD , Alexis K. Okoh MD , Shannon Cheffet-Walsh DO , Mehul Patel MD , David Carfagno DO , Druenell Linton MD , Robert Dimeff MD , David Braunreiter MD , Phillips Harrington MD , Fred H. Brennan Jr DO , Clifford Kavinsky MD, PhD , Marlon Everett MD , Brandon Park PhD , Marissa Gunnarsson MPH , Sean Snowden MBA , Lidia Mootz MBA , Tenley Koepnick BS , Jaime Wheeler MBA , Sarah E. Clarke DNP , Heather Prince PhD , E. Lee Rice DO
Introduction
Cardiovascular disease is the leading cause of death globally. Understanding the association between lifestyle habits, risk factors, and structural heart abnormalities is crucial for developing preventive strategies, especially among understudied populations.
Methods
The HUDDLE trial was a cross-sectional study of National Football League alumni and their family members aged ≥50 years who self-reported health histories and underwent noninvasive cardiovascular disease screening, including transthoracic echocardiography. Cardiovascular disease risk factors were evaluated using a modified American Heart Association Life’s Simple 7 (physical activity, tobacco use, obesity, hypertension, diabetes, alcohol intake, and hyperlipidemia) and assessed as ideal, intermediate, or poor.
Results
Of 498 participants, 92.4% had at least 1 poor health metric, with 15.9% having ≥3. Former National Football League players aged <65 years had a higher prevalence of ≥3 poor metrics compared with other participants. Non-White former National Football League players exhibited nearly double the prevalence of having 3 or more poor health metrics as their White counterparts (23.9% vs 12.0%). Compared with those with no poor metrics, participants with 3–7 poor metrics had the highest odds of having structural heart abnormality (OR=2.40; 95% CI=1.08, 5.32), followed by those with 2 (OR=2.39; 95% CI=1.16, 4.92) and 1 (OR=1.79; 95% CI=0.87, 3.66) poor metric.
Conclusions
This subanalysis of the HUDDLE study identified a high prevalence of poor health metrics among former National Football League players and their families. Younger, non-White participants were more likely to have worse lifestyle habits than their counterparts. Increasing number of poor health metrics was associated with structural heart abnormalities.
Trial registration: This study is registered at http://www.clinicaltrials.gov (NCT0500958).
{"title":"Lifestyle Habits and Structural Heart Abnormalities Among Former Athletes and Their Families: HUDDLE Subanalysis","authors":"Michael K.D. Amponsah MD , Alexis K. Okoh MD , Shannon Cheffet-Walsh DO , Mehul Patel MD , David Carfagno DO , Druenell Linton MD , Robert Dimeff MD , David Braunreiter MD , Phillips Harrington MD , Fred H. Brennan Jr DO , Clifford Kavinsky MD, PhD , Marlon Everett MD , Brandon Park PhD , Marissa Gunnarsson MPH , Sean Snowden MBA , Lidia Mootz MBA , Tenley Koepnick BS , Jaime Wheeler MBA , Sarah E. Clarke DNP , Heather Prince PhD , E. Lee Rice DO","doi":"10.1016/j.focus.2025.100455","DOIUrl":"10.1016/j.focus.2025.100455","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiovascular disease is the leading cause of death globally. Understanding the association between lifestyle habits, risk factors, and structural heart abnormalities is crucial for developing preventive strategies, especially among understudied populations.</div></div><div><h3>Methods</h3><div>The HUDDLE trial was a cross-sectional study of National Football League alumni and their family members aged ≥50 years who self-reported health histories and underwent noninvasive cardiovascular disease screening, including transthoracic echocardiography. Cardiovascular disease risk factors were evaluated using a modified American Heart Association Life’s Simple 7 (physical activity, tobacco use, obesity, hypertension, diabetes, alcohol intake, and hyperlipidemia) and assessed as ideal, intermediate, or poor.</div></div><div><h3>Results</h3><div>Of 498 participants, 92.4% had at least 1 poor health metric, with 15.9% having ≥3. Former National Football League players aged <65 years had a higher prevalence of ≥3 poor metrics compared with other participants. Non-White former National Football League players exhibited nearly double the prevalence of having 3 or more poor health metrics as their White counterparts (23.9% vs 12.0%). Compared with those with no poor metrics, participants with 3–7 poor metrics had the highest odds of having structural heart abnormality (OR=2.40; 95% CI=1.08, 5.32), followed by those with 2 (OR=2.39; 95% CI=1.16, 4.92) and 1 (OR=1.79; 95% CI=0.87, 3.66) poor metric.</div></div><div><h3>Conclusions</h3><div>This subanalysis of the HUDDLE study identified a high prevalence of poor health metrics among former National Football League players and their families. Younger, non-White participants were more likely to have worse lifestyle habits than their counterparts. Increasing number of poor health metrics was associated with structural heart abnormalities.</div><div>Trial registration: This study is registered at <span><span>http://www.clinicaltrials.gov</span><svg><path></path></svg></span> (NCT0500958).</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 2","pages":"Article 100455"},"PeriodicalIF":0.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1016/j.focus.2025.100454
Marissa M. Shams-White PhD, MSTOM, MS, MPH , Erika J. Faust MPH , Meghan Zimmer MPH , Emily S. Krueger MS , Karen S. Regan MS, RD , Alfonso J. Alfini PhD, MS , Alison G.M. Brown PhD, MS , Marishka K. Brown PhD , Mary E. Evans PhD, RD , Kirsten A. Herrick PhD, MSc , Charlotte A. Pratt PhD, MS, RD , Eric J. Shiroma ScD, Med , Dana L. Wolff-Hughes PhD, MS , Jill Reedy PhD, MPH, RDN
Introduction
Diet, physical activity, and sleep are behaviors occurring at regular intervals over the 24-hour period. To better understand how they interact and impact the etiology and prevention of chronic diseases, studies are needed that collect data on all 3 behaviors. This scoping review of the authors’ portfolio aimed to identify cohort and interventional studies funded by the National Cancer Institute; National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases that collected measures on all 3 behaviors, on 2 behaviors to better understand existing gaps, and on those with data across a 24-hour period (temporal data).
Methods
Cohorts receiving National Cancer Institute funding; studies identified in the National Heart, Lung, and Blood Institute National Sleep Research Resource and National Institute of Diabetes and Digestive and Kidney Diseases Central Repository; and active National Cancer Institute, National Heart, Lung, and Blood Institute, and National Institute of Diabetes and Digestive and Kidney Diseases intervention grants in Fiscal Years 2021–2022 were reviewed. Data were collected from 2021 to 2022 and analyzed from 2022 to 2023.
Results
Twenty-nine cohort and 47 interventional studies collected data on all 3 behaviors, of which 3 cohorts and 20 interventions collected temporal data. Forty-two cohort and 160 interventional studies collected data on 2 behaviors, of which 3 cohorts and 50 interventions collected temporal data; sleep data were most commonly missing. The most common temporal measures were 24-hour dietary recalls and actigraphy.
Conclusions
Efforts to promote the collection of temporal data on all 3 behaviors simultaneously can support innovative research questions and analytic approaches focused on their interrelationships across the 24-hour period and health outcomes among various populations. Such efforts can inform tailored interventions and precision health research.
{"title":"Diet, Physical Activity, and Sleep Assessment: A Portfolio Scoping Review of Measures in NIH-Funded Epidemiologic Studies","authors":"Marissa M. Shams-White PhD, MSTOM, MS, MPH , Erika J. Faust MPH , Meghan Zimmer MPH , Emily S. Krueger MS , Karen S. Regan MS, RD , Alfonso J. Alfini PhD, MS , Alison G.M. Brown PhD, MS , Marishka K. Brown PhD , Mary E. Evans PhD, RD , Kirsten A. Herrick PhD, MSc , Charlotte A. Pratt PhD, MS, RD , Eric J. Shiroma ScD, Med , Dana L. Wolff-Hughes PhD, MS , Jill Reedy PhD, MPH, RDN","doi":"10.1016/j.focus.2025.100454","DOIUrl":"10.1016/j.focus.2025.100454","url":null,"abstract":"<div><h3>Introduction</h3><div>Diet, physical activity, and sleep are behaviors occurring at regular intervals over the 24-hour period. To better understand how they interact and impact the etiology and prevention of chronic diseases, studies are needed that collect data on all 3 behaviors. This scoping review of the authors’ portfolio aimed to identify cohort and interventional studies funded by the National Cancer Institute; National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases that collected measures on all 3 behaviors, on 2 behaviors to better understand existing gaps, and on those with data across a 24-hour period (temporal data).</div></div><div><h3>Methods</h3><div>Cohorts receiving National Cancer Institute funding; studies identified in the National Heart, Lung, and Blood Institute National Sleep Research Resource and National Institute of Diabetes and Digestive and Kidney Diseases Central Repository; and active National Cancer Institute, National Heart, Lung, and Blood Institute, and National Institute of Diabetes and Digestive and Kidney Diseases intervention grants in Fiscal Years 2021–2022 were reviewed. Data were collected from 2021 to 2022 and analyzed from 2022 to 2023.</div></div><div><h3>Results</h3><div>Twenty-nine cohort and 47 interventional studies collected data on all 3 behaviors, of which 3 cohorts and 20 interventions collected temporal data. Forty-two cohort and 160 interventional studies collected data on 2 behaviors, of which 3 cohorts and 50 interventions collected temporal data; sleep data were most commonly missing. The most common temporal measures were 24-hour dietary recalls and actigraphy.</div></div><div><h3>Conclusions</h3><div>Efforts to promote the collection of temporal data on all 3 behaviors simultaneously can support innovative research questions and analytic approaches focused on their interrelationships across the 24-hour period and health outcomes among various populations. Such efforts can inform tailored interventions and precision health research.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 1","pages":"Article 100454"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1016/j.focus.2025.100453
Jennifer L. Bragg-Gresham MS, PhD , Yiting Li MS , Julie Wright Nunes MD, MPH , William H. Herman MD, MPH , Neil R. Powe MD, MPH, MBA , Tanushree Banerjee PhD , Hal Morgenstern PhD , Austin G. Stack MD, MS , Tiffany C. Veinot MLS, PhD , Rajiv Saran MD, MRCP, MS
Introduction
The prevalence of chronic kidney disease among persons with diabetes in the U.S. appears to be decreasing. Understanding the reasons for this decrease is an important health policy issue.
Methods
Data on 7,320 adults with diabetes from National Health and Nutrition Examination Survey (1999–2018) were examined to estimate the prevalence of chronic kidney disease in 4-year cohorts. Chronic kidney disease was defined by an estimated glomerular filtration rate <60 ml/min/1.73m2 or urine albumin-to-creatinine ratio ≥30 mg/g. Diabetes and hypertension were defined by combination of self-report, medication, or laboratory detection. Weighted logistic regression models adjusting for demographics, comorbidities, angiotensin-converting enzyme inhibitor/angiotensin-2 receptor blocker medication, smoking, diet, and physical activity were used to assess change in chronic kidney disease prevalence over time.
Results
The prevalence of chronic kidney disease among individuals with diabetes decreased from 40.5% to 35.4% over 20 years (p=0.02) with a decline of ∼5% during each 4-year period (OR=0.95, 95% CI=0.90, 0.99) and ∼7% per 4-year period (OR=0.93, 95% CI=0.88, 0.98) for albuminuria. The reduction in chronic kidney disease prevalence was greater after adjusting for demographics (OR=0.92, 95% CI=0.88, 0.97). After adjusting for glucose; blood pressure; medication use; and health behaviors, including smoking, diet, and physical activity, the decreasing trend became nonstatistically significant (OR=0.95, 95% CI=0.90, 1.00), suggesting that these factors may have played a role in the lower chronic kidney disease prevalence over time. No decrease in chronic kidney disease was seen among individuals with hypertension.
Conclusions
The prevalence of chronic kidney disease among participants with diabetes has decreased steadily in the U.S. over the past 20 years, mostly from reductions in the prevalence of albuminuria. Improvements in medical management may explain part of the decrease. Individuals adopting healthy lifestyle behaviors may further explain the decrease.
{"title":"Decreasing Prevalence of Chronic Kidney Disease Among U.S. Adults With Diabetes, 1999–2018","authors":"Jennifer L. Bragg-Gresham MS, PhD , Yiting Li MS , Julie Wright Nunes MD, MPH , William H. Herman MD, MPH , Neil R. Powe MD, MPH, MBA , Tanushree Banerjee PhD , Hal Morgenstern PhD , Austin G. Stack MD, MS , Tiffany C. Veinot MLS, PhD , Rajiv Saran MD, MRCP, MS","doi":"10.1016/j.focus.2025.100453","DOIUrl":"10.1016/j.focus.2025.100453","url":null,"abstract":"<div><h3>Introduction</h3><div>The prevalence of chronic kidney disease among persons with diabetes in the U.S. appears to be decreasing. Understanding the reasons for this decrease is an important health policy issue.</div></div><div><h3>Methods</h3><div>Data on 7,320 adults with diabetes from National Health and Nutrition Examination Survey (1999–2018) were examined to estimate the prevalence of chronic kidney disease in 4-year cohorts. Chronic kidney disease was defined by an estimated glomerular filtration rate <60 ml/min/1.73m<sup>2</sup> or urine albumin-to-creatinine ratio ≥30 mg/g. Diabetes and hypertension were defined by combination of self-report, medication, or laboratory detection. Weighted logistic regression models adjusting for demographics, comorbidities, angiotensin-converting enzyme inhibitor/angiotensin-2 receptor blocker medication, smoking, diet, and physical activity were used to assess change in chronic kidney disease prevalence over time.</div></div><div><h3>Results</h3><div>The prevalence of chronic kidney disease among individuals with diabetes decreased from 40.5% to 35.4% over 20 years (<em>p</em>=0.02) with a decline of ∼5% during each 4-year period (OR=0.95, 95% CI=0.90, 0.99) and ∼7% per 4-year period (OR=0.93, 95% CI=0.88, 0.98) for albuminuria. The reduction in chronic kidney disease prevalence was greater after adjusting for demographics (OR=0.92, 95% CI=0.88, 0.97). After adjusting for glucose; blood pressure; medication use; and health behaviors, including smoking, diet, and physical activity, the decreasing trend became nonstatistically significant (OR=0.95, 95% CI=0.90, 1.00), suggesting that these factors may have played a role in the lower chronic kidney disease prevalence over time. No decrease in chronic kidney disease was seen among individuals with hypertension.</div></div><div><h3>Conclusions</h3><div>The prevalence of chronic kidney disease among participants with diabetes has decreased steadily in the U.S. over the past 20 years, mostly from reductions in the prevalence of albuminuria. Improvements in medical management may explain part of the decrease. Individuals adopting healthy lifestyle behaviors may further explain the decrease.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 2","pages":"Article 100453"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1016/j.focus.2025.100452
Sheryl Bedno MD, DrPH , John Russell MD, MPH , Katharine Beardmore MPH , Pauline Thomas MD
Public health emergencies often involve weather-related issues, such as flooding, heatwaves, wildfires, storms, and vector-borne or water-borne diseases. Extreme weather is becoming more frequent and intense owing to climate change. Preventive medicine physicians and other public health professionals are uniquely qualified to serve in leadership or advisory roles during the actual emergencies or preparedness for the climate-related emergencies. Many residency programs are now integrating climate education into their curriculum, but few include simulated exercises. The authors present a climate-exacerbated scenario, discussion questions, and consideration for next steps in educating public health leaders and other collaborators.
{"title":"Public Health Response to a Climate Emergency: A Teaching Exercise","authors":"Sheryl Bedno MD, DrPH , John Russell MD, MPH , Katharine Beardmore MPH , Pauline Thomas MD","doi":"10.1016/j.focus.2025.100452","DOIUrl":"10.1016/j.focus.2025.100452","url":null,"abstract":"<div><div>Public health emergencies often involve weather-related issues, such as flooding, heatwaves, wildfires, storms, and vector-borne or water-borne diseases. Extreme weather is becoming more frequent and intense owing to climate change. Preventive medicine physicians and other public health professionals are uniquely qualified to serve in leadership or advisory roles during the actual emergencies or preparedness for the climate-related emergencies. Many residency programs are now integrating climate education into their curriculum, but few include simulated exercises. The authors present a climate-exacerbated scenario, discussion questions, and consideration for next steps in educating public health leaders and other collaborators.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 2","pages":"Article 100452"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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