AJPM focus最新文献

{"title":"Cervical Cancer Screening Overuse Among Women With and Without Disability in the U.S. From 2007 to 2016","authors":"Preeti P. Zanwar PhD, MPH, MS ,&nbsp;Chan Shen PhD ,&nbsp;Matthew L. Smith PhD, MPH, CHES","doi":"10.1016/j.focus.2025.100366","DOIUrl":"10.1016/j.focus.2025.100366","url":null,"abstract":"<div><h3>Introduction</h3><div>Persons with disability, a recognized health disparity population with complex care needs, may be at risk for cervical cancer screening overuse. However, limited studies have examined cervical cancer screening overuse among women with and without disability using large nationally representative survey data. Among women with and without disability, the authors aimed to provide national estimates of cervical cancer screening overuse and the proportion of cervical cancer screening overuse among younger, middle-age, and older women.</div></div><div><h3>Methods</h3><div>The authors first utilized the U.S. Preventive Services Task Force guidelines to conceptualize and define cervical cancer screening overuse for women with and without disability on the basis of age-based recommendations of Papanicolaou testing frequencies. The authors used the definition of disability to include limitations in mobility or walking, hearing, vision, or cognition, activities of daily living, or instrumental activities of daily living as well as limitations in school, work, or housework. The authors then used the Medical Expenditure Panel Survey data pooled from 2007 to 2016 to estimate the survey-weighted proportion of cervical cancer screening overuse among younger women (aged 17–20.9 years and 21–29.9 years), middle-age women (aged 30–64.9 years), and older women (aged ≥65 years).</div></div><div><h3>Results</h3><div>The analytic sample comprised 101,083 women aged ≥17 years with and without disability or a survey-weighted population of 94.8 million, of whom 52.5% had no disability and 12.97% had any disability. There was a large difference in cervical cancer screening overuse between women with and without disability, with women without disability having much higher overuse rate. The survey-weighted proportion of cervical cancer screening overuse among middle-age women aged 30–64.9 years without disability and with disability was highest (52.5% vs 12.97%, <em>p</em>&lt;0.0001), followed by that among older women without and with disability (8.53% each, <em>p</em>&lt;0.0001).</div></div><div><h3>Conclusions</h3><div>Cervical cancer screening overuse is potentially occurring in women with and without disability, calling for a need to design multilevel interventions and economic incentives to deimplement low-value cervical cancer screening in healthcare delivery settings.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100366"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546362","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}

{"title":"Increasing Residential Radon Testing Through Outreach to Families of Newborn Children in Pennsylvania: Evaluation of Intervention Outcomes, 2002–2023","authors":"Tarya Pillay MPH ,&nbsp;Mia N. Ray BS ,&nbsp;Rebecca Bascom MD, MPH ,&nbsp;Jennifer L. Moss PhD","doi":"10.1016/j.focus.2025.100372","DOIUrl":"10.1016/j.focus.2025.100372","url":null,"abstract":"<div><h3>Introduction</h3><div>Few people undertake residential testing for radon, despite its known impact on lung cancer risk. Motivated by new parents’ interest in residential hazards, the Pennsylvania Department of Environmental Protection’s Newborn Radon Testing Project distributes free radon testing vouchers to new parents. Impacts on radon testing are unknown.</div></div><div><h3>Methods</h3><div>The authors evaluated the Newborn Radon Testing Project (2002–2023) utilizing the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Data came from project records as well as Pennsylvania Department of Health Birth Statistics. The authors analyzed outcomes according to Reach, Effectiveness, Adoption, Implementation, and Maintenance.</div></div><div><h3>Results</h3><div>Among 3,093,704 babies delivered in Pennsylvania hospitals from 2002 to 2023, 24,165 (0.78%) parents requested radon testing kits through the project (Reach). Of these, 11,556 (47.7%) completed the kits, and 41.8% had radon above 4 picocuries per liter, including 18.2% with very elevated radon (&gt;10.0 picocuries per liter) (Effectiveness). Among eligible hospitals, 87 of 107 (81%) partnered with the project (Adoption), and average program costs were $14,507 per year or $29 per analyzed kit (Implementation).</div></div><div><h3>Conclusions</h3><div>The Newborn Radon Testing Project holds promise for identifying homes with elevated indoor radon levels. Efforts are needed to increase participation and monitor remediation among new parents.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100372"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531354","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}

{"title":"Evaluating the Effect of Routine Lethal Means Counseling in the Emergency Department on Suicide Mortality Among Mental Health Patients","authors":"Steven C. Marcus PhD ,&nbsp;Sara W. Cullen PhD, MSW ,&nbsp;Ming Xie MS ,&nbsp;Jeffrey A. Bridge PhD ,&nbsp;Jeffrey M. Caterino MD, MPH ,&nbsp;Timothy Schmutte PsyD ,&nbsp;Mark Olfson MD, MPH","doi":"10.1016/j.focus.2025.100336","DOIUrl":"10.1016/j.focus.2025.100336","url":null,"abstract":"<div><h3>Introduction</h3><div>Each year in the U.S. there are more than 2 million emergency department visits for mental health disorders; approximately 500,000 of those are for self-harm. Although not widely implemented in emergency departments, lethal means counseling, which advises patients how to safely store firearms and other lethal means, has been found to improve the safe storage of firearms and medications, which are responsible for two thirds of suicide deaths.</div></div><div><h3>Methods</h3><div>An observational cohort study of 1,148,546 emergency department patients with mental health disorders was conducted to determine the association between routine emergency department lethal means counseling and suicide death (ICD-10-CM: X60–X84, Y87.0, U03) within the 30- and 180-day periods post-discharge. The sample included patients seen during 2016–2018 at one of the 438 hospitals identified in national Medicaid claims data who responded to an emergency department management of self-harm survey. Hospitals were dichotomized into whether or not they routinely provided lethal means counseling (on a routine basis versus usually but not routinely, sometimes, or never or rarely).</div></div><div><h3>Results</h3><div>Slightly more than one third (39.7%) of visits occurred in emergency departments that routinely provided lethal means counseling. Individuals with mental health disorders treated at emergency departments with routine lethal means counseling had significantly lower adjusted odds ratios of death by suicide within the 30-day (4.8, 7.9 deaths by suicide per 100,000 population, Adjusted Odds Ratio (AOR)=0.62, <em>p</em>=0.020) and 180-day (38.9, 50.4 per 100,000, AOR=0.77, <em>p</em>=0.049) periods following the emergency department episode. Of the 438 included hospitals, 37.0% routinely conducted lethal means counseling.</div></div><div><h3>Conclusions</h3><div>Where implemented routinely, lethal means emergency department counseling appears to reduce the risk of suicide during the critical 30- and 180-day periods following an emergency department visit among patients with mental health disorders.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100336"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676703","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}

{"title":"Early Treatment Engagement and Long-Term Smoking Abstinence Among Women With Cervical Intraepithelial Neoplasia or Cervical Cancer","authors":"Charles E. Hoogland PhD ,&nbsp;Steven K. Sutton PhD ,&nbsp;Bethany Shorey Fennell PhD ,&nbsp;Vani N. Simmons PhD ,&nbsp;Christine Vinci PhD ,&nbsp;Issam El Naqa PhD ,&nbsp;Ramzi G. Salloum PhD ,&nbsp;Sanjay S. Shete PhD ,&nbsp;Timothy Hembree DO, PhD ,&nbsp;Damon J. Vidrine Dr PH ,&nbsp;Jennifer I. Vidrine PhD","doi":"10.1016/j.focus.2025.100361","DOIUrl":"10.1016/j.focus.2025.100361","url":null,"abstract":"<div><h3>Introduction</h3><div>Cancer survivors who quit smoking have improved treatment response and decreased mortality. Although data indicate that greater tobacco cessation treatment engagement leads to better cessation outcomes in cancer survivors, little is known about how different tobacco treatment engagement patterns influence long-term cessation success. To help address this issue, this study examined how tobacco treatment engagement patterns predict cessation outcomes through 18 months and identified baseline participant characteristics predictive of treatment engagement patterns.</div></div><div><h3>Methods</h3><div>Data from a smoking-cessation RCT among women with a history of cervical intraepithelial neoplasia or cervical cancer comparing a 12-month, 6-session motivation and problem solving phone counseling intervention with standard treatment (tobacco quitline referrals) were analyzed. Treatment was completed remotely through self-administered nicotine replacement therapy and telephone counseling. Participants (<em>n</em>=202) were recruited in clinic in Oklahoma City and online nationally and randomly assigned to motivation and problem solving or standard treatment. Data from all 98 participants in motivation and problem solving alive at 18 months were included in the analyses.</div></div><div><h3>Results</h3><div>Controlling for baseline covariates, high total treatment engagement (i.e., completing ≥4 counseling sessions) predicted abstinence at 12 months (OR=11.37; 95% CI=2.34, 55.27; <em>p</em>=0.003) and 18 months (OR=12.71; 95% CI=1.42, 113.40; <em>p</em>=0.023). The best predictor of high total treatment engagement was high early treatment engagement (i.e., completing ≥3 counseling sessions within the first 3 months).</div></div><div><h3>Conclusions</h3><div>Given that few tobacco treatment interventions have demonstrated efficacy among cancer survivors, the current findings suggest a need for careful monitoring of treatment engagement and the possibility of making changes to treatment plans when early engagement is poor.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100361"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651373","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}

{"title":"Understanding Vaccine Disparities in the Bronx, New York, Through a Mixed Methods Analysis of Community and Provider Perspectives","authors":"Brett I. Bell MS ,&nbsp;Sarah Hill MD, MPH ,&nbsp;Justin Olivera MD ,&nbsp;Valerie Fong MD ,&nbsp;Michelle Schumacher PhD ,&nbsp;Madeline Friedman-DeLuca MS ,&nbsp;Tiffany Cheng MD ,&nbsp;Chetali Jain MD ,&nbsp;Tova Niderberg MD ,&nbsp;Taneisha Sinclair MD ,&nbsp;Damara N. Gutnick MD ,&nbsp;Oladimeji A. Oki MD ,&nbsp;Cara Stephenson-Hunter PhD","doi":"10.1016/j.focus.2025.100373","DOIUrl":"10.1016/j.focus.2025.100373","url":null,"abstract":"<div><h3>Introduction</h3><div>COVID-19 exacerbated inequities, impacting Black and Latinx communities in the Bronx, New York. COVID vaccination rates in the Bronx were initially lower, likely owing to vaccine confidence and hesitancy. Despite improved vaccination rates, persistent vaccine nonconfidence poses health equity challenges. The authors explored the factors contributing to vaccine nonconfidence among community members and healthcare providers.</div></div><div><h3>Methods</h3><div>The authors conducted a mixed-methods study with community members and healthcare providers. Thematic analysis was utilized for the conversations and focus groups, and surveys were analyzed quantitatively.</div></div><div><h3>Results</h3><div>Analysis of conversations and focus groups with 43 Bronx community members identified 6 themes: mistrust, autonomy, structural racism, misinformation and disinformation, faith and religion, and social responsibility. Misinformation, disinformation, mistrust, and patient–provider relationship issues significantly influenced vaccine nonconfidence. Structural racism contributed to limited access and racial prejudice. Religious beliefs influenced decision making, highlighting faith-based organizations' importance. Surveys of 48 providers revealed concerns about side effects, rapid vaccine rollout, misinformation, and community influence.</div></div><div><h3>Conclusions</h3><div>This study provides insights into the factors contributing to vaccine nonconfidence in the Bronx. Addressing these issues requires community-centered approaches and interventions that build trust, improve access, and provide accurate information. The authors propose integrating these findings into a novel curriculum to train Bronx medical students to work toward these goals.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100373"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661136","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}

{"title":"Evaluating the Association of Anxiety, Depression, and Diet With Gastrointestinal Pain in Young College Adults","authors":"Kathleen Harris MD ,&nbsp;Mickie L. Powell PhD ,&nbsp;Amandiy N. Liwo MD, MSPH ,&nbsp;Bijal Vashi BS ,&nbsp;Rosianna Gray PhD ,&nbsp;Alan Whitehead MS ,&nbsp;Christopher D. Graham PhD ,&nbsp;James A. Bibb PhD ,&nbsp;Chandler M. McLeod PhD ,&nbsp;Stephen A. Watts PhD ,&nbsp;Gregory D. Kennedy MD, PhD","doi":"10.1016/j.focus.2025.100358","DOIUrl":"10.1016/j.focus.2025.100358","url":null,"abstract":"<div><h3>Introduction</h3><div>College stress can often lead to poor diet choices that negatively impact health. This study explored the association of anxiety, depression, and diet with gastrointestinal pain and gastrointestinal quality of life in college students.</div></div><div><h3>Methods</h3><div>College students (N=312, 96% female, 4% male) enrolled in an introductory biology course completed an online survey to measure anxiety, depression, diet quality, gastrointestinal quality of life, and bowl disease.</div></div><div><h3>Results</h3><div>A total of 52% of students reported abdominal pain the prior year. Associations were found between abdominal pain and diet quality, gastrointestinal quality of life, depression, and anxiety scores. Students reporting abdominal pain reported lower diet scores, worse gastrointestinal quality of life scores, elevated depression, and anxiety scores. Significant predictors of pain were diet and depression.</div></div><div><h3>Conclusions</h3><div>Abdominal pain was significantly associated with diet, depression, and gastrointestinal quality of life. This has important implications for the health and well-being of college students and underscores the need for mental health resources for all college students.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100358"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651374","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}

{"title":"Hospital Utilization in Ambulatory Patients With COVID-19 With History of Tobacco Use","authors":"Niharika Khanna MD, MBBS, DGO ,&nbsp;Carissa S. Kwan MPH ,&nbsp;Elena N. Klyushnenkova PhD ,&nbsp;Michael B. Dark DrPH ,&nbsp;Janaki Deepak MBBS","doi":"10.1016/j.focus.2025.100352","DOIUrl":"10.1016/j.focus.2025.100352","url":null,"abstract":"<div><h3>Introduction</h3><div>Tobacco use is a risk factor for COVID-19 severity. This study explores an association between tobacco use and COVID-19–linked all-cause healthcare utilization in ambulatory patients.</div></div><div><h3>Methods</h3><div>Among 49,588 University of Maryland Medical System patients who tested positive for COVID-19 between February 1, 2020, and October 31, 2021, 20,621 ambulatory patients at first presentation were analyzed using a cross-sectional study. A multinomial multivariable logistic regression model was used to test the impact of tobacco use on hospital and emergency department utilization, with COVID-19 severity, comorbid diagnoses, obesity, chronic steroid use, sex, race, age, and Social Vulnerability Index included as covariates.</div></div><div><h3>Results</h3><div>Of the 20,621 patients, 2,030 (9.84%) were current users; 4,586 (22.24%) were former users; and 14,005 (67.92%) never used tobacco. A total of 16,518 (80.10%) patients remained ambulatory during their COVID-19 illness; 1,786 (8.66%) utilized the emergency department; and 2,317 (11.24%) were admitted to the hospital. Both former (AOR=1.286; 95% CI=1.132, 1.462; <em>p</em>=0.0001) and current (AOR=1.450; 95% CI=1.246, 1.689; <em>p</em>&lt;0.0001) tobacco users were more likely to visit the emergency department than never users. However, only former users were significantly more likely to be hospitalized than never users (AOR=1.320; 95% CI=1.187, 1.468; <em>p</em>&lt;0.0001).</div></div><div><h3>Conclusions</h3><div>Tobacco users with COVID-19 are more likely to have increased healthcare utilization than never users, with current users more likely to use the emergency department and former users more likely to utilize the hospital. Ambulatory patients who use tobacco should receive closer COVID-19 quarantine management to prevent severe outcomes and healthcare overutilization.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100352"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287392","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}

{"title":"Chronic Conditions and Adherence to COVID-19 Preventive Measures in Pitt County, North Carolina","authors":"London B. Grantham MPH ,&nbsp;Aaron M. Kipp PhD, MSPH ,&nbsp;C. Suzanne Lea PhD, MPH ,&nbsp;Kristina L. Simeonsson MD, MSPH","doi":"10.1016/j.focus.2025.100359","DOIUrl":"10.1016/j.focus.2025.100359","url":null,"abstract":"<div><h3>Introduction</h3><div>Individuals with chronic conditions have increased risk of severe COVID-19 infection. Few studies have been conducted in the U.S. regarding their engagement in recommended preventive behaviors. This study examines the associations between chronic conditions and adherence to COVID-19 preventive measures and vaccination intent in a community-based study conducted during the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted in July–December 2020 among residents in Pitt County, North Carolina. Online surveys collected information on demographics; physical health and health behaviors; and COVID-19 preventive behaviors, including vaccination intent. Logistic regression estimated the associations between any chronic condition (versus none) and adherence to each preventive measure (always/most of the time versus half the time or less), adjusting for age, race, biologic sex, smoking, and alcohol. Analyses were repeated with an increasing number of chronic conditions.</div></div><div><h3>Results</h3><div>Among 671 participants, adherence to preventive measures was often &gt;90%. Intent to vaccinate showed evidence of a statistically significant dose–response relationship with each additional number of chronic conditions (AOR=1.19; 95% CI=1.03, 1.37). An increased odds of wearing a facemask in public was also found for any chronic condition, although this did not reach statistical significance (AOR=1.69; 95% CI=0.97, 2.95). The authors did not find significant associations between having a chronic condition and adherence to other preventive measures such as avoiding large crowds or distancing 6 feet apart.</div></div><div><h3>Conclusions</h3><div>Adoption of preventive measures is an essential public health tool during epidemics/pandemics, particularly in the absence of vaccines. The study findings have implications for future public health messaging during a large-scale epidemic based on whether someone is likely engaged with and more trusting of the healthcare system (those with chronic conditions) versus those who are not.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100359"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627807","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}

{"title":"Positive Impact of Health Check-Ups and Guidance in the General Population: A Database-Based Cohort Study in Japan","authors":"Yukio Shimasaki MD, PhD ,&nbsp;Masanori Nojima MD, PhD, MPH","doi":"10.1016/j.focus.2025.100380","DOIUrl":"10.1016/j.focus.2025.100380","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite ongoing debate, the effectiveness of health check-ups as a general population health approach has not been conclusively determined. This retrospective cohort study aimed to evaluate the effect of a health check-up program on various health parameters over a long-term period in accordance with a long-standing practice of health check-ups and guidance in Japan.</div></div><div><h3>Methods</h3><div>Data from 3 prefectures in the Kanto region, encompassing individuals receiving health check-ups (aged 40–74 years) between 2008 and 2018, were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Health outcomes were tracked and analyzed using statistical models, stratifying by stages of behavioral change. The exposures of interest were health guidance (active support and motivational support) and whether or not health check-ups were skipped.</div></div><div><h3>Results</h3><div>The analysis suggests that receiving active or motivational support was associated with reductions in metabolic syndrome indicators among participants with multiple visits (<em>n</em>=2,372,239). In the year after active support, risk reductions were observed for systolic blood pressure ≥130 mmHg (−17% in both sexes), triglycerides ≥150 mg/dL (−27% in both sexes), HbA1c ≥5.6% (−20.7% in men and −17.8% in women), BMI ≥25 (−41.2% and −49.3% in men and women, respectively). Although the magnitude of effect on each indicator was about half that of active support, receiving motivational support was similarly associated with improvements in most indicators. Analysis based on a fuzzy regression discontinuity design provides robustness of the results. When individuals missed health check-ups, the risks of hypertension and high triglycerides were increased by 5%–10% and 5%–20%, respectively. Significant associations were also observed with a reduced risk for the need for antihyperlipidemic medication as well as cardiovascular disease onset and either cerebrovascular or cardiovascular disease onset in men and a reduced risk of cerebrovascular disease onset in women after active support. In addition, undergoing regular check-ups—defined as receiving health check-ups at every opportunity versus 2 times or fewer within 5 years—was associated with a reduced risk of high blood pressure, high triglycerides, elevated HbA1c, and high BMI in both men and women, particularly in individuals covered by national healthcare insurance.</div></div><div><h3>Conclusions</h3><div>Study findings suggest that the health guidance in the Japan’s specific health check-up programs in a general population is associated with improved health outcomes. Regular engagement also appears to be linked to sustained health benefits, highlighting the importance of strategies to enhance the long-term participation.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100380"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676704","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}

{"title":"Use of Nonresponse Adjustment Factors for the Social Determinants and Health Equity Module in the Behavioral Risk Factor Surveillance System, 2022","authors":"Jason Hsia PhD ,&nbsp;Machell Town PhD","doi":"10.1016/j.focus.2025.100321","DOIUrl":"10.1016/j.focus.2025.100321","url":null,"abstract":"<div><h3>Introduction</h3><div>The 2022 Behavioral Risk Factor Surveillance System introduced an optional module called social determinants and health equity to address health-related social needs, thereby supporting studies of social determinants of health. There were nonignorable nonresponses to the social determinants and health equity module.</div></div><div><h3>Methods</h3><div>Nonresponse referred to an interviewee who completed the Behavioral Risk Factor Surveillance System core survey but chose not to answer any of the social determinants and health equity module questions. The study included 2022 Behavioral Risk Factor Surveillance System participants from 39 states; Washington, DC; and 2 territories. The sequential multiple imputation approach was used to impute the household income. Multivariable logistic regression was used to estimate the propensity of not answering any questions in social determinants and health equity. A nonresponse adjustment factor was developed for each state using a propensity score estimated from the logistic regression model.</div></div><div><h3>Results</h3><div>Florida, California, and New Jersey had the highest nonresponse rates at 29.3%, 26.4%, and 25.6%, respectively. After excluding the outlier Puerto Rico, the median value of nonresponse adjustment factors for states ranged from 1.09 in Idaho to 1.67 in Florida.</div></div><div><h3>Conclusions</h3><div>The nonresponse adjustment will mitigate the nonresponse bias in the analysis of social determinants and health equity data. The adjustment factor developed by the authors will be useful for analysts from various states, programs, and institutions studying social determinants and health equity.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 4","pages":"Article 100321"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676705","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}