AJPM focus最新文献

{"title":"Religious Service Attendance, COVID-19 Vaccine Attitudes, and COVID-19 Vaccination Status: A Vaccine Safety Datalink Member Survey, 2022–2023","authors":"Joshua T.B. Williams MD ,&nbsp;Kate Kurlandsky BA ,&nbsp;Kristin Breslin MPH ,&nbsp;Hannah Cruz MPH ,&nbsp;Amy Stein PhD ,&nbsp;Jo Ann Shoup PhD ,&nbsp;Liza M. Reifler MPH ,&nbsp;Matthew F. Daley MD ,&nbsp;Bruno Lewin MD, DTMH ,&nbsp;Kristin Goddard MPH ,&nbsp;Michelle L. Henninger PhD ,&nbsp;Jennifer C. Nelson PhD ,&nbsp;Gabriela Vazquez-Benitez PhD, MSC ,&nbsp;Kayla E. Hanson MPH ,&nbsp;Candace C. Fuller PhD, MPH ,&nbsp;Simon J. Hambidge MD, PhD","doi":"10.1016/j.focus.2025.100404","DOIUrl":"10.1016/j.focus.2025.100404","url":null,"abstract":"<div><h3>Introduction</h3><div>The intersections of religion and vaccination became visible early in the COVID-19 pandemic. Yet, initial pandemic data reporting associations between religiosity and COVID-19 vaccine hesitancy is nearly 5 years old and has methodologic limitations. The aim of this study was to examine the associations between religious service attendance, COVID-19 attitudes, and COVID-19 vaccination at the midpoint of the COVID-19 public health emergency.</div></div><div><h3>Methods</h3><div>A survey of Vaccine Safety Datalink members, purposefully sampled by race, ethnicity, language, and pregnancy status (N=2,856), was administered from November 2022 through February 2023. Data were analyzed through weighting and multivariable logistic regression.</div></div><div><h3>Results</h3><div>Overall, 960 people (33%) responded; 22.8% (95% CI=15.2%, 30.3%) identified as Catholic, and 21.7% (95% CI=14.6%, 28.9%) identified as just Christian. Overall, 28.1% (95% CI=19.4%, 36.8%) reported never attending services, whereas 19.0% (95% CI=12.3%, 25.7%) attended weekly or more often. Compared with never attending services, religious service attendance weekly or more often was associated with increasing bivalent COVID-19 Omicron booster vaccine hesitancy (<em>p</em>&lt;0.01) and decreasing trust in the Centers for Disease Control and Prevention for COVID-19 or COVID-19 vaccine information (<em>p</em>=0.033). Self-reported COVID-19 vaccination ever (AOR=0.65; 95% CI=0.23, 1.84) or any bivalent COVID-19 Omicron booster vaccination (AOR=0.36; 95% CI=0.06, 2.20) were not associated with religious service attendance weekly or more often, compared with never attending services.</div></div><div><h3>Conclusions</h3><div>Observed associations between religious service attendance, vaccine attitudes, and trust in the Centers for Disease Control and Prevention encourage meaningfully redefining public health and faith community partnerships oriented toward COVID-19–related education and disease prevention.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100404"},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889872","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":"Association Between Opioid Dosage Tapering and Opioid Overdose Among Long-Term Higher-Dose Opioid Users","authors":"Hui Zhou PhD ,&nbsp;Katherine J. Pak MS ,&nbsp;Fagen Xie PhD ,&nbsp;Craig K. Chang MD ,&nbsp;Patricia L. Gray PharmD ,&nbsp;Deborah S. Ling-Grant PhD ,&nbsp;Joanna L. Barreras PhD, MSW ,&nbsp;Steven G. Steinberg MD ,&nbsp;Rulin C. Hechter MD, PhD","doi":"10.1016/j.focus.2025.100399","DOIUrl":"10.1016/j.focus.2025.100399","url":null,"abstract":"<div><h3>Introduction</h3><div>There has been a steady decline in the national opioid-dispensing rate in recent years. However, emerging evidence that suggests that abrupt discontinuation of opioids for pain may increase overdose risk. The authors examined associations between prescribed opioid tapering and short-term risk of overdose among adults who have received a new long-term high-dose opioid prescription.</div></div><div><h3>Methods</h3><div>This cohort study included adults (aged ≥18 years) without cancer who were newly prescribed a long-term high-dose opioid, that is, daily dose ≥50 morphine milligram equivalents for ≥183 days, between 2013 and 2018 in Kaiser Permanente Southern California. Opioid tapering within the evaluation period (3 months after being prescribed long-term high-dose opioid) was defined as a reduction ≥10% in monthly morphine milligram equivalents for at least 2 consecutive months compared with baseline morphine milligram equivalents. The association of opioid tapering with incident opioid overdose within 12 months was examined separately using multivariable Cox proportional hazard models with inverse probability of treatment weight. Sensitivity analyses were performed to differentiate the association by tapering rates.</div></div><div><h3>Results</h3><div>Among 12,866 eligible individuals, 7,372 (57.3%) initiated tapering within 3 months. Seventy-five patients had a documented opioid overdose event within 12 months during follow-up, resulting in an incidence rate of 0.022 and 0.013 event per 1,000 person-years, respectively, among the nontapered and tapered cohorts. Tapering within the evaluation period was associated with a 0.48 (hazard ratio=0.52; 95% CI=0.33, 0.82) reduction in risk of overdose in the subsequent 12 months. Sensitivity analyses suggested that a tapering rate of 20%–40% reduction monthly was associated with lower risk.</div></div><div><h3>Conclusions</h3><div>Among patients newly prescribed long-term high-dose opioids, initiating tapering within 3 months was shown to be associated with reduced short-term risk of opioid overdose. However, more studies are needed for further confirmation.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100399"},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159442","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":"Real-World Interventions for Type 2 Diabetes Prevention (REALITY): A Multisite Study to Assess the Effectiveness and Cost-Effectiveness of the National Diabetes Prevention Program","authors":"William H. Herman MD ,&nbsp;Benjamin D. Tyndall PhD ,&nbsp;O. Kenrik Duru MD ,&nbsp;Tannaz Moin MD ,&nbsp;Laura N. McEwen PhD ,&nbsp;Hui Shao PhD ,&nbsp;Ronald T. Ackermann MD ,&nbsp;Sara R. Jacobs PhD ,&nbsp;Simon Neuwahl MS ,&nbsp;Shihchen Kuo PhD ,&nbsp;Ping Zhang PhD ,&nbsp;Meda E. Pavkov MD ,&nbsp;Claudia Villatoro Santos MD, Phd ,&nbsp;REALITY Network","doi":"10.1016/j.focus.2025.100401","DOIUrl":"10.1016/j.focus.2025.100401","url":null,"abstract":"<div><h3>Introduction</h3><div>The National Diabetes Prevention Program was created on the basis of evidence from landmark clinical trials. Its format was modified to facilitate real-world delivery. The long-term effectiveness and cost-effectiveness of the National Diabetes Prevention Program and similar lifestyle change programs in real-world settings remain largely unknown. The Centers for Disease Control and Prevention issued a request for proposals to establish and fund a research network to determine the long-term effectiveness of the National Diabetes Prevention Program in reducing Type 2 diabetes incidence, improving cardiovascular disease risk factors and health-related quality of life, and reducing healthcare service utilization and costs.</div></div><div><h3>Methods</h3><div>Researchers at the University of California Los Angeles, Northwestern University, the University of Michigan, and Emory University, with a coordinating center at RTI International, were funded to examine incident Type 2 diabetes and cardiovascular disease risk factors among a diverse group of National Diabetes Prevention Program and MOVE! enrollees and nonenrollees using electronic health record and administrative claims data. The network will also assess health utility scores by conducting a health-related quality of life survey; examine healthcare utilization, costs, and cost-effectiveness of the National Diabetes Prevention Program and MOVE! for diabetes prevention; and assess the costs of delivering these programs.</div></div><div><h3>Results</h3><div>The study sites have collaborated with RTI and Centers for Disease Control and Prevention to develop common core data elements and standardized study procedures to ensure that each site collects data that can be harmonized across sites.</div></div><div><h3>Conclusions</h3><div>The results of this research will address the objectives of <em>Healthy People 2030</em>; help define the longer-term real-world effectiveness of the National Diabetes Prevention Program; and guide the resources needed to provide and improve program accessibility, sustainability, and effectiveness and improve population-level outcomes.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100401"},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333279","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":"Allostatic Load Patterns by U.S. Citizenship Status and Length of U.S. Residency Among Adults, 2009–2018","authors":"Kazumi Tsuchiya PhD ,&nbsp;Harry O. Taylor PhD ,&nbsp;Shakira F. Suglia ScD ,&nbsp;Michael D. Niño PhD ,&nbsp;Patricia O’Campo PhD ,&nbsp;Ryan T. Demmer PhD","doi":"10.1016/j.focus.2025.100400","DOIUrl":"10.1016/j.focus.2025.100400","url":null,"abstract":"<div><h3>Introduction</h3><div>Emerging research has documented that having a non-citizen status (e.g., temporary visa, undocumented) induces stress and, as a result, has adverse impacts on health. It is unclear whether chronic stress differs by citizenship status and length of U.S. residency using clinical biomarkers. The objective of this study was to examine allostatic load (or cumulative stress) by citizenship status and length of U.S. residency among U.S. adults.</div></div><div><h3>Methods</h3><div>The study sample included 27,705 adult respondents (aged ≥20 years) from the 2009–2018 National Health and Nutrition Examination Surveys. Multivariable Poisson regression models were estimated with U.S. citizenship status (U.S.-born citizens, naturalized citizens, noncitizens) and U.S. residency (shorter: &lt;15 years, longer: ≥15 years) on allostatic load. Allostatic load was defined with summative scores of 10 biomarkers (systolic blood pressure, diastolic blood pressure, high-density lipoprotein, total cholesterol, HbA1c, BMI, albumin, estimated glomerular filtration rate, white blood cell count, and asthma).</div></div><div><h3>Results</h3><div>Naturalized citizens with shorter U.S. residency (females only) and noncitizens with shorter U.S. residency had lower allostatic load than U.S.-born citizens. Naturalized citizens with longer U.S. residency had greater allostatic load than naturalized citizens with shorter U.S. residency (females only). Noncitizens with longer U.S. residency had higher allostatic load than both noncitizens with shorter U.S. residency and naturalized citizens with shorter U.S. residency (females only).</div></div><div><h3>Conclusions</h3><div>This study demonstrates nuanced impacts on allostatic load by citizenship status and length of U.S. residency, with differences by sex. The findings infer that citizenship status contributes to health inequities among immigrants, with greater attention needed to unpack citizenship-stress mechanisms.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100400"},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050065","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":"Comfort With Sharing Food Insecurity Risk for Clinical Care Among Individuals With and Without a Cancer History: Findings From a National Survey","authors":"Steven A. Benyahia BA ,&nbsp;Johnathan Torikashvili BS ,&nbsp;Tejasvi Paturu BA ,&nbsp;Marian Mikhael BS ,&nbsp;Oliver T. Nguyen MSHI ,&nbsp;Jessica Y. Islam PhD, MPH ,&nbsp;Amir Alishahi Tabriz MD, PhD, MPH ,&nbsp;Young-Rock Hong PhD, MPH ,&nbsp;Kea L. Turner PhD, MPH, MA","doi":"10.1016/j.focus.2025.100395","DOIUrl":"10.1016/j.focus.2025.100395","url":null,"abstract":"<div><h3>Introduction</h3><div>Food insecurity negatively affects timely access to care, treatment adherence, quality of life, and survival among cancer survivors. There is limited knowledge about cancer survivors’ comfort with sharing food insecurity risk for clinical care on a national scale. This study aims to assess comfort with sharing food insecurity risk for clinical care among adults with and without a cancer history and to identify factors that may be associated with comfort for sharing food insecurity risk.</div></div><div><h3>Methods</h3><div>Data were obtained from the National Cancer Institute’s Health Information National Trends Survey 6, which was administered from March 7, 2022, to November 8, 2022. Descriptive statistics were calculated to describe the study sample, and sample characteristics were compared by comfort with sharing food insecurity risk for clinical care. A multivariable logistic regression model was conducted to estimate the probability of comfort with sharing food insecurity risk for clinical care. Full-sample weights were applied to calculate population-level estimates, and jackknife replicate weights were applied to calculate SEs.</div></div><div><h3>Results</h3><div>The weighted sample included 188,146,395 participants (6.7% were cancer survivors). Overall, most cancer survivors (64.9%) and adults without a cancer history (58.7%) reported comfort with sharing food insecurity risk for clinical care. Controlling other factors, cancer survivors reported a similar comfort level with sharing food insecurity risk (OR=1.33; 95% CI=0.97, 1.80) compared to individuals without a cancer history. Controlling other factors, individuals reporting at or above the mean patient-centered communication (OR=1.52; 95% CI=1.24, 1.87) were more likely to report comfort with sharing food insecurity risk than individuals reporting below the mean patient-centered communication. Individuals experiencing food insecurity reported a similar comfort level with sharing food insecurity risk (OR=0.93; 95% CI=0.5, 1.31) compared to adults not experiencing food insecurity.</div></div><div><h3>Conclusions</h3><div>Study findings suggest that screening for food insecurity risk may be acceptable to cancer survivors and that patient-centered communication may support participation in food insecurity screening. Future studies are needed to assess cancer survivors’ preferences for sharing food insecurity risk for clinical care (what, when, where, and how data are shared) to ensure that implementation is aligned with patient preferences.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100395"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908700","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":"Integrating Training on Professional Development in Graduate Public Health: Preliminary Insights From a Qualitative Study of MPH Alumni Perspectives","authors":"Yi Gao MPH ,&nbsp;Ariz Keshwani MPH ,&nbsp;Sumreen Akhtar BS ,&nbsp;Leah C. Neubauer EdD, MA, CPH","doi":"10.1016/j.focus.2025.100397","DOIUrl":"10.1016/j.focus.2025.100397","url":null,"abstract":"<div><h3>Introduction</h3><div>For decades, researchers, educators, and policymakers have highlighted the benefits of well-designed course assignments in graduate settings, particularly those supporting learners in applying professional development objectives. Critically reflective course assignments enable learners to practice critical thinking and bridge gaps between theoretical knowledge and practical application. Despite its significant impact on overall competency and workforce outcomes, the integration and evaluation of experiential professional development training in academic public health curricula remain underexplored.</div></div><div><h3>Methods</h3><div>This study examined the perspectives of 13 Master of Public Health global health alumni across 4 cohorts within a Council on Education for Public Health–accredited program. Participants provided insights into key learning outcomes, themes, and the learning impact of engaging in a threaded Professional Development Educational Event and Analysis course assignment. A pragmatic design-guided analysis approach was employed to identify recurring themes and insights.</div></div><div><h3>Results</h3><div>Key learning outcomes included developing the habit of seeking and participating in professional development opportunities and incorporating topics beyond the formal Master of Public Health curriculum. Alumni emphasized the practical advantages of engaging in real-world settings and reflecting on their current and future public health practice.</div></div><div><h3>Conclusions</h3><div>Findings suggest that incorporating innovative, active, and experiential learning opportunities, along with assignments fostering critical reflection, enhances the preparation of a competent and effective public health workforce. This approach bridges the gap between academic training and workforce readiness, offering actionable insights for curriculum development in public health education.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100397"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903195","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":"Submaximal Exercise Testing for Metabolic Flexibility: A Possible Window Into Mitochondrial Function","authors":"Dale I. Lovell PhD ,&nbsp;Max Stuelcken PhD ,&nbsp;Alexander Eagles MD, PhD","doi":"10.1016/j.focus.2025.100398","DOIUrl":"10.1016/j.focus.2025.100398","url":null,"abstract":"","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100398"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903194","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":"Medical Cannabis Utilization Across States With Varying Legal Status","authors":"Deanna Romero BS ,&nbsp;Thomas A. Clobes PhD ,&nbsp;Marshall M. Mee ,&nbsp;Isaac Quintanilla Salinas PhD","doi":"10.1016/j.focus.2025.100396","DOIUrl":"10.1016/j.focus.2025.100396","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite increasing legalization of medical cannabis across the U.S., significant barriers to access and utilization remain, particularly in states with restrictive policies. This study aimed to explore the patterns of medical cannabis use, methods of acquisition, perceived efficacy, and barriers to use, with a focus on how these factors vary by state-level legal status.</div></div><div><h3>Methods</h3><div>A cross-sectional, nationwide survey was administered online during August–September 2023 to a purposefully sampled U.S. adult population. Of 2,824 respondents, 996 individuals self-identified as using cannabis for medical purposes and were included in the final analysis. Measures included demographic variables, cannabis usage patterns, therapeutic indications, perceived effectiveness, and challenges related to legal frameworks and healthcare disclosure.</div></div><div><h3>Results</h3><div>Cannabis use varied significantly by state legal status (chi-square=22.26, <em>p</em>=0.001), with 43.1% of respondents in fully legal states using medical cannabis, compared with 27% in prohibition states. Anxiety (65.9%), depression (48%), and chronic pain (37%) were the most commonly reported conditions. Participants reported diverse consumption methods, with smoking (74.3%) being the most common, although also associated with the highest rate of side effects (chi-square=216, <em>p</em>&lt;0.001). Overall, 32.3% of participants rated medical cannabis as a great deal effective for their primary condition. Legal status also influenced the conditions treated: bipolar disorder was more frequently reported in prohibition states, whereas degenerative neurologic conditions were more common in legal states. Notably, 43.2% of medical cannabis users had not disclosed their use to a primary care provider. Of those, nearly 40% cited fear of provider disapproval, and 27.1% cited concerns about legality—even in states where medical cannabis was permitted. In addition, 45% of those who experienced barriers cited cost as a deterrent, and over half reported using less medical cannabis owing to these challenges.</div></div><div><h3>Conclusions</h3><div>The findings highlight significant variations in medical cannabis usage and associated challenges based on state legal frameworks. Barriers such as cost and fear of disclosure underscore the need for clearer communication and policy reforms to improve access and patient–provider dialog. Further research is warranted to explore the clinical implications of medical cannabis use across diverse populations.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100396"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010336","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":"Examining Changes in Coalition Dynamics to Support Opioid Fatality Reduction","authors":"Darcy A. Freedman PhD ,&nbsp;Hannah K. Knudsen PhD ,&nbsp;Rouba A. Chahine PhD ,&nbsp;Timothy Hunt PhD ,&nbsp;Emmanuel Oga MD, MPH ,&nbsp;Alison M. Aldrich MPH ,&nbsp;Sara Roberts MSSA ,&nbsp;LaShawn Glasgow DrPH ,&nbsp;Bryan R. Garner PhD ,&nbsp;Sylvia Tan MS ,&nbsp;JaNae Holloway MSPH ,&nbsp;Timothy Huerta PhD ,&nbsp;Carol Baden ,&nbsp;Pamela Salsberry PhD ,&nbsp;Bridget Freisthler PhD","doi":"10.1016/j.focus.2025.100394","DOIUrl":"10.1016/j.focus.2025.100394","url":null,"abstract":"<div><h3>Introduction</h3><div>The goal was to evaluate how changes in coalition capacity and leadership were related to adoption and reach of overdose education and naloxone distribution in communities participating in the HEALing Communities Study.</div></div><div><h3>Study Design</h3><div>This was a multisite, cluster randomized waitlist-controlled trial; only analysis of Wave 1 data was performed.</div></div><div><h3>Setting/Participants</h3><div>Longitudinal analysis of cross-sectional surveys completed by coalition members from 33 communities in 4 states based on data collected from January 2021 to June 2022.</div></div><div><h3>Intervention</h3><div>Study coalitions (<em>n</em>=33) received the Communities That HEAL intervention to support expansion of evidence-based practices, including overdose education and naloxone distribution, to curtail opioid-related fatalities.</div></div><div><h3>Main Outcomes</h3><div>Coalition capacity and leadership were measured at the midpoint and end of the intervention using validated scales averaged at the community level. Community adoption and reach of overdose education and naloxone distribution were assessed as changes in the rate of community partners implementing overdose education and naloxone distribution strategies and naloxone units distributed from midpoint to the end of the intervention. Negative binomial and linear models, adjusted for baseline characteristics, were conducted in 2024.</div></div><div><h3>Results</h3><div>Increases in general coalition capacity, adjusted for changes in overdose education and naloxone distribution–specific coalition capacity, were significantly associated with higher rates of community partners engaged in overdose education and naloxone distribution implementation. There was a 56% increase over time in community partners engaged in overdose education and naloxone distribution implementation per unit increase in general capacity scores among coalitions receiving Communities That HEAL. Changes in coalition leadership and capacity did not significantly correlate with changes in naloxone being distributed.</div></div><div><h3>Conclusions</h3><div>Strengthening general coalition capacity is vital for increasing community partner engagement to expand adoption of overdose education and naloxone distribution. Findings support ongoing investment in coalition capabilities to enhance the effectiveness of public health interventions seeking to reduce opioid-related fatalities. Efforts to strengthen general capacities of coalitions, such as data-informed decision making and collective goalsetting, may accelerate implementation and scaling of evidence-based practices such as overdose education and naloxone distribution.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100394"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050066","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":"The Effects of Cannabis Access Laws on Sleep in the U.S.","authors":"Carol Xu BA,&nbsp;Zachary Sturman JD, PhD","doi":"10.1016/j.focus.2025.100387","DOIUrl":"10.1016/j.focus.2025.100387","url":null,"abstract":"<div><h3>Introduction</h3><div>The global average sleep duration has declined significantly, with substantial health and economic consequences. Given the increasing legalization of cannabis for medical and recreational use, this study examines the association between cannabis access laws and sleep duration in the U.S.</div></div><div><h3>Methods</h3><div>A two-way-fixed-effects difference-in-differences regression was used to analyze the impact of medical and recreational cannabis laws on sleep duration. Data were drawn from the American Time Use Survey, including 175,493 respondents aged 18–65 years from 2003 to 2021. Subgroup analyses were performed on sex and age groups. Analyses were conducted in 2024.</div></div><div><h3>Results</h3><div>Recreational cannabis laws were associated with an average reduction in sleep of 5.37 minutes per night (99% CI=0.91, 9.83), whereas medical cannabis laws had no significant effect on sleep duration. Recreational cannabis laws were associated with individuals falling asleep 7.14 minutes later (99% CI=3.12, 11.16) with no change in wake-up times, and only the eating and drinking category of time use was significantly affected, with an increase of 1.90 minutes. These findings were concentrated in males and those aged ≥25 years.</div></div><div><h3>Conclusions</h3><div>The implementation of recreational cannabis laws has a negative effect on sleep duration, highlighting the need for further research on the broad impacts of cannabis access on health.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100387"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010214","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}