AJPM focus最新文献_第9页

Trends in Breast Cancer Screening Between Medicare Beneficiaries With and Without Food Insecurity 有无食品不安全的医疗保险受益人之间乳腺癌筛查的趋势

AJPM focus

Pub Date : 2025-07-02 DOI: 10.1016/j.focus.2025.100386

Yeunkyung Kim PhD , Jihye Kim PhD , Sungchul Park PhD , Colleen Heflin PhD , Hyunjee Kim PhD , Yue Li PhD

Introduction

Despite the importance of food insecurity, there remains limited data on recent trends in disparities between individuals with and without food insecurity in the receipt of breast cancer screening. The authors examined national trends in breast cancer screening rates between female Medicare beneficiaries with and without food insecurity as well as determined whether access to breast cancer screening was disrupted by the COVID-19 pandemic.

Methods

The authors performed repeated cross-sectional analyses on 2018–2021 data of Medicare Current Beneficiary Survey Public Use Files. Study sample included 4,459 (in 2018); 4,565 (in 2019); 4,334 (in 2020); and 3,966 (in 2021) noninstitutionalized female Medicare beneficiaries. After applying survey weights, this corresponds to 119,746,358 total beneficiary-years over the 2018–2021 period. The authors fitted a logistic regression model to assess the differences in the receipt of breast cancer screening between female Medicare beneficiaries with and without food insecurity over time.

Results

The rate of breast cancer screening between female beneficiaries with and without food insecurity was not statistically different from 2018 to 2020. However, in 2021, female beneficiaries with food insecurity had a rate that was 8.1 percentage points (95% CI= −15.2, −1.0) lower than that of female beneficiaries without food insecurity.

Conclusions

These findings suggest the importance for identifying female Medicare beneficiaries who are at increased risk of food insecurity and missed breast cancer screening in clinical settings during and after the COVID-19 pandemic.

尽管粮食不安全很重要，但关于接受乳腺癌筛查的粮食不安全人群和非粮食不安全人群之间差异的最新趋势，数据仍然有限。作者研究了有和没有粮食不安全的女性医疗保险受益人之间乳腺癌筛查率的全国趋势，并确定乳腺癌筛查是否因COVID-19大流行而中断。方法对2018-2021年医疗保险现行受益人调查公共使用档案数据进行重复横断面分析。研究样本包括4459例（2018年）；4565人（2019年）；4334人（2020年）；和3,966名（2021年）非机构医疗保险女性受益人。在应用调查权重后，这相当于2018-2021年期间的总受益年为119,746,358年。作者拟合了一个逻辑回归模型来评估有和没有食品不安全的女性医疗保险受益人之间接受乳腺癌筛查的差异。结果2018年至2020年，有无粮食不安全的女性受益人乳腺癌筛查率无统计学差异。然而，2021年，粮食不安全的女性受益人的比率比没有粮食不安全的女性受益人低8.1个百分点（95% CI= - 15.2, - 1.0）。这些发现表明，在2019冠状病毒病大流行期间和之后，确定女性医疗保险受益人面临更高的粮食不安全风险和在临床环境中错过乳腺癌筛查的重要性。

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引用次数: 0

State Medical Cannabis Policy Implementation and Racial Disparities in Opioid Prescribing Among Medicare Beneficiaries: A Policy Impact Analysis 国家医疗大麻政策实施和种族差异在阿片类药物处方在医疗保险受益人：政策影响分析

AJPM focus

Pub Date : 2025-07-02 DOI: 10.1016/j.focus.2025.100391

Tyler J. Dunn PhD , Erin Holmes PhD , Yi Yang PhD , John P. Bentley PhD , Saim Kashmiri PhD , Sujith Ramachandran PhD

Introduction

U.S. cannabis policies have a history of racial disparities, highlighting the need for research surrounding racial inequities, particularly within the context of medicalization of cannabis and opioid prescribing. This study evaluated racial disparities in the relationship between state-level medical cannabis policy implementation and changes in opioid-prescribing patterns among Medicare beneficiaries.

Methods

Utilizing Medicare claims data from 2012 to 2015, beneficiaries aged ≥65 years were categorized into 3 state categories: Medical marijuana law implementation states, existing medical marijuana law states, and nonmedical marijuana law states. A difference-in-difference analysis was used to determine whether race moderated the relationship between medical cannabis policy implementation and opioid doses filled before and after policy implementation.

Results

A total of 449,336 Medicare beneficiaries were included in the study, comprising 387,713 White individuals (86.3%) and 61,623 racial minority individuals (13.7%). Nearly half of all (49.3%) beneficiaries received at least 1 opioid prescription. White individuals were significantly more likely to receive at least 1 opioid prescription than racial minorities (49.7% vs 46.8%, p<0.001). Morphine milligram equivalent per patient per month significantly increased for both White and racial minority individuals in all state categories, except for racial minority individuals in the medical marijuana law states. There were no significant differences in opioid-prescribing changes between White and racial minority individuals between state categories.

Conclusions

The study found no clear indication of racial disparities in the impact of medical cannabis policies on opioid prescribing. Future research should focus on access to medical cannabis and prescriber attitudes toward treating racial minority patients experiencing pain with cannabis.

IntroductionU.S。大麻政策有种族不平等的历史，突出表明需要围绕种族不平等进行研究，特别是在大麻医学化和阿片类药物处方的背景下。本研究评估了州一级医用大麻政策实施与医疗保险受益人阿片类药物处方模式变化之间关系的种族差异。方法利用2012 - 2015年医疗保险索赔数据，将年龄≥65岁的受益人分为医用大麻法律实施州、现有医用大麻法律实施州和非医用大麻法律实施州3大类。采用差异中差异分析来确定种族是否调节了医疗大麻政策实施前后阿片类药物剂量之间的关系。结果共纳入449,336名医疗保险受益人，其中白人387,713人（86.3%），少数族裔61,623人（13.7%）。近一半（49.3%）受益人至少获得了1份阿片类药物处方。白人比少数族裔更有可能接受至少1份阿片类药物处方（49.7% vs 46.8%, p < 0.001）。除了医用大麻合法化州的少数种族个体外，所有州的白人和少数种族个体每月每个患者吗啡毫克当量都显著增加。在各州类别中，白人和少数种族个体的阿片类药物处方变化无显著差异。研究发现，在医用大麻政策对阿片类药物处方的影响方面，没有明显的种族差异迹象。未来的研究应侧重于医用大麻的可及性和处方医师对治疗因大麻而疼痛的少数种族患者的态度。

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引用次数: 0

Racial and Ethnic Disparities in Cannabis Use Among U.S. Youth Who Use Tobacco: Findings From the Population Assessment of Tobacco and Health Study 吸烟的美国青少年大麻使用的种族和民族差异：烟草和健康研究的人口评估结果

AJPM focus

Pub Date : 2025-07-01 DOI: 10.1016/j.focus.2025.100392

Allison A. Temourian PhD , Pamela M. Ling MD, MPH , Vuong V. Do PhD , Nhung Nguyen PhD

Introduction

Limited research on youth tobacco use addresses cannabis use across different tobacco products and racial/ethnic subgroups. This study examines these patterns of cannabis use among youth who use tobacco using 6 waves of nationally representative data.

Methods

This study analyzed the Population Assessment of Tobacco and Health Study data Waves 1–6 (during 2013–2021) in 2024. The authors conducted cross-sectional weighted analyses for each wave. The authors estimated past 30-day use of cannabis among youth who reported past 30-day use of any tobacco, combustible tobacco, and e-cigarette for the total sample and for each racial and ethnic group (Hispanic, non-Hispanic White, non-Hispanic Black, and non-Hispanic other).

Results

Across 6 waves, cannabis-use prevalence was over 36% among youth who used any tobacco product, over 40% among those who used combustible tobacco, and 36% among those who used e-cigarettes. There were racial/ethnic disparities in cannabis use among youth who used e-cigarettes, with non-Hispanic Black, non-Hispanic other, and Hispanic youth reporting the highest cannabis-use prevalence. There were no significant racial/ethnic differences in cannabis use among youth who used combustible tobacco.

Conclusions

Cannabis use is highly prevalent among youth who use tobacco, with significant disparities by tobacco product and race/ethnicity. The disproportionately high prevalence of cannabis use among non-White youth highlights the need for tailored interventions to address these disparities in cannabis and tobacco use among youth.

关于青少年烟草使用的有限研究涉及不同烟草产品和种族/族裔亚群体的大麻使用情况。本研究利用6波具有全国代表性的数据，对吸烟青少年使用大麻的模式进行了调查。方法本研究分析了2024年第1-6波（2013-2021年）烟草与健康研究的人口评估数据。作者对每一波进行了截面加权分析。作者估计了过去30天使用任何烟草、可燃烟草和电子烟的青少年中过去30天的大麻使用情况，包括总样本和每个种族和族裔群体（西班牙裔、非西班牙裔白人、非西班牙裔黑人和非西班牙裔其他）。结果在6个浪潮中，使用任何烟草产品的青少年中大麻使用率超过36%，使用可燃烟草的青少年中大麻使用率超过40%，使用电子烟的青少年中大麻使用率超过36%。在使用电子烟的青少年中，大麻的使用存在种族/民族差异，非西班牙裔黑人、非西班牙裔其他和西班牙裔青少年报告的大麻使用率最高。在使用可燃烟草的青少年中，大麻的使用没有明显的种族/民族差异。结论青少年烟草使用中大麻使用非常普遍，且烟草产品和种族/民族差异显著。非白人青年吸食大麻的比例高得不成比例，这突出表明需要采取有针对性的干预措施，以解决青年吸食大麻和烟草方面的这些差异。

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引用次数: 0

Cost-Effectiveness Analysis of Implementing a Multisectoral Program for Colorectal Cancer Screening in an African American Community 在非裔美国人社区实施多部门结直肠癌筛查项目的成本效益分析

AJPM focus

Pub Date : 2025-06-30 DOI: 10.1016/j.focus.2025.100388

Tzeyu L. Michaud PhD , Paul A. Estabrooks PhD , Hongying Daisy Dai PhD , Keyonna M. King Dr.PH , John W. Ewing Jr. MS , Kayode T. Olabanji Bpharm, MSc , Su-Hsin Chang PhD, MS , Jungyoon Kim PhD

Introduction

To improve colorectal cancer screening uptake among African Americans, the authors collaborated with a public service agency (i.e., Douglas County Treasurers’ Office) and other community and healthcare partners to implement a multicomponent fecal immunochemical test intervention. The objectives of this study are to (1) determine the costs and cost-effectiveness of the community-based fecal immunochemical test intervention between the 2 different types of provision strategies: on-site distribution of fecal immunochemical test versus mailing of fecal immunochemical test upon request; and (2) estimate the budgetary impact if this program is sustained by community organizations or the local health department.

Methods

Using data from a community colorectal cancer screening outreach trial collected between January 3, 2022, and April 4, 2022, the authors conducted a cost-effectiveness analysis and a budget impact analysis of a multicomponent colorectal cancer screening program. Cost-effectiveness analysis was evaluated using 2 measures: an average implementation cost-effectiveness ratio using the effect and cost data of the overall colorectal cancer screening program and an incremental cost-effectiveness ratio when comparing the on-site distribution with mailing of fecal immunochemical test upon request. For the budget impact analysis, the authors used the process map developed for the outreach program workflow to guide the budget impact estimate of the on-site distribution. The authors further conducted a sensitivity analysis to estimate 1-year replication costs of the on-site distribution strategy.

Results

The overall community outreach program for colorectal cancer screening totaled $14,541, with labor costs of $12,757 and nonlabor costs of $1,784 for the 3-month period. Individually, total costs for on-site distribution (n=110) and mailing of fecal immunochemical test upon request (n=99) strategies were estimated at $8,629 and $5,912, respectively. The overall average implementation cost-effectiveness ratios were $70 per person enrolled, $246 per participant screened, and $969 per completed participant who tested positive. The incremental cost-effectiveness ratio was $129 for an additional percentage-point increase in colorectal cancer screening rates and $109 per additional person who completed the screening. The total replication cost of the on-site distribution of fecal immunochemical test kits was estimated at $7,329 over a 1-year budget cycle.

Conclusions

The on-site fecal immunochemical testing kit distribution is an effective, practical, relatively low-cost community outreach strategy to improve colorectal cancer screening rates among African American communities. Future studies should explore resources for sustainability and uptake in different settings.

为了提高非裔美国人对结直肠癌筛查的接受程度，作者与一家公共服务机构（即道格拉斯县财务办公室）以及其他社区和医疗保健合作伙伴合作，实施了一项多组分粪便免疫化学测试干预。本研究的目的是(1)在两种不同的提供策略之间确定社区粪便免疫化学测试干预的成本和成本效益：现场分发粪便免疫化学测试与根据要求邮寄粪便免疫化学测试；(2)如果该项目由社区组织或当地卫生部门维持，估计预算影响。方法利用2022年1月3日至2022年4月4日收集的社区结直肠癌筛查外展试验数据，作者对多组分结直肠癌筛查项目进行了成本效益分析和预算影响分析。成本-效果分析采用2项指标进行评估：使用整体结直肠癌筛查项目的效果和成本数据进行平均实施成本-效果比，以及根据要求比较现场分发和邮寄粪便免疫化学测试的增量成本-效果比。对于预算影响分析，作者使用为外展计划工作流程开发的流程图来指导现场分发的预算影响评估。作者进一步进行了敏感性分析，以估计现场分发策略的1年复制成本。结果整个结直肠癌筛查的社区外展项目总计14541美元，在3个月的时间里，人工成本为12757美元，非人工成本为1784美元。单独而言，现场分发（n=110）和邮寄粪便免疫化学测试（n=99）策略的总费用估计分别为8,629美元和5,912美元。总体平均实施成本-效果比为每位参与者70美元，每位筛查参与者246美元，每位检测呈阳性的参与者969美元。结直肠癌筛查率每增加一个百分点，增加的成本效益比为129美元，每增加一个完成筛查的人，增加的成本效益比为109美元。在1年预算周期内，现场分发粪便免疫化学测试包的总复制费用估计为7 329美元。结论现场发放粪便免疫化学检测试剂盒是一种有效、实用、成本相对较低的社区外展策略，可提高非洲裔美国人社区结直肠癌筛查率。今后的研究应探讨资源在不同环境下的可持续性和吸收性。

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引用次数: 0

Disinformation From Within and Brandolini’s Law: A Call to Time-Consuming Action 来自内部的虚假信息和布兰多里尼定律：呼吁采取耗时的行动

AJPM focus

Pub Date : 2025-06-30 DOI: 10.1016/j.focus.2025.100389

Casey Scott Husser MD

引用次数: 0

COVID-19 Pandemic, Parental Protective Factors, and Substance Use Onset Among Early Adolescents in Appalachia COVID-19大流行、父母保护因素和阿巴拉契亚地区早期青少年物质使用的发生

AJPM focus

Pub Date : 2025-06-28 DOI: 10.1016/j.focus.2025.100390

Hannah M. Layman PhD , Christa L. Lilly PhD , Geri A. Dino PhD , Traci D. Jarrett PhD , Carrie W. Rishel PhD , Alfgeir L. Kristjansson PhD

Introduction

During the pandemic, adolescents spent significantly more time at home with their families than during nonpandemic eras. This change could be beneficial because time spent with family has been linked to positive health outcomes; however, given the stress and strains accompanied by COVID-19, research has yet to assess the potential effect that increased family time may have had on youth substance use onset and development during this strenuous period.

Methods

School-based survey data from 2,322 students in the Young Mountaineer Health Study were collected during the fall of 2020 (Wave 1), spring of 2021 (Wave 2), and fall of 2021 (Wave3) and were used to create logistic regression models to identify variables at Wave 1 that related to 3 types of substance use onset in the sample at Wave 2 and Wave 3. The study’s primary independent variable was COVID-19–related emotional impact (scale range: 5–25).

Results

Average age of participants at Wave 1 was 11.50 years (males=42.9%). COVID-19–related emotional impact was positively associated with an increase in cigarette (AOR=1.06, p=0.008) and E-cigarette use onset (AOR=1.06, p<0.001). Parental monitoring (AOR=0.89, p=0.013) and parental social support (AOR=0.93, p=0.026) were associated with a decreased initiation of cigarette use, respectively.

Conclusions

The authors found that higher levels of COVID-19–related emotional impact were predictive of increased cigarette and E-cigarette onset but were only marginally related to alcohol use onset. The authors also identified that increased parental monitoring and parental social support might decrease the onset risks for cigarette and alcohol use among early adolescents.

大流行期间，青少年与家人呆在家里的时间明显多于非大流行时期。这种变化可能是有益的，因为与家人共度的时间与积极的健康结果有关；然而，鉴于COVID-19带来的压力和紧张，研究尚未评估在这一艰苦时期，家庭时间的增加可能对青少年药物使用的发生和发展产生的潜在影响。方法收集了2020年秋季（第1波）、2021年春季（第2波）和2021年秋季（第3波）青年登山运动员健康研究中2322名学生的学校调查数据，并用于创建逻辑回归模型，以确定第1波中与第2波和第3波样本中3种物质使用相关的变量。该研究的主要自变量是与covid -19相关的情绪影响（量表范围：5-25）。结果第一波参与者的平均年龄为11.50岁（男性占42.9%）。与covid -19相关的情绪影响与卷烟数量增加（AOR=1.06, p=0.008）和电子烟使用次数增加（AOR=1.06, p= 0.001）呈正相关。父母监督（AOR=0.89, p=0.013）和父母社会支持（AOR=0.93, p=0.026）分别与卷烟开始使用减少相关。作者发现，与covid -19相关的较高水平的情绪影响预示着香烟和电子烟的发病增加，但与酒精的发病仅略有相关。作者还发现，增加父母的监督和父母的社会支持可能会降低青少年早期吸烟和饮酒的发病风险。

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引用次数: 0

Associations Between Transportation Barriers in the Context of Other Social Needs and Cancer Screening Adherence 其他社会需求背景下的交通障碍与癌症筛查依从性之间的关系

AJPM focus

Pub Date : 2025-06-28 DOI: 10.1016/j.focus.2025.100385

Anna M. Morenz MD, MPH , Gloria D. Coronado PhD , Lingmei Zhou MS , Celia Valenzuela MD , Joshua M. Liao MD, MSc

Introduction

Socioeconomic inequities in breast and cervical cancer screening persist and may be driven by unmet social needs, such as transportation barriers. The association between transportation barriers and screening adherence, while adjusting for other social needs, remains poorly characterized.

Methods

A cross-sectional analysis of 2023 National Health Interview Survey data was conducted from October to December 2024. Multivariable logistic regression was used to assess associations between transportation barriers and breast and cervical cancer screening adherence.

Results

A total of 5,851 (survey-weighted 42.3 million) and 8,461 (survey-weighted 78.6 million) individuals were eligible for breast and cervical cancer screening, respectively. In adjusted analyses, transportation barriers were associated with lower likelihood of breast cancer screening (AOR=0.6; 95% CI=0.5, 0.9) but no difference in the likelihood of cervical cancer screening (AOR=0.9; 95% CI=0.7, 1.1). Low income, lack of health insurance, and low levels of formal education were also associated with lower adherence for both breast and cervical cancer screening.

Conclusion

After accounting for other social needs, transportation barriers are associated with lower likelihood of breast cancer screening—an inequity that may benefit from public health and healthcare interventions. Additional work is needed to understand the relationship between SES and cervical cancer screening adherence to inform future interventions.

乳腺癌和宫颈癌筛查中的社会经济不平等现象持续存在，可能是由于未满足的社会需求（如交通障碍）造成的。交通障碍和筛查依从性之间的联系，在调整其他社会需求的同时，仍然缺乏特征。方法对2024年10月至12月的2023年全国健康访谈调查数据进行横断面分析。多变量logistic回归用于评估交通障碍与乳腺癌和宫颈癌筛查依从性之间的关系。结果共有5851人（调查加权4230万人）和8461人（调查加权7860万人）符合乳腺癌和宫颈癌筛查的条件。在调整分析中，交通障碍与乳腺癌筛查可能性降低相关（AOR=0.6; 95% CI=0.5, 0.9），但与宫颈癌筛查可能性无差异（AOR=0.9; 95% CI=0.7, 1.1）。低收入、缺乏医疗保险和正规教育水平低也与乳腺癌和宫颈癌筛查依从性较低有关。在考虑了其他社会需求后，交通障碍与乳腺癌筛查的可能性较低有关，这种不平等可能受益于公共卫生和医疗保健干预。需要进一步的工作来了解SES和宫颈癌筛查依从性之间的关系，以便为未来的干预措施提供信息。

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引用次数: 0

Assessment of Restaurant Beverage Offerings on Children’s Menus in New Orleans and Baton Rouge, Louisiana 对新奥尔良和路易斯安那州巴吞鲁日儿童菜单上的餐馆饮料产品的评估

AJPM focus

Pub Date : 2025-06-26 DOI: 10.1016/j.focus.2025.100382

Lisa P. Hofmann MPH , Yin Wang PhD , Melissa Fuster PhD , Charles Stoecker PhD , Elizabeth Gollub PhD , Megan Knapp PhD

Introduction

Childhood obesity and related health consequences are associated with sugar-sweetened beverage consumption and present significant health challenges in the U.S., particularly among minoritized and low-income populations. Louisiana, with some of the highest obesity and cardiometabolic disease rates in the U.S., exemplifies these concerns. Dining out increases sugar-sweetened beverage intake and underscores the need for interventions.

Methods

This observational study examines the proportion of restaurants offering beverages with children’s meals on printed and QR code menus, the types of beverages they offer, and correlates of offering these beverages across 287 restaurants in New Orleans, Louisiana, before its healthy default beverage policy was implemented and in Baton Rouge, Louisiana, which does not have a healthy default beverage policy. On-site environmental assessments were conducted in restaurants offering children’s menus.

Results

Only 14.6% of restaurants with children’s meals offered only healthy default beverage options, 39.4% offered sugar-sweetened beverages, and 46% did not specify children’s beverages on their menus. Logistic regression analysis indicated that restaurants categorized as fast food, affiliated with a chain, or offering children's meals with age restrictions were significantly more likely to include beverages in their children's meals. Furthermore, chain and fast-food restaurants were more likely than fast-casual restaurants to include only healthy default beverages on the children’s menus.

Conclusions

Ultimately, this research contributes to the broader discourse on improving nutritional environments in restaurant settings and underscores the need for evidence-based interventions to mitigate the impact of sugar-sweetened beverage consumption on childhood obesity and health outcomes. The findings provide a foundation for future studies evaluating the effectiveness of healthy default beverage policies.

儿童肥胖及相关健康后果与含糖饮料消费有关，在美国，尤其是少数族裔和低收入人群中，这是一个重大的健康挑战。路易斯安那州是美国肥胖和心脏代谢疾病发病率最高的州之一，是这些担忧的例证。外出就餐增加了含糖饮料的摄入量，强调了干预的必要性。本观察性研究考察了路易斯安那州新奥尔良市实施健康默认饮料政策之前和路易斯安那州巴吞鲁日市没有实施健康默认饮料政策之前的287家餐馆中，在印刷和二维码菜单上提供儿童餐饮料的餐馆比例、他们提供的饮料类型以及提供这些饮料的相关性。在提供儿童菜单的餐厅进行了现场环境评估。结果只有14.6%的儿童餐餐厅只提供健康的默认饮料选项，39.4%的餐厅提供含糖饮料，46%的餐厅没有在菜单上注明儿童饮料。Logistic回归分析表明，被归类为快餐、连锁店附属或提供有年龄限制的儿童餐的餐馆，更有可能在儿童餐中加入饮料。此外，连锁店和快餐店比快速休闲餐厅更有可能在儿童菜单上只提供健康的默认饮料。最终，本研究有助于更广泛地讨论改善餐厅环境的营养环境，并强调需要基于证据的干预措施来减轻含糖饮料消费对儿童肥胖和健康结果的影响。研究结果为未来评估健康默认饮料政策有效性的研究提供了基础。

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引用次数: 0

Evaluating Whole Health Engagement Among Homeless-Experienced Veterans in an Emergency Shelter: A Quality Improvement Study 评估紧急避难所中无家可归经验丰富的退伍军人的整体健康参与：一项质量改进研究

AJPM focus

Pub Date : 2025-06-25 DOI: 10.1016/j.focus.2025.100383

Tawny Saleh MD, MS , Lillian Gelberg MD, MSPH, FAAFP , Melissa Y. Chinchilla PhD, MCP, MSHPM , Jennifer E. Allen ANP-BC, MSN , Kristen L. Connor MSPH , Lisa Altman MD , Peter Capone-Newton MD, PhD, MPH

Introduction

Whole Health programs aim to integrate mental, physical, and social health to improve veteran well-being. Homeless-experienced veterans may face barriers to engagement owing to housing instability and comorbidities. This study evaluated Whole Health participation among homeless-experienced veterans at the VA Greater Los Angeles Care, Treatment, and Rehabilitation Service site compared with that among the broader VA Greater Los Angeles Healthcare System veteran population.

Methods

A retrospective quality improvement study analyzed Whole Health participation among 619 homeless-experienced veterans at Care, Treatment, and Rehabilitation Service; 25,520 Whole Health participants at VA Greater Los Angeles Healthcare System; and 84,358 total VA Greater Los Angeles Healthcare System veterans. Chi-square and t-tests assessed demographic and health differences. Thematic analysis of personal health inventory reflections explored wellness priorities.

Results

Whole Health participation was higher among Care, Treatment, and Rehabilitation Service homeless-experienced veterans (42%) than among the broader VA Greater Los Angeles Healthcare System Whole Health population (22%) (p<0.001). Whole Health participants at Care, Treatment, and Rehabilitation Service were older (56.8±13.4 vs 53.8±13.7 years; p=0.006), with different age group distribution (p=0.02). Chronic pain, post-traumatic stress disorder, depression, and substance use were more prevalent among homeless-experienced veterans than among the general veteran population (p<0.001). Early Whole Health engagement was associated with longer shelter stays. Personal health inventory themes included personal development (88%), housing (68%), and family/social connection (56%).

Conclusions

Whole Health programs may be effective and acceptable among homeless-experienced veterans when integrated into supportive housing environments.

全面健康计划旨在整合心理、身体和社会健康，以改善退伍军人的福祉。由于住房不稳定和合并症，有无家可归经验的退伍军人可能面临参与的障碍。本研究评估了退伍军人管理局大洛杉矶护理、治疗和康复服务站的无家可归经验退伍军人的整体健康参与情况，并将其与更广泛的退伍军人管理局大洛杉矶医疗保健系统退伍军人人口进行了比较。方法采用回顾性质量改善研究，分析619名在护理、治疗和康复服务中心工作的退伍军人的整体健康参与情况；VA大洛杉矶医疗保健系统的25,520名Whole Health参与者；以及84,358名退伍军人管理局大洛杉矶医疗保健系统退伍军人。卡方检验和t检验评估了人口统计学和健康差异。个人健康清单反映的专题分析探讨了健康优先事项。结果护理、治疗和康复服务无家可归的退伍军人的整体健康参与率（42%）高于退伍军人管理局大洛杉矶医疗保健系统整体健康人群（22%）（p<0.001）。护理、治疗和康复服务的全健康参与者年龄较大(56.8±13.4岁vs 53.8±13.7岁；P =0.006)，不同年龄组分布差异有统计学意义（P =0.02）。慢性疼痛、创伤后应激障碍、抑郁和药物使用在无家可归的退伍军人中比在普通退伍军人中更为普遍（p<0.001）。早期全面健康参与与较长的庇护所停留时间有关。个人健康调查主题包括个人发展（88%）、住房（68%）和家庭/社会关系（56%）。结论将整体健康计划融入支持性住房环境中，对有无家可归经历的退伍军人可能是有效和可接受的。

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引用次数: 0

Heterogeneity in BMI Percentile and Weight Status Among Asian American Youth 亚裔美国青年BMI百分位数和体重状况的异质性

AJPM focus

Pub Date : 2025-06-25 DOI: 10.1016/j.focus.2025.100381

Darcy M. Van Deventer BS , Margo A. Sidell SCD , Catherine Lee PhD , Deborah R. Young PhD , Monique M. Hedderson PhD , Deborah A. Cohen MD, MPH , Emily F. Liu MPH , Lee J. Barton MS , Galina Inzhakova MPH , Bing Han PhD

Introduction

There are important and understudied health differences among subgroups of Asian Americans. The authors examined differences in BMI percentile and body weight status among Asian American youth.

Methods

The authors conducted a retrospective cohort study using electronic health records in 2011–2020 from 2 integrated healthcare systems in California. Single-race, non-Latino White, and Asian American youth aged 2–19 years during the study period were included. Asian American subgroups included East, South, Southeast, and unidentified. Whites were the reference group. Study outcomes included age- and sex-specific BMI percentile and body weight status category (underweight, overweight or obesity, obesity). Series of 1-sample estimates for study outcomes were calculated by calendar year and biological ages.

Results

A total of 395,134 youth were included in the study (mean [SD] age at baseline of 8.26 [5.61] years; mean [SD] BMI percentile of 53.8 [30.3]), including 23,183 East Asians; 34,783 South Asians; and 34,738 Southeast Asians. Southeast Asians had the highest age-adjusted prevalence of obesity (2019 estimate: 13.3%) than East Asians (5.2%), South Asians (7.8%), and Whites (11.8%). South Asians had the highest prevalence of underweight (2019 estimate: 11.8%) than East Asians (5.5%), Southeast Asians (3.9%), and White (3.6%).

Conclusions

Substantial heterogeneity among Asian American youth was found in the study cohort. Asian American youth face distinct challenges of unhealthy weight statuses unique to their subgroups.

亚裔美国人亚群之间存在着重要的、尚未充分研究的健康差异。作者研究了亚裔美国青年的身体质量指数百分位数和体重状况的差异。方法：作者使用2011-2020年加州2个综合医疗系统的电子健康记录进行了一项回顾性队列研究。研究期间包括2-19岁的单种族、非拉丁裔白人和亚裔美国青年。亚裔美国人亚群包括东部、南部、东南部和身份不明。白人作为参照组。研究结果包括年龄和性别特异性BMI百分位数和体重状况类别（体重过轻、超重或肥胖、肥胖）。研究结果的单样本估计值按日历年和生物年龄计算。结果共纳入395,134名青少年(基线时平均[SD]年龄为8.26[5.61]岁；平均[SD] BMI百分位数为53.8[30.3])，包括23,183名东亚人；南亚34,783人；34,738名东南亚人。东南亚人的年龄调整肥胖率最高（2019年估计：13.3%），高于东亚人（5.2%）、南亚人（7.8%）和白人（11.8%）。南亚人的体重不足患病率最高（2019年估计为11.8%），高于东亚人（5.5%）、东南亚人（3.9%）和白人（3.6%）。结论在研究队列中发现亚裔美国青年存在显著的异质性。亚裔美国青年面临着独特的不健康的体重状况的挑战。

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