American Journal of Preventive Medicine

BackgroundCannabinoid hyperemesis syndrome (CHS) is characterized by episodes of severe nausea, vomiting, and abdominal pain among those with heavy cannabis use. We estimated differences between those reporting CHS symptoms and other daily and less frequent cannabis users on drug use, psychiatric problems, other health problems, antisocial behavior, and personality. MethodsThe National Firearms, Alcohol, Cannabis, and Suicide survey was administered to 7034 US adults in 2025. Survey items assessed substance use, common psychiatric symptoms, personality traits, and symptoms of CHS. ResultsThose with CHS symptoms reported the highest rates and greatest variety of drug use compared to others who used cannabis. Those with CHS symptoms reported higher rates of other drug use than those who used cannabis daily without CHS symptoms across a variety of drug classes, including opioids, hallucinogens, and sedatives, higher rates of drug overdoses, and greater use of all drug classes than those with less-than-daily cannabis use. Those with CHS symptoms also reported more depression, anxiety, sleep problems, chronic pain, antisocial behavior, intimate partner violence, and disinhibited personality traits than those who used daily (mean d = 0.58) and less frequently (mean d = 0.69) and those with no cannabis use in the past 12 months (mean d = 0.99). ConclusionsThose with CHS symptoms exhibit a variety of psychological and behavioral problems including higher rates of other drug use, psychiatric symptoms, antisocial behavior, and dysfunctional personality traits. Results highlight the importance of understanding and addressing the broader psychosocial challenges faced by people experiencing CHS symptoms. Highlights O_LICHS symptoms are linked to greater polysubstance use and overdose risk C_LIO_LICHS symptoms are associated with depression, anxiety, sleep, and pain problems C_LIO_LICHS tied to antisocial behavior and intimate partner violence C_LIO_LICHS shows disinhibited personality traits and low well-being C_LIO_LINational survey identifies high-risk psychosocial CHS profile C_LI

BackgroundIf access to Medicaid improves health outcomes, it may also result in lower long-term spending, however the association between Medicaid expansion and Medicare spending is unknown. In this analysis we sought to investigate the association between Medicaid expansion and per capita Medicare spending at the county level. MethodsThis is an observational analysis of all U.S. counties in the ten years from 2010 to 2019. We used a difference-in-difference event study to investigate the difference in per capita Medicare spending between counties in states that expanded Medicaid and counties in states that did not expand Medicaid. The exposure was treatment year, which characterized whether a county was in an expansion state and when expansion occurred. In non-expansion counties, treatment year was assigned 0 for all observations. In expansion counties, treatment year ranged from -3 to +6, with treatment year 1 corresponding to the first full year of expansion. The primary outcome was fee-for-service Medicare spending per capita in each county. A secondary analysis investigated subcategories of per capita spending including inpatient, outpatient, skilled nursing care, inpatient rehabilitation, home health, and hospice care. ResultsWe analyzed 1,648 expansion and 1,494 non-expansion counties, with ten observations per county, one for each year between 2010 and 2019. In the adjusted event study analysis, the difference between expansion and non-expansion counties in expansion year 5 compared to pre-expansion was -200 [95% Confidence Interval (CI): -406, 6] dollars. In the subcategory analysis, the difference in inpatient care, skilled nursing care, outpatient care, and home health spending were -46 [95% CI: -103, 12], -92 [95% CI: -194, 11], 57 [95% CI: -67, 181], and 55 [95% CI: -17, 126] dollars per capita respectively. ConclusionsMedicaid expansion is not consistently significantly associated with lower Medicare spending compared to pre-expansion. However, observed trends towards lower spending and cost-shifting from inpatient to outpatient settings in expansion counties warrant additional investigation.

BackgroundSince the 2025 Presidential Inauguration, the Trump Administration has terminated billions of dollars in federal funding for science; however, the impacts of these grant terminations on the mental health and substance use fields have not yet been examined. We thus aimed to quantify and map the costs associated with federally funded mental health- and substance use-related grants that have been prematurely terminated. MethodsWe used a comprehensive dataset of grants terminated by the National Institutes of Health (NIH), National Science Foundation (NSF), and Substance Abuse and Mental Health Services Administration (SAMHSA) compiled from multiple sources. After identifying terminated mental health- and substance use-related grants from this database via a two-step screening process, we quantified their number and associated lost funding for each congressional district, which we visualized using a series of maps to examine trends and regional variations. OutcomesWe identified 474 mental health- and/or substance use-related grants that were terminated by the NIH, NSF, or SAMHSA from February 28, 2025, through April 11, 2025, totaling $2,098,731,548 in lost funds. Congressional districts corresponding to urban centers with large academic and research institutions (e.g., New York City, Boston) experienced the most pronounced losses from NIH and NSF grants, whereas districts located throughout the Mid-Atlantic, Midwest, Southeast, and Southwest were the hardest hit by the termination of SAMHSA block grants (i.e., those used to pay for community mental health and substance use services). InterpretationAgainst a backdrop of ongoing and intersecting mental health and substance use crises, the Trump Administration has slashed research dollars on these topics, creating a chilling effect on the field. Such cuts are likely to destabilize existing mental health and substance use services and exacerbate inequities between and within U.S. states, ultimately intensifying the challenges faced by local communities. FundingNone to report.

Governments are considering financial incentives to increase vaccine uptake to end the COVID-19 pandemic. Incentives being offered include cash-equivalents such as vouchers or being entered into lotteries. Our experiment involved random assignment of 1,628 unvaccinated participants in the United States to one of three 45 second informational videos promoting vaccination with messages about: (a) health benefits of COVID-19 vaccines (control); (b) being entered into lotteries; or (c) receiving cash equivalent vouchers. After seeing the control health information video, 16% of individuals wanted information on where to get vaccinated. This compared with 14% of those assigned to the lottery video (odds ratio of 0.82 relative to control: 95% credible interval 0.57-1.17) and 22% of those assigned to the cash voucher video (odds ratio of 1.53 relative to control: 95% credible interval 1.11-2.11). These results support greater use of cash vouchers to promote COVID-19 vaccine uptake and do not support the use of lottery incentives.

We use geospatial data to examine the unprecedented national program currently underway in the United States to distribute and administer vaccines against COVID-19. We quantify the impact of the proposed federal partnership with the company Dollar General to serve as vaccination sites and compare vaccine access with Dollar General to the current Federal Retail Pharmacy Partnership Program. Although dollar stores have been viewed with skepticism and controversy in the policy sector, we show that, relative to the locations of the current federal program, Dollar General stores are disproportionately likely to be located in Census tracts with high social vulnerability; using these stores as vaccination sites would greatly decrease the distance to vaccines for both low-income and minority households. We consider a hypothetical alternative partnership with Dollar Tree and show that adding these stores to the vaccination program would be similarly valuable, but impact different geographic areas than the Dollar General partnership. Adding Dollar General to the current pharmacy partners greatly surpasses the goal set by the Biden administration of having 90% of the population within 5 miles of a vaccine site. We discuss the potential benefits of leveraging these partnerships for other vaccinations, including against influenza.

ObjectiveAs cannabis use has increased in the United States, so has cannabinoid hyperemesis syndrome (CHS), a disorder characterized by severe nausea, vomiting, and abdominal pain among heavy cannabis users. We previously showed that CHS symptoms are associated with several behavioral and psychological characteristics linked to psychosocial impairment. We examined links between CHS symptoms and suicidal thoughts, behaviors, and proximal suicide risk factors. MethodsWe used data from the National Firearms, Alcohol, Cannabis, and Suicide survey, a nationally representative survey of 7,034 US adults. Items assessed symptoms of CHS and suicidal thoughts and behaviors. Comparisons focused on: those with daily cannabis use and CHS symptoms (n = 191), those with daily cannabis use without CHS symptoms (n = 882), those with past year cannabis use but not daily use (n = 1288), and those without past year cannabis use (n = 4673). ResultsThose with CHS symptoms reported the highest prevalence of suicidal thoughts and behaviors with most lifetime rates being significantly higher than those with daily cannabis use without CHS symptoms. Those with CHS symptoms also reported higher mean-levels of thoughts and feelings associated with suicide (i.e., perceived burdensomeness, thwarted belongingness, defeat, entrapment) than all the other groups. ConclusionsThose with CHS symptoms reported especially high rates of suicidal thoughts, behaviors, and attempts even when compared to others with daily cannabis use. People with CHS symptoms appear to be at high risk of suicide, possibly related to distress from their gastrointestinal symptoms and psychiatric, substance use, and medical comorbidities.

BackgroundThe COVID-19 pandemic continues to adversely affect the U.S., which leads globally in total cases and deaths. As COVID-19 vaccines are under development, public health officials and policymakers need to create strategic vaccine-acceptance messaging to effectively control the pandemic and prevent thousands of additional deaths. MethodsUsing an online platform, we surveyed the U.S. adult population in May 2020 to understand risk perceptions about the COVID-19 pandemic, acceptance of a COVID-19 vaccine, and trust in sources of information. These factors were compared across basic demographics. FindingsOf the 672 participants surveyed, 450 (67%) said they would accept a COVID-19 vaccine if it is recommended for them. Males (72%), older adults ([≥]55 years; 78%), Asians (81%), and college and/or graduate degree holders (75%) were more likely to accept the vaccine. When comparing reported influenza vaccine uptake to reported acceptance of the COVID-19 vaccine: 1) participants who did not complete high school had a very low influenza vaccine uptake (10%), while 60% of the same group said they would accept the COVID-19 vaccine; 2) unemployed participants reported lower influenza uptake and lower COVID-19 vaccine acceptance when compared to those employed or retired; and, 3) black Americans reported lower influenza vaccine uptake and lower COVID-19 vaccine acceptance than nearly all other racial groups. Lastly, we identified geographic differences with Department of Health and Human Services regions 2 (New York) and 5 (Chicago) reporting less than 50 percent COVID-19 vaccine acceptance. InterpretationAlthough our study found a 67% acceptance of a COVID-19 vaccine, there were noticeable demographic and geographical disparities in vaccine acceptance. Before a COVID-19 vaccine is introduced to the U.S., public health officials and policymakers must prioritize effective COVID-19 vaccine-acceptance messaging for all Americans, especially those who are most vulnerable. FundingThe study was funded by the Yale Institute for Global Health.

BACKGROUNDHealthcare is a major contributor to global greenhouse gas emissions. Colorectal cancer (CRC) screening is one of the most widely used healthcare services in the US, indicated for approximately 134 million adults. Recommended screening options include fecal immunochemical tests (FITs) every year, CT colonographies (CTCs) every 5 years, or colonoscopies every 10 years. We compared the environmental impacts of these tests and identified opportunities for impact reduction. METHODSWe conducted a comparative life cycle assessment of three CRC screening strategies at the University of California, San Francisco. We performed on site audits to document the materials and energy used for each screening test. We used the ReCiPe 2016 method to estimate the environmental impacts of these procedures, measured by global warming potential (GWP) and damage to human health. We estimated the 10-year cumulative impacts of each screening strategy using a Markov reward model. We accounted for model uncertainty using hierarchical Monte Carlo simulations. FINDINGSFIT-based screening had the lowest environmental impacts, with a roughly 20% margin of superiority over colonoscopies, and this finding was robust in sensitivity analyses. Across tests, the biggest cause of environmental harm was car-based transportation of patients and staff. Prioritizing FITs over screening colonoscopies in the US could enhance population health by roughly 5.2 million disability adjusted life years per decade. Transitioning to electric vehicles could reduce the GWP of all screening tests by 15-20%. INTERPRETATIONGiven the similar efficacy and safety of these tests, payors should prioritize FITs for low-risk patients. Government initiatives to decarbonize transportation, incentivize telehealth, and mandate environmental product declarations will help reduce the environmental impacts of healthcare more generally. Our results call for a closer look at resource-intensive preventative health strategies, which could result in more harm than good if applied to a low-risk population. FUNDINGNIH, UCSF

BackgroundWe sought to quantify whether there were statistically significant disparities along race and ethnicity lines during the early rollout of Covid-19 vaccine booster doses in the United States. We also studied whether such disparities replicated or widened disparities that had already been observed during the initial series rollout as of 2 months earlier (Janssen) or 6 months earlier (Pfizer-BioNTech or Moderna), which comprised the booster-eligible population. MethodsThis cross-sectional study of US adults (ages [≥]18 years) used public data from US Centers for Disease Control and Prevention. The observed shares of vaccine doses for each race and ethnicity were compared to the expected shares, predicted based upon the compositions of the booster-eligible and initial series-eligible populations. ResultsAs of November 16, 2021, 123.5 million US adults were eligible for a booster dose of either the Pfizer-BioNTech, Moderna, or Janssen vaccines. Of these, 21.7 million had received a booster dose, among whom race and ethnicity information was available for 18.8 million booster recipients. A statistically significant higher share of Non-Hispanic White and Non-Hispanic Multiple/Other race individuals had received a booster vaccination than projected based on the composition of the booster-eligible population. A statistically significant lower share of Hispanic, Non-Hispanic American Indian/Alaskan Native, Non-Hispanic Asian, Non-Hispanic Black, and Non-Hispanic Native Hawaiian/Other Pacific Islander individuals had received a booster vaccination than expected based on the booster-eligible population. A secondary analysis of the booster-eligible population found that some of these disparities had already occurred at the time of the initial series. However, the booster campaign widened all of those disparities and added new disparities for Non-Hispanic American Indian/Alaskan Native and Non-Hispanic Native Hawaiian/Other Pacific Islander individuals. ConclusionDisparities in Covid-19 vaccine administration on race and ethnicity lines occurred during the initial series rollout in the US. However, these disparities were not merely replicated but widened by the early booster rollout.

ImportanceCannabinoid Hyperemesis Syndrome (CHS) is an emerging condition among those with heavy cannabis use characterized by persistent and severe nausea and vomiting. However, very little is known about the national prevalence of CHS, outside of healthcare settings, and among those who use cannabis frequently. ObjectiveTo determine the national prevalence of CHS symptoms, diagnosis, and associated characteristics. DesignA cross-sectional, nationally representative survey of US adults. SettingThe National Firearms, Alcohol, Cannabis, and Suicide survey was conducted in 2025. Participants7,034 US adults over 18 years old provided survey data. ExposuresNot applicable. Main Outcome and MeasuresItems were included that assess symptoms of CHS, along with multiple measures of cannabis use and problem use. ResultsThe prevalence of those reporting daily cannabis use in the past 5 years was 15.2%, corresponding to an estimated over 40 million US adults. Among those who used cannabis daily, 17.8% reported CHS-like symptoms (i.e., severe nausea, vomiting, or abdominal pain), which translates to an estimated 7.2 million US adults, or a 2.7% national prevalence rate. Only 11.5% of those with a symptom prolife consistent with CHS reported receiving a CHS diagnosis from a medical provider. Respondents reporting CHS symptoms were younger, more likely to be female and non-White race, lower income, less educated, and endorsed more cannabis use problems relative to those who used cannabis daily or less frequently. Conclusions and RelevanceA small but significant number of US adults with daily cannabis use reported symptoms consistent with CHS. Beyond patterns of cannabis use, those with CHS symptoms had fewer economic resources and endorsed more cannabis-related problems, even when compared to others with daily cannabis use. Most people reporting CHS symptoms were not diagnosed by a medical provider, suggesting that there may be a substantial cohort who is experiencing CHS symptoms but is not seeking medical treatment or having their condition recognized by medical providers. As cannabis use increases, it is likely that CHS will also become more common, underscoring the importance of expanded research on this condition. KEY POINTSO_ST_ABSQuestionC_ST_ABSHow frequently do people who use cannabis daily experience symptoms of Cannabinoid Hyperemesis Syndrome (CHS)? FindingsIn this nationally representative survey, 17.8% of those with daily cannabis use reported CHS-like symptoms (severe nausea, vomiting, or abdominal pain), which translates to over 7 million US adults. Those reporting CHS symptoms were younger, more likely to be female and non-White race, lower income, less educated, and endorsed more cannabis use problems relative to those who used cannabis daily and those who used less frequently. MeaningA significant proportion of those who use cannabis daily report symptoms consistent with CHS.

BackgroundThroughout US history, chronic and infectious diseases have severely impacted minority communities due to lack of accessibility to quality healthcare, accurate information, and underlying racism. These fault lines in the care of minority communities in the US have been further exposed by the rise of COVID-19 pandemic. This study examined the factors associated with COVID-19 vaccine hesitancy among African American and Latinx communities in Eastern Pennsylvania (PA). MethodsSurvey data was collected in July 2021 in Philadelphia, Scranton, Wilkes-Barre, and Hazleton, PA. The 203 participants (38.7% Black, 27.5% Latinx) completed the 28-question survey of COVID-19 vaccination attitudes in either English or Spanish. ResultsOut of a total of 181 participants that met inclusion criteria of completed surveys, results indicate that 63.5% (n=115) were acceptant of the COVID-19 vaccine whereas the remainder 36.5% (n=66) were hesitant. Binary logistic regression results showed that age, concern for vaccine efficacy, race, knowledge on the vaccine, and belief that the COVID-19 virus is serious significantly influenced COVID vaccine hesitancy. Minorities were more likely to be hesitant toward vaccination (OR: 2.77, 95% CI: 1.13, 6.79) than non-Hispanic whites. Those who believed the COVID vaccine was ineffective (OR: 8.29, 95% CI: 3.78,18.2), and that the virus is not serious (OR: 8.28, 95% CI: 1.11, 61.8) showed the greatest odds of hesitancy. ConclusionsContributing factors of vaccine hesitancy in minority communities were age, concern for vaccine efficacy, and education. Understanding and addressing the barriers to COVID-19 vaccination in minority groups is essential to decreasing transmission and controlling this pandemic.

The development and deployment of COVID-19 vaccines were crucial to combating the global pandemic, but vaccine hesitancy posed a challenge and remains a crucial problem today. Understanding why people delay or refuse vaccination can help with current and future vaccine campaigns by suggesting both target audiences and messaging. Because hesitant individuals report different reasons for their hesitancy, distinguishing between different types of hesitancy can help identify who will benefit from which strategies. Using 311,494 responses from the U.S. COVID-19 Trends and Impact Survey (CTIS), we used Latent Class Analysis to examine distributions of concurrently reported reasons for hesitancy using latent class analysis, comparing distributions of responses across racial and ethnic groups. Using responses from both the early phase of vaccine availability and after all U.S. adults became eligible in the spring of 2021, we investigated differences between prospective vs. lived hesitancy. LCA revealed three different types of COVID-19 vaccine hesitancy. Some respondents primarily reported health-related concerns as reasons for hesitancy, while others indicates distrust of the government and vaccines, but the majority report fewer distinct reasons. In February 2021, White, Black, and Hispanic respondents had similar distributions of these types, but by May the results diverged. In May, White respondents were more likely to report trust concerns than Black or Hispanic respondents, who were more likely to report health concerns as their reasons for continued hesitancy. Our results contribute to the development of a more nuanced picture of COVID-19 vaccine hesitancy and the motivations behind it. The distinction between health-concerned and distrustful types of vaccine hesitancy highlights the importance of confidence in vaccine uptake, and in targeted strategies to address address hesitancy.

BackgroundPatients are referred for colonoscopy for symptom assessment, screening, and surveillance. Public health measures to mitigate the spread of the COVID-19 pandemic disrupted services and increased patient delays for colonoscopy services in Quebec. The differential impact of these interruptions by colonoscopy indication is largely unknown. MethodsUsing 2018-2022 retrospective clinical data from two high-volume Montreal endoscopy centres and provincial administrative data, we characterized changes in colonoscopy wait times and the proportion of waitlisted patients who were delayed (wait time exceeded provincial guidelines) by procedure indication and demographics. We used regression to examine patient characteristics associated with delayed procedures during pre- and intra-COVID-19 periods. We used time series analysis to characterize trends in the proportion of waitlisted patients delayed. ResultsThe COVID-19-related public health measures resulted in record-high delays (median increase in wait times of 34-159% across indications). While older patients experienced longer wait times pre-pandemic, intra-COVID-19 wait times increased disproportionately for patients younger than 50. The proportion of waitlisted patients delayed peaked mid-2020 (56.9% for screening; 56.0% for symptom assessment patients). By early 2022, the proportion delayed had fallen to 37.3% for screening patients but remained at 53.8% for symptom assessment patients. ConclusionsIn Quebec, intra-COVID-19 colonoscopy delays disproportionately impacted symptom assessment procedures and younger patients. Additional capacity or improved triaging may be needed to address persistent delays. Understanding the effects of the pandemic on colonoscopy services can help inform strategies to mitigate harms from on-going delays in Quebec.

BackgroundLittle is known about public perceptions of antivirals for the treatment of mild-to-moderate COVID-19 in the United States (US). Our objective was to explore adult perceptions toward COVID-19 antivirals with the goal of improving outreach communications about antivirals for COVID-19. MethodsDuring July 2022, potential respondents 18 years and older were randomly sampled from a national opt-in, non-representative, cross-sectional internet panel, with oversampling of African Americans, Hispanics, and adults 65 years and older. Respondents were asked about sociodemographic factors, and knowledge, attitudes, and perceptions regarding COVID-19 antivirals. Results were weighted to represent the non-institutionalized US adult population. ResultsAmong 1,155 respondents, 51% were female, 60% were 18-49 years, 21% were 50-64 years, and 19% were 65 years or older. Compared to those aged 18-49 years and 50-64 years, a greater proportion of adults 65 years and older were knowledgeable about COVID-19 antivirals and would take them if they tested positive or their doctor recommended them. Adults 65 years and over and those reporting immunosuppression or disability had the highest rates of willingness to take antivirals. For all groups, the proportion of people willing to take antivirals increased by >20% if recommended by their doctor. Respondents in the 50-64 and 65+ groups who were sure they would take COVID-19 antivirals were more likely to be fully vaccinated and less likely to be living in isolation. ConclusionGroups that are less likely to have been vaccinated, those living in isolation, and those not sure about whether they would take an antiviral or not may be at risk for not receiving treatment to prevent severe COVID-19 outcomes. However, trust in doctor recommendations may be enough to overcome individual patient concerns about COVID-19 antivirals. Targeted initiatives to educate those at risk for severe COVID-19 outcomes about the effectiveness of antivirals, including those who are unvaccinated given their increased risk of severe disease, may be needed to further lower this populations risk of severe COVID-19.

In addition to the overwhelming health effects of COVID-19, the disease has inflicted unprecedented economic damage. Vast resources have been directed at COVID-19 testing and health care while economic activity has been substantially curtailed due to disruptions resulting from individual choices and government policies. This study estimates the economic loss associated with COVID-19 deaths in the U.S. from February 1, 2020 through July 11, 2020. We use estimates of years of life lost that are based on the age and gender of decedents. Using a value of life year estimate of $66,759, we calculate economic losses of roughly $66 billion. The losses are concentrated in New York and New Jersey, which account for 17.5% of the total losses. Our analysis of per capita losses by state indicates that the highest values are located in the northeastern region of the country, while the values in the western states are relatively low. While economic losses associate with COVID-19 deaths is just one aspect of the pandemic, our estimates can provide context to the value of prevention and mitigation efforts. JEL codesI12, I18, J17

BackgroundRecent evidence suggests that willingness to vaccinate against COVID-19 has been declining throughout the pandemic and is low among ethnic minority groups. MethodsObservational study using a nationally representative longitudinal sample (N =7,840) from the Understanding America Study (UAS). Changes in the percentage of respondents willing to vaccinate, undecided, or intending to refuse a COVID-19 vaccine were examined over 20 survey waves from April 1 2020 to February 15 2021. ResultsAfter a sharp decline in willingness to vaccinate against COVID-19 between April and October 2020 (from 74.0% to 52.7%), willingness to vaccinate increased by 8.1% (p <.001) to 60.8% between October 2020 and February 2021. A significant increase in willingness to vaccinate was observed across all demographic groups examined and Black (15.6% increase) and Hispanic participants (12.1% increase) showed particularly large changes. ConclusionsWillingness to vaccinate against COVID-19 increased in the US from October 2020 to February 2021. Funding statementN/A

BackgroundWe examined the geographic and racial/ethnic distribution of the SARS-CoV-2 vaccine age-ineligible population (0-15 years old) in the U.S., and calculated the proportion of the age-eligible population that will need to be vaccinated in a given geo-demographic group in order to achieve either 60% or 75% vaccine coverage for that population as a whole. MethodsUS Census Bureau population estimates for 2019 were used to calculate the percent vaccine ineligible and related measures for counties, states, and the nation as a whole. Vaccination targets for the 30 largest counties by population were calculated. Study measures were calculated for racial/ethnic populations at the national (n=7) and state (n=6) levels. ResultsPercent of population ineligible for vaccine varied widely both geographically and by race/ethnicity. State values ranged from 15.8% in Vermont to 25.7% in Utah, while percent ineligible of the major racial/ethnic groups was 16.4% of non-Hispanic whites, 21.6% of non-Hispanic Blacks, and 27.5% of Hispanics. Achievement of total population vaccine coverage of at least 75% will require vaccinating more than 90% of the population aged 16 years and older in 29 out of 30 of the largest counties in the U.S. ConclusionsThe vaccine-ineligibility of most children for the next 1-2 years, coupled with reported pervasive vaccine hesitancy among adults, especially women and most minorities, means that achievement of adequate levels of vaccine coverage will be very difficult for many vulnerable geographic areas and for several racial/ethnic minority groups, particularly Hispanics, Blacks, and American Indians.

Overdose prevention health centers (OPHCs), also known as overdose prevention centers or safe injection facilities (SIFs), are an evidence-based strategy for people to use drugs in an environment monitored by health care professionals with access to drug use education, sterile supplies, and referral infrastructure to access higher levels of medical and behavioral health resources. Though still illegal under federal law throughout the United States, many legal or quasi-legal (including some in the United States) have operated since the 1980s. Using CDC overdose deaths and United States Census Bureau population data, we estimate 1,325 deaths could have been averted between 2020 and June 2025 if 1 out of 400 injections had taken place at an OPHC. At this rate, 26 HIV transmissions and 5,723 Hepatitis C Virus transmissions would have been averted. Over $1.8 billion in discounted lifetime costs to treat those infections could have been saved. This data supports OPHCs as one viable public health intervention to avert deaths and avoid infections. Furthermore, a web application was created to assist users explore this analysis, data visualizations, and even alter model assumptions, including variables like what percent of injections occur at an OPHC.

IntroductionTo assess vaccine acceptance among adults living in a largely rural Southern state. MethodsData were collected between October 3 and October 17, 2020 using random digit dialing. Participants included residents aged 18+, able to understand English or Spanish, and provide informed consent. The primary outcome was a multi-dimensional COVID-19 vaccine acceptance measure. Scores varied between -3 to +3. ResultsThe sample (n=1,164) was weighted to be representative of the states population. Black participants had the lowest overall vaccine acceptance (0.5) compared to White participants (1.2). Hispanic participants had the highest scores (1.4). In adjusted models, Black participants had 0.81 points lower acceptance than White participants, and Hispanic participants had 0.35 points higher acceptance. Hispanic participants had the highest scores for all five vaccine acceptance dimensions, relatively equivalent to White participants. Black participants had consistently lower scores, especially perceived vaccine safety (mean -0.2, SD 0.1). ConclusionsThe lowest vaccine acceptance rates were among Black participants particularly on perceived vaccine safety. While Black participants had the lowest acceptance scores, Hispanic participants had the highest. This variability shows the value of a multi-dimensional vaccine acceptance measure to inform COVID-19 vaccination campaign strategies.

BackgroundVaccination for seasonal influenzas is particularly important during the COVID-19 pandemic, but the influenza vaccination coverage in the U.S. was far lower than the targeted rate. ObjectiveTo examine how peoples actual uptake of the influenza vaccine and the disparity of the vaccination changed during the pandemic. MethodsA survey was conducted online in November 2022. Respondents were asked for influenza vaccination during each of the three latest seasons, prior influenza vaccination history, and COVID-19 vaccination. A linear regression model was used to estimate how the respondents change in influenza vaccination was associated with their demographics, COVID-19 vaccination status, and other related variables. ResultsNearly 70% of US adults had influenza vaccine each season during past the three seasons of the COVID-19 pandemic. The prevalence of influenza vaccination varied markedly across demographics. Non-Hispanic Black, Hispanic, and people with low educational attainment were more likely to see relatively negative changes in their level of influenza vaccination. Respondents who uptook their COVID-19 vaccine in 2022 increased their level of influenza vaccine more than those who uptook the vaccine in 2021. ConclusionsOur study indicated that influenza vaccination increased during the pandemic compared with before the pandemic. The disparity of influenza vaccination by race/ethnicity and socioeconomic status may enlarge during the pandemic. Tailored interventions were needed to target some groups to promote their vaccination uptake.