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

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.

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.

BackgroundSeasonal influenza imposes a significant clinical and economic burden in the United States despite the availability of effective vaccines. ObjectivesTo estimate the cost of illness associated with seasonal influenza among U.S. adults and to examine the relationship between vaccination coverage and influenza related outcomes. MethodsWe combined Centers for Disease Control and Prevention influenza burden estimates with contemporary healthcare utilization, cost, and labor market data to estimate direct medical costs and productivity losses for the 2023 24 influenza season. Panel data regressions with fixed effects were used to evaluate the association between adult influenza vaccination rates and hospitalization and mortality outcomes using data from the 2010 11 through 2023 24 seasons. Scenario analyses assessed how alternative vaccination rates would have affected costs and mortality. ResultsInfluenza among adults was associated with an estimated $29 billion in total economic burden in the 2023 24 season, including approximately $16 billion in direct healthcare costs and $13 billion in productivity losses. Higher vaccination rates were significantly associated with lower mortality among adults aged 18 years and older and reduced hospitalization rates among adults aged 50 years and older. Achieving historical peak vaccination coverage would have reduced total costs by approximately $3 billion and averted more than 8000 deaths. ConclusionsAdult influenza vaccination is associated with substantial reductions in mortality and economic burden, underscoring its value as a cost relevant public health intervention.

IntroductionAge-group specific disparities for dentalcare use persist in the United States. The COVID-19 led to delays in non-urgent dentalcare. We provide national estimates on dentalcare use and influencing factors for the U.S. population before and during the COVID-19. MethodsWe used nationally representative Medical Expenditure Panel Survey for over pre-COVID-19 years (2018-2019) and COVID-19 years (2020-2021) We estimated yearly survey-weighted trends in mean non-zero dental visits by age followed Poisson regression, controlling for a comprehensive set of confounders across five domains of influence. Dentalcare visits were defined as visits to any dentalcare provider. ResultsOverall analytic sample included non-institutionalized community living persons (unweighted n=6518, weighted N[~]320 million) grouped as ages 0-17, 18-44, 45-64, 65-74 and 75+ present in all four years The prevalence ratio (PR) for dental visits was slightly higher for ages 75+ in comparison to ages 65-74 across years 2018-2021 and increased from 1.73 (95% CI: 1.4, 2.1) to 1.84 (95% CI: 1.5, 2.3) to 2.13 (95% CI: 1.7, 2.7) from 2018 to 2020 but rebounding to near pre-pandemic level in 2021 to 1.66 (95% CI, 1.3, 2.0). Consistent factors during COVID-19 pandemic years 2020-2021 that increased dental visits included dental insurance, high income, and having a usual source of care (p<0.01). ConclusionsDentalcare use rebounded for older adults in 2021 but remained below pre-pandemic levels. Practical ImplicationsIncreasing dentalcare visits across ages remains a key policy priority. Continued monitoring of dentalcare use trends beyond COVID-19 among older adults is critical to improve their oral health.

ImportanceAs the population of older people with HIV (PWH) in the US is growing, costs to Medicare are expected to rise substantially. ObjectivesTo project the number of Medicare beneficiaries with HIV aged 65y+ on ART in the US from 2026-2035 and the budget impact on Medicare. Design, Setting, and ParticipantsWe developed the novel CHARMED simulation model and projected the number of Medicare beneficiaries with HIV aged 65y+ on ART and associated costs from 2026 to 2035; we populated the model with age and sex-stratified clinical data and costs derived from 2023 Traditional Medicare (TM) claims and accounted for enrollment in Medicare Advantage, as well as healthcare inflation. Main Outcomes and MeasuresNumbers of Medicare beneficiaries with HIV aged 65y+ on ART and undiscounted costs to Medicare from 2026-2035. ResultsWe projected that 111,600 PWH would be enrolled in Medicare and in care at the beginning of 2026 (65-69y: 57,370; 70-74y: 32,940; 75-79y: 14,670; 80y+: 6,610). By the end of 2035, this number would nearly double, to 193,560 (65-69y: 70,490; 70-74y: 62,820; 75-79y: 38,290; 80y+: 21,960). Annual costs to Medicare for PWH 65y+ on ART would increase 2.5-fold, from $11.4 billion at the end of 2026 to $28.6 billion at the end of 2035. Cumulative 10-year costs are projected to be $195.6 billion with 66.5% of cumulative costs due to ART. If ART costs are reduced by 60% as per the Inflation Reduction Act or generic ART, Medicare would save $78.0 billion over the next decade. Conclusions and RelevanceThe number of Medicare beneficiaries with HIV 65y+ on ART will more than double over the next decade, resulting in $195.6 billion in 10-year total costs to Medicare. Reducing ART costs through the IRA or generic oral ART could lead to 40% lower overall Medicare spending for older Medicare beneficiaries with HIV. KEY POINTSO_ST_ABSQuestionC_ST_ABSAs the population of people with HIV in the US grows older, what are the expected costs to Medicare and the impact of antiretroviral therapy (ART) costs? FindingsUsing microsimulation modeling, we find that the number of Medicare beneficiaries with HIV 65y+ on ART will more than double over the next decade. At current costs of ART and health care-associated inflation, total 10-year costs to Medicare are anticipated to be $196.5 billion; reducing ART costs through the Inflation Reduction Act or generic ART could lower Medicare spending by 40%. MeaningEfforts to reduce ART costs, while maintaining access to high-quality ART, are critical to reduce total Medicare costs as more people with HIV are anticipated to enroll in Medicare in the next 10 years.

ObjectivesTo investigate how nutrition readiness to change influences implementation of dietary behavior changes and to compare the gut microbiomes and document gut microbiome composition changes over time in individuals with early Alzheimers disease dementia (eAD), mild cognitive impairment (MCI), and healthy controls (HC) Overall, this study aims to add to the emerging field of how the gut microbiome influences the nervous system. MethodsThis is a sub-study of a multi-prong proof-of-concept, observational study mapping the gut microbiome: 15 HC, 15 MCI, 15 eAD (n=45). At 0-, 3-, and 6-months, participants are provided lifestyle recommendations tailored to their gut microbiome. Participants may choose to implement this or not and are observed throughout (observational intervention study). In this sub-study, a survey is developed and implemented in conjunction with dietary assessment (DietID) to evaluate the role of Readiness to Change in implementation of dietary recommendations. ResultsThis is the sub-study protocol from an ongoing parent study. DiscussionThis protocol presents a novel intervention to assess the gut microbiome, individual dietary patterns, and readiness to make lifestyle change related to diet. Trial RegistrationNCT06039267

BackgroundSeveral colorectal cancer (CRC) screening modalities are guideline-recommended in the United States, yet they vary considerably in screening interval and real-world adherence. As a result, single-round test performance may not reflect cumulative effectiveness over time. This study compared the 10-year longitudinal outcomes of two CRC screening strategies-- triennial next-generation multitarget stool DNA testing (ng mt-sDNA) and decennial screening colonoscopy. MethodsThis study used the validated, microsimulation-based Colorectal Cancer and Adenoma Incidence and Mortality (CRC-AIM) model to estimate 10-year cumulative outcomes for two guideline-recommended screening strategies: triennial ng mt-sDNA and decennial colonoscopy. Model inputs included test-specific performance and real-world adherence. Outcomes included CRC and precancerous lesions detected, CRC mortality reductions, and life-years gained (LYG). Sensitivity analyses examined the effects of varying both screening adherence and follow-up colonoscopy adherence. ResultsOver 10 years per 1,000 individuals offered screening, the ng mt-sDNA screening test detected 13% more precancerous lesions and 11% more CRC cases than colonoscopy, with a greater proportion of CRCs identified through screening rather than symptomatic detection. ng mt-sDNA resulted in greater CRC mortality reduction (33% vs 20%) and 62% more life-years gained, with consistent findings across sensitivity analyses. ConclusionsWith real-world adherence, screening with triennial ng mt-sDNA demonstrates superior cumulative effectiveness compared with decennial colonoscopy, driven by higher adherence and favorable longitudinal performance. These findings support the expanded use of noninvasive stool-based screening to reduce CRC mortality and alleviate capacity constraints associated with colonoscopy-based screening. Broader adoption of ng mt-sDNA may enhance population-level CRC prevention by increasing participation and improving early detection across the screening eligible population.

ObjectivesTo examine associations between cardiometabolic conditions and health-related quality of life (HRQoL) and to evaluate whether condition-associated HRQoL changed from 2001 to 2022. MethodsWe analyzed nationally representative data from U.S. adults aged [&ge;]18 years in the Medical Expenditure Panel Survey, 2001-2022. Survey years without BMI data (2017, 2019, 2021) were excluded. EQ-5D utilities were mapped from SF-12 scores using a validated algorithm. For each survey year, survey-weighted multivariable regression models estimated associations of sociodemographic characteristics, BMI, and cardiometabolic conditions (diabetes, heart disease, high blood pressure, high cholesterol, obesity, stroke) with HRQoL measured by EQ-5D. Temporal changes in condition-associated HRQoL decrements were assessed using meta-regression across years. Associations in recent survey years were summarized using pooled estimates from 2015, 2016, 2018, and 2022. ResultsOverall HRQoL improved from 2001 to 2022 across age groups, with the largest improvement among older adults. In pooled analyses, stroke was associated with the largest adjusted HRQoL decrement (-0.0714), followed by heart disease (-0.0503), diabetes (-0.0427), high blood pressure (-0.0328), obesity (-0.0305), and high cholesterol (-0.0236). Additional adjustment for BMI attenuated condition-associated decrements, most notably for obesity (-0.0305 to -0.0183), diabetes (-0.0427 to -0.0414), and high blood pressure (-0.0328 to -0.0316). Over time, diabetes- and heart disease-associated decrements attenuated linearly (diabetes: - 0.0489 in 2001 to -0.0406 in 2022; heart disease: -0.0591 to -0.0493). High blood pressure (-0.0337 in 2001, -0.0415 in 2012, -0.0306 in 2022) and obesity (-0.0305 in 2001, -0.0283 in 2012, -0.0367 in 2022) showed nonlinear patterns. ConclusionsCondition-associated HRQoL decrements varied over time, and recent-year utility estimates are recommended for population health research. HRQoL decrements for diabetes and heart disease attenuated, consistent with improvements in treatment and survival. High blood pressure-associated were lowest around 2012, and obesity-associated became more negative after 2012, consistent with worsening blood pressure control and obesity severity.

BackgroundVaccine hesitancy is a growing issue that the WHO ranks as one of the top 10 threats to global health. Public confidence in vaccines and rates of routine childhood vaccination have been declining around the world since the pandemic, when many countries saw the instatement of COVID-19 vaccine mandates. ObjectivesWe leveraged the COVID-19 add-on study, conducted by the CHILD Cohort Study (Canadas most phenotypically diverse, large prospective longitudinal birth cohort), to determine characteristics associated with adult participants vaccine hesitancy. Our goal was to identify potential strategies for addressing vaccine uptake concerns. This study complements others by examining more behavioural, socioeconomic, attitudinal and additional characteristics, in some cases with greater granularity, and by further exploring the effects of COVID-19 vaccine mandates on vaccine uptake and beliefs. MethodsWe generated penalized logistic regression models and used statistical tests to analyze a dataset of nearly 700 questionnaire responses where vaccine hesitancy was measured by participants agreement or disagreement with the following statements: "Getting myself vaccinated is important for the health of others in my community" and "Getting vaccinated is a good way to protect myself from disease. We also examined whether vaccination status or opinions changed after the imposition of vaccine mandates. ResultsWhile vaccine mandates were successful in increasing COVID-19 specific vaccine uptake in hesitant individuals vs confident individuals, they were ineffective in modifying hesitant individuals beliefs about vaccines. Vaccine-confident individuals were more likely to engage in pandemic safety measures such as physical distancing, while vaccine-hesitant individuals were more likely to have or had chronic medical conditions in the past, experience economic precarity, have lower socioeconomic status and/or formal education level, have had difficulty accessing medical care, and rely on friends and internet sites that were not governmental for COVID-19 related information. ConclusionsTo ensure that relevant information regarding vaccines reaches all segments of the population, outreach strategies should be tailored to individuals with a variety of cultural or educational backgrounds. Improving access to medical care could also improve access to reliable information. Vaccine mandates do not impact an individuals beliefs in vaccines, and so countering vaccine hesitancy itself is likely to be more effective in terms of ensuring continuous vaccine uptake in a population.

ObjectivePregnant women are at higher risk of severe COVID-19, and vaccination significantly reduces the risk of severe infection. Despite its benefits, only 13% of pregnant women in the U.S. had received the updated 2024-25 vaccine by December 2024, with uptake varying across sociodemographic groups. This study examines perceptions on COVID-19 vaccination during pregnancy among U.S. adults enrolled in the Chasing Covid Cohort, analyzing responses across 16 surveys between March 2020 and December 2023 (N=4488). MethodsKey variables included sociodemographic characteristics, susceptibility to severe COVID-19 disease, perceived worry about COVID-19, individual and household vaccination status, symptoms of anxiety and depression, trusted information sources, and having a regular healthcare provider. Perceptions of vaccine safety and efficacy during pregnancy were measured using five Likert-scale statements, categorized into agreement, uncertainty, and disagreement. Exploratory factor analysis identified two constructs--safety and efficacy--which were analyzed in relation to participant characteristics using bivariate analysis and chi-square tests, and multivariable robust Poisson regression models. ResultsAmong all respondents and women of reproductive age, less than half (40%) perceived the COVID-19 vaccine as safe during pregnancy, and just over half recognized its efficacy. Individuals with a personal physician and those who trusted public health institutions or healthcare providers were more inclined to agree with the vaccines safety and efficacy. ConclusionsThese findings highlight the influence of demographic factors on vaccine perceptions, the potential impact of social networks during pregnancy, and the critical role of trust in public health institutions in promoting vaccine uptake.

BackgroundVaccine-preventable diseases pose significant health risks to older adults. Despite widespread vaccine availability, hesitancy related to uncertainty, misinformation, and access challenges continues to affect vaccination uptake, presenting an ongoing public health concern. ObjectiveThis study aimed to assess perceptions related to vaccination, develop age-appropriate educational strategies through community engagement, and evaluate changes in vaccine-related attitudes following an educational intervention among older adults in rural Delaware and Maryland. Study DesignA mixed-methods approach was employed, combining quantitative surveys with qualitative focus groups and interviews to examine vaccination-related perceptions and experiences. ParticipantsThe study included 124 participants prior to the intervention and 89 participants following the intervention. Participants were older adults residing in Sussex County (Delaware) and Somerset and Wicomico Counties (Maryland). AnalysisQuantitative data were analyzed using logistic regression, while qualitative data were analyzed thematically using inductive coding techniques. Comparisons between pre-and post-intervention findings examined changes in reported barriers, facilitators, perceptions, and confidence related to vaccination. ResultsPrior to the intervention, limited access to clear and reliable information (57.4%) and uncertainty toward public health guidance (36.8%) were commonly reported barriers, while family support and healthcare provider recommendations were identified as key facilitators. Following the intervention, reported barriers to vaccination decreased by 93%, and confidence in healthcare provider guidance increased by 190%. Educational materials were well received, with participants reporting improved understanding of vaccine effectiveness and safety, although some hesitation remained. ConclusionEducational interventions delivered through community-engaged approaches were associated with reduced barriers and increased confidence in vaccination among older adults. These findings highlight the value of targeted health education in supporting informed decision-making and suggest the need for continued public health efforts to sustain vaccine confidence. Further research is warranted to assess long-term outcomes and applicability across additional settings.

Pregnant individuals have a greater susceptibility to severe disease from the coronavirus 2019 disease (COVID-19). Pregnant people also tend to be vaccine-hesitant, which is even more pronounced in certain racial and ethnic minority groups. The study objective was to determine whether social media ads promoting COVID-19 vaccination could influence vaccination likelihood among pregnant and recently pregnant participants who self-identified as Black or African American. Participants were interviewed individually or in focus groups to explore their attitudes about vaccination and to ask them to rate their COVID-19 vaccination likelihood after seeing a panel of ads featuring different messengers (e.g., doctor, peer, elder, faith leader) and content types (e.g., social proof, text-heavy, fear-based, activation). Ad ratings were analyzed using linear mixed models to examine the effect of vaccination status, ad messenger, and ad content type. Interviews were coded and analyzed for qualitative themes. Ad scores differed significantly by vaccine status, with vaccinated participants rating ads as more likely to inspire vaccine uptake, while unvaccinated participants rated ads negatively. No specific messenger or content type was rated as more probable to motivate vaccination. There was a significant interaction between faith-based messengers and COVID-19 vaccination status, with faith leaders perceived as more favorable by unvaccinated participants (p=0.008). Vaccine-hesitant respondents cited mistrust of healthcare providers and fears of medical racism. Although we did not identify content types that might be helpful in a public health vaccine campaign targeting Black pregnant people, faith leaders may be a trusted messenger for unvaccinated individuals.

ObjectivesEstimate the HIV testing, diagnoses, and test positivity rates among Medicaid beneficiaries in 2016-2021 and assess the impact of the COVID-19 pandemic on these outcomes. DesignProspective observational study of Medicaid enrollment, inpatient, and outpatient claims data from 27 states, 2016-2021. MethodsWe assessed Medicaid claims from adult beneficiaries with full benefits whose first continuous enrollment was [&ge;]6 months without dual enrollment in other insurance, and without previous HIV diagnosis. We estimated the rates of annual testing, HIV diagnosis, and proportion of positive HIV tests among the tested using Poisson regression models. Bayesian structural time series modelling was performed to examine the pandemics impact on study outcomes with 3/16/2020-12/31/2021 as the pandemic period. We estimated rates overall and by age, sex, race/ethnicity, and states level of COVID-19-related restriction policies. ResultsWe included 20,508,785 beneficiaries. Male beneficiaries, especially 18-34-year-olds, had lower annual testing uptake and higher test positivity rates than female beneficiaries. Black beneficiaries had higher annual testing rates than White and Hispanic beneficiaries. While the pandemic acutely disrupted the increasing pre-pandemic testing trend, the rates recovered to the expected level had the pandemic not happened, except among 18-34-year-old male beneficiaries, whose pandemic rates were, on average, 18.1% lower (95% confidence interval:-22.3,-13.8) than projected rates. HIV diagnosis and test positivity rates were not affected by the pandemic. ConclusionThe pandemic significantly impacted the testing uptake among young male beneficiaries, highlighting the need for innovative strategies to improve HIV testing uptake in this demographic, restoring it to pre-pandemic levels or better.

In 2021, the U.S. Surgeon General issued an advisory to address the youth mental health crisis that included actions media organizations could take regarding their coverage of mental illness and traumatic events including natural disasters, pandemics, and mass violence. Although research indicates that both news and social media are associated with worse adolescent mental health outcomes, it is unknown whether news outlets adhere to the U.S. Surgeon Generals recommendations on social media. This study aimed to describe how news media organizations adhered to federal recommendations in their reporting of mental health or illness and collective trauma events on the TikTok social media platform. We conducted a directed content analysis of TikTok videos posted by four leading U.S. news organizations from December 2021 to December 2022 Videos covering relevant topics were coded based on their adherence to advisory guidelines. Of 5,344 TikTok videos posted during the timeframe, 950 (17.8%) covered news related to mental health or illness, climate change or weather-related disasters, mass shootings, and the COVID-19 pandemic. Content had a median adherence rate of 19.5% (range: 0.0-83.9%); however, substantial variability was observed across guidelines, news organizations, and topics. The two recommendations with the highest adherence rate were "fact-based reporting" and "no language that shocks, provokes, or creates a sense of panic" (40.0-76.1%). The recommendations with the lowest adherence rate (0.0-8.0%) were "include ways the public can make a positive difference" and "include content warnings on distressing content." Findings can inform news media efforts to develop content that protects youth mental health and interventions that support youth news consumption on social media. Author SummaryYoung people across the United States (U.S.) turn to social media for news about current events. Unfortunately, many social media posts from news media organizations amplify distressing events, and seeing this content has negative consequences for youth mental health. Recognizing the potential ways in which social media can affect youth mental health, the U.S. Surgeon General issued an advisory to address the youth mental health crisis that included actions news media organizations could take when sharing content of mental illness and traumatic events. Here, we use content analysis methods to analyze whether news media organizations followed the federal recommendations when covering mental illness and collective trauma events on TikTok. Content that covered these topics had a median adherence rate to the Surgeon General recommendations of 19.5% (range: 0.0-83.9%); however, substantial variability was observed across guidelines, news organizations, and topics. Our study offers new insights public health leaders can use to inform efforts to promote media content that protects youth mental health.

IntroductionMortality and smoking rates vary over time across the US. The Cancer Intervention and Surveillance Modeling Network--Lung Working Group (CISNET-LWG) has developed a smoking history generator to describe the effects smoking on health. This work further refines these parameters and quantifies effects on life expectancy MethodsData from the National Health Interview Survey (NHIS) and the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) were used to estimate smoking history parameters for each state. The age-period-cohort was used in most cases, but an age-cohort mode was used for cessation probabilities. Population mortality data were used to estimate mortality rates for all causes, lung cancer, and non-lung cancer. These were partitioned by smoking status. ResultsCalifornia and Kentucky are states with more or less aggressive tobacco control. The difference between population cohort life expectancy and life expectancy of never smoker was greater for males than for females, and it was greater in Kentucky than California because of higher smoking rates. These differences decreased with time. Similar result are shown for each state. ConclusionsVariation in smoking parameters and mortality trends vary considerably among states. These show variation in exposure to tobacco smoking and their effects on life expectancy. The Southeast region tends to have greater differences from never smokers because of higher smoking rates. However, there are also other factors affecting mortality rates.

BackgroundCOVID-19 vaccine hesitancy remains a public health issue despite the fact that vaccines are readily available and recommended for all persons aged [&ge;]5 years in the United States. We aimed to describe parents plan to vaccinate their children in two different populations: families in a prospective, longitudinal cohort study and families experiencing homelessness enrolled in cross-sectional surveillance for acute respiratory infections. MethodsParticipants were parents/guardians of children aged <18 years, recruited either from a serial cross-sectional homeless study in Seattle-King County, Washington or from a household cohort study in the Seattle Metropolitan area. Participants were surveyed during October 2020--May 2021 about their plans to vaccinate their child against COVID-19. Vaccine plans were described by study population as well as by sociodemographic features and over time. ResultsAmong parents of 640 children enrolled in the household study surveyed in October 2021, 66% reported planning to vaccinate their child vaccinated against COVID-19 once vaccines became available. This proportion increased slightly over the study period, to 75% in May 2021. In the homeless study, 1284 surveys were collected from parents of 338 children. The proportion of parents of families experiencing homelessness who planned to have their child vaccinated against COVID-19 ranged from 52% in November 2020 to 16% in March 2021. ConclusionCOVID-19 vaccine plan among parents of children experiencing homelessness in Seattle-King County decreased over time, with the majority of parents reporting that they did not plan or were undecided about COVID-19 vaccination for their children by May 2021. Further investigations are needed among families experiencing homelessness to assess vaccine attitudes and perceived barriers to getting their children vaccinated against COVID-19. SummaryPlans to get vaccinated against COVID-19 was less common in children experiencing homelessness and intent decreased over time during the study, whereas vaccination was acceptable in other families in Seattle, WA

Vaccine hesitancy emerged as a major challenge during the COVID-19 pandemic and has persisted beyond it, raising concerns about public readiness for vaccination in future pandemics. While extensive research has examined vaccine hesitancy for COVID-19 and routine immunization, it is unknown how the general population would respond to vaccination in a future pandemic, and what conditions might facilitate acceptance. Here, we analyzed data from a nationwide internet-based survey conducted in Japan between December 2024 and January 2025, involving 28,000 participants aged 15-84 years. We assessed intentions to receive vaccination in a hypothetical future pandemic under varying assumptions regarding disease fatality and vaccine immunity durability. Associations between vaccination intention and sociodemographic, psychological, health-related, informational, and infectious disease-related factors were examined. We further explored priority conditions that could increase vaccination intention. We found that only 53.1% of respondents indicated willingness to be vaccinated in a future pandemic with a case fatality rate comparable to COVID-19, representing a marked decline from observed COVID-19 vaccination coverage. Notably, 35.8% of individuals who had vaccinated during the COVID-19 pandemic reported hesitancy toward vaccination in a future pandemic. Higher assumed fatality rates and longer vaccine protection modestly increased willingness, particularly among those with ambivalent attitudes. Vaccination intention was lower among adults aged 20-40 years, women, individuals with lower income or education, and those endorsing misinformation or conspiracy beliefs, while higher infectious disease knowledge, greater fear of COVID-19, and active information seeking were associated with greater willingness. Clustering analysis identified eight distinct groups with heterogeneous priority structures. Free vaccination and clinical trial evidence were universally valued, whereas trust in authorities, domestic vaccine production, and convenience varied substantially across clusters. Public willingness to vaccinate in a future pandemic may be substantially lower than during COVID-19 and is shaped by diverse priorities. Tailored strategies and risk communication approaches that address heterogeneous concerns may be critical for strengthening preparedness for future pandemics.

ObjectivesGastric cancer (GC) is a leading cause of cancer mortality in the United States (U.S.), yet no routine screening strategy exists. Opportunistic upper endoscopy (EGD) performed during screening colonoscopy (EGD-SC) may provide a practical early detection approach. We evaluated the feasibility, acceptability, patient perspectives, and diagnostic yield of EGD-SC. MethodsThis single-center, open-label, single-arm prospective trial enrolled adults aged 45-80 years scheduled for colonoscopy without prior EGD in the past five years. Feasibility was assessed by enrollment, added procedural time, and safety. Acceptability, patient beliefs, motivators, barriers, and satisfaction were assessed using pre- and post-procedure surveys. Gastric biopsies evaluated for precancerous lesions. ResultsOf individuals contacted, 51.6% expressed interest and 26.6% enrolled (n=50; median age 56; 48% male; 68% high-risk). Median added time was 17 minutes (range 9-26), with no complications. All participants rated EGD-SC as satisfactory (100%) and 90% as acceptable; most preferred the combined procedure (97.5%) and would recommend it to family or friends (92.5%). Knowledge gaps were common: nearly half lacked awareness of GC risk factors; although 72% viewed screening as beneficial, only 23.3% perceived GC as severe, and none considered themselves highly susceptible. EGD found H. pylori infection (32%), atrophic gastritis (14%), and intestinal metaplasia (12%), with higher prevalence among high-risk participants. ConclusionsEGD-SC is feasible, safe, and highly acceptable, with strong patient endorsement and meaningful detection of GC precursor lesions. These findings support risk-stratified EGD-SC as a promising and pragmatic strategy for GC prevention and early detection in the U.S.

Nurses represent the largest segment of the United States healthcare workforce and played an instrumental role in the countrys response to the COVID-19 pandemic. Yet, little attention has been given to the contribution of this component of the U.S. medical personnel in the nations ability to face public health crisis. We present a cross-sectional, ecological analysis using cumulative annual reports from different national databases to assess the relationship between registered nurse (RN) density at a state level and age-adjusted COVID-19 mortality within the state, using data from 2021 when mortality rates were peaking in the U.S. At the state level, an increase of 1,000 RNs per 100,000 people, was associated with an estimated 24 to 44 fewer COVID-19 deaths per 100,000 residents (B= -0.024, {beta}= -0.146, 95% CI: -0.044 to -0.003, p = .024). In this multivariate analysis including medical co-morbidities, vaccination, health insurance, and poverty level, RN density explained nearly 11% of the variability in COVID-19 mortality among states. Our findings underscore the critical role played by nurses in responding to the COVID-19 pandemic, and the importance of incorporating nursing workforce data into planning for future public health emergencies.