Preventive Medicine Reports

Background: Despite the significant risks associated with online substance procurement (SP), few researchers have examined this practice in U.S. youth. The studies that do exist are cross-sectional and cannot temporally connect specific digital behaviors to online SP. This longitudinal cohort study examined youth SP and digital media habits to determine whether use of certain smartphone applications correlated with increased odds of online SP or being contacted online about procuring drugs or alcohol. Methods: A cohort of U.S. youth (aged 15-20) with a history of non-daily substance use in the 3 months prior to enrollment was recruited to use the digital phenotyping smartphone application EARS for 90 days. On a nightly basis, participants were asked to complete surveys about online experiences related to SP and instances of substance use. Smartphone-generated screen use data were also collected passively each day. Results: Out of 112 enrolled participants, 106 were able to be included in analyses. Over approximately 3 months, 28.3% of participants (n=30) reported a collective 91 instances where they used social media to acquire drugs or alcohol. Screen use data demonstrated temporal relationships between social media SP and applications previously connected to the social media drug-purchasing process (e.g., TikTok, encrypted apps), as well as other school-specific social media. Discussion: Our results provide critically needed research evidence to support a body of literature composed predominantly of anecdotal reports. Despite measures taken by social media companies to prevent use of their platforms for drug procurement, underage youth continue to engage in this practice.

Background Home Test-to-Treat (HTTT) programs deliver timely antiviral treatment for acute respiratory infections, including COVID-19 and influenza, through at-home testing and telehealth. Because access is often measured by visit occurrence, variation in how and when care is delivered may be overlooked. We hypothesized that telehealth access follows distinct process-based patterns. Methods We analyzed de-identified encounters from the national HTTT program (September 2023-July 2024); 6,213 of 8,160 eligible individuals remained after exclusions for missing data. Phenotypes were derived by k-means clustering of standardized variables capturing encounter timing, modality preference, process duration, and sociodemographic and digital access attributes. Ten-day surveys assessed symptom duration and healthcare utilization. Results Three phenotypes emerged: Delayed/Disrupted Access (n = 1,537; 24.7%), Digitally Engaged but Socioeconomically Vulnerable (n = 1,460; 23.5%), and Mainstream Access and Efficient Utilization (n = 3,216; 51.8%). Mean process duration differed (15.93 [SD 3.84] vs 3.69 [3.31] vs 2.87 [2.41] hours; p < 0.001). Synchronous preference was lowest in the Digitally Engaged group (22.9%); antiviral prescribing was high (88.6%-91.9%). Among 10-day respondents (n = 1,023), symptom duration did not differ. Emergency department visits were most frequent in the Digitally Engaged group (2.3% vs 0.0% and 0.5%; p = 0.02) and urgent care in the Delayed/Disrupted group (5.8% vs 4.1% vs 2.0%; p = 0.02). Conclusions Telehealth use in a national HTTT program formed distinct phenotypes defined by timing, modality, and care-process efficiency. Evaluating equity requires attention to how and when care is delivered, not simply whether it occurred.

Objective: To verify the association between perceived social & emotional support and self-reported food insecurity in the United States Design: Cross-sectional secondary data analysis Setting: Behavioral Risk Factor Surveillance System (BRFSS) data from 2024, collected via a nationwide telephone survey. Food insecurity was defined as responding always, usually, or sometimes to "During the past 12 months how often did the food that you bought not last, and you didn't have money to buy more?" Social support was measured using a BRFSS item assessing the frequency with which respondents received the social and emotional support they needed. Adjusted logistic regression models were used to assess the relationship between these variables while controlling for a wide variety of demographic, socioeconomic, and health status factors. Participants: Adults (n = 190,577) aged 18-80 years old (72.3% non-Hispanic White) Results: Individuals who reported only "sometimes" receiving the social and emotional support they need were more likely to report food insecurity as compared to those who "always" receive such support (aOR = 1.75; 95% CI 1.56, 1.96). Conclusions: These findings indicate that decreased social support may put individuals at higher risk of food insecurity. Future work should seek to understand the mechanisms of this association to inform targeted policy and other interventional programs.

Background: Self-reported confidence in health information seeking does not reliably predict accurate health knowledge, yet the population-level distribution of this discordance and its demographic predictors have received limited direct study. This study aimed to identify and characterize a Confident-Incorrect phenotype among U.S. adults: individuals with high perceived health information competence who simultaneously hold inaccurate or fatalistic beliefs about cancer. Methods: Cross-sectional analysis of HINTS 7 (N = 7,278). A Confidence Index (3-item digital literacy composite (Cronbach's = 0.674) and an Evidence-Consistent Knowledge Score (factual cancer knowledge minus a cancer fatalism composite; fatalism subscale = 0.563) were computed and combined into a discordance framework. Median-split classification produced four phenotypes. Gaussian Mixture Model clustering with four components provided moderate independent validation (inter-method agreement = 65.2%). Survey-weighted multinomial logistic regression (n = 5,771; McFadden pseudo-R2 = 0.129) examined phenotype predictors. Results: An estimated 20.3% of U.S. adults were classified as Confident-Incorrect. They reported confidence levels similar to Well-Informed adults (z = 0.72 vs. 0.82) but scored 2.8-fold lower on objective cancer knowledge (0.74 vs. 2.06 out of 4) and exhibited the highest cancer fatalism of any phenotype (3.17 vs. 1.65 out of 4). Only 14.3% correctly identified alcohol as a cancer risk factor (vs. 58.8% of Well-Informed adults). Cancer screening rates did not differ meaningfully across phenotypes. Lower education (OR = 0.754), Hispanic ethnicity (OR = 1.788), non-Hispanic Black race (OR = 1.893), higher social media use (OR = 1.097), and lower trust in scientists (OR = 0.749) independently predicted Confident-Incorrect membership. Conclusions: An estimated one in five U.S. adults is overconfident in health information competence while holding substantially inaccurate beliefs about cancer prevention. Cancer screening rates did not follow the expected gradient across phenotypes, a null finding that cautions against inferring immediate behavioral impact from observed belief gaps. Interventions targeting specific factual errors and cancer fatalism are more likely to reach this group than general health literacy programs.

OBJECTIVES To quantify socioeconomic inequalities in antibiotic prescribing for common infections in primary care, and assess whether these inequalities arise from differences in consultation frequency, prescribing behaviour, or variation in vaccination uptake, smoking, and body mass index. DESIGN Population based cohort study. SETTING Primary care data from Clinical Practice Research Datalink, England. PARTICIPANTS 17,195,399 children and adults estimated to have been registered with a general practice in 2019. MAIN OUTCOME MEASURES Antibiotic prescribing rates (prescriptions per person-year), consultation rates (consultations per person-year), and probability of receiving an antibiotic prescription following consultation. RESULTS Higher deprivation was associated with higher antibiotic prescribing rates for most respiratory tract indications. In children, prescribing rates were 44.8% (95% confidence interval [CI] 41.9% to 47.7%) higher for upper respiratory tract infections and 47.6% (95% CI 44.2% to 51.3%) higher for lower respiratory tract infections in the most versus least deprived twentile. In adults, prescribing rates for lower respiratory tract infections were 22.7% (95% CI 21.4% to 24.1%) higher in the most deprived twentile. Prescribing rates for other indications showed weak, U-shaped, or negative associations with deprivation. Prescribing inequalities were primarily driven by inequalities in consultation rates rather than probability of receiving antibiotics once consulted. Lower influenza vaccination uptake partly accounted for higher consultation rates for respiratory infections among more deprived children, while smoking prevalence contributed to inequalities among adults. CONCLUSIONS Socioeconomic inequalities in antibiotic prescribing vary by indication type and are largely explained by consultation frequency. Reducing inequalities may require interventions that decrease the need to consult, e.g. improving influenza vaccination coverage in children and reducing smoking among adults, rather than focussing solely on prescribing behaviour.

Abstract Aims To examine which demographic groups nicotine pouch advertisers chose to target on social media, and which groups Meta's algorithms actually delivered the adverts to. Design Cross-sectional analysis of advert-level data from the Meta Ad Library. Setting Meta social media platforms (including Facebook and Instagram) in the UK. Cases A random sample of 741 nicotine pouch adverts shown in the 12 months up to December 2025, and a comparison sample of 1,125 general adverts. Analyses of reach were restricted to adverts eligible for all genders and adult ages (444 pouch adverts; 674 general). Measurements Outcomes were advertiser-set gender and age-group targeting criteria (i.e., groups eligible to be shown each advert) and estimated advert reach to each group (i.e., number of people who saw each advert). Male-to-female reach ratios within age groups, and reach ratios comparing age groups, were calculated per advert and summarised using geometric means. To assess whether patterns were pouch-specific, comparisons with general adverts were made using ratios of reach ratios (RRR). Findings Advertisers of nicotine pouches targeted a broad sample; most adverts (79.1%; 586/741) were eligible to be shown to all genders, the remainder were restricted to men only. All were restricted to adults (minimum age 18 years) and most (95.6%; 708/741) had no upper age limit. Despite this, of pouch adverts eligible to be shown to all adults, adverts were more likely to reach men, particularly among younger men. Among 18-24-year-olds, pouch adverts reached around ten times as many men as women (RR 10.0, 95% CI 8.7-11.5), compared with a slight skew towards women for general adverts (RR 0.81, 95% CI 0.71-0.94), corresponding to an RRR of 12.3 (95% CI 10.0-15.1). Pouch adverts also showed a skew in reach towards younger age groups. Relative to those aged 35-44 years, reach was higher among 18-24-year-olds for nicotine pouch adverts (RR 1.33, 95% CI 1.17-1.51) but much lower for general adverts (RR 0.19, 95% CI 0.17-0.21), corresponding to an RRR of 7.0 (95% CI 6.0-8.2). Conclusions Nicotine pouch adverts on social media are often eligible to be shown broadly to all demographic groups but are disproportionately delivered to young men.

Background: The ECAIL trial, launched in 2017, targets hard-to-reach families and evaluates a multicomponent childhood obesity prevention intervention. At a maternity hospital in Lille, France, healthcare providers screened pregnant women experiencing social vulnerability, and dietitians delivered a home-based intervention until age 2. The COVID-19 pandemic led to a six-month suspension in 2020. This study compared eligibility and participation before the pandemic and after resumption, and examined how the pandemic and subsequent cost-of-living crisis shaped implementation and reach. Methods: We analyzed 5,744 eligibility questionnaires distributed at the maternity ward. Inclusion criteria included [&ge;]1 indicator of social vulnerability (e.g., socioeconomic disadvantage, precarious housing, or social isolation). To capture implementation experiences, a psychosocial researcher conducted a focus group with six dietitians delivering the intervention; it was recorded, transcribed, and analyzed thematically focusing on reach, acceptability, and adaptation. Results: Eligibility increased from 29.7% (n=955) prepandemic to 33.6% (n=849) after resumption, while the distribution of vulnerability criteriaremainedsimilar across periods:78.3% received social/medical benefits; employment was not the main source of household income for 58.7%; 24.4% experienced financial hardship; 14.7% reported social isolation; 6.0% lived in precarious housing; and 19.0% had three or more vulnerabilities. Participation among eligible women remained stable (24.6%; n=443). Qualitative findings indicated dietitians satisfaction and participants enthusiasm for the resumption of home visits, particularly in addressing social isolation. After resumption, the introduction of a pre-visit COVID-19 questionnaire reduced missed appointments. Converging qualitative and quantitative findings indicated sustained, and in some cases strengthened, provider engagement despite pandemic-related strain on hospital services. Conclusions: This study shows that a complex intervention can maintain reach and acceptability through adaptive implementation under major contextual disruptions.The rapid resumption of home-based services emerged as a robust strategy for engaging and retaining socially disadvantaged families, highlighting the importance of flexible, context-sensitive approaches during social and economic crises.

Objective: Cross-sectional studies indicate associations between self-reported social media use and adolescent wellbeing outcomes. We aimed to evaluate longitudinal associations of objectively measured smartphone and social media use with psychosocial wellbeing. Design: Observational study with one year of follow-up Setting: High schools in Finland from 2022 to 2023 Population: 259 adolescent girls (mean age 16.3 years at baseline) Main outcome measures: screenshots depicting smartphone and social media use, Bergen Social Media Addiction Scale (BSMAS), Generalized Anxiety Disorder-7 questionnaire, Body Appreciation Scale 2 (BAS-2) and visual analogue scales (VAS) of mood, tiredness, and loneliness Results: Across one year of follow-up, anxiety, body appreciation, and mood improved, but possible social media addiction increased from 15% to 17%. Social media addiction at baseline was associated with increased anxiety (r=0.29, p<0.001), lower body appreciation (r=-0.15, p=0.022), and more loneliness (r=0.20, p=0.001) at follow-up. Anxiety at baseline was associated with social media addiction at follow-up (r=0.19, p=0.005). The highest quartile of TikTok users reported more social media addiction (BSMAS 19 [IQR 16-21] vs. 17 [IQR 14-20]; p=0.009) and lower body appreciation (BAS-2 32 [IQR 28-38] vs. 35 [IQR 29-40]; p=0.003) than did others. The highest quartile of Snapchat users reported more social media addiction (BSMAS 19 [IQR 15-21] vs. 17 [IQR 14-20]; p=0.007) and tiredness (VAS 21 [IQR 13-32] vs. 26 [IQR 15-35]; p=0.049) than did others. Conclusions: Consistent with cross-sectional studies, social media addiction was associated with poorer psychosocial outcomes across follow-up. Policies to protect adolescents from social media addiction are urgently needed.

Background Chinas rapidly ageing population has increased the demand for long-term care insurance (LTCI), while the sustainability of current financing arrangements remains uncertain. Understanding willingness to pay (WTP) for improved LTCI services among LTCI beneficiaries or primary family caregivers may provide empirical evidence for discussions on acceptable and sustainable contribution mechanisms. Methods We conducted a contingent valuation survey among 278 LTCI beneficiaries or primary family caregivers in Panjin City, Liaoning Province, China. An iterative bidding game with randomized starting bids was used to elicit monthly WTP for a predefined LTCI service improvement scenario. Tobit regression models with heteroskedasticity-robust standard errors were used to estimate factors associated with WTP, including household income, disability severity, satisfaction with current services, and demographic characteristics. Results The mean monthly WTP for improved LTCI services was approximately CNY 300, compared with the current average monthly premium of approximately CNY 120. The median WTP was CNY 250. Higher household income was positively associated with WTP. Compared with participants with monthly household income below CNY 5,000, those in the highest income group above CNY 30,000 reported an additional WTP of CNY 178.9. More severe disability was also associated with higher WTP, whereas greater satisfaction with current LTCI services was associated with lower WTP. These associations were generally consistent across alternative model specifications. Conclusions LTCI beneficiaries or primary family caregivers in this Chinese pilot city reported a willingness to contribute more for improved LTCI services, particularly among those with higher income, greater care needs, or lower satisfaction with current services. These findings may inform discussions on differentiated contribution arrangements and service quality improvements in LTCI financing reform. However, the results should be interpreted cautiously because the study was conducted in a single pilot city and relied on stated-preference data.

Background: Long-acting pre-exposure prophylaxis (PrEP) expands HIV prevention options for women. However, PrEP impact depends on addressing persistent gaps in awareness, access, and use. Artificial intelligence (AI) tools, including conversational agents, are being explored to advance PrEP uptake, but comfort with AI may influence their impact. Thus, we examined women's comfort with AI and its association with PrEP awareness. Methods: We analyzed self-reported data from women aged [&ge;]18 years in a cross-sectional survey conducted in New York City from August 2023 to August 2024. We performed descriptive analyses, applied latent class analysis to identify AI knowledge/comfort profiles, and estimated unadjusted and adjusted odds ratios to assess associations between profile membership and PrEP awareness. Results: Among 306 respondents without a diagnosis of HIV who completed AI-related survey items, the median age was 36. Most women identified as Hispanic/Latina (60%) or Non-Hispanic Black (18%), had not completed college (53%), and spoke only English or were bilingual (81%). Latent class analysis identified four AI knowledge/comfort profiles that differed by PrEP awareness, race/ethnicity, borough, prior drug use, and technology utilization. Women with varied AI knowledge, broad AI discomfort, and comfort with clinicians maintaining privacy had lower odds of PrEP awareness (OR: 0.35, 95% CI: 0.16-0.75), but this association did not persist after statistical adjustment. Conclusions: PrEP awareness and AI knowledge were limited, yet many women expressed openness to AI-enabled tools when privacy was assured. AI-enabled HIV prevention tools should prioritize trust, transparency, confidentiality, and the lived contexts of the women they intend to serve.

Background: Non-communicable diseases (NCDs) account for approximately 75% of global deaths, with 79% occurring in low- and middle-income countries. Tobacco use remains a major modifiable risk factor, contributing to more than 8 million deaths annually. In Zambia, evidence on tobacco use among individuals with hypertension, diabetes mellitus, and cardiovascular disease remains limited. This study assessed the prevalence and determinants of tobacco use among adults with NCDs in Zambia. Methods: We conducted a secondary analysis of the 2017 Zambia STEPS survey. The analytic sample included 716 adults aged 18-69 years with self-reported hypertension, diabetes, and/or cardiovascular disease. Tobacco use was defined as current smoking or smokeless tobacco use. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs), accounting for the complex survey design. Results: Among 716 participants, 65.5% had hypertension, 7.7% diabetes, and 26.8% cardiovascular disease; 89.5% had multimorbidity. The overall prevalence of tobacco use was 12.2%. Prevalence was 12.2% among those with hypertension, 5.5% among those with diabetes, and 14.1% among those with cardiovascular disease. Tobacco use was significantly higher among males. Female sex was associated with lower odds of tobacco use (AOR = 0.16, 95% CI: 0.05-0.54, p = 0.004). Secondary education (AOR = 0.15, 95% CI: 0.03-0.66) and higher education (AOR = 0.04, 95% CI: 0.01-0.44) were protective. Alcohol consumption increased the odds of tobacco use (AOR = 5.23, 95% CI: 1.17-23.28). Conclusion: Tobacco use remains common among adults with NCDs in Zambia. Integration of tobacco cessation interventions into routine NCD care is urgently needed.

Background: Statins are key to preventing atherosclerotic cardiovascular disease and lowering low-density lipoprotein cholesterol and cardiovascular events. However, skepticism regarding their safety and value persists and is increasingly influenced by social media. TikTok has emerged as a major source of health information, but its content varies in quality and accuracy. This study evaluated the quality, attitudes, misinformation, and engagement of statin-related content on TikTok. Methods: Public TikTok videos were collected using predefined search terms and coded by creator type, thematic content, and overall attitude. Video quality was assessed using the DISCERN instrument, the Patient Education Materials Assessment Tool for Audiovisual Materials, and the Global Quality Score. False or misleading claims were independently reviewed by two cardiology fellows. Associations between engagement and quality were also examined. Results: Of 1,349 screened videos, 258 met inclusion criteria. Most were educational (91.0%), with non-physician healthcare providers (34.5%) as the largest creator group. Risks or negative effects were discussed more often than benefits (63.2% vs 42.2%), and 39.5% contained at least one false or misleading claim, most often from complementary and alternative medicine providers and wellness promoters. Quality differed by creator type across all instruments, with physician-created content scoring highest. Video popularity showed minimal association with informational quality. Conclusion: Statin-related TikTok content frequently emphasizes harms, often contains misinformation, and varies substantially in quality by creator type. Greater involvement of healthcare professionals on social media may help improve digital health literacy and counter misleading information about statin therapy.

Background. Tobacco smoke exposure, quantified by serum cotinine, is associated with cardiovascular, metabolic, and sleep-related health risks. The relationship between biomarker-verified tobacco smoke exposure and objectively measured, free-living wrist-worn ambient light patterns has not been examined in a nationally representative U.S. adult sample. Methods. We analyzed NHANES 2011-2014 cross-sectional data from 6,937 adults aged >20 years with valid serum cotinine and wrist-worn Physical Activity Monitor (PAM) ambient light data. Seven light outcomes were modeled using survey-weighted linear regression with log2(cotinine+1) as the continuous exposure across four covariate adjustment levels. Benjamini-Hochberg false discovery rate (FDR) correction was applied across the 7 outcomes within each model. Results. In Model 2 (adjusted for age, sex, race/ethnicity, education, poverty-income ratio, BMI, and survey cycle; N = 6,350), higher serum cotinine was associated with significantly higher nighttime light (beta = +0.024, 95% CI: 0.010, 0.038; p-FDR = 0.014) and lower evening light (beta = -0.031, 95% CI: -0.055, -0.008; p-FDR = 0.042). In exploratory behavioral models without alcohol (Model 3a; N = 5,766), both nighttime and evening associations remained FDR-significant. After additional adjustment for alcohol, which substantially reduced the sample due to 37.6% missingness (Model 3b; N = 3,866), the nighttime association attenuated below the FDR threshold, while the evening association remained FDR-significant. Categorical analyses showed progressively higher nighttime light across cotinine groups, and a hypothesis-generating sex interaction was identified (p-interaction = 0.001). Conclusions. Higher serum cotinine concentrations were associated with higher nighttime and lower evening ambient light after sociodemographic adjustment. Attenuation after behavioral adjustment and the cross-sectional design preclude causal inference. Longitudinal studies with formal mediation analyses are needed to clarify the temporal ordering and mechanisms linking tobacco smoke exposure, smoking-related behaviors, and personal light-dark cycle patterns.

Objectives: To examine COVID19 vaccine uptake among people diagnosed with sexually transmitted and bloodborne infections (STBBI) and reported methamphetamine users in Manitoba, Canada, during the acute phase of the COVID19 pandemic. Methods: We conducted a retrospective matched cohort study using linked population based administrative healthcare, laboratory, and vaccination databases in Manitoba. Individuals aged 16+ years with laboratory confirmed chlamydia/gonorrhea (CT/NG), syphilis, HIV, and/or documented methamphetamine use during the four years prior to March 1, 2020 were included in eight exposed cohorts. Each cohort was matched to unexposed comparators on age, sex, geographic region, and income quintile. The primary outcome was receipt of 2+ COVID19 vaccine doses between December 1, 2020 and March 31, 2022. Poisson regression models estimated adjusted rate ratios (aRRs) and 95% confidence intervals (95% CIs) for vaccine uptake. Results: Compared with matched comparators, most exposed cohorts were less likely to complete the COVID19 primary vaccine series. Individuals in the Syphilis Only (aRR: 0.87, 95% CI: 0.85 0.90), Syphilis Plus (aRR: 0.84, 95% CI: 0.81 0.86), CT/NG Only (aRR: 0.95, 95% CI: 0.94 0.96), CT/NG Plus (aRR: 0.82, 95% CI: 0.80 0.85), Methamphetamine Only (aRR: 0.78, 95% CI: 0.76 0.80), and Methamphetamine + STBBI cohorts (aRR: 0.74, 95% CI: 0.72 0.77) had significantly lower vaccine uptake. The HIV Only cohort did not differ significantly from matched comparators (aRR: 0.98, 95% CI: 0.95 1.01). Lower uptake was concentrated among individuals living in lower-income areas. Conclusions: People diagnosed with STBBI and methamphetamine users in Manitoba experienced significant inequities in COVID19 vaccine uptake, particularly those with STBBI coinfections and concurrent substance use. Integrated vaccination approaches linked with HIV, harm reduction, and addiction services may improve vaccine equity during future public health emergencies.

Background: Black and Latino adults in the United States experience a disproportionate burden of cardiometabolic conditions due to interacting behavioral, social, and structural drivers of health. Less is known about the impact of integrating digital health tools into CHW-led interventions to improve cardiometabolic health. This trial evaluates a multilevel community-digital health promotion model delivered by CHWs to improve service utilization, health behaviors and cardiometabolic health among Black and Latino adults. Methods: This community-partnered trial uses a randomized delayed-control group with a phased recruitment design. Four cohorts (N = 664) are enrolled through three community-based organizations (CBOs). Eligible participants are 18 years who self-identify as Black or Latino, and have prediabetes/diabetes, hypertension, or overweight/obesity. Participants are allocated to either (1) a multilevel intervention consisting of CBO and CHW capacity building combined with individualized CHW-led lifestyle coaching and group activities supported by digital tools, or (2) a delayed control group receiving SMS-only cardiometabolic health education. Data collected at baseline, 6, 9, and 18 months include surveys and health metrics. Qualitative data are collected from participants and community partners to assess intervention acceptability, implementation facilitators and barriers, and sustainability. Results: The primary outcome is health service utilization at 6 and 9 months. Secondary outcomes include health behaviors, health metrics, and social determinants of health. Sustainability of health behaviors and health metrics is assessed at 18 months. Conclusions: Findings will provide evidence to inform scalable, sustainable community-digital health models for CHW-supported cardiometabolic health interventions in underserved communities.

University Students are particularly vulnerable to disordered eating behaviors (DEB) and attitudes (DEA). This study expands upon the knowledge base of DEA and DEB in university students by employing a netnography as a precursor to the main study to establish the following research questions: What is the relationship between the perceived quality of dining services and DEA? What is the relationship between the perceived availability of dining services and DEA? And lastly, how does prior experience with dining services affect eating patterns and attitudes toward food? The first study utilized a netnographic approach in order to evaluate issues with university dining services, leading to the design of the second study. Students at an upper Midwestern university (n=88) were surveyed via convenience sampling. Eating attitudes, eating behaviors, and relationships with dining services were measured. A statistically significant relationship between the availability of services and the DEA was found. A statistically significant relationship between the availability of services and risk behaviors was found. However, no statistically significant correlation existed between first-year dependence on on-campus dining services and risk behavior related to eating disorders or eating attitudes. Based on this, we know the quality of nutrition and the availability of services impacted students eating attitudes and behaviors, not inherent dependence.

Background: Prenatal substance exposure (PSE) occurs when an individual is exposed to substances in utero. PSEs may have lasting effects on mental health. We tested whether PSEs show threshold, cumulative, or individual substance associations with childhood psychiatric diagnoses. Methods: Clinical variables (demographics, ICD-9/10 diagnoses, PSE history) were extracted from electronic health records from the University of Minnesota Adoption Medicine Clinic. PSEs were identified from caregiver and child-protective-services narratives and/or toxicology (cord tissue/blood, meconium). For each ICD-9/10 diagnostic category, we fit logistic regression models comparing (1) exposure thresholds (0, 1, 2, 3, 4+ exposures), (2) a cumulative exposure count, and (3) individual substances to estimate marginal odds ratios (ORs) with 95% Confidence Intervals (CIs). Results: Psychiatric diagnoses increased with the number of PSEs. Relative to no exposure, odds of an Anxiety Disorder rose from OR 1.47 (95% CI 1.16-1.87) with one exposure to OR 2.03 (1.64-2.52) with >=4 exposures. Higher cumulative exposure scores were associated with Anxiety Disorders (OR 1.28, 1.18-1.38), Behavioral and Emotional Disorders (OR 1.42, 1.31-1.54), Substance Use Disorders (OR 1.52, 1.29-1.79), and Mood Disorders (OR 1.16, 1.04-1.30). Alcohol, tobacco, and marijuana exposures were associated with increased odds of at least one psychiatric diagnosis, and each substance showed at least one significant diagnostic cluster when modeled independently. Conclusion: Increasing numbers of PSEs were associated with higher odds of psychiatric diagnoses, with patterns varying by substance and outcome. These findings motivate research on exposure timing and combinations to support earlier identification and intervention for at-risk children.

Pharmacogenomics (PGx) offers a pathway towards personalised medicine, which relies on health consumer involvement in making informed decisions. As consumers increasingly seek health information online, high-quality digital resources are essential to support informed consent and shared decision making. The complexity of PGx and widespread limitations in health literacy raise concerns about whether existing consumer-facing online PGx resources are understandable and sufficiently comprehensive. This study evaluates the readability, visual design, and informational quality of publicly available online written PGx health information. Twenty-three webpages met inclusion criteria. The mean readability corresponded to approximately 15 years of formal education (university level), substantially exceeding the Australian Government's recommended Year 7 reading level for public health materials. Informational quality was generally low, with most webpages being rated as poor or very poor. In contrast, visual design quality was relatively strong, with webpages achieving on average around three-quarters of the criteria. Although the visual presentation of PGx webpages is generally professional, their high reading difficulty and limited discussion of treatment choices and uncertainties reduce their usefulness for health consumer education. Improving readability, clearly communicating risks and limitations, and incorporating decision-support features may enhance the ability of online resources to support informed consent and shared decision making.

Background: Xylazine and medetomidine are veterinary sedatives increasingly detected as adulterants in the U.S. illicit drug supply. In response, several states have scheduled xylazine. Whether these policies are associated with subsequent changes in xylazine and medetomidine detections remains unclear. Methods: We conducted a state-level, semiannual, serial cross-sectional study using National Forensic Laboratory Information System (NFLIS) data from 1999 to 2025. The primary outcomes were xylazine and medetomidine reports per 100,000 NFLIS drug reports. We used staggered difference-in-differences event-study models to estimate changes in report rates after xylazine scheduling. Sensitivity analyses excluded Florida and expanded the treatment definition to include states that criminalized xylazine without formal scheduling. Falsification analyses examined steroid and antidepressant reports as negative-control outcomes. Results: NFLIS recorded 101,987 xylazine reports and 12,085 medetomidine reports. Xylazine scheduling was not associated with a significant change in xylazine report rates (ATT, 2,872.29 per 100,000; 95% CI, -2,024.63 to 7,769.21; p=.250). In contrast, xylazine scheduling was associated with a significant increase in medetomidine report rates (ATT, 1,536.51 per 100,000; 95% CI, 211.14 to 2,861.88; p=.023). Sensitivity analyses produced similar findings. Negative-control outcomes showed no significant changes. Conclusions: State xylazine scheduling was associated with increases in medetomidine reports but no significant change in xylazine reports. These findings suggest that scheduling may be followed by changes in adulterant composition rather than reductions in overall 2-adrenergic agonist involvement. Our study highlights the importance of monitoring the unintended effects of xylazine scheduling and supporting continued investment in public health surveillance, drug checking, and harm reduction services.

Introduction Care home (CH) influenza vaccination of staff improves resident health, yet uptake remains low at just over 11% (England, 2025/2026). We report an economic evaluation (EE) of "FluCare", an intervention to increase staff influenza vaccination through: vaccination clinics at CHs; promotional materials; and CH financial incentives. Method Seventy-five CHs were randomised to FluCare or control. A cost-consequence analysis took the influenza vaccination programme funder perspective, but also extended to the National Health Service (NHS) and CH perspective. Costs included: influenza vaccination; administration fee; FluCare components; CH resident NHS utilisation. Outcomes were: staff influenza vaccination rates; staff sickness; and resident mortality. Sensitivity analyses excluded intervention CHs that did not host vaccination clinics. Results Compared to control CHs, adjusted analysis found intervention homes with a mean absolute increase in vaccination rates of 1.8% (95% CI: -6.0%, 10.8%; p=0.572) at an increased cost of {pound}451 (95% CI: {pound}239, {pound}675; p<0.001) to the vaccination programme funders: {pound}249 per additional percentage point (PAPP) per CH. Vaccination clinics were delivered late in the influenza season, with 80% taking place from February 2023. Including only intervention CHs that hosted staff flu vaccination clinics (23/35), increases the mean difference to 10.1% (95% CI: 0.9%, 21.9%; p=0.018) and costs to {pound}805 (95% CI: {pound}603, {pound}1,079; p<0.001): {pound}79 PAPP per CH. Differences between trial arms in other costs and outcomes were marginal and generally non-significant. Conclusions FluCare delivered little improvement when staff flu vaccination clinics did not occur and had little impact on other costs/outcomes. Cost-effectiveness depends on willingness-to-pay for increased staff vaccination, but cost PAPP per CH improved from {pound}249 to {pound}79 when only CHs hosting clinics were considered. Late implementation, likely reduced impact by limiting clinic delivery, as reflected in sensitivity analysis. Future evaluations should implement FluCare earlier in the season.