Preventive Medicine Reports

BackgroundOral nicotine pouches (ONPs) have become the second most commonly used nicotine product among U.S. youth. However, little is known about how ONP use is distributed across population subgroups and how strongly it is patterned by use of other tobacco or nicotine products. MethodData were drawn from the 2021-2023 waves of the National Youth Tobacco Survey (NYTS), a nationally representative survey of U.S. middle and high school students (N = 66,349). We estimated the annual survey-weighted prevalence of current ONP use ([≥]1 day in the past 30). Using 2023 data (N = 20,174), we estimated prevalence by demographics and other tobacco/nicotine product use, and fitted survey-weighted Poisson regression models to estimate associations of current ONP use with demographics and other nicotine/tobacco product use. ResultsIn 2023, 1.6% reported current ONP use (95% confidence interval [CI] 1.0-2.1), up from 0.8% in 2021 (95% CI 0.5-1.0). Prevalence in 2023 was higher among males (2.3%, 95% CI 1.5-3.1) than females (0.8%, 95% CI 0.4-1.3), and among students who used any other tobacco or nicotine product (13.4%, 95% CI 10.3-16.5) than those who did not (0.4%, 95% CI 0.1-0.8). In fully adjusted models, use of nicotine products other than cigarettes or e-cigarettes showed the strongest association with ONP use (APR 21.1, 95% CI 13.0-34.0), followed by cigarette smoking (APR 2.0, 95% CI 1.1-3.7) and e-cigarette use (APR 1.9, 95% CI 0.8-4.5). Most current ONP users also used other tobacco/nicotine products (75.0%), though 16.6% reported no lifetime use of other products. ConclusionsOverall ONP prevalence among U.S. youth remains low but is increasing. While ONP use is largely concentrated in youth who use other nicotine/tobacco products, it is also increasing among adolescents who are otherwise nicotine-naive. These findings highlight the need for continued monitoring and targeted regulations that balance harm reduction for people who smoke against the risk of expanding nicotine dependence among youth. Key Points QuestionWhat are the prevalence, demographic patterns, and tobacco/nicotine co-use profiles of oral nicotine pouch users among US middle and high school students? FindingsIn this cross-sectional study of 66,349 students from the 2021-2023 National Youth Tobacco Survey, current oral nicotine pouch use doubled from 0.8% in 2021 to 1.6% in 2023. Most users also used other tobacco or nicotine products, but the proportion of current users with no lifetime use of other products increased from 7.4% to 16.6%. MeaningAlthough oral nicotine pouch use among US youth remains low, increasing uptake among adolescents without prior tobacco or nicotine exposure suggests a need for targeted prevention efforts alongside continued surveillance.

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.

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.

ObjectivesLung cancer screening (LCS) is the only screening test incorporating behavioral risk factors into eligibility determination. However, collecting necessary smoking history data has been challenging, limiting screening uptake. In this study, we evaluated how a program coordinators detailed shared decision-making (SDM) impacted smoking data reliability. MethodsPatients who underwent a baseline screening low-dose CT between July 31, 2013, and August 25, 2023, were stratified into pre- and post-intervention cohorts. The intervention was a comprehensive pre-CT smoking history assessment with SDM by an LCS program coordinator, implemented on July 31, 2017. We compared the completeness and concordance of smoking history data between clinician and patient self-report. ResultsAmong 3795 patients, 670 (18%) were pre- and 3125 (82%) were post-intervention. Having a coordinator reduced missing smoking data (p<0.001), but did not eliminate it. Both groups showed high concordance between clinician-documented and self-reported smoking status (pre: kappa=0.84, 95% confidence interval [CI] 0.79-0.89; post: kappa=0.84, 95% CI 0.83-0.86). Correlations strengthened for smoking duration (rho=0.71 vs. 0.65, p=0.026) and years since quitting (rho=0.83 vs. 0.80, p=0.21) after involving a coordinator. Correlations for smoking intensity and pack years remained fair (rho<0.6). LCS eligibility based on self-reported smoking history increased from 46.0% (308/670) pre- to 64.1% (2003/3125) post-intervention, below the 100% eligibility using clinician-documented history. ConclusionsSmoking data reliability improved after a dedicated LCS program coordinator implemented a smoking history assessment. Meanwhile, challenges remained with the ascertainment of total pack-years. Detailed probing and patient education may be insufficient to overcome challenges in assessing smoking intensity.

BackgroundTobacco use among young people remains a major public health concern in Indonesia, where smoking prevalence is high and metabolic risk factors such as overweight and hypertension are increasing. Evidence linking smoking behavior, particularly e-cigarette use, to early cardiometabolic risk in low- and middle-income countries is still limited. This study examined overweight and hypertension profiles among young smokers using nationally representative data from Indonesia. MethodsThis secondary analysis used data from the Indonesian Health Survey 2023. Participants were young adults aged 18-25 years with complete information on smoking status, anthropometry, and blood pressure (n = 12,770). Smoking status was categorized as conventional smokers, e-smokers, and dual smokers. Outcomes included overweight/obesity (BMI [&ge;]23 kg/m2), central obesity (waist circumference [&ge;]90 cm for men and [&ge;]80 cm for women), and hypertension ([&ge;]130/80 mmHg). Logistic regression models estimated adjusted odds ratios (AOR) controlling for age, gender, smoking duration, residence, and socioeconomic proxy variables. ResultsMost respondents were conventional smokers (94%), followed by dual smokers (4%) and e-smokers (2%). E-smokers showed higher mean BMI and the greatest prevalence of overweight/obesity (40%) and central obesity (18%). After adjustment, e-smokers and dual smokers had higher odds of overweight/obesity (AOR = 1.37 and 1.41, respectively) and central obesity (AOR = 1.47 and 1.53, respectively) compared with conventional smokers. Hypertension prevalence (11-13%) did not differ significantly across smoking categories. ConclusionAmong young Indonesian smokers, e-cigarette and dual use were associated with higher odds of overweight and central obesity but not hypertension. These findings highlight the importance of integrating tobacco control with early metabolic risk prevention strategies targeting youth.

In December 2022, California enacted a comprehensive ban on the sale of flavored tobacco products, including menthol cigarettes. Using data from the Behavioral Risk Factor Surveillance System, this study employed difference-in-differences (DiD) models to examine adult smoking prevalence in California before (January 2017-December 2022) and after the ban (January 2023-December 2024), compared to states without flavor bans. From 2017-2024, smoking prevalence declined steadily in both California (from 11.8% to 7.9%) and the comparator states (from 18.5% to 12.4%). Adjusting for sociodemographic and year-fixed effects, the DiD estimate among adults 21+ was not significant (aOR=1.09; 95% CI: 1.00-1.20; p=0.0522). However, DiD effects showed significantly lower cigarette decline for age 21-34 (aOR=1.26; 95% CI: 1.05-1.52; p=0.0146) and for Hispanic adults (aOR=1.19; 95% CI: 1.01-1.41; p=0.0433). These results suggest that the flavor ban in California did not significantly affect overall adult 21+ smoking prevalence compared to states without such policies but may have reduced the decline in cigarette smoking among adults aged 21-34 and Hispanic individuals.

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.

Background and ObjectivesPatient portals allow adolescents and caregivers of pediatric patients to better engage with health care, improving their medication adherence, health knowledge, self-efficacy, and receipt of preventive care. However, disparities in access to and comfort with using these portals persist. Hospitalization represents a promising opportunity to address these disparities among a high-risk population. Design/MethodsWe conducted a cross-sectional analysis to identify disparities in portal enrollment and use (logins, messaging, or telehealth use) among patients admitted to two pediatric hospitals within a single health system from 2022-2024. We calculated unadjusted rates of portal enrollment and use before, during, and after hospitalization, stratified by patient-level factors (age, race/ethnicity, insurance coverage, medical complexity), household-level factors (preferred language), and population-level factors (neighborhood opportunity). We then used multivariable logistic regression to identify associations between these factors and portal enrollment and use. ResultsAmong 40,371 hospitalized patients, 93% had enrolled in our patient portal. Patients who identified as Non-Hispanic Black, were publicly insured, had a household language other than English, and lived in lower opportunity neighborhoods had significantly decreased odds of portal enrollment and use before, during, and after hospitalization. ConclusionsDespite high overall rates of portal enrollment among our patient population, we observed persistent disparities in portal enrollment and use. Efforts to promote equitable portal usage among hospitalized children may be most effective when focused on families who are publicly insured, prefer languages other than English, or live in lower opportunity neighborhoods.

General-purpose large language models (LLMs) like ChatGPT are increasingly used for medical advice despite lacking medical training and frequently producing incorrect or unsafe output. Older adults health information-seeking behaviors using LLMs remain poorly characterized. We conducted a cross-sectional survey of 574 US adults aged 50+ recruited via Prolific, balanced by sex and race. Participants reported health information sources, ChatGPT and PubMed use, demographics, and health literacy. Most participants (92%) searched online for health information. All had heard of ChatGPT, and 63% used it for medical information, compared to 44% who had heard of PubMed and 39% who used it. Those with inadequate health literacy had higher odds of ChatGPT use for medical advice (AOR 2.36, 95% CI 1.30-4.52) versus those with adequate health literacy. In conclusion, with more than half of older adults using LLMs for medical advice, the development of safer, purpose-trained medical LLMs is warranted.

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.

BackgroundArticle 5.3 of the WHO Framework Convention on Tobacco Control requires Parties to protect policies from tobacco industry interference, yet implementation remains weak internationally. Aotearoa New Zealands (Aotearoa NZ) is seen as a leader in tobacco control, yet little is known about its implementation of Article 5.3 protections. This study examines these protections as well as existing transparency measures in light of the 2024 repeal of world-leading tobacco control policies. MethodsInterviews with current and former: public health experts, politicians, officials and political journalists, and analysis of key texts. ResultsAotearoa NZs Article 5.3 implementation and scope is constrained, leaving invisible and exploitable paths of influence. Public health experts argued protections have been neglected from the start. Politicians were unaware of Article 5.3 obligations, and reported limited guidance on industry interactions. These gaps are compounded by non-existent lobbying laws and ill-equipped transparency measures. ConclusionDespite the countrys reputation for strong tobacco controls, structural policy and implementation failures leave Aotearoa NZs health policies vulnerable to industry interference. Aotearoa NZ and other Parties should consider institutionally embedding comprehensive Article 5.3 protections to safeguard policy decisions from tobacco industry influence. WHAT THIS PAPER ADDSO_ST_ABSWhat is already known on this topicC_ST_ABSTobacco industry interference remains the biggest barrier to tobacco control policies, with evidence consistently identifying gaps in Parties implementation of Framework Convention on Tobacco Control Article 5.3 protections. Parties often rely on pre-existing measures such as lobbying laws. What this study addsThis is the first study examing Aotearoa NZs implementation of Article 5.3. It shows that despite its reputation as a tobacco control leader, implementation is severely limited and pre-existing measures are inadequate, enabling a system in which industry interference can go on unseen. How this study might affect research, practice or policyBy identifying how structural policy gaps enable industry interference, this study highlights the need for comprehensive institutional embedding of Article 5.3 protections across government, and consideration of its codification into law.

BackgroundEarly life social determinants of health, such as childhood trauma, have implication on adverse health outcomes later in the life course. Our objective was to develop a childhood trauma measure within the Health and Retirement Study (HRS) - a large, diverse, U.S.-based aging cohort. MethodsData from the HRS Psychosocial and Lifestyle Questionnaire [2006-2016] and Life History Survey [2015-2017]) surveys collected thirteen binary items measuring self-reported exposure to early life adversity across the two study questionnaires. Participants who completed both questionnaires and had exposure items available were included in the analyses. Frequencies and percentages for self-reported trauma items are presented for the study sample and by gender and race/ethnicity. Using complete cases, exploratory factor analyses followed by Mokken scale analyses were performed to evaluate the scalability of the childhood trauma items. Predictive criterion validity of the final domains was evaluated with general health and socioeconomic indicators at participant baseline. ResultsAmong the sample with complete childhood trauma data available (n=9,340), most were women (60.7%), White/Non-Hispanic (73.2%), and had a high school/general education degree (54.0%). The most reported childhood traumas were paternal separation [&ge;]6-months (22.8%), parental death (21.4%), sibling death (18.1%), and problematic parental substance use (17.5%). Two scales were formed based on factor analysis and scalability coefficients. The domain measuring disruption of family structure had strong scalability (HT = 0.55) and included living in an orphanage, foster care, parents divorced/separated, [&ge;]6-month from mother and/or father, and grandparents as primary caretakers. A second domain measuring adverse experiences of parent and/or sibling death had moderate scalability (HT = 0.41). Parental substance abuse and physical abuse clustered together in a third domain with weak scalability (HT = 0.39). ConclusionsThe early adversity items available in the HRS offer meaningful domains for which researchers can evaluate childhood trauma exposure in the context of aging outcomes in older adults. In particular, the family structure domain and parental/sibling death demonstrated moderate-to-strong scalability and may have important implications for health trajectories later in life.

OBJECTIVEOpioid misuse exacts a tremendous toll on society. Mindfulness-Oriented Recovery Enhancement (MORE) is an efficacious treatment for opioid misuse. Yet, the cost-effectiveness of this intervention remains unknown. METHODSCost-effectiveness and cost-benefit analyses of a randomized clinical trial with enrollment of 250 adults with chronic pain prescribed long-term opioid therapy who were misusing opioids. Participants were randomized to MORE (training in mindfulness, reappraisal, and savoring positive experiences) or supportive group psychotherapy across 8 weekly 2-hour groups. Incremental cost-effectiveness ratios (ICER) and benefit-to-cost ratios (BCRs) were computed using the primary outcome of opioid misuse at 9-month follow-up, as assessed by a composite measure based on self-report, clinical interview, and urine screen. RESULTS250 randomized patients (64.0% female) had an average age of 51.8 years (SD=11.9), were mostly taking oxycodone or hydrocodone (69%), and had mean morphine equivalent opioid dose of 101.0 (IQR=74) mg. At 9-mo. follow-up, the difference in the probability of having a positive Drug Misuse Index (DMI) rating was 0.24 (0.54 for MORE participants vs. 0.78 for controls). The ICER of MORE relative to supportive psychotherapy was $116.3 per averted case of opioid misuse, $8.9 per life-year, and $8.0 per quality-adjusted life-year. MORE is cost-saving vs. supportive psychotherapy after adjusting for healthcare costs. Excluding all benefits associated with averting fatal overdoses results in a BCR of 84.2. CONCLUSIONSGiven MOREs cost-effectiveness, private and public payers should consider disseminating this evidence-based therapy broadly across the nation to reduce mortality and morbidity associated with the ongoing opioid crisis. HIGHLIGHTSO_LIMindfulness-Oriented Recovery Enhancement (MORE) substantially reduced opioid misuse among adults with chronic pain on long-term opioid therapy. C_LIO_LIMORE was highly cost-effective vs. supportive psychotherapy, costing $116 per averted opioid misuse case, and MORE was cost saving when accounting for healthcare costs associated with opioid misuse. C_LIO_LIFindings suggest wide dissemination of this evidence-based treatment could yield major healthcare and other economic benefits in addressing the opioid crisis. C_LI

IntroductionElectronic nicotine delivery systems (ENDS) products continue to evolve, and so ongoing analysis of transition rates over time is important for tracking real-world associations between ENDS and cigarette use and for providing the information necessary to project future public health outcomes. MethodsUsing the Population Assessment of Tobacco and Health (PATH) Study Waves 6-7 (2021-2022), we applied a Markov multistate transition model to estimate transition rates for initiation and cessation of each product. We estimated one-year transition probabilities for each transition. These results were compared to estimated rates and probabilities in Waves 1-6 (2014- 2021). ResultsThe fraction adopting ENDS use in 2021-22 among those who had never previously established tobacco product use, those not currently using tobacco products, and those currently smoking cigarettes increased to 0.5% (95% confidence intervals [CI]: 0.4, 0.6%), 2.7% (95% CI: 2.3, 3.2%), and 6.8% (95% CI: 6.1, 7.6%), respectively. These increases were driven by young adults (ages 18-24), with respective transition fractions of 2.7% (95% CI: 2.3, 3.2%), 23.6% (95% CI: 20.2, 27.0%), and 19.2% (95% CI: 14.0, 24.5%). The fraction of adults who transitioned from dual cigarette and ENDS use to cigarette-only use remained around 25% (26.2% [95% CI: 21.7, 30.7%]), while the fraction who transitioned to ENDS-only use increased to 24.2% (95%CI: 20.5, 27.9%). The increase in the dual to ENDS-only use transition was also driven by young adults (34.4% [95% CI: 26.2, 42.6%]) and adults ages 25-34 (29.4% [95% CI: 23.1, 35.7%]). ConclusionPublic health efforts are needed to promote cigarette cessation among older adults, specifically. What this paper addsO_ST_ABSWhat is already known on this topicC_ST_ABSO_LITransitions in cigarette and ENDS use have been changing over time. Young adults have been early adopters of ENDS, with older adults less likely to try ENDS or to completely switch from cigarettes to ENDS. C_LIO_LIFrequency of product use likely impacts the likelihood of product quitting or switching. C_LI What this study addsO_LIWe found increasing adoption of ENDS among adults who have never smoked, those not currently using cigarettes or ENDS, and those using cigarettes only. These patterns were driven by young adults, with little cigarette cessation or switching to ENDS among older adults. C_LIO_LIDaily (vs non-daily) use of ENDS facilitated cigarette cessation among those using cigarettes and ENDS, but it was a barrier to ENDS cessation among those using ENDS only. C_LI How this study might affect research, practice, or policyO_LIPublic health efforts are needed to promote cigarette cessation among older adults who smoke, many of whom may already be experiencing the health effects of tobacco use. C_LIO_LIStudies are needed to develop strategies for leveraging ENDS to maximize smoking cessation while also helping those who successfully quit smoking to avoid long-term ENDS use. C_LI

ObjectiveAlthough COVID-19 vaccination is important for People Living with HIV given their elevated infection and comorbidity risks, some PLHIV are hesitant to accept vaccination. Hence, we conducted a cross-sectional study in British Columbia, Canada, aimed to identify socio-economic and health-related factors predicting COVID-19 vaccine uptake and contributing to hesitancy among PLHIV. MethodsA 34-item anonymous self-administered survey was disseminated to PLHIV accessing services through HIV and AIDS-related organisations e-newsletters between November 2022 and January 2023 in British Columbia. The survey included sociodemographic information, COVID-19 factors, HIV indicators, and the Vaccine Hesitancy Scale. Descriptive and inferential statistics were conducted to detect significant associations between the sociodemographic characteristics, health-related factors and COVID-19 vaccine uptake using IBM(R) SPSS(R) 28 and significance level at p<0.05. ResultsFrom the 276 respondents (mean age 29.93{+/-}7.55), 54.7% were men, 31.6% identified as sexual minorities, and 46.7% were of indigenous origin. Approximately 40% of the respondents received at least three vaccine doses, while 82.2% received at least one dose. Vaccine hesitancy was associated with lower education, age <44, and low income. Predictors of COVID-19 vaccine uptake included age [OR=1.06, 95% CI=1.01-1.12], bachelors degree [OR=0.22, 95% CI=0.07-0.72], family/friends infected with COVID-19 [OR 3.68 95% CI=1.56 - 8.67], HIV viral load >500 copies [OR=0.20, 95% CI=0.06-0.61], belief in vaccine importance [OR= 0.51, CI=0.28-0.95], trust in Health Canadas information [OR 0.49 CI=0.29-0.83], and concerns about vaccine adverse effects [OR=0.35, CI=0.22-0.56]. Concerns about vaccine adverse effects reduced the likelihood of receiving three COVID-19 vaccine doses by 65%. ConclusionsConsiderations must be taken around specific factors that may have an impact on COVID-19 vaccination rates among PLHIV, including information about vaccine adverse effects, HIV viral load, age, and education level. This insight should guide the development of policies and interventions aimed at encouraging individuals to maintain an up-to-date vaccination status.

BackgroundAlcohol consumption and binge drinking during pregnancy have been rising in the US since 2006. Unfortunately, capacity to diagnose fetal alcohol spectrum disorder (FASD) remains suboptimal. Incorporating the lived experiences of affected populations improves service access and responsiveness, and enhances quality of care. This qualitative study thus explored barriers and facilitators in the FASD diagnostic journey from the perspectives of caregivers of children diagnosed with FASD and clinicians engaged in screening, evaluating, or diagnosing FASD or linking children to needed interventions. MethodsCaregivers were biological, adoptive, foster, or other guardians of children recently diagnosed with FASD at a large teaching hospital system serving a major southeastern metropolitan area. Clinicians were providers at this same hospital system who screened, evaluated, or diagnosed children with FASD or linked them to needed interventions. Study staff conducted semi-structured qualitative interviews with participants that covered barriers and facilitators arising during this diagnostic journey. Thematic analysis methods were applied to identify patterns across transcripts. ResultsEleven clinicians and 15 caregivers participated. Clinicians and caregivers reported that barriers to FASD evaluation and diagnosis included (1) cost; (2) wait times; and (3) prenatal alcohol exposure documentation, often shaped by stigma; no facilitators were identified. Facilitators to linkage to interventions were caregiver education on FASD symptoms, services to address these symptoms, and how to connect to these services. Barriers were absence of needed services, long travel distances to existing services, and cost. ConclusionsIn this sample, stigma, cost, and provider availability impeded the FASD diagnostic journey and linkage to care. Promising proposed federal legislation (i.e., the FASD Respect Act) targets these barriers, and thus holds potential to support evaluation, diagnoses, and linkage to care among children with FASD.

BackgroundMigrant domestic helpers are vulnerable to obesity and mental disorders, yet few interventions target this population. To address the research gap, we designed healthy lifestyle intervention tailored to this population and evaluated its effectiveness on healthy behaviors and mental well-being among Filipino domestic helpers in Hong Kong. MethodsThe intervention included dietary education and yoga practice, delivered onsite or online. Questionnaire surveys were conducted at baseline, immediately post-intervention, and four weeks post-intervention. Healthy Eating Vital Sign (HEVS) assessed dietary behvior, and PHQ-4 assessed mental health. Linear mixed-effects models were used to assess the changes in dietary behaviors and mental health. ResultsOf 318 participants (271 onsite), over 95% reported willingness to improve diet and lifestyle, and recommend the program to employer families. Four weeks post-intervention, participants showed statistically significant improvements in dietary behavior (HEVS score: - 0.55; 95% confidence interval (CI): -0.92 to -0.18) and mental health (PHQ-4 score: -0.30; 95% CI: -0.57 to -0.02), with greater benefits among those with poorer baseline diet (HEVS: -1.90; 95% CI: -2.50 to -1.29) or higher mental stress (PHQ-4: -0.71; 95% CI: -1.16 to -0.27). Improvements included vegetable and fruit intake, breakfast frequency, and reduced depressive symptoms. ConclusionsThis healthy lifestyle intervention was well-accepted and brought improvements in dietary behavior and mental health among migrant domestic helpers, particularly those at higher risk. These findings contribute to an under-researched area and highlight the potential of integrating such low-cost, accessible interventions into community health initiatives to reduce health disparities in this vulnerable population.

Large language models (LLMs) are increasingly used for qualitative analysis in substance use research, yet their performance relative to human coders remains underexplored. This study compares ChatGPT-4.0 with human coders in identifying and describing the core innovation of NIH grants focused on reducing opioid overdose. A total of 118 NIH HEAL Initiative grant abstracts were independently coded by ChatGPT and humans to generate innovation descriptions, which were then evaluated by both human raters and ChatGPT for depth/detail and relevance/completeness using 5-point Likert scales. Identical instructions were used across all coding and evaluation stages. ChatGPT-generated descriptions were consistently rated higher than human-generated descriptions on both dimensions. Human evaluators rated ChatGPT outputs at an average of 4.47 for both depth/detail and relevance/completeness, compared to 3.33 and 3.24 for human outputs, respectively (F(1,176)=133.9, p<0.001). These findings suggest that LLMs, when carefully prompted, can enhance the efficiency and quality of qualitative research evaluation.

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.

ObjectiveThe study aimed to analyze factors associated with cotinine levels as an early risk indicator for chronic diseases and students readiness to quit smoking in Praya Barat District. MethodsThis study used a cross-sectional design involving 563 high school students in Praya Barat District. Data analysis was performed using the Chi-square test and multiple logistic regression to identify determinants of high cotinine levels. ResultsA total of 67% of subjects had high cotinine levels, indicating high levels of nicotine exposure among students. The results of the analysis showed that the main determinants of high cotinine levels were cigarette consumption of [&ge;]5 cigarettes/day (AOR=2.426; 95% CI=1.534-3.838; p<0.001), male gender (AOR=2.100; 95% CI=1.358-3.250; p=0.001), family members who smoke (AOR=2.149; 95% CI=1.359-3.399; p=0.001), rarely of exercise (AOR=2.155; 95% CI=1.350-3.440; p=0.001), and personal history of chronic disease (AOR=2.646; 95% CI=1.653-4.234; p<0.001). Meanwhile, willingness to participate in a smoking cessation program did not show a significant relationship (p=0.093). ConclusionsMost students showed high cotinine levels, indicating significant exposure to nicotine and a potential risk of chronic disease in the future. The most influential factors were active smoking behavior, a family environment of smokers, and low levels of physical activity.