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.

Sales of deep-discount cigarettes are growing; yet little is known about who is using these products and their potential impact on tobacco use behavior. Using multinomial logistic regression, this cross-sectional analysis of 2021 National Survey on Drug Use and Health data examines associations between sociodemographic characteristics and smoking behaviors and odds of using value and deep-discount cigarettes (versus premium). Use of value and deep-discount cigarettes was significantly more prevalent for older adults and people with lower incomes and significantly less prevalent among non-Hispanic Black individuals. People who received government assistance, smoked daily, smoked more than a pack of cigarettes per day, and who met the criteria for nicotine dependence were significantly more likely to use deep-discount--but not value--brands than premium cigarettes. More research is needed to better understand how deep-discount cigarettes may impact tobacco use behavior (including smoking cessation), particularly among people with low socioeconomic status.

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

BackgroundVaccination against COVID-19 will likely involve children in order to mitigate transmission risks in community settings. Successful implementation of COVID-19 immunization in the United States may hinge on factors associated with parents likelihood of immunizing their children and themselves. MethodsWe fielded a national household survey in English and Spanish from June 5-10, 2020 (n=1,008). Parents were asked about their likelihood of immunizing their children and themselves against COVID-19. We fit separate regression models of parents likelihood to vaccinate themselves and their children against COVID-19, using bivariate and multivariable approaches in analyses weighted to be nationally representative. ResultsOverall, 63% of parents (95% CI: 59%, 66%) were likely to vaccinate their children against COVID-19, and 60% (57%, 64%) were likely to get a vaccine themselves. These responses were highly correlated (Pearsons r=0.89). Parent age, sex, marital status, education level, and income were all associated with parents likelihood to vaccinate their children and themselves in bivariate analyses; race/ethnicity was significantly associated with parents likelihood to vaccinate their children. In multivariable analyses, younger parents were significantly less likely than older parents to vaccinate their children and themselves against COVID-19, as were parents with high school or less education compared with parents with bachelors degrees and non-Hispanic White parents compared with Hispanic parents (all p<.05). ConclusionIn this national survey, only approximately 60% of U.S. parents stated that they are likely to vaccinate their children or themselves against COVID-19. Addressing parents hesitancy to vaccinate themselves and their children against COVID-19 will be instrumental to achieving herd immunity in the US.

IntroductionEarly COVID-19 vaccine acceptance rates suggest that up to one-third of HCWs may be vaccine-hesitant. However, it is unclear whether hesitancy among HCWs has improved with time and if there are temporal changes whether these differ by healthcare worker role. MethodsIn October 2020, a brief survey was sent to all participants in the Healthcare Worker Exposure Response and Outcomes (HERO) Registry with a yes/no question regarding vaccination under emergency use authorization (EUA): "If an FDA emergency use-approved vaccine to prevent coronavirus/COVID-19 was available right now at no cost, would you agree to be vaccinated?" The poll was repeated in December 2020, with the same question sent to all registry participants. Willingness was defined as a "Yes" response, and hesitancy was defined as a "No" response. Participants were stratified into clinical care roles. Baseline demographics of survey respondents at each timepoint were compared using appropriate univariate statistics (chi-squared and t-tests). Analyses were descriptive, with frequencies and percentages reported for each category. ResultsOf 4882 HERO active registry participants during September 1 - October 31, 2020, 2070 (42.4%) completed the October survey, and n=1541 (31.6%) completed the December survey. 70.2% and 67.7% who were in clinical care roles, respectively. In October, 54.2% of HCWs in clinical roles said they would take an EUA-approved vaccine, which increased to 76.2% in December. The largest gain in vaccine willingness was observed among physicians, 64.0% of whom said they would take a vaccine in October, compared with 90.5% in December. Nurses were the least likely to report that they would take a vaccine in both October (46.6%) and December (66.9%). We saw no statistically significant differences in age, race/ethnicity, gender, or medical role between time points. When restricting to the 998 participants who participated at both time points, 69% were vaccine-willing at both time points; 15% were hesitant at both time points, 13% who were hesitant in October were willing in December; and 2.9% who were willing in October were hesitant in December. ConclusionsIn a set of cross-sectional surveys of vaccine acceptance among healthcare workers, willingness improved substantially over 2 calendar months during which the US had a presidential election and two vaccine manufacturers released top-line Phase 3 trial results. While improved willingness was observed in all role categories, nurses reported the most vaccine hesitancy at both time points.

BackgroundTo effectively promote vaccine uptake, it is important to understand which people are most and least inclined to be vaccinated and why. PurposeTo identify predictors of COVID-19 vaccine uptake and reasons for non-vaccination. DesignA longitudinal English-language survey study. SettingOnline in December-2020, January-2021, and March-2021. Participants. 930 US respondents (63% Veterans). MeasurementsSurveys included questions about respondents behaviors, well-being, healthcare experiences, and attitudes regarding the pandemic. ResultsThe proportion of respondents who received [&ge;]1-dose of a COVID-19 vaccine increased from 18% in January to 67% in March. Older age predicted vaccine uptake in January (OR=2.02[95%CI=1.14-3.78], p<.001) and March (10.92[6.76-18.05], p<.001). In January, additional predictors of vaccine uptake were higher numeracy (1.48[1.20-1.86], p<.001), COVID-19 risk perceptions (1.35[1.03-1.78], p=.029), and believing it is important that adults get the COVID-19 vaccine (1.66[1.05-2.66], p=.033). In March, additional predictors of vaccine uptake were believing it is important that adults get the COVID-19 vaccine (1.63[1.15-2.34], p=.006), previous (January) COVID-19 vaccine intentions (1.37[1.10-1.72], p=.006), and belief in science (0.84[0.72-0.99], p=.041). Concerns about side effects and the vaccine development process were the most common reasons for non-vaccination. Unvaccinated respondents with no interest in getting a COVID-19 vaccine were younger (0.27[0.09-0.77], p=.016), held negative views about COVID-19 vaccines for adults (0.15[0.08-0.26], p<.001), had lower trust in healthcare (0.59[0.36-0.95], p=.032), and preferred to watch and wait in clinically ambiguous medical situations (0.66[0.48-0.89], p=.007). LimitationsReliance on the accuracy and consistency of self-reported data. ConclusionThese findings offer important insights regarding key predictors of vaccine uptake during the early stages of the COVID-19 vaccine rollout in the US, which can help guide health communications and public outreach. Evidence that attitudes and intentions towards COVID-19 vaccines are important predictors of uptake provides validation for studies which have used these measures and reinforces the need to develop effective strategies for addressing concerns about vaccine safety and development which continue to be at the forefront of vaccine hesitancy. RegistrationThe pre-registration document associated with this manuscript is available at: https://aspredicted.org/MKS_HRZ.

We aimed to understand factors that distinguish vaccine hesitancy from early uptake or refusal to inform public health strategies for the next emergent infectious disease pandemic and clinician-patient communication around vaccine decision-making. The study included 10,176 participants of the Colorado Center for Personalized Medicine biobank who completed a survey in Summer 2021 which included information on COVID-19 vaccine hesitancy, attitudes, and uptake. Survey data were linked to electronic health records prior to the COVID-19 pandemic to catalogue pre-existing health conditions. Early COVID-19 vaccine uptake was high (N=9,873, 96.1%), consistent with high health literacy in this population. While many demographic factors, vaccine considerations, and pre-existing conditions distinguished early uptake from hesitancy or refusal (P<0.05), only two characteristics distinguished the hesitant from the refusal group. Hesitant individuals were more likely than refusers to report good (31.9% versus 25.8%) or fair or poor (16.4% versus 13.4%) health. Also, they were less likely to report trust in scientists as a key factor impacting their decision to receive the COVID-19 vaccine (15.9% versus 25.8%). These findings highlight the urgent need for more tailored public health strategies to reach the distinct group of individuals who remain open to vaccination. Healthcare professionals may be especially well-positioned to address these concerns in clinical conversations by connecting individual health status and pre-existing conditions to the benefits of vaccination. Clinical Trials RegistryN/A HighlightsO_LIMany factors distinguish uptake of COVID-19 vaccines from hesitancy or refusal. C_LIO_LIPoorer health and trust in science differentiated hesitancy from refusal. C_LIO_LIThese results may guide early vaccine uptake and readiness for future pandemics. C_LI

IntroductionGiven the rapidly changing media landscape and tobacco marketplace, timely data on media consumption and exposure to pro-tobacco content across media channels among lesbian, gay, and bisexual (LGB) young adults is imperative for developing counter-messaging and public education campaigns for these individuals. MethodsUsing 2023 data from young adults in California, this study examined how social media use differed across media channels for heterosexual and LGB young adults, by gender identity. Exposure to pro-tobacco content across media channels between heterosexual and LGB young adults, by gender identity was also compared. ResultsFindings from a representative sample of young adults in California showed that more LGB young adults reported using Tumblr and fewer reported using Facebook and Snapchat, compared with heterosexual young adults, among both males and females. Additionally, social media use differed by gender identity. For example, use of Reddit was more common among LGB versus heterosexual females, but there were no differences by sexual identity among males. Exposure to tobacco marketing was more common among LGB females compared with heterosexual females, but this was not the case for males. Exposure to user-generated e-cigarette content, and self-reported visits to e-cigarette websites, were more common among LGB females compared to heterosexual females. ConclusionsThese findings highlight the importance of treating LGB individuals as a heterogeneous group. As such, anti-tobacco campaigns designed for LGB individuals that leverage social media will want to consider which social media platforms are most used among their target audience, ensuring maximum campaign reach.

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.

BackgroundRapid coronavirus 2019 (COVID-19) testing in symptomatic cases is extremely important for preventing the spread of COVID-19 infection and early therapeutic intervention. In contrast, whether symptomatic patients are tested depends largely on their health literacy, interpretation, and knowledge of COVID-19. We aimed to investigate the rate of COVID-19 testing avoidance despite having common cold symptoms in patients with cardiovascular disease and examine factors related to testing avoidance. MethodsA large-scale epidemiological questionnaire survey, the Japan COVID-19 and Society Internet Survey 2022 (JACSIS), was conducted online from April to May 2022. The rate of COVID-19 testing avoidance was investigated in patients aged 20 to 80 years with cardiovascular risk factors (hypertension, dyslipidemia, or diabetes) or a history of cardiovascular disease (angina, myocardial infarction, or stroke), only those exhibiting common cold symptoms during the 2 months in the survey. ResultsOf the 1,565 eligible patients, 58% (909 patients) did not undergo COVID-19 testing. Multivariate analysis revealed that older age, obesity, non-walking regularly, long sedentary time, eating alone, frequent snacking, and having received 4 COVID-19 vaccinations were independently associated with testing avoidance. ConclusionsIn the chronic phase of the COVID-19 pandemic, prompt COVID-19 testing at the time of symptomatic disease is important, and strategies to reduce testing hesitancy should be considered.

IntroductionE-cigarette use among youth and young adults remains of public health concern. Pod-based e-cigarettes, including JUUL, significantly changed the e-cigarette landscape in the United States (US). Using an online survey, we aimed to explore the socio-behavioral correlates, predisposing factors, and addictive behaviors among young adult pod-mod users within a University in Maryland, USA. Methods112 eligible college students aged 18-24 years recruited from a University in Maryland who reported using pod-mods were included in this study. Participants were categorized into current/non-current users based on past-30-day use. Descriptive statistics were used to analyze participants responses. ResultsOf the 112 participants with mean age 20.5{+/-}1.2 years, 56.3% were female, 48.2% White, and 40.2% reported past-30-day (current) use of pod-mods. The mean age of first experimentation with pod-mods was 17.8{+/-}1.4 years, while the mean age of regular use was 18.5{+/-}1.4 years, with the majority (67.9%) citing social influence as the reason for initiation. Of current users, 62.2% owned their own devices, and 82.2% predominantly used JUUL and menthol flavor (37.8%). A significant proportion of current users (73.3%) reported buying pods in person, 45.5% of whom were below the age of 21. Among all participants, 67% had had a past serious quit attempt. Among them, 89.3% neither used nicotine replacement therapy nor prescription medications. Finally, current use (adjusted odds ratio (aOR):4.52; 95%CI:1.76,11.64), JUUL use (aOR:2.56; 95%CI:1.08,6.03), and menthol flavor (aOR:6.52; 95%CI:1.38,30.89) were associated with reduced nicotine autonomy, a measure of addiction. ConclusionOur findings provide specific data to inform the development of public health interventions targeted at college youth, including the need for more robust cessation support for pod-mod users.

BackgroundThe estimates of economic burden due to smoking attributed illnesses provide an opportunity to assess its overall impact on the economy and generate evidence for public health policy interventions for tobacco control. In this study, we estimated out of pocket expenditures on tobacco attributed illnesses and smoking attributable burden in Pakistan. MethodsWe used a prevalence-based disease-specific cost approach by including three major tobacco attributed illnesses i.e. lung cancer, chronic obstructive pulmonary disease, and cardiovascular diseases. Our analysis included out of pocket healthcare expenditures including direct and indirect costs which were estimated by interviewing the patients of selected illnesses. The smoking-attributable expenditure was calculated by the WHO tool kit. ResultsIn 2018, the economic burden attributed to smoking related illnesses was Rs 192 billion (USD 1.3 billion). Smoking-attributable expenditure on cardiovascular disease was Rs 123 billion (USD 0.9 billion) which was 69% of the total economic cost of tobacco attributed illnesses in Pakistan. The economic cost in males was nearly three times higher than females. ConclusionsOur study showed a significant economic burden due to tobacco attributed illnesses in Pakistan which can be prevented by implementing tobacco control policies effectively.

ObjectivesMenthol flavoring is a critical public health issue, but prior work has largely represented the voices of White adults who smoke (AWS) menthol cigarettes who comprise a small subset of AWS menthol cigarettes in the US. This study compared perceptions of a hypothetical MC/FC ban among Black and White AWS menthol cigarettes. MethodsParticipants were a convenience sample of 2,113 Black and 1,087 White AWS menthol cigarettes collected through Amazon Mechanical Turk between July 2023 and January 2024. Participants reported opinions about a MC/FC ban, likely public health outcomes, and hypothetical impact of the ban on their smoking behavior. Stepwise logistic regression modeled factors associated with ban opposition/ambivalence. ResultsOver one-third of menthol cigarette users supported a MC/FC ban (Black, 37.2% vs White, 34.5%, p=.13], but Black AWS were more likely to endorse public health benefits of a ban assessed via agreement with 5 statements of FDA rationale [3.0 (SD=1.7) versus 2.4 (SD=1.8), p<.001]. Smoking more cigarettes per day, belief that menthol cigarettes are more addictive/harder to quit, and intent to continue using nicotine under a ban increased odd of opposition/ambivalence. ConclusionsCompared to White AWS, Black AWS were more likely to believe that a MC/FC ban would benefit public health and showed no statistical difference in overall support for a ban. Targeted outreach to those who consume more menthol products and those who do not intend to quit nicotine could increase ban support among menthol users. Summary Box1) What is the current understanding of this subject?Knowledge of the publics perception of a MC/FC ban is largely informed by White menthol cigarette users. Given that Blacks represent the majority of AWS menthol cigarettes in the US, the paucity of data from Black voices engenders a critical gap in research used to inform health policy. 2) What does this report add to the literature?Compared to White AWS, Black AWS were more likely to believe that a MC/FC ban would benefit public health and showed no statistical difference in overall support for a ban. To our knowledge, this study comprises the largest convenience sample of perceptions and perceived impact of a federal MC/FC product standard among Black AWS menthol cigarettes in the US and provides valuable evidence to inform policy action in these areas. 3) What are the implications for public health practice?Findings support ongoing efforts to advance a MC/FC product standard and suggest that targeted outreach to those who consume more menthol products and those who do not intend to quit nicotine could increase ban support among menthol users.

BackgroundAdolescent tobacco and nicotine product (TNP) use remains a public health concern, with emerging gender convergence and rising e-cigarette use among females. We examined gender-specific trends in Georgian adolescents alongside national tobacco control policies and social context. MethodsWe analyzed nationally representative Global Youth Tobacco Survey data from Georgia (2014, 2017, and 2023) for youth aged 11-17 to estimate prevalence and patterns of current TNP use in the context of tobacco-related advertising and promotion, secondhand smoke, and national policy, via a policy review. Adjusted prevalence estimates were derived using post- estimation predictive margins after fitting multinomial logistic regression models. ResultsFrom 2014 to 2023, current TNP use declined among boys but increased among girls, particularly in exclusive e-cigarette use. The percentages reporting no current TNP use increased among boys from 77.4% to 85.6% (p < 0.01), but declined among girls from 92.1% to 88.1% (p = 0.04). By 2023, exclusive e-cigarette use was more prevalent among girls than boys. Across sexes, exposure to pro-tobacco advertising and promotion and secondhand smoke declined. Exposure to anti-tobacco promotion peaked in 2017 and receded by 2023. The policy review documented strengthened measures, alongside gaps in oversight of digital marketing and newer products, including e-cigarettes. ConclusionsGeorgias tobacco control policies have contributed to reduced TNP use among boys and a less permissive social environment. Rising e-cigarette use among girls is concerning. Policies should close regulatory gaps, enhance enforcement, and address evolving product and marketing developments to prevent TNP uptake and protect adolescents from tobacco-related harms. SUMMARY BOXO_ST_ABSWhat is already known on this topicC_ST_ABSAdolescent tobacco use patterns are shifting globally, with narrowing gender gaps and rising use of new products like e-cigarettes, especially among girls. In Georgia, the impact of recent tobacco control reforms targeting youth tobacco and nicotine product use by gender had not been fully assessed. What this study addsBetween 2014 and 2023, TNP use significantly declined among boys in Georgia but rose in exclusive e-cigarette use among girls. Exposure to tobacco advertising and promotion and secondhand smoke decreased, yet gaps in anti-tobacco promotion and regulation of novel products persist. How this study might affect research, practice or policyFindings from this study reinforce WHOs call for gender-responsive tobacco control policies. Regulatory measures must address how product design and marketing tactics exploit gendered social norms and youth vulnerabilities. Comprehensive, gender-responsive strategies that strengthen anti-tobacco promotion and close regulatory gaps are essential to counter these influences and protect all adolescents from targeted industry tactics.

ObjectivesBy raising the legal age of sale from 18 to 21 years old, Tobacco 21 laws (T21) are reshaping the tobacco landscape in the United States. In 2019, Maryland became the 13th state to adopt T21. This study is among the first to examine the perception, awareness, and ease of compliance of T21 among tobacco retailers through a two-wave survey conducted pre-T21 and post-T21. DesignSurveys were conducted among the states more than 6,000 registered retailers prior to the states T21 law going into effect and eight months later after T21 had been enacted. The pre-T21 and post-T21 survey instruments measured retailer awareness, support, and perceived ability to comply with T21, current tobacco practices, revenue from tobacco products, and challenges faced in compliance. 414 retailers completed the pre-T21 survey and 360 completed the post-T21 survey. The final survey data was weighted to reflect the geographic distributions of licensed tobacco retailers in Maryland. ResultsThere was no significant difference in retailer awareness, support and challenges comparing pre and post T21. One notable caveat is lack of consumer knowledge about T21, resulting in retailers being responsible for educating customers. ConclusionsThe evaluation of T21 and impact to retailers is a valuable tool in determining the laws success and barriers to implementation. Results support the idea that T21 laws have had a minor impact on how retailers conduct their business. As a result of the communication and materials provided by the state, retailers largely understand the law and how to adhere to guidelines.

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

Food insecurity is an important social risk factor that is directly linked to patient health and well-being. The Department of Veterans Affairs (VA) aims to identify and resolve food insecurity through social and clinical interventions. However, evaluating the impact of such interventions is made challenging by the lack of follow-up data on Veteran food insecurity status. One potential solution is to leverage documentation of food insecurity in electronic health records (EHRs). In this paper, we developed and validated a natural language processing system to identify food insecurity status from clinical notes and applied it to study longitudinal trajectories of food insecurity among a large cohort of food insecure Veterans. Our analyses provide insight into the timing and persistence of Veteran food insecurity; in the future, our methods will be used to evaluate food insecurity interventions and evaluate VA policy.

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.

IntroductionRecent research underscores the exceptionally young age distribution of Covid-19 deaths in the United States compared with international peers. This brief characterizes how high levels of Covid mortality at midlife ages (45-64) are deeply intertwined with continuing racial inequity in Covid-19 mortality. MethodsMortality data from Minnesota in 2020-2022 were analyzed in June 2022. Death certificate data and published vaccination rates in Minnesota allow vaccination and mortality rates to be observed with greater age and temporal precision than national data. ResultsBlack, Hispanic, and Asian adults under age 65 were all more highly vaccinated than white populations of the same ages during most of Minnesotas substantial and sustained Delta surge and all of the subsequent Omicron surge. However, white mortality rates were lower than those of all other groups. These disparities were extreme; at midlife ages (ages 45-64), during the Omicron period, more highly-vaccinated populations had COVID-19 mortality that was 164% (Asian-American), 115% (Hispanic), or 208% (Black) of white Covid-19 mortality at these ages. In Black, Indigenous, and People of Color (BIPOC) populations as a whole, Covid-19 mortality at ages 55-64 was greater than white mortality at 10 years older. ConclusionsThis discrepancy between vaccination and mortality patterning by race/ethnicity suggests that, if the current period is a "pandemic of the unvaccinated," it also remains a "pandemic of the disadvantaged" in ways that can decouple from vaccination rates. This result implies an urgent need to center health equity in the development of Covid-19 policy measures.

To evaluate the national effect of CDD on reducing road traffic mortality, we analyzed crude road traffic mortality rates data collected between 2006 and 2016 through Chinas National Disease Surveillance System. Linear regression models were fit with the pre-CDD data (2006-2011) and used to predict mortality rates in the post-CDD years (2012-2016). It is estimated that the new law was associated with 317,197 (95% CI: 280,425[~]353,968) lives saved in the entire country in the first 5-years of the new law. Similar reduction in mortality rates was observed in both urban and rural areas. The decline in non-occupants was more prominent and occurred earlier than that in occupants, among whom the road traffic mortality rate did not show a statistically significant reduction in the first 4 years of the new law. Our study shows that CDD is particularly effective in protecting non-occupants and is equally effective in both rural and urban areas in China.