American Journal of Preventive Medicine最新文献

{"title":"State X-Waiver Statutes and Buprenorphine Prescriber Rates After Federal X-Waiver Elimination, 2021-2023.","authors":"Filmon Wolde, Bradley C Martin, Mahip Acharya, Laura Gressler, Chenghui Li, Jacob T Painter, Corey J Hayes","doi":"10.1016/j.amepre.2026.108508","DOIUrl":"10.1016/j.amepre.2026.108508","url":null,"abstract":"<p><strong>Introduction: </strong>This study examined whether U.S. jurisdictions that retained elements of the X-waiver in their statutes after federal elimination had lower buprenorphine prescriber rates than those that did not retain such elements.</p><p><strong>Methods: </strong>Using a 25% random sample from IQVIA PharMetrics Plus for Academics, data from January 2021 to October 2023 (analyzed from 2025 to 2026) were modeled using comparative interrupted time series models of monthly rates of unique buprenorphine prescribers per 10,000 eligible prescribers and jurisdiction fixed-effects generalized estimating equations. Jurisdictions were classified by whether they incorporated X-waiver language into their statutes at the jurisdiction-month level, per the Center for Public Health Law Research at Temple University. Models were adjusted for 3-month rolling opioid use disorder diagnosis rates and annual age-adjusted opioid overdose mortality rates. Analyses were stratified by provider type. Three sensitivity analyses tested an alternative specification and excluded jurisdictions with unstable buprenorphine prescribing rates and enrollment.</p><p><strong>Results: </strong>Forty-nine jurisdictions and 1,558 jurisdiction-months were included. Mean buprenorphine prescriber rates were higher in jurisdictions with X-waiver references than in those without (96.84 vs 47.01 buprenorphine prescribers/10,000 eligible prescribers). No differences in either the level (-8.69 per 10,000 [95% CI= -19.96, 2.59; p=0.131]) or trend (+0.74 per month [95% CI= -0.92, 2.40; p=0.380]) of buprenorphine prescribers were found between jurisdiction-months with and without references to the X-waiver after X-waiver elimination. Findings were consistent across strata and sensitivity analyses.</p><p><strong>Conclusions: </strong>Findings suggest that removing jurisdiction-level statutory X-waiver references is unlikely to expand access because structural barriers persist.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108508"},"PeriodicalIF":4.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legal Financial Obligations in Specialty Courts: Measuring Net Burden Across Court-Based Diversion and Treatment.","authors":"Thomas R Kirchner","doi":"10.1016/j.amepre.2026.108613","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108613","url":null,"abstract":"<p><p>Legal financial obligations (LFOs) are increasingly recognized as public health exposures that can deepen poverty, destabilize housing and employment, and extend criminal legal involvement. Lindenfeld and Rouhani's Current Issues article¹ offers an important framework for incorporating fines, fees, and surcharges into public health research. This commentary extends that agenda to specialty courts, which primarily operate across Sequential Intercepts 2 (access and entry into diversion) and 3 (participation, treatment engagement, completion, and revocation risk; Table 1). Specialty courts are not merely sites where additional LFOs may be imposed; they are court-based diversion and treatment programs designed to reduce incarceration and connect participants to behavioral health care. Existing constitutional doctrine and recent state reforms already limit punishment for inability to pay and support proportionate alternatives to fines and fees. Research should therefore distinguish gross charges from net participant burden by measuring public and insurance offsets, grant support, treatment subsidies, fee waivers, timing of assessments, nonlegal participation costs, and the consequences of nonpayment. A net-burden framework can help identify when financial conditions function as harmful debt, when they are offset by public financing, and when replacing participant revenue is necessary to preserve diversion capacity while advancing equity.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108613"},"PeriodicalIF":4.7,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lead Ammunition Use and Post-Shooting Hygiene Practices Among U.S. Firearm Owners.","authors":"Christian Hoover, David Hemenway","doi":"10.1016/j.amepre.2026.108573","DOIUrl":"10.1016/j.amepre.2026.108573","url":null,"abstract":"<p><strong>Introduction: </strong>Lead is a neurotoxicant with no safe exposure level. Firearm use represents an underrecognized source of exposure through aerosolized lead from ammunition and primers, with the potential for secondary and tertiary take-home exposures that may affect children. Few studies have quantified firearm use, and to the authors' knowledge, none have considered ammunition type or post-shooting hygiene behaviors.</p><p><strong>Methods: </strong>A cross-sectional analysis of the National Firearm Survey, a nationally representative survey conducted in December 2024 and analyzed in 2025-2026, was performed. The sample included adults aged 18 or older who owned a firearm, reported firing a firearm in the past year, used lead-based ammunition (or were unsure of the type), and answered questions about post-shooting hygiene behavior (n=1,565). Participants reported demographic and geographic characteristics (e.g., race, U.S. region, child in household) and firearm behaviors (e.g., shooting frequency, duration, indoor shooting, and storage practices). Outcomes were self-reported post-shooting hygiene behaviors (e.g., showering, changing clothes or shoes, isolating gear before entering the home), examined individually and as a summed continuous index using quasi-Poisson regression. Weighted percentages and rate ratios were estimated.</p><p><strong>Results: </strong>Among U.S. firearm owners who shot in the past year (75% male, 57% aged 31-59 years), 97% reported using lead-based ammunition or were unsure of the type. Most reported shooting monthly or less (94%) but for ≥30 minutes (91%); 32% primarily shot indoors. Overall, 46% (95% CI=43%, 49%) engaged in no post-shooting hygiene behaviors, and 30% (95% CI=27%, 33%) engaged in only 1. Hygiene behaviors were more common among non-White, younger, urban-dwelling individuals with higher education and income and among those who shot more frequently and for longer durations. Approximately 6 million U.S. children live in households where firearms with lead-based ammunition are shot annually and where caregivers report no post-shooting hygiene behaviors.</p><p><strong>Conclusions: </strong>The use of lead-based ammunition is nearly universal among U.S. shooters, while post-shooting hygiene behaviors are uncommon and may represent a substantial pathway for residential lead exposure.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108573"},"PeriodicalIF":4.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of an Augmented Reality Location-Based Game on Physical Activity in Middle-Aged Sedentary Workers.","authors":"Hsin-Yen Yen, Fang-Yu Liu, Hao-Yun Huang","doi":"10.1016/j.amepre.2026.108599","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108599","url":null,"abstract":"<p><strong>Introduction: </strong>Prolonged sitting and physical inactivity among office workers pose severe global health risks. Location-based games have emerged as a novel gamified approach to counteract these sedentary lifestyles. This study investigated the effectiveness of a location-based game on physical activity behaviors, psychological determinants, and body composition.</p><p><strong>Study design: </strong>The study design used a two-arm, non-randomized controlled trial between February and May 2025.</p><p><strong>Participants: </strong>Participants were 70 sedentary office workers aged 40 years and above who were assigned to experimental and control groups.</p><p><strong>Intervention: </strong>The experimental group engaged in an 8-week intervention that integrated location-based gameplay, Pikmin Bloom, with progressive daily step goals monitored via a chatbot.</p><p><strong>Main outcome measures: </strong>The evaluation used a self-reported questionnaire and objective body composition metrics.</p><p><strong>Results: </strong>The experimental group had achieved significant within-group improvements in walking and total physical activity after the intervention. Significant group-by-time interactions were observed for all body composition parameters, with the experimental group demonstrating superior improvements in body weight, body mass index, body fat percentage, and skeletal muscle mass compared to the control group.</p><p><strong>Conclusion: </strong>These findings suggest that location-based games can serve as efficacious and accessible mHealth tools for modifying health behaviors in sedentary populations. By transforming routine walking into an interesting and engaging experience, such interventions yield meaningful enhancements in physical activity for occupational health promotion.</p><p><strong>Trial registration: </strong>The study protocol was preregistered at ClinicalTrials.gov (NCT06910995).</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108599"},"PeriodicalIF":4.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Volunteering Give an Extra Health Boost? Volunteering and High Blood Pressure Among Insured and Uninsured U.S. Adults in Late Midlife.","authors":"Byeongju Ryu, Seoyoun Kim, Koichiro Shiba, Cal J Halvorsen","doi":"10.1016/j.amepre.2026.108596","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108596","url":null,"abstract":"<p><strong>Introduction: </strong>High blood pressure (HBP) is a major predictor of cardiovascular disease, a leading cause of death in the U.S. Growing evidence suggests that formal volunteering in later life is associated with a lower prevalence of HBP; however, it remains unclear whether these benefits extend to adults in late midlife and whether they differ by health insurance status.</p><p><strong>Methods: </strong>This prospective cohort study analyzed data from the 2012-2018 Health and Retirement Study. The analytic sample included 4,169 respondents between the ages of 50 and 64. Because blood pressure was measured in half the sample in alternating waves, data were pooled across waves. To address selection into volunteering, energy-balance weights were created using participants' pre-baseline (t₀; 2012/2014 subsamples) sociodemographic and health-related characteristics to balance the distribution of these characteristics between volunteers and non-volunteers at baseline (t₁; 2014/2016 subsamples). Weighted Poisson regression models with robust error variance estimated the population-average treatment effects of volunteering on HBP at post-baseline (t₂; 2016/2018 subsamples). Differences in effect estimates between insured and uninsured groups were assessed using seemingly unrelated estimation.</p><p><strong>Results: </strong>Volunteering was associated with a lower prevalence of HBP in the full sample (prevalence ratio (PR)=0.86, p=0.005). In subgroup analyses, compared with non-volunteers, volunteers were less likely to have HBP in both the uninsured (PR=0.64, p=0.005) and insured (PR=0.90, p=0.044) groups. The estimated effects differed significantly across groups (F[1, 4168]=4.05, p=0.044), indicating that volunteering may have a greater influence on reducing HBP prevalence among uninsured individuals than among insured counterparts.</p><p><strong>Conclusions: </strong>Volunteering may serve as a non-pharmacological, community-based intervention to support cardiovascular health in late midlife. While not a substitute for health insurance, findings suggest that uninsured individuals may derive additional health gains from volunteering.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108596"},"PeriodicalIF":4.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of High-Dose Influenza Vaccine on Cardiorespiratory Outcomes in Older Adults: An Updated Systematic Review and Meta-Analysis.","authors":"Larissa Araújo de Lucena, Bezalel Hakkeem, Nathalia Schettino Samad, Gabriel Erzinger, Guilherme Silva Mendes Gaia, Juliana Giorgi, Francesco Stabile, Vitória Martins Prizão, Paulo de Coelho Castro, David Abraham Batista da Hora, Larissa C Hespanhol, Mrunalini Dandamudi, Ferdinand Gilbert Saraiva da Silva Maia, Eveline Pipolo Milan, Martha Gulati","doi":"10.1016/j.amepre.2026.108598","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108598","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults face an increased risk of influenza-related complications, particularly cardiovascular (CV) events. The comparative effectiveness of high-dose inactivated influenza vaccine (HD-IIV) versus standard-dose inactivated influenza vaccine (SD-IIV) for these outcomes remains uncertain.</p><p><strong>Methods: </strong>Databases including PubMed, Cochrane Library, and Embase were searched from inception through September 2025 for randomized controlled trials (RCTs) comparing HD-IIV with SD-IIV in adults aged ≥ 65 years. Data synthesis was performed using a random-effects model to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I² statistic and Cochran's Q test.</p><p><strong>Results: </strong>Six RCTs contributing 593,048 randomizations were included, with 296,754 (50.04%) allocated to HD-IIV. Participants were 53.6% female, and 46.1% had known CV disease. Follow-up ranged from 14 days to 2 years (mean 372 days). HD-IIV was associated with fewer serious cardiorespiratory events (RR 0.92; 95% CI 0.89-0.95), pneumonia events (RR 0.81; 95% CI 0.68-0.96), hospitalizations due to heart failure (HF) (RR 0.87; 95% CI 0.78-0.98), and any respiratory disease (RR 0.93; 95% CI 0.86-1.00). No differences were detected for hospitalization for pneumonia or influenza (RR 0.73; 95% CI 0.50-1.08), MACE (RR 0.94; 95% CI 0.86-1.02), stroke (RR 0.92; 95% CI 0.83-1.02), or hospitalization for coronary events (RR 0.99; 95% CI 0.87-1.12).</p><p><strong>Conclusion: </strong>In adults aged ≥ 65 years, HD-IIV was associated with modest reductions in serious cardiorespiratory events, pneumonia events, and HF hospitalizations compared with SD-IIV, whereas hospitalization for pneumonia/influenza and broader atherothrombotic CV endpoints did not differ.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108598"},"PeriodicalIF":4.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Long-term Survival After Acute Ischemic Stroke Among Medicare Beneficiaries: Population-based Cohort Study.","authors":"Xin Tong, Robert K Merritt, Susan A Carlson","doi":"10.1016/j.amepre.2026.108597","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108597","url":null,"abstract":"<p><strong>Introduction: </strong>Few studies have examined temporal trends in long-term survival after acute ischemic stroke (AIS) across demographic groups. This study examined long-term survival trends among Medicare fee-for-service (FFS) beneficiaries hospitalized with AIS during 2000-2019, with follow-up through 2024.</p><p><strong>Methods: </strong>This study analyzed data from 2,118,429 FFS beneficiaries aged ≥66 years hospitalized with incident AIS between January 1, 2000, and December 31, 2019. The cohort was categorized into four time periods: 2000-2004, 2005-2009, 2010-2014, and 2015-2019. Adjusted 1- and 5-year survival were estimated using Cox proportional hazards model across age, sex, race and ethnicity and Charlson Comorbidity Index (CCI) categories. Trends were assessed using average annual percent change (AAPC) via Joinpoint regression.</p><p><strong>Results: </strong>From 2000-2004 to 2015-2019, adjusted 1- and 5-year stroke survival increased significantly from 80.3% to 83.4% (AAPC: 0.22%), and from 46.1% to 52.2% (AAPC: 0.75%), respectively. Survival increased across all age groups, both sexes, all race and ethnicity categories, and CCI categories. Beneficiaries aged ≥75 years showed greater annual increases in 1-year survival than those aged 66-74 years. Black beneficiaries had greater increases in 1-year survival than White beneficiaries, although their survival remained lower. Beneficiaries with more comorbidities (CCI ≥2) had greater improvements compared to those without comorbidities, though they maintained lower survival.</p><p><strong>Conclusions: </strong>Long-term survival after AIS improved significantly for Medicare FFS beneficiaries over time. However, the varying degrees of improvement and the persistent differences across demographic groups highlight the need for focused and tailored strategies to reduce differences in stroke outcomes.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108597"},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utah’s Move From 0.08 to 0.05 Blood Alcohol Concentration Per Se Policy: Effects on Driver Crash Fatalities Compared With Contiguous States","authors":"Kaigang Li PhD, MEd,&nbsp;James C. Fell MS,&nbsp;Niyousha Hosseinichimeh PhD,&nbsp;Siwei Hu PhD,&nbsp;Federico E. Vaca MD, MPH","doi":"10.1016/j.amepre.2026.108380","DOIUrl":"10.1016/j.amepre.2026.108380","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to assess the early effects of Utah’s 0.05 g/dL blood alcohol concentration per se law—passed in 2017 and enacted in 2018—on crash fatalities by comparing Utah with its 6 contiguous states.</div></div><div><h3>Methods</h3><div>Using data from the Fatality Analysis Reporting System, the authors conducted a difference-in-differences analysis comparing prelaw (2016) and postlaw (2019) outcomes, crash fatalities across 5 blood alcohol concentration levels (&lt;0.01, ≥0.01, ≥0.05, ≥0.08, and ≥0.15 g/dL) between Utah and contiguous states. Eleven-year trends (2013–2023) in crash fatalities per 100 million vehicle miles traveled were displayed. Data were analyzed in 2025 using SAS, Version 9.4, for data preparation and statistical analyses.</div></div><div><h3>Results</h3><div>Utah experienced significantly larger reductions in crash fatalities than contiguous states, with difference-in-differences estimates ranging from −0.67 to −1.17 (all <em>p</em>&lt;0.05). The largest decrease was observed for crashes involving drivers with blood alcohol concentration ≥0.01 (difference-in-differences = −1.17, 95% CI= −1.88 to −0.46). For nonalcohol-related crashes (blood alcohol concentration &lt;0.01), both Utah and adjoining states experienced decreases, but the differences were not statistically significant for fatalities (<em>p</em>=0.96).</div></div><div><h3>Conclusions</h3><div>Utah’s 0.05 blood alcohol concentration law was associated with meaningful decreases in alcohol-related crash fatalities, strengthening the evidence supporting the public health importance of evidence-based policy and strongly supporting broader adoption of 0.05 blood alcohol concentration limits nationwide.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"71 4","pages":"Article 108380"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redlined Care: HOLC Neighborhood Grades and Opioid Treatment Program Locations.","authors":"Jennifer W Tsai, Adam L Haber, Jonathan H Cantor, Ricky N Bluthenthal, Steven Shoptaw, Corey S Davis, Elizabeth A Samuels","doi":"10.1016/j.amepre.2026.108591","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108591","url":null,"abstract":"","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108591"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-processed food intake as a marker of environmental exposure: reframing the prevention target.","authors":"Jimmy Chun Yu Louie","doi":"10.1016/j.amepre.2026.108592","DOIUrl":"https://doi.org/10.1016/j.amepre.2026.108592","url":null,"abstract":"<p><p>High intake of ultra-processed foods (UPFs) is consistently associated with obesity, cardiometabolic disease, and premature mortality, and preventive practice has largely answered that signal by treating intake as an individual behavior to be corrected through education, counseling, and provision of more information. This article asks whether that frame matches the determinants of demand that the behavioral and social sciences actually describe. Those drivers converge on a compact set of forces: the reward biology of sweet, fatty, and energy-dense foods; the hyper-palatability, soft texture, and rapid eating rate that promote passive overconsumption; habit and automaticity; the low cost per calorie of ultra-processed energy; time scarcity and convenience; and the availability structured by the local food environment. These operate through biology, price, time, environment, and habit, channels that deliberative knowledge reaches only weakly. Consistent with an environmental reading, the socioeconomic gradient of intake reverses between high-income and many low- and middle-income settings, so that the same category marks disadvantage in one place and affluence in another. This article argues that high UPF intake is better understood as a marker of exposure to an obesogenic environment than as a personal failing, with consequences for clinical counseling, risk communication, and the cautious use of an imperfectly measured indicator. The reframing changes interpretation rather than measurement, and keeps in view the commercial and regulatory decisions that produce the environment. Because demand is generated by different mechanisms in different contexts, segmented, mechanism-matched prevention follows more directly than a single universal message.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108592"},"PeriodicalIF":4.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}