American Journal of Preventive Medicine最新文献

{"title":"Racial and Ethnic Disparities in Prehospital Restraint Use and Sedation","authors":"Thomas J. McAdam MPH ,&nbsp;Seth J. Prins PhD, MPH ,&nbsp;John R. Pamplin II PhD, MPH ,&nbsp;Pia M. Mauro PhD, MPH ,&nbsp;Sarah Gutkind PhD, MSPH ,&nbsp;Megan E. Marziali MPH ,&nbsp;Zachary L. Mannes PhD, MPH","doi":"10.1016/j.amepre.2025.108066","DOIUrl":"10.1016/j.amepre.2025.108066","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency medical service clinicians routinely encounter patients experiencing behavioral health emergencies, yet limited data describe the prehospital use of physical restraints or sedatives. Systemic racism and challenges in access to behavioral health care may contribute to disparities in restraint and sedation use among minoritized groups. This study examined whether race and ethnicity were associated with prehospital use of physical restraints and/or sedation among patients with behavioral health emergencies.</div></div><div><h3>Methods</h3><div>Using the 2022 ESO Data Collaborative consisting of ∼12,000,000 emergency medical service healthcare encounters, this study estimated the associations between race and ethnicity (non-Hispanic White, Black/African American, Hispanic any race, Asian, or American Indian/Alaskan Native) and physical restraint and/or sedation use (yes, no) among patients aged ≥15 years who had an emergency medical service encounter for a behavioral health emergency. AOR estimates with 95% CIs are presented.</div></div><div><h3>Results</h3><div>Approximately 7.1% (<em>n</em>=3,799) of behavioral health encounters involved any restraint or sedation use. All racial and ethnic minoritized groups were more likely to receive physical restraints (AOR range=1.62–2.72, <em>p</em>&lt;0.05) than non-Hispanic White patients, whereas Black/African American, Hispanic, and American Indian/Alaskan Native patients were more likely to be sedated with antipsychotics or benzodiazepines (AOR range=1.27–3.21, <em>p</em>&lt;0.05). Black/African American patients were also more likely than non-Hispanic White patients to be concurrently restrained and sedated (AOR=1.30, 95% CI=1.09, 1.55).</div></div><div><h3>Conclusions</h3><div>Disparities in restraint and sedation use may perpetuate poor psychiatric outcomes for racially and ethnically minoritized groups, particularly Black/African American patients, in a system that already hinders their access to mental health treatment.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 6","pages":"Article 108066"},"PeriodicalIF":4.5,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977440","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":"Healthcare and non-healthcare costs: youth with diabetes and food insecurity.","authors":"Alice M Ellyson, Jason A Mendoza, Angela D Liese, Ashley Tabah, Traci A Bekelman, A Caroline Rudisill, Dana Dabelea, Edward A Frongillo, Catherine Pihoker, Faisal S Malik, Davene R Wright","doi":"10.1016/j.amepre.2025.108028","DOIUrl":"https://doi.org/10.1016/j.amepre.2025.108028","url":null,"abstract":"<p><strong>Introduction: </strong>This study prospectively evaluated the association of household food insecurity and acute care costs and productivity loss in youth and young adults (YYA) with type 1 and type 2 diabetes.</p><p><strong>Methods: </strong>This observational cohort study included 1,256 YYA with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth Food Security Study with data collected at three time points between 2015-2022. Both household food insecurity (HFI, measured using the US Household Food Security Survey Module) and costs (measured using survey responses on utilization and productivity losses) were self-reported by young adult participants or caregivers of adolescents. The relationship between HFI and costs was analyzed using generalized adjusted linear regression. We also analyzed the moderating role of continuous health insurance coverage.</p><p><strong>Results: </strong>Each additional 1-point increase in the HFI score was associated with a $1,077 (95%CI= [663, 1,491]) increase in measured 12-month costs. Costs were $4,384 (95%CI=[2,635, 6,133]) higher in households that were experiencing HFI versus those who were not. Youth and young adults with continuous health insurance coverage saw smaller increases in costs ($864, 95%CI=[461, 1,267]) compared to those without continuous coverage ($1,820, 95%CI=[379, 3,261]).</p><p><strong>Conclusions: </strong>This study found a positive association between HFI and costs for YYA with diabetes, and this relationship was modified by continuous health insurance coverage. Future work should use linked claims and electronic health record data to better inform efforts aiming to reduce HFI burden and improve the continuity of insurance coverage for this population.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108028"},"PeriodicalIF":4.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856912","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":"Buprenorphine Dispensation After X-Waiver Elimination by Clinician Specialty","authors":"Elizabeth M. Stone PhD ,&nbsp;Fangzhou Xie MA ,&nbsp;Jennifer Miles PhD ,&nbsp;Hillary Samples PhD ,&nbsp;Mark Olfson MD, MPH ,&nbsp;Stephen Crystal PhD","doi":"10.1016/j.amepre.2025.108055","DOIUrl":"10.1016/j.amepre.2025.108055","url":null,"abstract":"<div><h3>Introduction</h3><div>Elimination of the X-waiver, which required clinicians to complete additional registration to prescribe buprenorphine for opioid use disorder, removed one barrier to treatment. This study examined the association of the X-waiver elimination with buprenorphine dispensations by clinician specialty.</div></div><div><h3>Methods</h3><div>Using IQVIA Longitudinal Prescription data, patients with 15 or more days of dispensed buprenorphine supply each month from May 2021 to December 2024 were identified. Interrupted time series analyses (conducted in 2025) examined changes in monthly counts of clinicians associated with dispensations and patients, overall and stratified by clinician specialty.</div></div><div><h3>Results</h3><div>During the study period, 189,771 clinicians dispensed buprenorphine to 2,699,441 patients. X-waiver elimination was associated with significant increases in the number of clinicians associated with dispensed buprenorphine prescriptions overall (change in level= 1,626 clinicians; 95% CI=577, 2,674; <em>p</em>&lt;0.01; change in slope: 15 clinicians per month, 95% CI=13, 18, <em>p</em>&lt;0.001) and across all specialties. X-waiver elimination was associated with a decrease in the number of patients with buprenorphine dispensations in January 2023 overall (change in level= −24,104 patients; 95% CI= −40,010, −8,198; <em>p</em>&lt;0.01) and from all clinician groups except behavioral health physicians. Decreasing monthly rates of patients with buprenorphine dispensed by behavioral health physicians slowed after X-waiver elimination; monthly rates of buprenorphine patients with dispensations from primary care providers increased after (versus before) the policy change.</div></div><div><h3>Conclusions</h3><div>Although the number of clinicians associated with dispensed buprenorphine prescriptions after X-waiver elimination increased across all clinician types, patient-level gains associated with X-waiver elimination were limited.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 5","pages":"Article 108055"},"PeriodicalIF":4.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856910","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":"Kind Kids, Healthy Teens: Child Prosociality and Fruit and Vegetable Intake","authors":"Farah Qureshi ScD ,&nbsp;Krista P. Woodward MPH, MSW ,&nbsp;Laura D. Kubzansky PhD ,&nbsp;Julia K. Boehm PhD","doi":"10.1016/j.amepre.2025.107965","DOIUrl":"10.1016/j.amepre.2025.107965","url":null,"abstract":"<div><h3>Introduction</h3><div>Prosocial behaviors (i.e., being kind, caring, and cooperative) are believed to shape health and well-being starting in childhood. Yet, limited research has examined their long-term impact on health outcomes later in life. This study examined associations between childhood prosocial behaviors and fruit and vegetable consumption patterns across adolescence.</div></div><div><h3>Methods</h3><div>Participants were from the United Kingdom Millennium Cohort Study (N=6,265). Caregivers reported children’s prosocial behaviors using the Strengths and Difficulties Questionnaire at ages 5 (2005–2007), 7 (2007–2009), and 11 (2011–2013) years. In 2024, Poisson regression was conducted to assess the associations between prosocial behaviors at age 5 years and sustained healthy levels of self-reported fruit and vegetable consumption across ages 14 (2014–2016) and 17 (2017–2019) years, defined as eating ≥2 portions of each daily. To evaluate heterogeneity by developmental stage, secondary analyses considered associations with prosocial behaviors at ages 7 and 11 years. All analyses adjusted for relevant confounders.</div></div><div><h3>Results</h3><div>More engagement in prosocial behaviors at age 5 years was associated with a greater likelihood of sustaining healthy fruit and vegetable consumption over time (adjusted prevalence ratio per 1 SD=1.14; 95% CI=1.02, 1.27). Comparable associations were observed with prosocial behaviors at ages 7 (adjusted prevalence ratio per 1 SD=1.12; 95% CI=1.03, 1.23) and 11 (adjusted prevalence ratio per 1 SD=1.13; 95% CI=1.03, 1.24) years.</div></div><div><h3>Conclusions</h3><div>Greater engagement in prosocial behaviors was related to healthy fruit and vegetable consumption patterns across adolescence with comparable associations when prosocial behaviors were measured at ages 5, 7, and 11 years. These findings suggest fostering prosociality throughout childhood may be a novel intervention strategy to promote healthy eating.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 4","pages":"Article 107965"},"PeriodicalIF":4.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818120","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":"Tribal Marijuana Possession Laws: Prohibition to Legalization Among Native American Nations","authors":"Todd Ebling PhD ,&nbsp;Mark Hall JD ,&nbsp;Jessica King Jensen PhD ,&nbsp;Sunday Azagba PhD","doi":"10.1016/j.amepre.2025.108046","DOIUrl":"10.1016/j.amepre.2025.108046","url":null,"abstract":"<div><h3>Introduction</h3><div>Amid the significant evolution of marijuana policy in the U.S., with numerous states adopting more permissive regulations, a notable gap exists in understanding how American Indian/Alaska Native tribes govern marijuana within tribal jurisdictions. This study aims to systematically document the legal status of marijuana possession in tribal laws.</div></div><div><h3>Methods</h3><div>An archive of tribal possession laws was compiled as of January 2025 using the National Indian Law Library’s Tribal Laws Gateway database, and this was supplemented with internet searches of tribal websites. The retrieved legal documents were then classified into 4 groups: prohibited, decriminalized, medically permitted, and recreationally permitted.</div></div><div><h3>Results</h3><div>The analysis revealed significant heterogeneity in the marijuana possession laws of 185 tribes, ranging from strict prohibitions with varying penalties to decriminalization, medical legalization, and recreational legalization with diverse policy frameworks. Whereas some tribes had policies aligned with surrounding state laws, others maintained distinct policies that diverged from both state and federal regulations. Marijuana possession remained illegal in many tribes; 16 tribes decriminalized possession, 38 permitted only medical marijuana, and 78 legalized recreational marijuana<strong>.</strong></div></div><div><h3>Conclusions</h3><div>This legal mapping of tribal approaches to marijuana possession provides a novel understanding of the topography and extent of tribal marijuana regulation. It highlights the intricate regulatory environment shaped by tribal sovereignty and state and federal factors. The observed variability shows the need for clear federal guidelines that respect tribal self-governance and support the development of culturally appropriate regulatory frameworks tailored to the unique needs of tribal communities.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 5","pages":"Article 108046"},"PeriodicalIF":4.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849508","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":"Prepregnancy Stressful Life Events and Perinatal Mental Health Disorders From Pregnancy to 3 Years After Childbirth: An Observational Study","authors":"Songtao Wu BMed ,&nbsp;Yue Zhang BMed ,&nbsp;Hui Wang MMed ,&nbsp;Jiyue Dai BMed ,&nbsp;Weijie Ding MMed ,&nbsp;Xiaoqin Zhu BMed ,&nbsp;Xiaolin Xu PhD","doi":"10.1016/j.amepre.2025.108039","DOIUrl":"10.1016/j.amepre.2025.108039","url":null,"abstract":"<div><h3>Introduction</h3><div>The associations of prepregnancy stressful life events with perinatal mental health disorders at multiple time points are not fully understood. This study aims to assess the associations of prepregnancy stressful life events with occurrences of maternal mental health disorders from pregnancy to 3 years after childbirth.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 1,994 women who had experienced childbirth from July 2020 to June 2021 in Huai’an, China, on the basis of the Grandmothers, Mothers, and Their Children’s Health study. Participants’ stressful life events 1 year before pregnancy included conflict with partners and family members; physical, sexual, or emotional abuse; deaths of friends or relatives; and financial stress. Maternal mental health disorders (including anxiety and depression) were determined during pregnancy and 1 year and 3 years after childbirth. Modified Poisson regression models were used to assess the associations, and the Shapley method was used to estimate the relative contributions of specific stressors. Data were collected during 2020–2023 and were analyzed during July 2024–February 2025.</div></div><div><h3>Results</h3><div>A total of 602 (30.2%) participants experienced prepregnancy stressful life events; 494 (24.8%), 432 (21.7%), and 240 (12.0%) participants were screened for mental health disorders during pregnancy, 1 year after childbirth, and 3 years after childbirth, respectively. Prepregnancy stressful life events were associated with 2.20-fold (95% CI=1.90, 2.56), 2.07-fold (95% CI=1.76, 2.43), and 2.98-fold (95% CI=2.34, 3.79) increased risks of maternal mental health disorders during pregnancy, 1 year after childbirth, and 3 years after childbirth, respectively. The associations were more evident for comorbid anxiety and depression as well as for persistent maternal mental health disorders. Financial stress and family conflicts were primary contributors to perinatal maternal mental health disorders.</div></div><div><h3>Conclusions</h3><div>Prepregnancy stressful life events were associated with maternal mental health disorders from pregnancy to 3 years after childbirth. Financial stress and family conflicts were primary contributors to these associations. These findings highlight the importance of consistent mental health monitoring during pregnancy and during the years after childbirth, particularly among those who experience stressful life events.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 5","pages":"Article 108039"},"PeriodicalIF":4.5,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818121","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":"Wisconsin policies shift handgun purchasing behavior 2000-2024.","authors":"C W Tomas, S Huang, K J Kallies, K M B Campbell, C A Kostelac, T A deRoon-Cassini","doi":"10.1016/j.amepre.2025.108041","DOIUrl":"https://doi.org/10.1016/j.amepre.2025.108041","url":null,"abstract":"<p><strong>Introduction: </strong>Firearm policies can directly impact manufacturing, sales, and accessibility of weapons. In Wisconsin, there were 3 statewide policy changes since 2011 that may have impacted firearm access: 1) legalization of concealed carry weapons [CCW], 2) repeal of 48-hour waiting periods to purchase a handgun, and 3) the COVID-19 pandemic stay-at-home order. The current study examined the impact of these policies on handgun purchases in WI and the association with firearm deaths.</p><p><strong>Methods: </strong>Background checks for handguns were examined using monthly counts (2000-2024) from the National Instant Criminal Background Check System. Firearm deaths were extracted from the Wisconsin Violent Death Reporting System (2004-2021). Seasonal autoregressive integrated moving average (SARIMA) models were used to forecast background check levels from one policy period to the next. Annual firearm deaths were correlated with annual handgun background checks.</p><p><strong>Results: </strong>There was a significant increase in observed handgun background checks compared to forecasted after each policy period (after CCW policy: mean increase = 204.3%, mean absolute percentage error, MAPE = 23.5; after 48-hour repeal: mean increase = 12.8%; MAPE = 20.27; after COVID-19 stay-at-home order: mean increase = 78.6%; MAPE = 43.20). Annual background checks were strongly correlated with annual firearm deaths (r = .887).</p><p><strong>Conclusions: </strong>The CCW policy had the strongest long-term relationship to the increase in handgun background checks. With each policy change, background check levels increased. Greater availability of firearms increases risk of firearm death and the strong association of firearm purchasing and firearm deaths warrants attention to relevant policies in Wisconsin.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"108041"},"PeriodicalIF":4.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812673","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":"Self-Rated Health by Time Since Smoking Cessation","authors":"Yusuff Adebayo Adebisi BPharm, MSc ,&nbsp;Najim Z. Alshahrani MBBS, MPH, MD ,&nbsp;Isaac Olushola Ogunkola BSc ,&nbsp;Nafisat Dasola Jimoh BTech","doi":"10.1016/j.amepre.2025.108040","DOIUrl":"10.1016/j.amepre.2025.108040","url":null,"abstract":"<div><h3>Introduction</h3><div>Although the physiologic benefits of quitting smoking are well established, less is known about how those who formerly smoked perceive these benefits over time. This study investigates the association between time since smoking cessation and self-rated health in a nationally representative sample and examines how predicted self-rated health varies by age, area-level deprivation, and education.</div></div><div><h3>Methods</h3><div>Data were drawn from the 2017, 2018, 2019, and 2021 waves of the Scottish Health Survey, yielding a sample of 5,701 adults aged ≥16 years who had formerly smoked. The primary outcome was self-rated health, grouped as very good/good, fair, or bad/very bad. The main exposure was time since quitting smoking, categorized as &lt;2 years, 2 to &lt;5 years, 5 to &lt;10 years, 10 to &lt;20 years, and ≥20 years. Generalized ordered logistic regression was used to estimate crude and AORs for self-rated health. Predictive margins were calculated to assess variation across sociodemographic subgroups. All analyses were conducted in 2025.</div></div><div><h3>Results</h3><div>Longer cessation duration was associated with significantly lower odds of reporting poorer self-rated health. Compared with those who had quit within the past 2 years, AORs were 0.81 (95% CI=0.62, 1.06; <em>p</em>=0.125) for those aged 2 to &lt;5 years, 0.75 (95% CI=0.58, 0.97; <em>p</em>=0.027) for those aged 5 to &lt;10 years, 0.63 (95% CI=0.49, 0.80; <em>p</em>&lt;0.001) for those aged 10 to &lt;20 years, and 0.45 (95% CI=0.36, 0.58; <em>p</em>&lt;0.001) for those aged ≥20 years. When modeled as a continuous ordinal variable, each additional cessation category was associated with lower odds of poorer self-rated health (AOR=0.82; 95% CI=0.78, 0.87; <em>p</em>&lt;0.001). Predicted probabilities of reporting good or very good health increased with time since quitting across all subgroups (<em>p</em>&lt;0.001). Among adults aged 45–64 years, probabilities rose from 59.7% (95% CI=53.6%, 65.9%) for those aged &lt;2 years to 72.2% (95% CI=69.4%, 74.9%) for those aged ≥20 years. Among those in the least deprived areas, the increase was from 64.4% (95% CI=54.0%, 74.8%) to 76.3% (95% CI=73.2%, 79.5%), and among individuals with higher education, it was from 65.7% (95% CI=58.1%, 73.4%) to 79.1% (95% CI=76.6%, 81.6%).</div></div><div><h3>Conclusions</h3><div>Longer time since smoking cessation is associated with more favorable self-rated health, suggesting a graded, perceived benefit over time. However, these perceived subjective health gains are not evenly distributed because individuals in disadvantaged groups continue to report lower probabilities of good health even after long-term cessation.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 5","pages":"Article 108040"},"PeriodicalIF":4.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812672","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":"A Pilot RCT Exploring Heated Tobacco Product Substitution for Menthol Cigarettes","authors":"Augustus M. White PhD ,&nbsp;Rabia Imran BA ,&nbsp;Nicoleta Gaitan RN ,&nbsp;Warren K. Bickel PhD ,&nbsp;Robert A. Perera PhD ,&nbsp;Caroline O. Cobb PhD ,&nbsp;Thomas E. Eissenberg PhD ,&nbsp;Andrew J. Barnes PhD","doi":"10.1016/j.amepre.2025.108029","DOIUrl":"10.1016/j.amepre.2025.108029","url":null,"abstract":"<div><h3>Introduction</h3><div>Flavors are a key regulatory target for tobacco products, but little is known about how flavors influence the appeal of heated tobacco products, such as IQOS, for people who smoke. This study assessed differences in the substitution feasibility of menthol- and regular/tobacco-flavored IQOS for menthol cigarettes.</div></div><div><h3>Study design</h3><div>This was an unblinded 2-week, parallel-group randomized pilot clinical trial.</div></div><div><h3>Setting/participants</h3><div>Thirty adults who smoked menthol cigarettes in Richmond, VA completed clinical laboratory sessions (Monday and Friday) and reported at-home tobacco consumption. Data were collected from November 2022 to September 2023 and analyzed from October 2023 to February 2024.</div></div><div><h3>Intervention</h3><div>Participants were randomized to use IQOS 2.4 with fresh menthol (IQOS-M) or regular tobacco (IQOS-T) HeatSticks (1:1) during Week 2 of the study in the clinical laboratory and throughout the second week while they were at home.</div></div><div><h3>Main outcome measures</h3><div>Laboratory visits involved 10-puff directed use bouts with puff topography, plasma nicotine measurement, subjective effects questionnaires, and the Experimental Tobacco Marketplace task. The primary outcome was the cross-price elasticity of IQOS in the Experimental Tobacco Marketplace at the final clinical laboratory session. Electronic daily diaries measured tobacco consumption at home.</div></div><div><h3>Results</h3><div>In the Experimental Tobacco Marketplace, the average (SD) cross-price elasticity for IQOS was 0.67 (0.09) when IQOS-M and IQOS-T were available concurrently versus 0.14 (0.03) when only IQOS-T was available (<em>p</em>&lt;0.05). At home, participants reduced their typical cigarette consumption by 80% when they had access to IQOS-M versus 37% with IQOS-T (<em>p</em>&lt;0.05). Differences in puff topography and nicotine delivery across IQOS flavors were not significant (<em>p</em>&gt;0.05).</div></div><div><h3>Conclusions</h3><div>Access to menthol-flavored heated tobacco products is an important determinant of potential substitution for people who smoke menthol cigarettes but may not be sufficient to promote complete substitution. Tobacco regulatory policies that restrict access to menthol-flavored heated tobacco products could promote complete tobacco cessation but may reduce attempts to substitute with heated tobacco products among people who smoke menthol cigarettes.</div></div><div><h3>Trial registration</h3><div>This trial was preregistered at www.clinicaltrials.gov (NCT05499377).</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 5","pages":"Article 108029"},"PeriodicalIF":4.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790592","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":"Cardiovascular Health Markers With Remote Team-Based Hypertension Management in a Safety-Net Population","authors":"Ethan Chervonski MD, MPH ,&nbsp;Elan Pelegri MS ,&nbsp;Franzenith De La Calle MS, RD ,&nbsp;Soumik Mandal PhD ,&nbsp;Claire A. Graves MD ,&nbsp;Doreen Colella RN, MSN ,&nbsp;Arielle Elmaleh-Sachs MD, MS ,&nbsp;Jacalyn Nay RN, MHL, CCM ,&nbsp;Isaac Dapkins MD ,&nbsp;Antoinette Schoenthaler EdD, MA","doi":"10.1016/j.amepre.2025.108031","DOIUrl":"10.1016/j.amepre.2025.108031","url":null,"abstract":"<div><h3>Introduction</h3><div>The impact of remote patient monitoring for hypertension on cardiovascular health remains ill defined. This study characterized the association between a remote patient monitoring, team-based hypertension intervention and cardiovascular health markers.</div></div><div><h3>Methods</h3><div>This retrospective, single-arm cohort study included patients with uncontrolled hypertension enrolled from February 2022 to July 2024 in the ALTA trial (clinicaltrials.gov NCT03713515) at 5 safety-net practices. The ALTA intervention involves remote patient monitoring supported by a virtual clinic managed by a nurse practitioner, a registered nurse, and a community health worker. Demographics, ALTA utilization, and cardiovascular health markers (blood pressure, lipids, glycemic indicators, BMI, and smoking history) at baseline and 12 months were collected. The 5 cardiovascular health markers were scored (0=poor, 1=intermediate, 2=ideal) and summed into a cardiovascular health score. The primary endpoint was a change in the 12-month cardiovascular health score among patients with a baseline score of ≤7. Secondary endpoints included changes in individual non-blood pressure markers among patients with baseline derangements.</div></div><div><h3>Results</h3><div>Among the 568 included patients (mean age: 56 years), most were female, non-Hispanic Black, and English-speaking individuals. Nurse practitioner visits were more common among females (<em>p</em>=0.04), with no other demographics predicting ALTA utilization. The cardiovascular health score improved from 4.5 to 5.2 (<em>n</em>=196, <em>p</em>&lt;0.001), independent of ALTA utilization. Total cholesterol (<em>n</em>=86, <em>p</em>&lt;0.001), low-density lipoprotein (<em>n</em>=128, <em>p</em>&lt;0.001), and triglyceride levels (<em>n</em>=51, <em>p</em>=0.004) also improved. Hemoglobin A_1c (<em>n</em>=195) dropped among patients with ≥1 nurse practitioner visit (<em>p</em>=0.02). Fasting glucose (<em>n</em>=135) and BMI (<em>n</em>=289) decreased in the highest tertile of nurse practitioner visits (<em>p</em>=0.03) and remote patient monitoring (<em>p</em>=0.02), respectively. Finally, 4 of 27 patients quit smoking.</div></div><div><h3>Conclusions</h3><div>Remote patient monitoring with team-based support was associated with cardiovascular health improvements. However, benefits may depend on the intervention’s utilization.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 5","pages":"Article 108031"},"PeriodicalIF":4.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790593","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}