Preventing Chronic Disease最新文献

{"title":"Racial and Ethnic Differences in Diet Quality by Education Level: Diminished Returns.","authors":"Chelsea R Singleton, Ana Peralta-Garcia, Danielle J Gartner, Kaustubh V Parab, Isa Adamu, Oluwafikayo S Adeyemi-Benson, Caryn N Bell","doi":"10.5888/pcd23.260004","DOIUrl":"10.5888/pcd23.260004","url":null,"abstract":"<p><p>Higher education is correlated with healthy eating, which prevents chronic disease. Recent evidence suggests that racial and ethnic minority populations with higher education levels consume fewer healthy foods than their non-Hispanic White counterparts. We analyzed data on 19,591 participants of the National Health and Nutrition Examination Survey (2011-2018). Linear regression models identified racial and ethnic differences in Healthy Eating Index (HEI)-2015 scores within categories of education level. Non-Hispanic Black adults with a bachelor's degree or higher had lower HEI-2015 scores (β = -1.69; SE = 0.79; P = .03) compared with non-Hispanic White adults with the same education level. These findings suggest that non-Hispanic Black populations in the US may experience diminished returns on educational investment.</p>","PeriodicalId":51273,"journal":{"name":"Preventing Chronic Disease","volume":"23 ","pages":"E39"},"PeriodicalIF":5.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Individual: Couple-Centered Health and Wellness Coaching to Address the Burden of Chronic Conditions.","authors":"Fariha Niazi, Shazia Akhtarullah","doi":"10.5888/pcd23.260070","DOIUrl":"10.5888/pcd23.260070","url":null,"abstract":"","PeriodicalId":51273,"journal":{"name":"Preventing Chronic Disease","volume":"23 ","pages":"E37"},"PeriodicalIF":5.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food Insecurity and Cardiovascular-Kidney-Metabolic Syndrome-Related Conditions Among US Adults, National Health and Nutrition Examination Survey, 2015-2020.","authors":"Deepali K Ernest, Bipin Singh, Aydee Hinojosa, Alveena Imran, Elizabeth A Onugha, Shreela V Sharma, Jayna M Dave","doi":"10.5888/pcd23.250372","DOIUrl":"10.5888/pcd23.250372","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome includes health disorders that are increasingly prevalent in the US, yet their relationship with food insecurity remains unclear. This study examined CKM syndrome-related conditions among US adults and their associations with food insecurity.</p><p><strong>Methods: </strong>This cross-sectional study analyzed data for 13,937 US adult participants from the 2015-2020 National Health and Nutrition Examination Survey. Information about demographic characteristics, food insecurity, and CKM syndrome-related conditions was self-reported on questionnaires. Weighted logistic regression models, adjusting for demographic variables and socioeconomic status, examined associations between food insecurity and CKM syndrome-related health outcomes.</p><p><strong>Results: </strong>Mean age of respondents was 47.4 years, and mean body mass index (weight in kg/height in m²) was 29.6. Of total respondents, 28.4% experienced marginal, low, and very low food security. Obesity (40.9%), hyperglycemia (58.9%), and hypertension (29.9%) were the most prevalent cardiometabolic conditions. Lower food security was associated with significantly higher odds of obesity, diabetes, weak or failing kidneys, and cardiovascular diseases (CVDs), with clear dose-response relationships. Compared with full food security, very low food security was associated with higher odds of congestive heart failure (adjusted odds ratio [AOR] = 3.69), coronary heart disease (AOR = 3.43), heart attack (AOR = 3.21), and stroke (AOR = 2.54). Additionally, the likelihood of low or very low food security increased stepwise with number of coexisting CVDs, with the highest odds observed among adults reporting 4 CVDs (AOR = 3.93).</p><p><strong>Conclusion: </strong>This study highlights that food insecurity is significantly associated with CKM syndrome-related conditions among US adults. Addressing food insecurity is critical to reducing its substantial health burden and improving population health.</p>","PeriodicalId":51273,"journal":{"name":"Preventing Chronic Disease","volume":"23 ","pages":"E36"},"PeriodicalIF":5.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial and Temporal Trends of Access to Birthing Hospitals in Illinois, 2016-2021.","authors":"Mechelle D Claridy, Barbara Chebet Keino, Lauren M Ramsey, Elizabeth J Conrey, Laurin Kasehagen, Jessica R Meeker, Amanda C Bennett","doi":"10.5888/pcd23.260064","DOIUrl":"10.5888/pcd23.260064","url":null,"abstract":"<p><strong>Introduction: </strong>Changes in the availability of birthing hospitals may affect geographic access to obstetric care. Travel time to the nearest birthing hospital is a measurable indicator of access. We estimated changes in travel time in Illinois from 2016 to 2021 and described the distribution of populations living in census tracts with increased travel time.</p><p><strong>Methods: </strong>We used Illinois Department of Public Health hospital data (2016-2021), US Census population-weighted block group (PWBG) centroids, and American Community Survey data (2017-2021). We estimated driving time from PWBG centroids to the nearest in-state birthing hospital (driving time) by using ArcGIS network analysis and averaging to census tracts. We assessed changes overall and by rural-urban classification, race and ethnicity, and educational attainment.</p><p><strong>Results: </strong>The number of Illinois birthing hospitals decreased 16.9%, from 118 in 2016 to 98 in 2021. Average driving time increased from 12.1 to 13.2 minutes overall, from 9.5 to 10.4 minutes in urban areas, and from 24.1 to 25.9 minutes in rural areas. Overall, 18.3% of Illinois residents (2,288,738 of 12,502,452) lived in census tracts with increased driving time. Among residents living in rural areas, 23.7% lived in affected tracts, compared with 17.4% among those living in urban areas. Among non-Hispanic White residents in Illinois, 14.9% lived in affected tracts, compared with 32.1% of non-Hispanic Black residents. Among college graduates, 14.8% lived in affected tracts, compared with 23.3% of residents with less than a high school education.</p><p><strong>Conclusion: </strong>From 2016 to 2021, changes in the availability of birthing hospitals in Illinois coincided with modest increases in driving time and were not evenly distributed across populations. These findings provide a descriptive assessment of geographic access to obstetric care and may inform efforts to address differences in access.</p>","PeriodicalId":51273,"journal":{"name":"Preventing Chronic Disease","volume":"23 ","pages":"E34"},"PeriodicalIF":5.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Collaboratives as a Community-Organizing Strategy to Improve Heart Health.","authors":"Callie Bradley, Suzanne Grossman, Kendall Farr, Michele King, Victoria Sanders, Hamilton Peoples, Patrick Wiggins","doi":"10.5888/pcd23.250398","DOIUrl":"10.5888/pcd23.250398","url":null,"abstract":"<p><p>Cardiovascular disease and other chronic diseases contribute substantially to illness, death, and health inequities in the US. Despite medical advances and interventions to improve the health outcomes among people with chronic diseases, additional strategies are needed. Communities are a powerful driver of health promotion and disease prevention. When engaged meaningfully, communities can enact and sustain health-related changes starting at the individual level and expand these changes to system and policy levels. Grounded in the social action model and the principles of shared governance, learning collaboratives can promote community engagement, mutual accountability, and local capacity building. By aligning public health efforts with community priorities, learning collaboratives offer a way to build community trust, deepen community partnerships, and support sustainable health initiatives. They can position communities not merely as sites of intervention but as meaningful change agents in addressing health. This article explores the use of learning collaboratives, and in particular, the Healthy Hearts Learning Collaboratives in Virginia, as practical tools for advancing community-driven strategies to reduce the incidence of chronic disease and poor health outcomes. It provides guidance for entities looking to implement learning collaboratives focused on improving health and ensuring that people with lived experience have an opportunity to contribute to improving conditions to promote health in their communities.</p>","PeriodicalId":51273,"journal":{"name":"Preventing Chronic Disease","volume":"23 ","pages":"E35"},"PeriodicalIF":5.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Top Food Contributors of Sodium Intake in US Children and Adults Aged 1 Year or Older, National Health and Nutrition Examination Survey, August 2021-August 2023.","authors":"Alain K Koyama, Rebecca C Woodruff, Sandra L Jackson, Janelle P Gunn, Julie L Self","doi":"10.5888/pcd23.260054","DOIUrl":"10.5888/pcd23.260054","url":null,"abstract":"<p><p>To identify the food categories contributing most to sodium intake in the US, we used 2021-2023 National Health and Nutrition Examination Survey data. Approximately one-third of total dietary sodium intake among children and adults came from deli meat sandwiches (5.0%), pizza (4.4%), savory snacks (4.4%), soups (4.4%), poultry (3.8%), pasta mixed dishes (3.8%), bread (3.1%), and cheese (2.7%). Among subgroups, the highest contributor to sodium intake among children aged 1 to 11 years was savory snacks (approximately 8%) and among non-Hispanic Asian participants, soups (8.7%). Information on current top contributors to sodium intake can be leveraged to inform sodium reduction interventions.</p>","PeriodicalId":51273,"journal":{"name":"Preventing Chronic Disease","volume":"23 ","pages":"E33"},"PeriodicalIF":5.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatiotemporal Modeling of Premature Mortality in Mississippi: A County-Level Analysis of Years of Potential Life Lost, 2015-2025.","authors":"Jae Eun Lee, Junghye Sung, Ji-Young Lee, Yalanda Barner, Edith Offiah, Alyce Hays","doi":"10.5888/pcd23.260035","DOIUrl":"10.5888/pcd23.260035","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding premature mortality through years of potential life lost (YPLL) is essential for identifying preventable deaths and health inequities, yet county-level spatiotemporal patterns remain understudied in states such as Mississippi that have high rates of premature mortality. This study examined spatiotemporal trends in premature mortality across Mississippi's 82 counties (2015-2025) using years of potential life lost (YPLL) before age 75 years.</p><p><strong>Methods: </strong>We determined county-level YPLL rates from County Health Rankings & Roadmaps (2015-2025) (underlying deaths from approximately 2012 to 2023). Trends were compared with US averages, stratified by education, income, and insurance status; mapped via GIS; analyzed for spatial clustering with calculated local indicators of spatial association (LISA); and modeled by using spatial autoregressive (SAR) lag models with year fixed effects.</p><p><strong>Results: </strong>From 2015 to 2025, Mississippi's YPLL rate rose 35.2% (10,918.3 to 14,763.9 per 100,000), far outpacing national trends and widening the gap between the state and the US by approximately 50%. Contrary to expectation, the largest increases occurred in high-education, high-income, low-uninsured (mostly urban/coastal) counties. Hot spots intensified in rural Delta and Mississippi River counties, while cold spots disappeared from urban and coastal areas. SAR models showed strong spatial dependence (ρ ≈ 0.32); key drivers were injury-related deaths (β = 58.9, P < .001), percentage of population that is non-Hispanic Black, and diabetes prevalence, while higher median household income was associated with lower YPLL.</p><p><strong>Conclusion: </strong>Mississippi's premature mortality pattern has shifted: rural burdens persist, but rapid deterioration in urban and more affluent counties now drives statewide worsening. Effective policy requires sustained rural investment in chronic disease control along with urban-focused interventions targeting injury and violence prevention, trauma systems, and mental health/substance-use services.</p>","PeriodicalId":51273,"journal":{"name":"Preventing Chronic Disease","volume":"23 ","pages":"E32"},"PeriodicalIF":5.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Minigrant Program for Multilevel Interventions to Promote Human Papillomavirus Vaccination in Rural Communities in Georgia.","authors":"Cam Escoffery, Courtney Petagna, Rithika Chari, Erica Hsu, Rohini Vijay Kadoo, Regine Haardörfer, Yue Guan, Alexandra B Morshed, Jessica Wells, Sarah Blake, Remy Hutchins","doi":"10.5888/pcd23.250328","DOIUrl":"10.5888/pcd23.250328","url":null,"abstract":"<p><strong>Introduction: </strong>Rates of human papillomavirus (HPV) vaccine are lower in rural counties than in urban areas. The objective of the minigrants evaluation was to assess HPV vaccination uptake, factors related to implementation success, and barriers to implementation.</p><p><strong>Methods: </strong>We conducted a concurrent, mixed-methods evaluation guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and CFIR (Consolidated Framework for Implementation Science) frameworks. Four health departments received funding, a toolkit with implementation strategies, and monthly technical assistance calls or a learning collaborative for 1 year. The data sources were program documents, staff interviews and surveys, immunization databases, and caregiver or young adult surveys. Key evaluation metrics were 1) reach of patients and adoption of intervention levels (patient, provider, or practice); 2) HPV vaccination effectiveness; 3) implementation perspectives from staff, caregivers, and young adults; 4) implementation barriers and facilitators; and 5) program sustainability capacity.</p><p><strong>Results: </strong>Most sites adopted 2 of 3 levels (patient, provider, or practice). Common multilevel strategies for series completion were patient education, incentives, provider training, and patient reminders. The total HPV vaccination rate increased 26.7% from 2023 to first quarter 2024, and initiation rate increase was 51.8% across the county departments. Overall, on a scale from 1 to 5, with 1 being \"strongly disagree\" to 5 being \"strongly agree,\" sites reported positive experiences with program implementation and perceived the program was feasible (mean, 4.4 points), acceptable (mean, 4.4 points), and appropriate (mean, 4.2 points). Staff members also reported high ease of implementation (mean, 4.0 points) and commitment to program delivery (mean, 4.8 points). The parents or caregivers (n = 20) reported in surveys that they saw educational materials (100%), received educational materials (90%), and received a vaccine reminder (75%). CFIR-related facilitators were priority of the health issues, leadership involvement, technology infrastructure, communications about the vaccine and program, available resources, and staff training at the inner setting and external support at the outer setting. Barriers included limited resources, communication and structural characteristics (eg, technology, issues related to electronic health records), and local attitudes and conditions. The mean program sustainability capacity score was 4.2, with highest scores for evaluation, effectiveness, and workflow integration.</p><p><strong>Conclusion: </strong>Multilevel intervention strategies can successfully increase HPV vaccination rates in rural settings with implementation supports to address cancer prevalence in rural areas.</p>","PeriodicalId":51273,"journal":{"name":"Preventing Chronic Disease","volume":"23 ","pages":"E30"},"PeriodicalIF":5.6,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menthol Tobacco Product Use Among US Middle and High School Students, National Youth Tobacco Survey, 2023-2024.","authors":"Katherine A Moran, Philip E Rosenbaum, Christina Meyers, Monica Cornelius, Margaret Mahoney, Michael Sawdey, Samantha N Cwalina, Livia Navon","doi":"10.5888/pcd23.250427","DOIUrl":"10.5888/pcd23.250427","url":null,"abstract":"<p><strong>Introduction: </strong>Most tobacco use begins during adolescence. We used National Youth Tobacco Survey (NYTS) data from 2023 and 2024 to examine menthol tobacco product use among US middle and high school students.</p><p><strong>Methods: </strong>We used pooled data from the 2023 and 2024 NYTS (n = 51,930) to calculate nationally representative prevalence estimates for past 30-day menthol and nonmenthol tobacco product use, stratified by sociodemographic and mental health indicators. We used χ² tests with Benjamini-Hochberg adjustments to compare behaviors.</p><p><strong>Results: </strong>During 2023 and 2024, 22.1% of students who currently used tobacco (representing 520,000 students) used menthol products. Overall, menthol products were used by 40.0% of students who smoked cigarettes, 18.0% who used e-cigarettes, and 11.5% who smoked cigars. Menthol tobacco use was significantly higher among males (vs females) (26.1% vs 18.3%), high schoolers (vs middle schoolers) (23.9% vs 17.0%), and those with moderate to severe anxiety or depression (vs no or mild symptoms) (25.0% vs 18.8%). By race and ethnicity, use ranged from 12.0% (non-Hispanic Black) to 28.6% (non-Hispanic multiracial). Compared with students who used nonmenthol products, a higher proportion of those who used menthol cigarettes or e-cigarettes reported younger age at first use of tobacco (<11 y) (42.5% vs 26.8% and 19.9% vs 13.2%, respectively), use on 20 to 30 of the past 30 days (38.2% vs 20.2% and 53.4% vs 33.2%, respectively), and fewer past-year smoking quit attempts (49.7% vs 63.2%, respectively).</p><p><strong>Conclusion: </strong>More than 500,000 US middle and high school students used menthol products; prevalence varied by sociodemographic and mental health indicators. Menthol tobacco use correlates with earlier initiation, higher frequency of use, and reduced past-year quit attempts. Additional efforts to reduce access to menthol products among young people may reduce tobacco use in this population.</p>","PeriodicalId":51273,"journal":{"name":"Preventing Chronic Disease","volume":"23 ","pages":"E31"},"PeriodicalIF":5.6,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Rates of Cesarean Delivery in Rural US Communities: A Systematic Review of Interventions and Approaches to Care.","authors":"Jena L Funakoshi, Hannah M Collins-Doijode, Kathryn L Braun","doi":"10.5888/pcd23.260039","DOIUrl":"10.5888/pcd23.260039","url":null,"abstract":"<p><strong>Introduction: </strong>Cesarean deliveries are the most common major surgery in the US, with rates rising disproportionately in rural communities. While sometimes medically necessary, unnecessary cesarean births increase risks for maternal death, long-term complications, and intergenerational health effects that contribute to the burden of chronic disease. This systematic review examined studies describing interventions and approaches to care that reported outcomes related to reducing cesarean delivery rates in rural US communities.</p><p><strong>Methods: </strong>We searched 4 databases in September 2025. Studies were eligible if they were conducted in rural US settings and reported cesarean-related outcomes associated with an intervention or care approach. We categorized interventions as patient level, provider level, or health system level. Two reviewers independently screened articles for inclusion, extracted data, and assessed study quality using the Newcastle-Ottawa Scale and the Joanna Briggs Institute checklist.</p><p><strong>Results: </strong>Nine studies met inclusion criteria. Of the 2 patient-level interventions, psychosocial education was associated with lower cesarean delivery rates (21% in intervention vs 40% in control), whereas a mobile health application showed only a marginal difference (27.1% among application users vs 27.7% among nonusers). None were categorized at the provider level. Seven interventions tested system-level models, primarily comparing hospitals with different staffing patterns; family medicine-led hospitals had lower rates of low-risk nulliparous, term, singleton, vertex cesarean delivery than hospitals staffed by both family medicine physicians and obstetricians (23% vs 28%), certified nurse-midwife-managed births had lower cesarean delivery rates than family medicine physician-managed births (8% vs 14%), and collaborative maternity care models integrating midwives, nurses, and obstetricians were associated with cesarean delivery rates declining from 26.2% to 11.2%.</p><p><strong>Conclusion: </strong>System-level approaches, particularly those that restructure maternity care teams, emphasize family medicine physician-led models, and integrate midwifery and culturally grounded childbirth practices, are more consistently associated with lower cesarean delivery rates in rural US settings than patient-level interventions alone. Future efforts to reduce unnecessary cesarean deliveries should prioritize strategies tailored to the variability of rural care capacity.</p>","PeriodicalId":51273,"journal":{"name":"Preventing Chronic Disease","volume":"23 ","pages":"E29"},"PeriodicalIF":5.6,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13426284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}