AJPM focus最新文献

{"title":"Evaluating Whole Health Engagement Among Homeless-Experienced Veterans in an Emergency Shelter: A Quality Improvement Study","authors":"Tawny Saleh MD, MS ,&nbsp;Lillian Gelberg MD, MSPH, FAAFP ,&nbsp;Melissa Y. Chinchilla PhD, MCP, MSHPM ,&nbsp;Jennifer E. Allen ANP-BC, MSN ,&nbsp;Kristen L. Connor MSPH ,&nbsp;Lisa Altman MD ,&nbsp;Peter Capone-Newton MD, PhD, MPH","doi":"10.1016/j.focus.2025.100383","DOIUrl":"10.1016/j.focus.2025.100383","url":null,"abstract":"<div><h3>Introduction</h3><div>Whole Health programs aim to integrate mental, physical, and social health to improve veteran well-being. Homeless-experienced veterans may face barriers to engagement owing to housing instability and comorbidities. This study evaluated Whole Health participation among homeless-experienced veterans at the VA Greater Los Angeles Care, Treatment, and Rehabilitation Service site compared with that among the broader VA Greater Los Angeles Healthcare System veteran population.</div></div><div><h3>Methods</h3><div>A retrospective quality improvement study analyzed Whole Health participation among 619 homeless-experienced veterans at Care, Treatment, and Rehabilitation Service; 25,520 Whole Health participants at VA Greater Los Angeles Healthcare System; and 84,358 total VA Greater Los Angeles Healthcare System veterans. Chi-square and <em>t</em>-tests assessed demographic and health differences. Thematic analysis of personal health inventory reflections explored wellness priorities.</div></div><div><h3>Results</h3><div>Whole Health participation was higher among Care, Treatment, and Rehabilitation Service homeless-experienced veterans (42%) than among the broader VA Greater Los Angeles Healthcare System Whole Health population (22%) (<em>p</em>&lt;0.001). Whole Health participants at Care, Treatment, and Rehabilitation Service were older (56.8±13.4 vs 53.8±13.7 years; <em>p</em>=0.006), with different age group distribution (<em>p</em>=0.02). Chronic pain, post-traumatic stress disorder, depression, and substance use were more prevalent among homeless-experienced veterans than among the general veteran population (<em>p</em>&lt;0.001). Early Whole Health engagement was associated with longer shelter stays. Personal health inventory themes included personal development (88%), housing (68%), and family/social connection (56%).</div></div><div><h3>Conclusions</h3><div>Whole Health programs may be effective and acceptable among homeless-experienced veterans when integrated into supportive housing environments.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100383"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake of Pneumococcal Vaccines Among U.S. Adults After 2022 Update to Recommendations","authors":"Ahuva Averin MPP ,&nbsp;Jeffrey Vietri PhD ,&nbsp;Adriano Arguedas Mohs MD ,&nbsp;Sarah J. Willis PhD, MPH ,&nbsp;Alexander Lonshteyn PhD ,&nbsp;Derek Weycker PhD","doi":"10.1016/j.focus.2025.100384","DOIUrl":"10.1016/j.focus.2025.100384","url":null,"abstract":"<div><h3>Introduction</h3><div>Updated recommendations for adult pneumococcal vaccination in the U.S. (publication date: January 27, 2022) incorporated 2 new vaccines (15- and 20-valent pneumococcal conjugate vaccines), removed 13-valent pneumococcal conjugate vaccine, and called for pneumococcal conjugate vaccine use among immunocompetent adults aged 19–64 years with certain medical conditions. This study assessed uptake of recommendations and disparities in uptake across subgroups of adults.</div></div><div><h3>Methods</h3><div>A retrospective cohort design and data from Optum’s deidentified Clinformatics Data Mart Database were employed. Study population comprised all adults aged ≥65 years and adults aged 19–64 years with ≥1 chronic (at-risk) or immunocompromising (high-risk) condition. Vaccine uptake (including 23-valent pneumococcal polysaccharide vaccine) was estimated using the Kaplan–Meier method.</div></div><div><h3>Results</h3><div>During 21-month follow-up period, 13.2% of adults (<em>n</em>=6.8 million) received pneumococcal vaccine, mostly 20-valent pneumococcal conjugate vaccine (9.6%). By age/risk conditions, 20-valent pneumococcal conjugate vaccine uptake was highest among adults aged 65–66 years (23.8%) and at-risk/high-risk adults aged 60–64 years (12.1%) and lowest among at-risk/high-risk adults aged 19–49 years (4.7%). By immunization history, 20-valent pneumococcal conjugate vaccine uptake was highest among adults with a history of 23-valent pneumococcal polysaccharide vaccine uptake only (15.1%) or 13-valent pneumococcal conjugate vaccine uptake only (10.6%) and lowest among those without prior pneumococcal vaccination (8.7%) or with a history of 13-valent pneumococcal conjugate vaccine + 23-valent pneumococcal polysaccharide vaccine uptake (7.9%).</div></div><div><h3>Conclusions</h3><div>Fewer than ∼1 in 7 U.S. adults received 20-valent pneumococcal conjugate vaccine in the first 21 months after the updated recommendations. Uptake was lower among at-risk/high-risk adults aged &lt;60 years, adults aged ≥75 years, and adults without prior pneumococcal vaccination. Routine evaluation of vaccination status by providers and additional strategies to increase uptake of recommend vaccines are warranted.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100384"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multi-Institutional Evaluation of Billing for Tobacco-Cessation Services: Opportunities to Improve Quality and Enhance Revenue Capture","authors":"Edward Anselm MD ,&nbsp;Derek J. Baughman MD ,&nbsp;Marcus Rauhut MS ,&nbsp;Taylor Martin DO, MPH ,&nbsp;Ishan Mahajan ,&nbsp;Allison B. McCoy PhD","doi":"10.1016/j.focus.2025.100379","DOIUrl":"10.1016/j.focus.2025.100379","url":null,"abstract":"<div><div>A recent paper identified significant gaps in billing for tobacco-cessation services for a multihospital health system. Underbilling can reflect poor billing practices, low rates of tobacco-cessation counseling, or a combination of both. The study design was applied to 2 academic medical centers. Deidentified data from the electronic medical records systems were used to identify adult tobacco users and their insurance coverage for patients who had visits to primary care clinics. The proportion of office visits where cessation services were billed was calculated. An economic evaluation of the missed counseling opportunities was based on insurance type and a fee-for-service-payment model. Billing of cessation services is consistently below 2% across the medical centers studied, suggesting substantial opportunities to improve quality and increase revenue. The prevalence of tobacco use in the patient populations studied was significantly lower than reported for that state by the Centers for Disease Control and Prevention.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144665889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Duration of Breastfeeding in Infancy and Levels of Central Adiposity and Systemic Inflammation in Early Middle Adulthood","authors":"Thomas W. McDade PhD ,&nbsp;Jessica A. Polos PhD ,&nbsp;Kiarri N. Kershaw PhD ,&nbsp;Taylor W. Hargrove PhD ,&nbsp;Stephanie M. Koning PhD","doi":"10.1016/j.focus.2025.100375","DOIUrl":"10.1016/j.focus.2025.100375","url":null,"abstract":"<div><h3>Introduction</h3><div>Overweight, obesity, and systemic inflammation contribute to chronic degenerative diseases that are major public health burdens associated with aging. This longitudinal cohort study investigates whether the duration of breastfeeding in infancy predicts waist circumference and chronic systemic inflammation in early middle adulthood.</div></div><div><h3>Methods</h3><div>Survey-weighted regression models were implemented with data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of adults (aged 33–44 years) with information on breastfeeding history as well as measures of waist circumference, C-reactive protein, and interleukin 6. Analyses focused on 3,417 and 3,570 participants with C-reactive protein and interleukin 6 measurements, respectively. Fixed-effects regression models were also used to analyze between-sibling differences in breastfeeding duration, waist circumference, and C-reactive protein/interleukin 6. C-reactive protein and interleukin 6 were quantified in serum with highly sensitive particle-enhanced nephelometric and electrochemiluminescent immunoassays, respectively.</div></div><div><h3>Results</h3><div>Longer duration of breastfeeding was associated with significantly lower waist circumference and lower C-reactive protein. Results were similar for interleukin 6 but statistically weaker. For individuals who were breastfed for 6–12 months and those not at all, marginal mean waist circumference was 94.8 cm (95% CI=92.5, 97.1) and 101.7 cm (95% CI=100.2, 103.2), respectively. Marginal mean C-reactive protein was 1.59 mg/L (95% CI=1.38, 1.84) versus 2.10 mg/L (95% CI=1.97, 2.24). Waist circumference mediated 57.3%–93.8% of the associations between breastfeeding duration and C-reactive protein, depending on duration category. Breastfeeding duration was negatively associated with waist circumference and inflammation in sibling comparisons, but estimates were imprecise and not statistically significant.</div></div><div><h3>Conclusions</h3><div>The convergence of obesogenic environments and low uptake of breastfeeding for cohorts born after the historical nadir of breastfeeding in the U.S. may contribute to epidemics of overweight/obesity and chronic inflammation that presage risk for chronic degenerative diseases of aging.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100375"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Associations Between Smoking Patterns and Employment Status Among a Nationally Representative Sample of U.S. Adults","authors":"Mirsada Serdarevic PhD ,&nbsp;Aro N. Choi MS ,&nbsp;David Gimeno Ruiz de Porras LPsy, MS, PhD ,&nbsp;Tracey E. Barnett PhD","doi":"10.1016/j.focus.2025.100376","DOIUrl":"10.1016/j.focus.2025.100376","url":null,"abstract":"<div><h3>Introduction</h3><div>Smoking is a leading preventable cause of death, with higher prevalence in certain occupations. Given the evolved work environment after COVID-19 and shifting tobacco use patterns, this study examines recent data to assess the associations between smoking status, employment status, and industry.</div></div><div><h3>Methods</h3><div>The authors analyzed data from the 2023 National Health Interview Survey. Participants were aged ≥18 years, and their employment status was classified as employed or unemployed on the basis of the prior week’s work; smoking status was classified as current, former, or never. The prevalence of employment and smoking was calculated. Weighted multinomial logistic regression was used to assess the associations between smoking status, employment status, and industry.</div></div><div><h3>Results</h3><div>Among the 26,442 adults (50.8% male, 63.6% non-Hispanic Whites, mean age of 49.3 years, 69.7% employed), 11.0% were current smokers, 23.4% were former smokers, and 65.6% were never smokers. Current smoking was highest in wholesale trade (20.5%), information (16.9%), and mining (15.9%) industries. After adjustment, unemployed individuals, particularly those unable to work owing to health reasons, had 93% higher odds of being current smokers (AOR=1.93; 95% CI=1.64, 2.28) and 35% higher odds of being former smokers (AOR=1.35; 95% CI=1.16, 1.58) than those who were employed.</div></div><div><h3>Conclusions</h3><div>This study highlights the current relationship between employment status, industry, and smoking behaviors in the U.S. Current smoking rates were highest in specific industries, underscoring the need for targeted interventions in these occupational settings. Tailored smoking cessation programs for high-risk industries and unemployed individuals, particularly those unable to work owing to health issues, are crucial. Public health policies should address the unique needs of both employed and unemployed populations to reduce smoking-related health disparities.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100376"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board and Journal Information","authors":"","doi":"10.1016/S2773-0654(25)00057-4","DOIUrl":"10.1016/S2773-0654(25)00057-4","url":null,"abstract":"","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 3","pages":"Article 100369"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Produce Prescription Program Grounded in Community Connection Improves Fruit Intake in Hawaiʻi","authors":"Monica K. Esquivel PhD, RDN ,&nbsp;Cherese Shelton BS ,&nbsp;Alicia Higa BS ,&nbsp;Hyeong Jun Ahn PhD ,&nbsp;May Okhiro MD, MS","doi":"10.1016/j.focus.2025.100365","DOIUrl":"10.1016/j.focus.2025.100365","url":null,"abstract":"<div><h3>Introduction</h3><div>In Hawai‘i, 50% of Native Hawaiian and Pacific Islander children live in a household experiencing food insecurity. Individuals from food insecure households experience increased risk for chronic health conditions that may be alleviated with healthy food. Wellness for Native Hawaiian and Pacific Islander populations can be achieved through the Pilinahā framework, comprising connection to self; community; past, present, and future; and land. The Keiki (child) Produce Prescription Program was designed to address the Pilinahā framework through a 6-month intervention that provided pediatric participants with vouchers totaling $50 per month to exchange for local, fresh fruits and vegetables from the farmers market along with nutrition education kits.</div></div><div><h3>Methods</h3><div>The community-designed intervention connected pediatric patients from a large federally qualified health center with the community farmers’ market. Eligibility consisted of children aged 2–17 years who screened positive for a nutrition-related chronic disease or food insecurity. Baseline survey and 6-month data collected included sociodemographic data, household food security, and fruit and vegetable consumption. Monthly voucher redemption was tracked.</div></div><div><h3>Results</h3><div>One hundred and twenty-one participants enrolled, 90 participants redeemed vouchers for 6 months, and 75 (62%) completed 6-month survey data. Participants redeemed $210 (70%) in vouchers on average. Children’s fruit consumption increased by 1.0 cups per day (p=0.014), whereas parent fruit consumption increased by 1.2 cups per day (<em>p</em>=0.0001). No changes to household food security or total fruit and vegetable consumption were observed.</div></div><div><h3>Conclusions</h3><div>The Keiki Produce Prescription Program improved fruit intake among households with children. High levels of program participation and completion reinforce the importance of community-engaged approaches to program development. Rigorous testing through RCTs and increasing engagement with nutrition education are recommended for future studies.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100365"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Behavioral Impact of the Massachusetts Flavored Tobacco Products Ban on Cigarette Smoking Among Adults Aged ≥21 Years","authors":"Evan A. Winiger PhD,&nbsp;Pavel N. Lizhnyak PhD,&nbsp;Scott W. Drenkard MA,&nbsp;Andrea R. Vansickel PhD","doi":"10.1016/j.focus.2025.100364","DOIUrl":"10.1016/j.focus.2025.100364","url":null,"abstract":"<div><h3>Introduction</h3><div>In June of 2020, Massachusetts became the first state to implement a statewide ban on flavored tobacco. To date, no study has analyzed the behavioral outcomes of a comprehensive statewide ban on flavored tobacco products among representative state samples of adults aged ≥21 years.</div></div><div><h3>Methods</h3><div>Using a difference-in-difference model from repeated cross-sectional data (Behavioral Risk Factor Surveillance System), the authors compared cigarette smoking prevalence in Massachusetts before (January 2017–May 2020) with that after (June 2020–December 2022) the implementation of a flavor ban, with 35 states serving as a comparison. Sensitivity analyses were conducted to ensure the robustness of the difference-in-difference findings.</div></div><div><h3>Results</h3><div>There was a consistent decline in smoking prevalence in Massachusetts (14.1% in 2017 to 10.7% in 2022) and comparator states (18.5% in 2017 to 14.8% in 2022). When adjusting for sociodemographic and the year-fixed effect, the analysis indicated significant effects of time (AOR=1.05; 95% CI=1.00, 1.11, <em>p</em>=0.0428) and treatment (AOR=0.89; 95% CI=0.84, 0.95, <em>p</em>=0.0002) but not for the difference-in-difference estimate (AOR=0.94; 95% CI=0.85, 1.03, <em>p</em>=0.1621).</div></div><div><h3>Conclusions</h3><div>The results indicate that the comprehensive flavor ban in Massachusetts did not significantly impact smoking prevalence relative to that in comparator states without flavor bans.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100364"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"U.S. Physicians’ Views on E-Cigarette Risks and Benefits to Adults Who Smoke Versus Young People Who Do Not Smoke","authors":"Monica Magalhaes PhD ,&nbsp;Michelle T. Bover Manderski PhD, MPH ,&nbsp;Michelle Jeong PhD ,&nbsp;William J. Young PhD ,&nbsp;Michael B. Steinberg MD, MPH ,&nbsp;Nir Eyal DPhil","doi":"10.1016/j.focus.2025.100363","DOIUrl":"10.1016/j.focus.2025.100363","url":null,"abstract":"<div><h3>Introduction</h3><div>Emerging evidence suggests that E-cigarettes are likely less harmful than combustible cigarettes, presenting an opportunity for adults who smoke to quit or switch. E-cigarettes also risk increasing the number of young people who become addicted to nicotine. Physicians’ perceptions of and attitudes toward this tradeoff remain underexplored.</div></div><div><h3>Methods</h3><div>A random sample of U.S. physicians (N=940) were surveyed on a variety of tobacco-related issues and on their treatment practices and demographics. Questions aimed to elicit tradeoffs between protecting youth from becoming addicted to nicotine and helping adult smokers quit.</div></div><div><h3>Results</h3><div>Most respondents (93%) reported caring about both helping adults quit smoking and protecting the young, with the majority (66.2%) prioritizing the latter. Of the various specialties, pediatricians were most likely to believe that preventing nicotine addiction among young people matters more than helping adults quit. Prioritization of youth over adults who smoke was also associated with being female, being younger, and having negative beliefs about the utility of E-cigarettes for smoking cessation.</div></div><div><h3>Conclusions</h3><div>The findings show that physicians attribute greater ethical priority to protecting young people than to reducing risk to adults. Improved education on the risks versus benefits of E-cigarettes may assist physicians in making appropriate recommendations depending on patients' needs.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100363"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State-Level Prevalence of Maternity Care Deserts: Association With Healthcare Access, Utilization, and Outcomes Among Medicaid Recipients","authors":"Dara E. Gleeson MPH, CHES ,&nbsp;Susan H. Busch PhD ,&nbsp;Jeannette R. Ickovics PhD","doi":"10.1016/j.focus.2025.100362","DOIUrl":"10.1016/j.focus.2025.100362","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;More than 2 million women of childbearing age live in U.S. counties without access to maternity care—counties referred to as maternity care deserts. The objective of this study was to identify whether living in a state with a high prevalence of maternity care deserts is associated with maternal and child health access and utilization and contributing to adverse health outcomes among Medicaid recipients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This is a descriptive, cross-sectional, secondary data analysis using most recent data available (2021–2023) from multiple existing state-level sources (e.g., Medicaid Health Care Core Data Sets, March of Dimes Peristats, Pregnancy Risk Assessment Monitoring System). State-level analyses included all U.S. states, District of Columbia, and Puerto Rico (N=52). Analyses were stratified by state prevalence of maternity care deserts (high=states where ≥21% of counties have no hospital/birth center providing obstetric services). Multivariate analyses of covariance were used to test associations with 3 domains of dependent variables: healthcare access (i.e., mental health, pediatrics, family medicine), utilization (e.g., timely access to pre and postnatal care, vaccinations), and maternal/child health outcomes (e.g., maternal and infant mortality).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Three multivariate analysis of covariance tests indicated significant main effects for state-level maternity care desert prevalence and all domains (all &lt;em&gt;p&lt;/em&gt;&lt;0.009), with large effect sizes (η2≥0.14). Effects were durable, even after controlling for state-level covariates. States/territories with high prevalence of maternity care deserts had more rural counties (t= −4.22, &lt;em&gt;p&lt;/em&gt;&lt;0.001), lower levels of educational attainment (t= −2.32, &lt;em&gt;p&lt;/em&gt;=0.024), and lower median household income (t=3.09, &lt;em&gt;p&lt;/em&gt;=0.004). Those living in states/territories with high prevalence of maternity care deserts had 30% fewer mental healthcare providers (487.50 vs 696.50/100,000 population) and 36% fewer pediatricians (14.25 vs 22.31/100,000 population). They were ∼14% less likely to receive timely prenatal and postpartum care. Infants were 28.62% less likely to receive influenza vaccinations before second birthday. Critically, those in states/territories with high prevalence of maternity care deserts had 34.20% greater risk of maternal mortality, 18.34% greater risk of infant mortality, and 8.92% greater risk of low birthweight.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;High state-level prevalence of maternity care deserts is associated with adverse maternal and child outcomes; exacerbating concerns as health during the perinatal period sets the trajectory for health across the lifespan. Policy and practice solutions must address pervasive health inequities associated with maternity care deserts (e.g., expanding access to maternity care through family medicine physicians, doulas, telehealth access, and suppo","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100362"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}