AJPM focus最新文献

{"title":"Added Sugars Intake and Metabolic Syndrome in U.S. Hispanic/Latino Adults: Longitudinal Results From the Hispanic Community Health Study/Study of Latinos","authors":"Luis A. Rodríguez PhD, MPH, RD , Patrick T. Bradshaw PhD, MS , Alka M. Kanaya MD , Alex Akushevich MS , Anna Maria Siega-Riz PhD, MS , Leonor Corsino MD, MHS , Sandra S. Albrecht PhD, MPH , Carmen R. Isasi MD, PhD , Yasmin Mossavar-Rahmani PhD, RD, CDN , Martha Daviglus MD, PhD, MPH , Linda Van Horn PhD, RDN , Linda C. Gallo PhD , Daniela Sotres-Alvarez DrPH, MS","doi":"10.1016/j.focus.2025.100459","DOIUrl":"10.1016/j.focus.2025.100459","url":null,"abstract":"<div><h3>Introduction</h3><div>Excessive sugar-sweetened beverage consumption is associated with metabolic syndrome, but few studies have evaluated the associations with added sugars from all dietary sources. The authors evaluated cross-sectional and longitudinal associations between added sugars intake and metabolic syndrome and its components in a cohort of U.S. Hispanic/Latino adults. In addition, the authors conducted a secondary analysis to evaluate whether sugar-sweetened beverages were independently associated with metabolic syndrome and its components.</div></div><div><h3>Methods</h3><div>The authors used baseline (<em>n</em>=12,484) and 6.2-year follow-up (<em>n</em>=5,576) data from adults aged 18–74 years without diabetes from the Hispanic Community Health Study/Study of Latinos. The authors derived added sugars and sugar-sweetened beverage intake at baseline from two 24-hour dietary recalls using the National Cancer Institute methodology and categorized participants using quintiles of added sugars percentage per day for added sugars or 8 fl oz servings per day for sugar-sweetened beverages. The authors used the National Cholesterol Education Program—Third Adult Treatment Panel definition of metabolic syndrome and metabolic syndrome components. In cross-sectional analyses, the authors used multivariate logistic and linear regression to estimate the ORs for binary outcomes and mean differences for continuous outcomes. In longitudinal analyses, the authors used Poisson regression to estimate incidence rate ratios.</div></div><div><h3>Results</h3><div>Metabolic syndrome prevalence was 24.8% at baseline, and average added sugars was 14.4%. In the cross-sectional analysis, those in the fifth quintile of added sugars had odds of metabolic syndrome (OR=1.01, 95% CI=0.74, 1.39; <em>p</em>-trend=0.622) similar to the odds for those in the lowest quintile. In the longitudinal analyses, there was no significant association between added sugars and metabolic syndrome incidence in minimally or fully adjusted models (overall <em>p</em>-trend=0.84 and 0.93, respectively). In secondary analyses, cross-sectionally, sugar-sweetened beverage intake was significantly associated with waist circumference (<em>p</em>-trend=0.003), high-density lipoprotein cholesterol (<em>p</em>-trend<0.001), and fasting glucose (<em>p</em>-trend<0.001). Longitudinally, among individual components, those consuming more than two 8 fl oz servings per day had a 35% higher rate of reduced high-density lipoprotein cholesterol (incidence rate ratio=1.35, 95% CI=1.02, 1.79; <em>p</em>-trend=0.009).</div></div><div><h3>Conclusions</h3><div>Added sugars were not associated with prevalent or incident metabolic syndrome among U.S. Hispanic/Latino adults. However, findings from secondary analyses suggest that sugar-sweetened beverages may have a distinct metabolic impact, particularly on waist circumference, high-density lipoprotein cholesterol, and fasting glucose, warranting fur","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 1","pages":"Article 100459"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467522","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":"Emergency Department Utilization for Acute Myocardial Infarction, U.S., May–September 2018–2023","authors":"Essi M. Havor PhD ,&nbsp;LaTonia C. Richardson PhD ,&nbsp;Omoye E. Imoisili MD ,&nbsp;Fátima Coronado MD ,&nbsp;Sandra L. Jackson PhD ,&nbsp;Abigail L. Gates MSPH ,&nbsp;Lakshmi Radhakrishnan MPH ,&nbsp;Ambarish Vaidyanathan PhD ,&nbsp;Fleetwood Loustalot PhD ,&nbsp;Angela M. Thompson-Paul PhD ,&nbsp;Rebecca C. Woodruff PhD","doi":"10.1016/j.focus.2025.100426","DOIUrl":"10.1016/j.focus.2025.100426","url":null,"abstract":"<div><h3>Introduction</h3><div>Exposure to extreme heat and wildfire-related hazards, such as poor air quality, can increase the risk of acute cardiovascular events. This study assessed whether acute myocardial infarction–related emergency department visits increased in 2023—a year of increased heat and wildfire smoke exposure in the U.S.—compared with visits in the 5 preceding years combined.</div></div><div><h3>Methods</h3><div>This serial cross-sectional study identified acute myocardial infarction–related emergency department visits among adults aged ≥18 years from National Syndromic Surveillance Program data using discharge diagnosis codes. Daily mean acute myocardial infarction–related emergency department visit rates per 100,000 all-cause emergency department visits during May–September 2023 were compared with those during May–September 2018–2022 for adults overall and by subgroup.</div></div><div><h3>Results</h3><div>During May–September 2023, the daily acute myocardial infarction–related emergency department visit rate (699.5 acute myocardial infarction–related emergency department visits per 100,000) was 16.5% (95% CI=14.8, 18.2) higher than the rate in 2018–2022 (600.4 acute myocardial infarction–related emergency department visits per 100,000). Overall, acute myocardial infarction–related emergency department visit rates increased across age groups, in both sexes, and in most HHS regions. HHS Regions 2 and 4 reported the largest relative increases in acute myocardial infarction–related emergency department visit rate (27.0% [95% CI=22.9, 31.4] and 30.0% [95% CI=27.7, 32.5], respectively).</div></div><div><h3>Conclusions</h3><div>Acute myocardial infarction–related emergency department visit rates were higher in May–September 2023 than in May–September 2018–2022. Near real-time surveillance data can be leveraged to monitor emergency department visits for acute cardiovascular conditions across different time periods to inform clinical and public health practices.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 1","pages":"Article 100426"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419244","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":"Differences in the Use of Smokeless Tobacco, Alcohol, and Co-Use Among U.S. High-School Students: Analysis of National Youth Risk Behavior Survey Data","authors":"Ganna Kostygina PhD ,&nbsp;Yoonsang Kim PhD ,&nbsp;Alex Kresovich PhD ,&nbsp;Simon Page BA ,&nbsp;Shyanika W. Rose PhD ,&nbsp;Sherry L. Emery PhD, MBA","doi":"10.1016/j.focus.2025.100445","DOIUrl":"10.1016/j.focus.2025.100445","url":null,"abstract":"<div><h3>Introduction</h3><div>This study was aimed to examine the bidirectional relationships and patterns of concurrent smokeless tobacco and alcohol use among U.S. high-school students, investigating whether demographic characteristics and behavioral factors differentially predict concurrent versus single substance use of smokeless tobacco or alcohol (referred to as either-alone use in the remaining parts of this paper).</div></div><div><h3>Methods</h3><div>Analysis of nationally representative Youth Risk Behavior Survey data was perfomed, combining 3 cross-sectional surveys (2019, 2021, 2023) from 39,164 students in Grades 9–12. Logistic regression examined the bidirectional smokeless tobacco–alcohol associations, whereas multinomial models compared the characteristics of concurrent users, users of smokeless tobacco or alcohol alone, and nonusers.</div></div><div><h3>Results</h3><div>The authors found a strong bidirectional relationship: smokeless tobacco users had 3.8 times higher odds of alcohol use than non-users, and similarly, alcohol users had 4.5 times higher odds of smokeless tobacco use than non-users, adjusting for covariates. This relationship was asymmetric: 84.5% of smokeless tobacco users reported alcohol use, whereas only 7.8% of alcohol users reported smokeless tobacco use. Males had lower odds of either-alone use but 2.2 times greater odds of concurrent use (relative to neither use) than females. Past-year sports participation was associated with smokeless tobacco use and alcohol use as well as concurrent use, with athletes showing 2.2 times higher odds of concurrent use relative to neither use and 1.4 times higher odds of concurrent use relative to either-alone use than nonathletes. Furthermore, combustible tobacco users and E-cigarette users were more likely to be concurrent smokeless tobacco and alcohol users.</div></div><div><h3>Conclusions</h3><div>The strong yet asymmetric relationship suggests that smokeless tobacco users may be a crucial target for alcohol prevention. The distinct risk patterns for concurrent use—particularly among males and other tobacco users—indicate that prevention strategies should likely differ between concurrent and either-alone use. Results also suggest reconsidering how substance use prevention is approached in sports contexts, particularly given the strong association between athletic participation and concurrent smokeless tobacco and alcohol use.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 1","pages":"Article 100445"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736498","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":"Barriers and Enablers to WIC Participation: Review of Evidence From Studies Published Between 2019 and 2024","authors":"Roger Figueroa PhD, MPH, MSc ,&nbsp;Tirna Purkait PhD, MS, MTech ,&nbsp;Jaclyn Saltzman PhD, MPH ,&nbsp;Gwyneth Frederick MPH ,&nbsp;Ibukun Owoputi PhD, MSc ,&nbsp;Ruyu Liu PhD, MSc, RD ,&nbsp;Julio Salas BSc ,&nbsp;Katherine Baker PhD, MPH, MS, NDTR","doi":"10.1016/j.focus.2025.100444","DOIUrl":"10.1016/j.focus.2025.100444","url":null,"abstract":"<div><h3>Introduction</h3><div>The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) supports low-income mothers and children aged &lt;5 years in the U.S. with nutrition and healthcare resources; however, not all eligible individuals participate. This scoping review aimed to synthesize evidence on factors associated with WIC participation from the perspective of WIC program implementers; WIC participants; and WIC-eligible nonparticipants.</div></div><div><h3>Methods</h3><div>Qualitative, quantitative, and mixed-methods studies published between March 2019 and December 2024 in peer-reviewed journals were included. Eligible studies were U.S. based, were published in English, and included at least 12 participants. Systematic searches were conducted across the following databases: MEDLINE, PsycINFO, Cochrane Library, Web of Science, and Scopus. Screening and data extraction were completed in Covidence, and the study quality was assessed using the Mixed Methods Appraisal Tool.</div></div><div><h3>Results</h3><div>Among 33 studies included, 15 were qualitative (45.4%), 13 were quantitative (39.3%), and 5 were mixed methods (15.1%). On average, studies met 85.1% of the quality criteria. Overall, the most commonly assessed barriers and enablers were at the organizational level—particularly program logistics and staff interactions. For individual factors, the most assessed concepts were knowledge, awareness, perceptions, and feelings about Special Supplemental Nutrition Program for Women, Infants, and Children. Fewer studies examined interpersonal (<em>n</em>=6) or community/cultural (<em>n</em>=5) factors, although participants frequently reported a lack of culturally relevant food options and mixed experiences with staff interactions.</div></div><div><h3>Discussion</h3><div>In summary, there are multiple factors at the individual, interpersonal, organizational, and structural levels that are associated with WIC participation. Barriers and enablers at the individual and organizational levels were most common in the published literature from 2019 to 2024. Although the overall study quality was moderate to high, findings across levels were mixed.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 1","pages":"Article 100444"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684560","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":"Lingering Hesitancy: Persistent Uncertainty About the COVID-19 Vaccines Among Previously Vaccinated Individuals","authors":"Francis K. Kazungu MS ,&nbsp;Sinan Almukhtar MD, MPH ,&nbsp;Emily Stiehl PhD ,&nbsp;Manorama M. Khare PhD, MS ,&nbsp;Ronald C. Hershow MD ,&nbsp;Sanjib Basu PhD ,&nbsp;Noah McWhirter MS ,&nbsp;Sage J. Kim PhD","doi":"10.1016/j.focus.2025.100437","DOIUrl":"10.1016/j.focus.2025.100437","url":null,"abstract":"<div><h3>Introduction</h3><div>Routine vaccination is an important public health measure to prevent severe illness from COVID-19. Although the determinants of vaccine hesitancy have been explored in prior research, limited information is available on the varying perceptions of the COVID-19 vaccines among previously vaccinated individuals. This study investigates how individuals previously vaccinated against COVID-19 might develop hesitancy toward future doses, a concept that the authors define as lingering hesitancy.</div></div><div><h3>Methods</h3><div>The authors conducted an online cross-sectional survey with 560 vaccinated respondents in 6 urban Chicago community areas (<em>n</em>=440) and Stephenson County, a rural county in Northern Illinois (<em>n</em>=120), between December 2021 and April 2022. The authors explored the role of an individual’s sociocultural context (i.e., urban/rural setting, political affiliation, and race/ethnicity) in developing lingering hesitancy. Lingering hesitancy was operationalized using 2 constructs: (1) negative COVID-19 vaccine attitudes and (2) COVID-19 vaccine safety concerns. The authors also investigated whether mistrust in the government and institutions as well as barriers to accessing the COVID-19 vaccines mediate the relationship between context and lingering hesitancy.</div></div><div><h3>Results</h3><div>The authors found significantly higher negative attitudes toward the COVID-19 vaccines and higher safety concerns among conservative versus liberal respondents (b=0.37, <em>p</em>&lt;0.001; b=0.21, <em>p</em>&lt;0.01, respectively) and among urban versus rural residents (b=0.45, <em>p</em>&lt;0.001; b=0.37, <em>p</em>&lt;0.001). Black/African American participants reported higher vaccine safety concerns than White participants (mean=2.6 vs 2.4, <em>p</em>&lt;0.05). A significant portion of lingering hesitancy among conservative and Black/African American respondents was mediated by mistrust in the government and institutions. Barriers partially mediated vaccine safety concerns among Hispanic respondents.</div></div><div><h3>Conclusions</h3><div>Most public health efforts aimed at COVID-19 vaccine outreach and messaging have focused on increasing vaccine uptake, thereby targeting unvaccinated individuals. As the focus shifts toward annual COVID-19 vaccinations, it is essential to consider lingering hesitancy among those who have received previous vaccine doses. This article provides a framework for implementing vaccine-messaging campaigns that increase confidence and build trust in routine vaccinations.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 1","pages":"Article 100437"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789665","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":"Comparison of Benefit-to-Burden Ratios for Stool-Based Colorectal Cancer Screening Tests in the U.S.: A Decision Analytical Modeling Approach","authors":"John B. Kisiel MD ,&nbsp;A. Mark Fendrick MD ,&nbsp;Derek W. Ebner MD ,&nbsp;Michael Dore MD ,&nbsp;Chris Estes MPH ,&nbsp;Vahab Vahdat PhD ,&nbsp;A. Burak Ozbay PhD ,&nbsp;Paul J. Limburg MD","doi":"10.1016/j.focus.2025.100429","DOIUrl":"10.1016/j.focus.2025.100429","url":null,"abstract":"<div><h3>Introduction</h3><div>The U.S. Preventive Services Task Force recommends average-risk colorectal cancer screening beginning at age 45 years with the multitarget stool DNA test at 1–3-year intervals or annual fecal immunochemical tests. In this decision analytical model study, the validated Colorectal Cancer Adenoma Incidence and Mortality model incorporated updated aggregate test performance data to estimate the benefit-to-burden ratio of stool-based screening tests across recommended intervals and age ranges and identify the efficient strategies.</div></div><div><h3>Methods</h3><div>Screening strategies of multitarget stool DNA or fecal immunochemical tests at 1–3-year intervals over various age ranges were evaluated for average-risk individuals in the U.S. Performance inputs for an updated marker panel (next-generation multitarget stool DNA) and fecal immunochemical tests were obtained from a meta-analysis. The primary analysis was an efficient frontier generated for life-years gained (benefit) compared with no screening versus the number of lifetime colonoscopies (burden) for each screening strategy. Strategies are efficient if no other strategy provides more life-years gained with equivalent or fewer colonoscopies and are near efficient if they are within 3 days of life-years gained of the efficient frontier.</div></div><div><h3>Results</h3><div>All screening strategies resulted in positive life-years gained versus no screening (178–352 life-years gained/1,000 individuals). Nine of the 11 efficient strategies started screening at age 45 years. Triennial next-generation multitarget stool DNA between ages 45 and 75 years was the only stool-screening strategy at U.S. Preventive Services Task Force–recommended ages and intervals that was efficient. Recommended strategies of annual fecal immunochemical tests and annual next-generation multitarget stool DNA between ages 45 and 75 years were near efficient.</div></div><div><h3>Conclusions</h3><div>Performance advantages associated with triennial next-generation multitarget stool DNA from ages 45 to 75 years provided the best benefit to burden of the age- and interval-recommended stool-based screening strategies.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 1","pages":"Article 100429"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419245","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":"Proximity to Healthcare Services Among Individuals With Duchenne Muscular Dystrophy","authors":"Shiny Thomas MBBS, MPH ,&nbsp;Treeva A. Jaff BDS, MSc ,&nbsp;Kristin M. Conway PhD ,&nbsp;Paul A. Romitti PhD ,&nbsp;Tabassum Z. Insaf MBBS, PhD ,&nbsp;Kristin Sommerhalter PhD ,&nbsp;Amber Gedlinske MPH ,&nbsp;Emma Crenshaw BSPH ,&nbsp;Nedra Whitehead PhD ,&nbsp;Brian Humphries MS ,&nbsp;Reba Berry RN ,&nbsp;Julie Royer MSPH ,&nbsp;Joshua R. Mann MD, MPH ,&nbsp;Sergey Krikov MS ,&nbsp;Manju Jayasimha Pula Jayaram MPH ,&nbsp;Marcia L. Feldkamp PhD ,&nbsp;the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet)","doi":"10.1016/j.focus.2025.100443","DOIUrl":"10.1016/j.focus.2025.100443","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to describe travel from residence to healthcare facilities among individuals with Duchenne muscular dystrophy.</div></div><div><h3>Methods</h3><div>The sample included 302 males with Duchenne muscular dystrophy born on January 1, 2000, and followed through December 31, 2015. Using geocoded residential and facility addresses, the authors estimated travel time for trips to unique facilities.</div></div><div><h3>Results</h3><div>The authors identified 7,546 provider visits and 6,064 visits to unique facilities. Over an average of 4.8 person-years of follow-up, the authors estimated a mean of 5.3 unique provider visits and a mean of 4.3 unique visits to facilities per person-year. Overall median drive time exceeded 1.5 hours roundtrip, and averaged overall median 1-way public transit time was 1.9 hours. The longest drive times were detected among younger, non-Hispanic Whites, and other race/ethnicity groups.</div></div><div><h3>Conclusions</h3><div>The findings suggest long travel times for clinical care for a subset of individuals. Additional research is needed to examine the burden associated with traveling to healthcare facilities.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 1","pages":"Article 100443"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736497","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":"Acceptability of Extreme Risk Protection Orders Across Regions of Colorado","authors":"Madeline Balser MPH, MSW ,&nbsp;Christopher E. Knoepke PhD, MSW, LCSW ,&nbsp;Megan Sanders MPP ,&nbsp;Kate Little BA ,&nbsp;Leslie M. Barnard MPH, DrPH ,&nbsp;Erin Wright-Kelly MA, DrPH","doi":"10.1016/j.focus.2025.100442","DOIUrl":"10.1016/j.focus.2025.100442","url":null,"abstract":"<div><h3>Introduction</h3><div>The utilization of Extreme Risk Protection Orders (ERPOs) throughout Colorado varies regionally. Given the potential of ERPOs to decrease firearm violence, this study aims to explore community acceptability of ERPOs in Colorado and to compare acceptability among regions.</div></div><div><h3>Methods</h3><div>The cross-sectional 2023 Colorado Firearm Injury Prevention Survey was administered to 1,520 Colorado adults across 4 geographic regions. Respondents ranked the appropriateness of ERPOs in 5 high-risk scenarios to assess acceptability. Responses were weighted to represent each region’s population, and differences in acceptability were analyzed using logistic regression.</div></div><div><h3>Results</h3><div>More than 70% of Colorado adults across all regions deemed ERPOs at least sometimes appropriate in all 5 scenarios. Although there were minimal regional differences in ERPO acceptability, the West/South region was significantly less likely than other regions to say ERPOs were at least sometimes appropriate in 2 of 5 scenarios (<em>p</em>&lt;0.01).</div></div><div><h3>Conclusions</h3><div>Community support for ERPOs is generally high across culturally diverse Colorado regions, suggesting that the acceptability of ERPOs as a violence prevention intervention might not align with regional disparities in ERPO utilization. Few regional differences in acceptability underscore the need to align ERPO application and educational efforts with this widespread public support. Policymakers and public health professionals should challenge narratives purporting low public support for ERPOs and prioritize the education of community members about how and when ERPOs could be useful.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"5 1","pages":"Article 100442"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736499","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":"Identifying Prenatal Care Barriers for Pregnant Individuals With Intellectual and Developmental Disabilities Living in Central Michigan","authors":"Nicholas J. Sirhan MD ,&nbsp;Paige B. Benard MD ,&nbsp;M. Ariel Cascio PhD ,&nbsp;Kelly R. Ellis WHNP, MPH, MSN, PMH-C ,&nbsp;Brenda M. Varriano MD, MSc ,&nbsp;Neli P. Ragina PhD","doi":"10.1016/j.focus.2025.100407","DOIUrl":"10.1016/j.focus.2025.100407","url":null,"abstract":"<div><h3>Introduction</h3><div>Pregnancy among individuals with intellectual or developmental disabilities poses unique challenges, with studies showing higher rates of adverse outcomes. There remains a gap in understanding patient-reported barriers to accessing health care during pregnancy, especially in rural areas such as central Michigan. This study investigates the barriers to prenatal care for pregnant individuals with intellectual or developmental disabilities in central Michigan.</div></div><div><h3>Methods</h3><div>Using a mixed-method approach, 9 participants from the Central Michigan University Healthcare obstetrics/gynecology clinic completed a survey designed to identify specific challenges in accessing care.</div></div><div><h3>Results</h3><div>The findings revealed several motivations for seeking prenatal care, such as learning about labor and ensuring a healthy baby, but also highlighted significant barriers, including transportation issues, discomfort with male examiners, unplanned pregnancies, and depression.</div></div><div><h3>Conclusions</h3><div>The study underscores the need for tailored educational resources and integrated mental health support to address these challenges. Despite recruitment difficulties due to the population's limited visibility and interaction with healthcare systems, the study provides valuable insights into the complex and intersecting factors affecting healthcare access for this vulnerable demographic. The results emphasize the necessity for further research with larger sample sizes to develop comprehensive strategies that ensure equitable prenatal care access for pregnant individuals with intellectual or developmental disabilities.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100407"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159439","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":"Association Between Opioid Dosage Tapering and Opioid Overdose Among Long-Term Higher-Dose Opioid Users","authors":"Hui Zhou PhD ,&nbsp;Katherine J. Pak MS ,&nbsp;Fagen Xie PhD ,&nbsp;Craig K. Chang MD ,&nbsp;Patricia L. Gray PharmD ,&nbsp;Deborah S. Ling-Grant PhD ,&nbsp;Joanna L. Barreras PhD, MSW ,&nbsp;Steven G. Steinberg MD ,&nbsp;Rulin C. Hechter MD, PhD","doi":"10.1016/j.focus.2025.100399","DOIUrl":"10.1016/j.focus.2025.100399","url":null,"abstract":"<div><h3>Introduction</h3><div>There has been a steady decline in the national opioid-dispensing rate in recent years. However, emerging evidence that suggests that abrupt discontinuation of opioids for pain may increase overdose risk. The authors examined associations between prescribed opioid tapering and short-term risk of overdose among adults who have received a new long-term high-dose opioid prescription.</div></div><div><h3>Methods</h3><div>This cohort study included adults (aged ≥18 years) without cancer who were newly prescribed a long-term high-dose opioid, that is, daily dose ≥50 morphine milligram equivalents for ≥183 days, between 2013 and 2018 in Kaiser Permanente Southern California. Opioid tapering within the evaluation period (3 months after being prescribed long-term high-dose opioid) was defined as a reduction ≥10% in monthly morphine milligram equivalents for at least 2 consecutive months compared with baseline morphine milligram equivalents. The association of opioid tapering with incident opioid overdose within 12 months was examined separately using multivariable Cox proportional hazard models with inverse probability of treatment weight. Sensitivity analyses were performed to differentiate the association by tapering rates.</div></div><div><h3>Results</h3><div>Among 12,866 eligible individuals, 7,372 (57.3%) initiated tapering within 3 months. Seventy-five patients had a documented opioid overdose event within 12 months during follow-up, resulting in an incidence rate of 0.022 and 0.013 event per 1,000 person-years, respectively, among the nontapered and tapered cohorts. Tapering within the evaluation period was associated with a 0.48 (hazard ratio=0.52; 95% CI=0.33, 0.82) reduction in risk of overdose in the subsequent 12 months. Sensitivity analyses suggested that a tapering rate of 20%–40% reduction monthly was associated with lower risk.</div></div><div><h3>Conclusions</h3><div>Among patients newly prescribed long-term high-dose opioids, initiating tapering within 3 months was shown to be associated with reduced short-term risk of opioid overdose. However, more studies are needed for further confirmation.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100399"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159442","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}