AJPM focus最新文献

{"title":"Examining Changes in Coalition Dynamics to Support Opioid Fatality Reduction","authors":"Darcy A. Freedman PhD ,&nbsp;Hannah K. Knudsen PhD ,&nbsp;Rouba A. Chahine PhD ,&nbsp;Timothy Hunt PhD ,&nbsp;Emmanuel Oga MD, MPH ,&nbsp;Alison M. Aldrich MPH ,&nbsp;Sara Roberts MSSA ,&nbsp;LaShawn Glasgow DrPH ,&nbsp;Bryan R. Garner PhD ,&nbsp;Sylvia Tan MS ,&nbsp;JaNae Holloway MSPH ,&nbsp;Timothy Huerta PhD ,&nbsp;Carol Baden ,&nbsp;Pamela Salsberry PhD ,&nbsp;Bridget Freisthler PhD","doi":"10.1016/j.focus.2025.100394","DOIUrl":"10.1016/j.focus.2025.100394","url":null,"abstract":"<div><h3>Introduction</h3><div>The goal was to evaluate how changes in coalition capacity and leadership were related to adoption and reach of overdose education and naloxone distribution in communities participating in the HEALing Communities Study.</div></div><div><h3>Study Design</h3><div>This was a multisite, cluster randomized waitlist-controlled trial; only analysis of Wave 1 data was performed.</div></div><div><h3>Setting/Participants</h3><div>Longitudinal analysis of cross-sectional surveys completed by coalition members from 33 communities in 4 states based on data collected from January 2021 to June 2022.</div></div><div><h3>Intervention</h3><div>Study coalitions (<em>n</em>=33) received the Communities That HEAL intervention to support expansion of evidence-based practices, including overdose education and naloxone distribution, to curtail opioid-related fatalities.</div></div><div><h3>Main Outcomes</h3><div>Coalition capacity and leadership were measured at the midpoint and end of the intervention using validated scales averaged at the community level. Community adoption and reach of overdose education and naloxone distribution were assessed as changes in the rate of community partners implementing overdose education and naloxone distribution strategies and naloxone units distributed from midpoint to the end of the intervention. Negative binomial and linear models, adjusted for baseline characteristics, were conducted in 2024.</div></div><div><h3>Results</h3><div>Increases in general coalition capacity, adjusted for changes in overdose education and naloxone distribution–specific coalition capacity, were significantly associated with higher rates of community partners engaged in overdose education and naloxone distribution implementation. There was a 56% increase over time in community partners engaged in overdose education and naloxone distribution implementation per unit increase in general capacity scores among coalitions receiving Communities That HEAL. Changes in coalition leadership and capacity did not significantly correlate with changes in naloxone being distributed.</div></div><div><h3>Conclusions</h3><div>Strengthening general coalition capacity is vital for increasing community partner engagement to expand adoption of overdose education and naloxone distribution. Findings support ongoing investment in coalition capabilities to enhance the effectiveness of public health interventions seeking to reduce opioid-related fatalities. Efforts to strengthen general capacities of coalitions, such as data-informed decision making and collective goalsetting, may accelerate implementation and scaling of evidence-based practices such as overdose education and naloxone distribution.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100394"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050066","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":"Cost-Effectiveness Analysis of Implementing a Multisectoral Program for Colorectal Cancer Screening in an African American Community","authors":"Tzeyu L. Michaud PhD ,&nbsp;Paul A. Estabrooks PhD ,&nbsp;Hongying Daisy Dai PhD ,&nbsp;Keyonna M. King Dr.PH ,&nbsp;John W. Ewing Jr. MS ,&nbsp;Kayode T. Olabanji Bpharm, MSc ,&nbsp;Su-Hsin Chang PhD, MS ,&nbsp;Jungyoon Kim PhD","doi":"10.1016/j.focus.2025.100388","DOIUrl":"10.1016/j.focus.2025.100388","url":null,"abstract":"<div><h3>Introduction</h3><div>To improve colorectal cancer screening uptake among African Americans, the authors collaborated with a public service agency (i.e., Douglas County Treasurers’ Office) and other community and healthcare partners to implement a multicomponent fecal immunochemical test intervention. The objectives of this study are to (1) determine the costs and cost-effectiveness of the community-based fecal immunochemical test intervention between the 2 different types of provision strategies: on-site distribution of fecal immunochemical test versus mailing of fecal immunochemical test upon request; and (2) estimate the budgetary impact if this program is sustained by community organizations or the local health department.</div></div><div><h3>Methods</h3><div>Using data from a community colorectal cancer screening outreach trial collected between January 3, 2022, and April 4, 2022, the authors conducted a cost-effectiveness analysis and a budget impact analysis of a multicomponent colorectal cancer screening program. Cost-effectiveness analysis was evaluated using 2 measures: an average implementation cost-effectiveness ratio using the effect and cost data of the overall colorectal cancer screening program and an incremental cost-effectiveness ratio when comparing the on-site distribution with mailing of fecal immunochemical test upon request. For the budget impact analysis, the authors used the process map developed for the outreach program workflow to guide the budget impact estimate of the on-site distribution. The authors further conducted a sensitivity analysis to estimate 1-year replication costs of the on-site distribution strategy.</div></div><div><h3>Results</h3><div>The overall community outreach program for colorectal cancer screening totaled $14,541, with labor costs of $12,757 and nonlabor costs of $1,784 for the 3-month period. Individually, total costs for on-site distribution (<em>n</em>=110) and mailing of fecal immunochemical test upon request (<em>n</em>=99) strategies were estimated at $8,629 and $5,912, respectively. The overall average implementation cost-effectiveness ratios were $70 per person enrolled, $246 per participant screened, and $969 per completed participant who tested positive. The incremental cost-effectiveness ratio was $129 for an additional percentage-point increase in colorectal cancer screening rates and $109 per additional person who completed the screening. The total replication cost of the on-site distribution of fecal immunochemical test kits was estimated at $7,329 over a 1-year budget cycle.</div></div><div><h3>Conclusions</h3><div>The on-site fecal immunochemical testing kit distribution is an effective, practical, relatively low-cost community outreach strategy to improve colorectal cancer screening rates among African American communities. Future studies should explore resources for sustainability and uptake in different settings.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100388"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027771","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":"Projected Impact of Higher E-cigarette or Combustible Cigarette Taxes on Use of Both Products in the U.S.","authors":"Krishna P. Reddy MD, MS ,&nbsp;Nora Mulroy BA ,&nbsp;Breanna Richards ScM ,&nbsp;Linzy V. Rosen BA ,&nbsp;Amirah Fawziyyah ScM ,&nbsp;Nancy A. Rigotti MD ,&nbsp;Douglas E. Levy PhD ,&nbsp;Stavroula A. Chrysanthopoulou PhD","doi":"10.1016/j.focus.2025.100406","DOIUrl":"10.1016/j.focus.2025.100406","url":null,"abstract":"<div><h3>Introduction</h3><div>Higher taxes on e-cigarettes could reduce their use but might encourage combustible tobacco cigarette use. Simulation models enable evaluation of dynamic transitions between cigarette and e-cigarette use or nonuse and population-level projections in response to a policy change, such as higher taxes.</div></div><div><h3>Methods</h3><div>The authors used a microsimulation model to project the relative impact of higher taxes on cigarettes, e-cigarettes, or both on the prevalence of cigarette and e-cigarette use among U.S. youth (aged 12–17 years), young adults (aged 18–24 years), and adults (aged ≥25 years). They used multi-state models to derive the probabilities of transition across states of current/former/never cigarette smoking and e-cigarette use from Waves 2–5 (2015–2019) of the Population Assessment of Tobacco and Health Study. These transition probabilities were applied to a simulated cohort in the Simulation of Tobacco and Nicotine Outcomes and Policy model, reflective of Wave 5 of the Population Assessment of Tobacco and Health Study, to project cigarette and e-cigarette use over 5 years in a <em>Status Quo</em> scenario. For tax scenarios, the authors estimated the impact of a $1 increase in cigarette tax (<em>Cigarette Tax</em>), e-cigarette tax (<em>E-cig Tax</em>), or both (<em>Combined Tax</em>). They performed sensitivity analysis around transition parameters and tax effects to evaluate the influence of uncertainty in these estimates.</div></div><div><h3>Results</h3><div>Compared with Status Quo, the relative changes among youth/young adults/adults in the prevalence of use at 5 years would be as follows: Cigarette Tax, –4%/–19%/–3% (cigarette use) and 0%/+3%/+3% (e-cigarette use); E-cig Tax, 0%/–10%/–2% (cigarette use) and –27%/–63%/–25% (e-cigarette use); and Combined Tax, –5%/–28%/–3% (cigarette use) and –27%/–62%/–25% (e-cigarette use). Model results were the most variable in young adults, reflecting greater uncertainty around tax effects in this population. The results of cigarette smoking and e-cigarette use prevalence, regardless of tax impact, were sensitive to the probabilities of initiation among youth and young adults and the probabilities of cessation among adults.</div></div><div><h3>Conclusions</h3><div>A higher tax on e-cigarettes alone would likely reduce e-cigarette use prevalence at 5 years and might not increase cigarette smoking prevalence. A combined tax on both products would likely produce larger reductions in cigarette and e-cigarette use, maximizing public health benefits.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100406"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222023","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":"Nutritional Educational Intervention in Users With Psychiatric Disorders Living in Supported Housing: A Pilot Study","authors":"Giulia Picardo MD ,&nbsp;Clara Donnoli RN, MSN ,&nbsp;Maria Rosaria Barbera MSc ,&nbsp;Marina Agostini MSc ,&nbsp;Giuseppe Ducci MD ,&nbsp;Giuseppe Liotta PhD","doi":"10.1016/j.focus.2025.100368","DOIUrl":"10.1016/j.focus.2025.100368","url":null,"abstract":"<div><h3>Introduction</h3><div>The pilot data analysis assessed the weight and eating habits of users in Supported Housing (SH) across six Rome districts, verifying the feasibility of a nutritional education intervention.</div></div><div><h3>Methods</h3><div>The study team conducted a quantitative, quasi-experimental study. The cohort consisted of 92 users living in 57 houses, categorized by age, sex, and diagnosis. The intervention carried out between October 2021 and January 2022 consisted of 2 phases, an educational session on the food pyramid and national dietary guidelines for staff assisting users and an education intervention to promote healthier lifestyle choices to the users.</div></div><div><h3>Results</h3><div>Results reported an average BMI of 28 kg/m² (SD = ±5.74) categorizing users as belonging in average to the overweight BMI class. Adherence to the Mediterranean diet based on the Del Balzo and Savastano1 questionnaire was overall scarce (90.1%). The educational intervention positively impacted 90.3% of users who demonstrated an increase in consumption of fruit and vegetables and a decrease in consumption of fried food and soft drinks. A weight decrease was experienced by 43.4% (13/30) of the cohort. Average weight loss, in the group who lost weight, was 7.6kg (SD = ±6.93).</div></div><div><h3>Conclusions</h3><div>The study suggests the feasibility and potential impact of public health initiatives addressing obesity in the population with psychiatric disorders.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100368"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050067","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":"Content Analysis of Cannabis Discourses on Twitter/X in the U.S.","authors":"Zidian Xie PhD ,&nbsp;Runtao Zhou BS ,&nbsp;Qihao Yun BS ,&nbsp;Jianghang Wu BS ,&nbsp;Zhengyuan Wang BS ,&nbsp;Mengmeng Yu BS ,&nbsp;Karen M. Wilson MD ,&nbsp;Dongmei Li PhD","doi":"10.1016/j.focus.2025.100408","DOIUrl":"10.1016/j.focus.2025.100408","url":null,"abstract":"<div><h3>Introduction</h3><div>With the legalization of both medical and recreational cannabis use in many U.S. states, this study aims to explore public perceptions and discussions about cannabis on social media in the U.S.</div></div><div><h3>Methods</h3><div>Twitter (now rebranded as X) data on cannabis were collected between February 2022 and February 2023 using the Twitter/X streaming Application Programming Interface. To assess the attitude of tweets toward cannabis and to determine whether Twitter/X users were cannabis users, human-guided deep-learning models called bidirectional encoder representations from transformers were used. The sex and age of users were inferred using a deep-learning facial recognition algorithm (DeepFace). The Latent Dirichlet Allocation topic model was used to comprehend the discussed topics.</div></div><div><h3>Results</h3><div>Among 2,865,562 unique noncommercial cannabis tweets from the U.S., 648,018 tweets (22.62%) had a positive attitude toward cannabis, 234,202 (8.17%) had a negative attitude, and 1,983,342 (69.21%) had a neutral attitude. Among 821,451 unique Twitter/X users, 348,795 (42.46%) were potential cannabis users. The U.S. states allowing recreational cannabis use had 12.19 Twitter/X and cannabis users per 10,000 population, compared to 7.22 users in states without it; however, the difference was not statistically significant (<em>p</em>=0.95). The 25–34 years age group (37.14%) was the most represented among Twitter/X and cannabis users. The predominant topic in the positive tweets was “Cannabis’s medical value,” whereas the main topic in the negative tweets was “Having difficulty quitting cannabis.”</div></div><div><h3>Conclusions</h3><div>This study provides a detailed overview of public perceptions of cannabis in the U.S., aiding policymakers and public health authorities in developing effective regulatory policies about cannabis.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100408"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050069","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":"Decline in Type 1 Diabetes in Young Children After Rotavirus Vaccination: Data From 8 Countries","authors":"Mary A.M. Rogers PhD, MS","doi":"10.1016/j.focus.2025.100409","DOIUrl":"10.1016/j.focus.2025.100409","url":null,"abstract":"<div><h3>Introduction</h3><div>Vaccination for rotavirus has been a component of national immunization programs in more than 100 countries, principally intended to decrease hospitalizations and deaths from gastroenteritis in young children. Rotavirus is a major cause of gastroenteritis in infants but can additionally result in apoptosis of pancreatic cells and hyperglycemia. Therefore, it is suspected to be a contributor to Type 1 diabetes mellitus. The purpose of this investigation was to examine whether the incidence of Type 1 diabetes in young children decreased after a rotavirus vaccination program was introduced.</div></div><div><h3>Methods</h3><div>Publications were assembled with country-specific incidence rates of Type 1 diabetes in children aged &lt;5 years. Data regarding the introduction of national rotavirus vaccination programs were available from the WHO. Using an interrupted time series design, prevaccination rates of Type 1 diabetes were compared with postvaccination rates.</div></div><div><h3>Results</h3><div>Data regarding incidence rates of Type 1 diabetes in children aged &lt;5 years before and after vaccine introduction were available from 8 countries. In 7 of these countries (Australia, Austria, Finland, Ireland, Israel, Mexico, and Wales), the incidence of Type 1 diabetes in young children decreased after the rotavirus vaccination program began. In 1 country (Dominican Republic), the number of annual cases of Type 1 diabetes was too small to evaluate an effect.</div></div><div><h3>Discussion</h3><div>The data suggest that a national rotavirus vaccination program may contribute to lower rates of Type 1 diabetes in young children.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100409"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159440","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":"Blasting Off Again: An Observational Study on Substance Use Content Exposure in Pokémon Twitch Streams","authors":"Matthew C. Nali BA ,&nbsp;Meng Zhen Larsen BA, BS ,&nbsp;Tim K. Mackey MAS, PhD","doi":"10.1016/j.focus.2025.100413","DOIUrl":"10.1016/j.focus.2025.100413","url":null,"abstract":"<div><h3>Introduction</h3><div>The Pokémon franchise has an array of media (i.e., TV series, movies, merchandise, and Trading Card Game) that has attracted global youth and adults since its creation in 1996. Specifically, users have been known to discuss, promote, and purchase Pokémon Trading Card Game on the livestreaming platform Twitch. However, Pokémon Trading Card Game livestreaming content may also include potentially harmful content for youth and adolescents, such as depictions of substance use. Hence, the objective of this study was to assess whether popular Twitch Pokémon Trading Card Game content and influencers promote substance use topics and behavior.</div></div><div><h3>Methods</h3><div>This study was conducted in 3 phases: (1) data mining on 2 Twitch data aggregation websites (Sullygnome.com and TwitchTracker.com) within the Pokémon Trading Card Game category; (2) data filtering using keywords through a snowball sampling strategy on the title of a Twitch stream; and (3) content coding using the WHO protocol on Internet Monitoring of Marketing of Unhealthy Products to Children and Adolescents for influencer and microinfluencer substance use marketing, including depictions of substance use or promotion of products on the streamer’s profile. The authors also conducted an assessment of any underage moderation for Twitch livestreams.</div></div><div><h3>Results</h3><div>A total of 1,025 highly active Pokémon Trading Card Game streamers were recruited and analyzed. The use and promotion of substance use in the form of alcohol, cannabis, or tobacco was detected in 25.07% (<em>n</em>=257) of these Pokémon Trading Card Game Twitch streamers. Frequent substance use detected was alcohol (90.27%, <em>n</em>=232), followed by polysubstance use (6.61%, <em>n</em>=17), cannabis (<em>n</em>=6, 2.33%), and tobacco (<em>n</em>=2, 0.78%). Content coding detected 3 general themes, with behavioral being the most observed. This included behavioral content of substance use for the specific reason of casual use (46.06%, <em>n</em>=228) and for intoxication (26.26%, <em>n</em>=130). In addition, close to three quarters (72.76%, <em>n</em>=187) of streamers’ accounts did not prohibit underage access to account content or livestreams.</div></div><div><h3>Conclusions</h3><div>In this study, the authors detected Twitch streamers violating Twitch community guidelines that may have exposed millions of youths and young adults in the Pokémon Trading Card Game category to different depictions of substance use. Although Twitch prohibits monetary gain in exchange for posting substance use content, the apparent lack of enforcement of Twitch community guidelines and the absence of age verification means that youth who enjoy Pokémon Trading Card Game content may also be exposed to content actively promoting substance use behaviors.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100413"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268257","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":"Adolescent Exposure to Food and Alcohol Advertising on TV in the U.S., 2013–2022","authors":"Lisa M. Powell PhD ,&nbsp;Julien Leider MA ,&nbsp;Rebecca M. Schermbeck MPH, MS, RD ,&nbsp;Jennifer L. Harris PhD, MBA","doi":"10.1016/j.focus.2025.100430","DOIUrl":"10.1016/j.focus.2025.100430","url":null,"abstract":"<div><h3>Introduction</h3><div>Reducing adolescent consumption of unhealthy foods and alcohol is a primary public health objective. Youth exposure to food and alcohol marketing is associated with increased consumption. This study measured changes in adolescents’ exposure to food-related and alcohol TV advertising from 2013 to 2022 and the nutrition quality of advertised food and beverage products.</div></div><div><h3>Methods</h3><div>This repeated cross-sectional study assessed U.S. TV ratings data on advertising exposure among adolescents aged 12–17 years (including separate ratings for Black and White adolescents) from The Nielsen Company for 2013, 2014, 2015, 2018, and 2022. For food and beverage product advertisements, nutrient content information was used to identify products high in nutrients to limit.</div></div><div><h3>Results</h3><div>Adolescents’ exposure to food-related advertising declined from 2013 to 2022 by 83.8%, from 5,983 to 969 TV advertisements per year. Exposure to alcohol advertising also fell substantially over this period but to a lesser extent—down by 70.6% with 95 advertisements seen per year in 2022. The percentage of food and beverage advertisements seen for products high in nutrients to limit fell modestly from 77.5% in 2013 to 69.0% in 2022. The proportion of food and beverage products high in sugar fell from 51.6% to 40.6%, whereas the proportion of products high in sodium increased from 19.3% to 25.1%. Similar changes in exposure were observed between White and Black adolescents; thus, the racial gap in marketing exposure persisted.</div></div><div><h3>Conclusions</h3><div>Adolescents’ exposure to TV advertising for food-related products and alcohol fell substantially over the last decade, yet adolescents still see almost 1,100 of such advertisements annually, primarily for unhealthy products. This suggests that current voluntary industry self-regulatory standards are insufficient to fully reduce youth exposure to harmful marketing, which may require broader mandatory policies that limit their total exposure to food-related and alcohol advertising.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100430"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363542","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":"Prevalence and Correlates of Firearm Screening and Counseling in Primary Care in Southeast Michigan","authors":"Joseph B. Ladines-Lim MD, PhD ,&nbsp;Magdalena Hecht MD ,&nbsp;Caleb Arthur MD ,&nbsp;Autumn Pu MD ,&nbsp;Melissa Ross MD ,&nbsp;Kayla Secrest MD ,&nbsp;Aaron Sifuentes MD ,&nbsp;Justin Litzner BS ,&nbsp;Jennifer Stojan MD, MHPE ,&nbsp;Michelle Degli Esposti PhD ,&nbsp;Jennifer Meddings MD, MSc","doi":"10.1016/j.focus.2025.100370","DOIUrl":"10.1016/j.focus.2025.100370","url":null,"abstract":"<div><h3>Introduction</h3><div>The American College of Physicians recommends firearm screening and safety counseling for high-risk patients, although frequency of practice is unclear. The authors evaluated the prevalence and correlates of firearm screening and counseling during health maintenance exams.</div></div><div><h3>Methods</h3><div>The authors performed a cross-sectional analysis of all health maintenance exams for patients aged ≥18 years at an academic center in Southeast Michigan from September 2021 to February 2022. Primary outcomes included documentation of attempted firearm screening and counseling after positive screens. Multinomial logistic regression models estimated the associations between primary outcomes and patient and clinician characteristics using multilevel modeling to account for interclinic variability.</div></div><div><h3>Results</h3><div>In 27,686 health maintenance exams across 17 clinic sites, attempted screening was documented in 99.8% of visits, principally through routine questionnaires, with positive, negative, or no responses in 15.2%, 48.0%, and 36.8%, respectively. One outlier clinic site documented attempted screening in only 0.9% of health maintenance exams and was excluded. Counseling occurred in 1.1% of positive screens; clinic sites accounted for 36.3% of variability. Counseling was less likely for females (AOR=0.65; 95% CI=0.51, 0.82), patients aged ≥65 years (AOR=0.31; 95% CI=0.21, 0.47), and Asian patients (AOR=0.31; 95% CI=0.16, 0.61) and more likely for internal medicine–pediatrics/family medicine clinicians than internal medicine clinicians (AOR=4.42; 95% CI=1.99, 9.82).</div></div><div><h3>Conclusions</h3><div>Clinicians documented attempted firearm screening in nearly all health maintenance exams but seldom counseling, which varied across sites and was linked to patient sociodemographic characteristics and clinician specialty as opposed to high-risk clinical features such as psychiatric disorder. Findings suggest that training and quality improvement efforts are needed to ensure appropriate risk-based counseling.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100370"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050063","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":"Real-World Interventions for Type 2 Diabetes Prevention (REALITY): A Multisite Study to Assess the Effectiveness and Cost-Effectiveness of the National Diabetes Prevention Program","authors":"William H. Herman MD ,&nbsp;Benjamin D. Tyndall PhD ,&nbsp;O. Kenrik Duru MD ,&nbsp;Tannaz Moin MD ,&nbsp;Laura N. McEwen PhD ,&nbsp;Hui Shao PhD ,&nbsp;Ronald T. Ackermann MD ,&nbsp;Sara R. Jacobs PhD ,&nbsp;Simon Neuwahl MS ,&nbsp;Shihchen Kuo PhD ,&nbsp;Ping Zhang PhD ,&nbsp;Meda E. Pavkov MD ,&nbsp;Claudia Villatoro Santos MD, Phd ,&nbsp;REALITY Network","doi":"10.1016/j.focus.2025.100401","DOIUrl":"10.1016/j.focus.2025.100401","url":null,"abstract":"<div><h3>Introduction</h3><div>The National Diabetes Prevention Program was created on the basis of evidence from landmark clinical trials. Its format was modified to facilitate real-world delivery. The long-term effectiveness and cost-effectiveness of the National Diabetes Prevention Program and similar lifestyle change programs in real-world settings remain largely unknown. The Centers for Disease Control and Prevention issued a request for proposals to establish and fund a research network to determine the long-term effectiveness of the National Diabetes Prevention Program in reducing Type 2 diabetes incidence, improving cardiovascular disease risk factors and health-related quality of life, and reducing healthcare service utilization and costs.</div></div><div><h3>Methods</h3><div>Researchers at the University of California Los Angeles, Northwestern University, the University of Michigan, and Emory University, with a coordinating center at RTI International, were funded to examine incident Type 2 diabetes and cardiovascular disease risk factors among a diverse group of National Diabetes Prevention Program and MOVE! enrollees and nonenrollees using electronic health record and administrative claims data. The network will also assess health utility scores by conducting a health-related quality of life survey; examine healthcare utilization, costs, and cost-effectiveness of the National Diabetes Prevention Program and MOVE! for diabetes prevention; and assess the costs of delivering these programs.</div></div><div><h3>Results</h3><div>The study sites have collaborated with RTI and Centers for Disease Control and Prevention to develop common core data elements and standardized study procedures to ensure that each site collects data that can be harmonized across sites.</div></div><div><h3>Conclusions</h3><div>The results of this research will address the objectives of <em>Healthy People 2030</em>; help define the longer-term real-world effectiveness of the National Diabetes Prevention Program; and guide the resources needed to provide and improve program accessibility, sustainability, and effectiveness and improve population-level outcomes.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100401"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333279","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}