BACKGROUND: Treatment for lung cancer can improve prognosis, but 5-year survival remains low at 26%. An examination of treatment using data with higher population coverage, and among a broader number of treatment modalities and individual characteristics, would provide greater insight into differences in lung cancer treatment. RESEARCH QUESTION: Among adults diagnosed with lung cancer, how does reported receipt of lung cancer treatment differ by sociodemographic characteristics? STUDY DESIGN AND METHODS: We used 2015-2020 National Program of Cancer Registry data covering 89% of the US population to describe first-course treatment among people aged ≥ 20 years and diagnosed with lung and bronchus cancer. We performed multivariable logistic regression to examine associations between sociodemographic characteristics and treatment received. RESULTS: Among 1,068,155 people diagnosed with lung cancer, 22% received surgery, 41% received chemotherapy, 40% received radiation, 13% received immunotherapy, and 75% received at least one of the four treatments. People who were aged ≥ 45 years (OR range, 0.08-0.67); were of American Indian or Alaska Native (OR, 0.82; 95% CI, 0.77-0.87), Black (OR, 0.82; 95% CI, 0.81-0.84), or Hispanic (OR, 0.80; 95% CI, 0.78-0.82) race/ethnicity; resided in a nonmetropolitan county (OR, 0.98; 0.96-0.99); resided in the bottom 25% (OR, 0.80; 95% CI, 0.78-0.81) and middle 50% (OR, 0.87; 95% CI, 0.86-0.88) of counties by economic status (considers unemployment rate, per capita market income, and poverty rate); and in the West US census region (OR, 0.95; 95% CI, 0.94-0.97) had significantly lower odds of receiving at least one of the four treatments. INTERPRETATION: Chemotherapy and radiation were the most common types of first-course treatment reported. Receipt of at least one of the four treatments examined was lower among several groups, including certain racial and ethnic groups and those residing in counties with lower economic status. Future studies might further identify and intervene on factors underlying differences.

BACKGROUND: Since 2013, national trends in behavioral factors that increase STI risk among adolescent and young adult (A/YA) females have been mixed (e.g., fewer sex partners, lower condom use). We used data from a national sample of A/YA females to examine racial disparities in CT prevalence considering these trends. METHODS: Using 2011-March 2020 National Health and Nutrition Examination Survey data, we estimated the prevalence, unadjusted and adjusted prevalence ratios (APRs) of a positive CT urine test among sexually experienced non-Hispanic Black (Black), Hispanic, non-Hispanic Other race (NHO), and non-Hispanic White (White) A/YA females. Percentages were categorized by race/ethnicity, and each compared to the average of the other race/ethnic groups (e.g., Black vs. Hispanic, NHO and White). Covariates included age group, health insurance coverage, number of sex partners and condom use (both past year). RESULTS: Overall, the prevalence of CT infection among A/YA females was 5.8% (95% CI: 4.5%-7.3%). CT prevalence was higher among Black females (vs. Hispanic, NHO, and White) (11.7%; 95%CI: 8.7%-15.2%) and lower among White females (vs. Black, Hispanic, and NHO) (3.2%; 95%CI: 1.7%-5.5%). Compared with the average CT prevalence for Hispanic, NHO, and White females, Black females had a higher adjusted CT prevalence (APR: 2.48, 95%CI: 1.63-3.75). CONCLUSIONS: Nationally, CT prevalence was 2.5 times as high among Black A/YA females than the average prevalence for Hispanic, NHO, and White females. Inclusion of behavioral STI risk factors did not attenuate this association. Research incorporating sexual network-level factors associated with CT transmission may provide additional insights.

IMPORTANCE: Invasive group A Streptococcus (GAS) infections are associated with substantial morbidity, mortality, and economic burden. OBJECTIVE: To update trends in invasive GAS disease incidence rates in 10 US states between 2013 and 2022. DESIGN, SETTING, AND PARTICIPANTS: Clinical, demographic, and laboratory data for invasive GAS cases were collected as part of population-based surveillance in the Active Bacterial Core surveillance network covering 34.9 million persons across 10 US states. A case was defined as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis or streptococcal toxic shock syndrome between January 1, 2013, and December 31, 2022. Demographic and clinical data were collected from medical record review. From 2013 to 2014, available isolates were emm typed and antimicrobial susceptibilities determined using conventional methods; from 2015 onward, whole-genome sequencing was used. MAIN OUTCOMES AND MEASURES: Incidence rates by sex, age, race, and selected risk factors; clinical syndromes, outcomes, and underlying patient conditions; and isolate characteristics, including antimicrobial susceptibility. RESULTS: Surveillance in 10 US states identified 21 312 cases of invasive GAS from 2013 through 2022, including 1981 deaths. The majority of cases (57.5%) were in males. Among case-patients, 1272 (6.0%) were aged 0 to 17 years, 13 565 (63.7%) were aged 18 to 64 years, and 6474 (30.4%) were 65 years or older; 5.5% were American Indian or Alaska Native, 14.3% were Black, and 67.1% were White. Incidence rose from 3.6 per 100 000 persons in 2013 to 8.2 per 100 000 persons in 2022 (P < .001 for trend). Incidence was highest among persons 65 years or older; however, the relative increase over time was greatest among adults aged 18 to 64 years (3.2 to 8.7 per 100 000 persons). Incidence was higher among American Indian or Alaska Native persons than in other racial and ethnic groups. People experiencing homelessness, people who inject drugs, and residents of long-term care facilities had substantially elevated GAS incidence rates. Among tested isolates, those nonsusceptible to macrolides and clindamycin increased from 12.7% in 2013 to 33.1% in 2022. CONCLUSIONS: Invasive GAS infections increased substantially in 10 US states during a surveillance period from 2013 to 2022. Accelerated efforts to prevent and control GAS are needed, especially among groups at highest risk of infection.

BACKGROUND: Black or African American and Hispanic/Latino gay, bisexual, and other men who have sex with men (BMSM and HLMSM) in the United States (US) are disproportionately affected by HIV. We analyze the cost and cost-effectiveness of HIV self-testing through online recruitment of BMSM and HLMSM into an HIV self-testing study. SETTING: 11 US states, February 2020-February 2021. METHODS: BMSM and HLMSM aged ≥18 years without previous HIV diagnosis or current pre-exposure prophylaxis use were recruited through dating and general interest websites/apps (sites). Using the healthcare provider perspective and a 16-month timeframe, we assessed economic costs (2022 US Dollars) of online recruitment, HIV self-test (HIVST) distribution, and participant support. A time-motion study tracked staff time spent on study implementation activities. We reported incremental program cost, cost per HIVST used, and cost per new HIV diagnosis comparing recruitment via dating versus general interest sites. RESULTS: The total cost was $275,776 to enroll 1,306 participants through dating sites, and support 1,005 MSM who used an HIVST (11.74% positivity). The total cost was $168,099 to enroll 600 participants through general interest sites, and support 511 MSM who used an HIVST (5.48% positivity). Recruitment via dating versus general interest sites was more costly and more effective, with incremental cost-effectiveness ratios (ICERs) of $218/HIVST used and $1,196/new diagnosis, relatively low cost per new HIV diagnosis compared with those estimated in other HIV testing interventions. ICERs were higher for HLMSM versus BMSM. CONCLUSIONS: HIV self-testing through dating and general interest site recruitment may be an effective and cost-effective approach to increase new HIV diagnoses.

During the 2023-2024 respiratory syncytial virus (RSV) season, vaccination was recommended for adults ≥60 years based on shared clinical decision-making with their healthcare providers. We examined RSV vaccine uptake and characteristics associated with uptake among age-eligible Kaiser Permanente Southern California (KPSC) patients. Our study cohort included all patients ≥60 years from September 23, 2023 (i.e., date RSV vaccination first became available at KPSC; N = 1,003,132) to April 9, 2024 (i.e., end of local RSV season). To identify sociodemographic and clinical characteristics associated with RSV vaccination, we used multivariable robust Poisson regression to estimate the adjusted relative risk (aRR) and 95 % CI. Overall, 7.6 % of patients were vaccinated for RSV. In multivariable regression analyses, those aged 70-79.9 years (aRR: 1.36; 95 % CI: 1.34-1.39) and aged ≥80 years (aRR: 1.35; 95 % CI: 1.32-1.38) were more likely to be vaccinated, compared with those aged 60-69.9 years. Compared with Non-Hispanic White patients, Asian (aRR: 0.95; 95 % CI: 0.93-0.97), Hispanic (aRR: 0.52; 95 % CI: 0.51-0.54), Non-Hispanic Black (aRR: 0.69; 95 % CI: 0.67-0.71), Pacific Islander (aRR: 0.91; 95 % CI: 0.84-0.98), and Native American or Alaska Native (aRR: 0.80; 95 % CI: 0.70-0.92) patients were less likely to be vaccinated. Those in higher neighborhood deprivation quartiles were less likely to be vaccinated (Q2: aRR: 0.86; 95 % CI: 0.85-0.88; Q3: aRR: 0.77; 95 % CI: 0.76-0.79; and Q4: aRR: 0.67; 95 % CI: 0.65-0.68), compared with those in the lowest deprivation quartile. We found low vaccination uptake and identified disparities in vaccination that might exacerbate existing disparities in RSV infection and severe RSV disease among certain populations. CDC's ACIP recently updated their recommendations for all adults 75+ years, and this might begin to address these disparities.

Introduction: Motor-vehicle crash (MVC) deaths increased by a record 10% from 2020 to 2021 in the United States and disproportionately impacted persons of certain racial/ethnic groups. Methods: Mortality data from the National Vital Statistics System was used to describe MVC death rate trends during 2019–2022 by six racial/ethnic groups: non-Hispanic (NH) American Indian or Alaska Native (AIAN), NH Asian, NH Black, NH Native Hawaiian or Other Pacific Islander (NHOPI), NH White, and Hispanic. Age-adjusted death rates per 100,000 population, 95% confidence intervals (CIs), and annual percent change in rates were calculated. Results: Overall MVC death rates increased during 2019–2022, and rates were highest among NH AIAN and NH Black persons across all years. During 2019–2020, death rates increased the most among NH Black persons (+26.0%). During 2020–2021, rates increased among all racial/ethnic groups, with the greatest increase among NH NHOPI persons (+66.7%) and NH AIAN persons (+27.8%). Conclusions: These findings highlight stark differences by racial/ethnic group in MVC death rates and changes in these rates. Between 2019 and 2022, NH AIAN, NH Black, and NH NHOPI populations experienced the largest increases in MVC death rates, although there was large variation in rates and trends. Widespread adoption of a comprehensive suite of prevention strategies, such as the Safe System approach, while targeting subpopulations with the greatest burden of MVC deaths could reduce these differences and the overall burden of MVCs. Practical Applications: These findings show which subpopulations could experience the greatest impacts from transportation safety investments in reducing overall MVC death rates in the United States. © 2025

Background: Cardiomyopathies, particularly peripartum cardiomyopathy (PPCM), significantly contribute to maternal morbidity in the United States. Objectives: The authors estimated the prevalence and mortality of PPCM and other cardiomyopathies (OCMs) during pregnancy among women aged 15 to 55 years from 2010 to 2020 in the United States using a cross-sectional analysis of multiple data sets. Methods: We identified PPCM, OCM, and deliveries using International Classification of Diseases and diagnosis related group codes in the National Inpatient Sample. We calculated PPCM and OCM prevalence and adjusted prevalence ratios (aPRs) by select covariates. We identified pregnancy-related deaths from all cardiomyopathies combined and PPCM exclusively from 2015 to 2020 Pregnancy Mortality Surveillance System. We calculated pregnancy-related mortality ratios (PRMR) by select covariates. Results: The overall PPCM and OCM prevalence were 105.1 (95% CI: 101.8-108.3) and 76.1 (95% CI: 73.6-78.7) cases per 100,000 delivery hospitalizations, respectively. PPCM prevalence increased with advancing maternal age and decreasing neighborhood income and exhibited marked differences among Black and American Indian or Alaska Native women (aPR: 3.58 [95% CI: 3.36-3.82] and aPR: 1.96 [95% CI: 1.57-2.45], respectively). PPCM prevalence was higher among those with chronic hypertension and diabetes (aPR: 12.17 [95% CI: 11.51-12.88] and aPR: 6.25 [95% CI: 5.77-6.78], respectively). The overall cardiomyopathy and PPCM PRMR were 2.1 and 1.0 deaths per 100,000 live births, respectively. PRMR were highest among those aged ≥40 years and among American Indian and Black women (overall cardiomyopathy PRMR: 7.3, 6.0 deaths per 100,000 live births respectively). Conclusions: Intensifying efforts to address cardiomyopathies and enhance cardiovascular health before, during, and following pregnancy may reduce the burden of maternal morbidity. © 2025 The Authors

Parabens are widely used preservatives with endocrine-disrupting properties, but their role in glucose metabolism during pregnancy is unclear. This study examines prospective associations between urinary concentrations of four parabens in early and mid-pregnancy and gestational diabetes (GDM). A matched case-control study nested within a diverse longitudinal pregnancy cohort (PETALS) with universal GDM screening matched GDM cases to two controls (111 cases; 222 controls). Urine samples collected 2015-2017 in early (14 ± 2.3 weeks) and mid-pregnancy (20 ± 2.4 weeks) were analyzed for paraben concentrations with mass spectrometry. Area-under-the-time-concentration-curve (AUC) assessed cumulative exposure. Conditional logistic regression models evaluated associations between paraben concentrations and GDM, adjusting for covariates. We a priori examined effect modification by Asian/Pacific Islander (A/PI) race/ethnicity due to the case-control matching and GDM prevalence highest among A/PI. Participants were 31 ± 5 years old and 40 % A/PI, 33 % Hispanic, 14 % White and 9 % Black. Methylparaben and propylparaben had >94 % detection, while ethylparaben and butylparaben ranged from 22 %-51 %. Paraben exposure was not associated with GDM overall. Among A/PI, higher methylparaben concentrations exhibited higher odds of GDM: early-pregnancy OR 1.14 per IQR (95 % CI: 0.89,1.45) and AUC 1.07 (0.89,1.30) compared to non-A/PI (early-pregnancy 0.81 [0.62,1.06] and AUC 0.70 [0.44,1.12]; P(interaction) = 0.01 and 0.03, respectively). A/PI mid-pregnancy ethylparaben exposure (detectable vs non-detectable) was linked to higher GDM odds (2.00 [0.84,4.76] vs. non-A/PI 0.47 [0.17,1.27]; P(interaction) = 0.04) as was mid-pregnancy propylparaben exposure (Tertile 2 vs. 1: 3.67 [1.21,11.1] vs. non-A/PI 0.70 [0.22, 2.25]; P(interaction) = 0.04). Although overall paraben exposure was not associated with GDM, interactions by A/PI race/ethnicity suggested potential increased odds of GDM related to propylparaben, methylparaben, and ethylparaben exposure. Future studies should explore paraben exposure in diverse populations.

IMPORTANCE: In 2023, the first respiratory syncytial virus (RSV) vaccines were recommended for US adults 60 years or older, but few data are available about which patients were most likely to receive vaccine to inform future RSV vaccine outreach efforts. OBJECTIVE: To assess patient- and community-level characteristics associated with RSV vaccine receipt and patient knowledge and attitudes related to RSV disease and RSV vaccines. DESIGN, SETTING, AND PARTICIPANTS: During the first season of RSV vaccine use from October 1, 2023, to April 30, 2024, adults 60 years or older hospitalized with RSV-negative acute respiratory illness were enrolled in this cross-sectional study from 26 hospitals in 20 US states. Sociodemographic and clinical data were abstracted from health records, and structured interviews were conducted for knowledge and attitudes about RSV disease and RSV vaccines. EXPOSURES: Age, sex, race and ethnicity, pulmonary disease, immunocompromised status, long-term care facility residence, medical insurance, social vulnerability index (SVI), and educational level. MAIN OUTCOMES AND MEASURES: The exposures were identified a priori as possible factors associated with RSV vaccine receipt and were entered into a modified Poisson regression model accounting for state clustering, to assess for association with RSV vaccine receipt. Knowledge and attitudes were summarized with frequencies and proportions. RESULTS: Among 6746 hospitalized adults 60 years or older, median age was 73 (IQR, 66-80) years and 3451 (51.2%) were female. Among the 6599 patients with self-reported race and ethnicity, 699 (10.6%) were Hispanic, 1288 (19.5%) were non-Hispanic Black, 4299 (65.1%) were non-Hispanic White, and 313 (4.7%) were other race or ethnicity. There were 700 RSV-vaccinated (10.4%) and 6046 unvaccinated (89.6%) adults. Among 3219 unvaccinated adults who responded to RSV knowledge questions, 1519 (47.2%) had not heard of RSV or were unsure; 2525 of 3218 (78.5%) were unsure if they were eligible for RSV vaccine or thought they were not. In adjusted analyses, characteristics associated with RSV vaccination were being 75 years or older (adjusted risk ratio [ARR], 1.23; 95% CI, 1.10-1.38, P < .001), being male (ARR, 1.15; 95% CI, 1.01-1.30; P = .04), and having pulmonary disease (ARR, 1.39; 95% CI, 1.16-1.67; P < .001), immunocompromised status (ARR, 1.30; 95% CI, 1.14-1.48; P < .001), low (ARR, 1.47; 95% CI, 1.18-1.83, P < .001) or moderate (ARR, 1.47; 95% CI, 1.21-1.79; P < .001) SVI, and educational level consisting of 4 or more years of college (ARR, 2.91; 95% CI, 2.14-3.96; P < .001), at least some college or technical training (ARR, 1.85; 95% CI, 1.35-2.53; P < .001), or grade 12 education or General Educational Development (ARR, 1.44; 95% CI, 1.03-2.00; P = .03). RSV vaccination was less likely among residents of long-term care facilities, patients with Medicaid coverage, and uninsured patients. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of hospitalized adults, knowledge of RSV disease and RSV vaccine eligibility was low. Older adults and those with certain medical conditions were more likely to have received vaccine, suggesting appropriate prioritization, but sociodemographic differences in vaccine uptake occurred.

Drug-resistant shigellosis is increasing, particularly among men who have sex with men (MSM). During July-October 2022, an extended-spectrum β-lactamase-producing Shigella sonnei cluster of 9 patients was identified in Chicago, of whom 8 were MSM and 6 were festival attendees. The cluster also included 4 domestic travelers to Chicago. Sexual health care for MSM should include shigellosis diagnosis and prevention.

Pre-exposure prophylaxis (PrEP) is an effective tool in protecting persons from acquiring HIV infection through sex or injection drug use. However, awareness and willingness to use PrEP among Black gay, bisexual, and other men who have sex with men (BMSM) remain suboptimal compared to White MSM (WMSM) in the United States. Our aims were to (1) assess the factors associated with PrEP awareness and willingness to use PrEP among MSM and (2) compare the PrEP perceptions among BMSM versus non-Black MSM. Data were drawn from two cross-sectional behavioral surveys in Baltimore, MD: Behavioral Surveillance Research (BESURE) conducted in 2017, and Safe Spaces 4 Sexual Health (SS4SH), conducted in 2018 and 2019. Descriptive statistics were used to summarize the study population. We used Poisson regression models to identify variables associated with awareness of PrEP and willingness to use PrEP. PrEP perceptions were assessed via 13 items scored on a 5-point Likert scale. Finally, we conducted a post-hoc exploratory bivariate analysis of the relationship between PrEP perception and willingness to use PrEP, stratified by race/ethnicity. A total of 261 MSM participated in this study. Many of the participants were aware of PrEP (75.1%). Factors associated with greater PrEP awareness included having greater than a high school education (aRR 1.22, 95% CI 1.04, 1.43); and earning more than $25,000 annually (aRR 1.24, 95% CI 1.08, 1.42). Participants who had received money in exchange for sex one or more times were less likely to be aware of PrEP (aRR 0.59, 95% CI 0.36, 0.95). More than half of the participants were willing to use PrEP (55.3%). In bivariate and multivariable analyses, demographic or behavioral characteristics were not significantly associated with willingness to use PrEP. Higher agreement with the following statements was associated with lower willingness to use PrEP: "Having to take a pill every day is difficult" (RR 0.89, 95% CI 0.82-0.97) and, "I am concerned about the side effects of PrEP" (RR 0.89, 95% CI 0.82-0.96), and "PrEP is for people who have riskier sex lives than I do" (RR 0.86, 95% CI 0.78-0.95). Conversely, higher willingness to use PrEP was associated with comfortable having sex without a condom (RR 1.11, 95% CI 1.02-1.21), less anxious about sex (RR 1.12, 95% CI 1.02-1.24), and my friends think that I should take PrEP (RR 1.19, 95% CI 1.07-1.32). We found BMSM compared to non-Black MSM had higher mean scores related to taking a daily pill (p = 0.041), concerns about side effects (p = 0.012), concerns about people thinking they had HIV (p = 0.001), concerns about the financial costs of PrEP (p = 0.038) and caution when dealing with healthcare organizations/medical mistrust (p = 0.019). Perceptions with a statistically significant lower score among BMSM versus non-Black MSM included statements such as, comfortable having sex without a condom (p = 0.003) and less anxious about sex (p < 0.001). We conclude HIV prevention strategies, programs, and interventions should be cognizant of PrEP perceptions that facilitate or hinder PrEP uptake in Baltimore City, MD.

PURPOSE: Chlamydia and gonorrhea are the 2 most common bacterial sexually transmitted infections in the United States. Nonadherence to the Centers for Disease Control and Prevention treatment guidelines remains a concern. We examined how well chlamydia and gonorrhea treatment in primary care settings adhered to guidelines. METHODS: We used electronic health records from the PRIME registry to identify patients with diagnosis codes or positive test results for chlamydia and/or gonorrhea from 2018 to 2022. Outcomes were the first dates of antibiotic administered within 30 days after a positive test result for the infection. Descriptive statistics were calculated for patient sociodemographic characteristics. We used a multivariate parametric accelerated failure time analysis with shared frailty modeling to assess associations between these characteristics and time to treatment. RESULTS: We identified 6,678 cases of chlamydia confirmed by a positive test and 2,206 cases of gonorrhea confirmed by a positive test; 75.3% and 69.6% of these cases, respectively, were treated. Females, individuals aged 10-29 years, suburban dwellers, and patients with chlamydia-gonorrhea coinfection had higher treatment rates than comparator groups. Chlamydia was infrequently treated with the recommended antibiotic, doxycycline (14.0% of cases), and gonorrhea was infrequently treated with the recommended antibiotic, ceftriaxone (38.7% of cases). Time to treatment of chlamydia was longer for patients aged 50-59 years (time ratio relative to those aged 20-29 years = 1.61; 95% CI, 1.12-2.30) and for non-Hispanic Black patients (time ratio relative to White patients = 1.17; 95% CI, 1.04-1.33). CONCLUSIONS: Guideline adherence remains suboptimal for chlamydia and gonorrhea treatment across primary care practices. Efforts are needed to develop interventions to improve quality of care for these sexually transmitted infections.

Geosocial networking applications (GSN apps) are important tools for HIV/sexually transmitted infection prevention among men who have sex with men (MSM). Strategies for identifying high transmission and acquisition among GSN app users are needed to prioritize public health response. Community viral load (CVL) is associated with HIV transmission and can be used to identify populations with behaviors/environment associated with HIV/STI risk. We sought to determine user profile characteristics and utilization patterns associated with GSN app use in high CVL census tracts (CT). We used routine HIV surveillance data from in-care individuals and their viral loads at the point of diagnosis to estimate CVL in 200 CTs across Baltimore City. CTs were ordered based on CVL and categorized into quantiles from high to low. Among GSN user profiles, multiple imputation methods were used to complete missing profile characteristics. We then used imputed datasets to explore the association between profile characteristics, app utilization times, and app use in high CVL CTs using a Poisson regression model with robust error variances. Data on 606 profiles were collected originally and imputed 50 times to create a complete data set for analysis. GSN app users were aged 18-65 years [mean = 33.9, 95% confidence interval (CI): 33.1-34.7], with 52.2% Black (95% CI: 47.9- 56.5%), 6.8% living with HIV (95% CI: 4.4- 9.2%), 39.1% in high CVL CTs (95% CI: 35.2- 43.0%), 50.6% use at nighttime (95% CI: 46.7- 54.6%) and 51.6% use during the weekend (95% CI: 47.6- 55.6%). Black MSM users [Relative risk (RR) = 1.12, 95% CI: 1.04-1.20] were associated with GSN app use in high CVL CTs. MSM with profiles listing versatile sex position preference (RR = 1.12, 95% CI: 1.02-1.23) and profiles listing top sex position preference (RR = 1.13, 95% CI: 1.03-1.23) were associated with GSN app use in high and medium CVL CTs. GSN app user profiles of people in high and medium CVL CTs, especially Black MSM and those who report top and versatile sexual positions, may benefit from online prevention messages and real-time notification of health resources presently available in their communities to reduce HIV transmission.

INTRODUCTION: Non-survey-based data sources (e.g. electronic health records, administrative claims) have been used to estimate vaccination coverage among US adults. However, these data sources were not collected for research or surveillance purposes and may have substantial limitations. The objectives of this narrative review were to: 1) identify published studies that used non-survey-based data sources to estimate adult vaccination coverage for one or more routinely recommended vaccines; and 2) summarize the strengths and limitations of these data sources for coverage assessments. AREAS COVERED: Thirty-four publications derived from 9 data sources were reviewed: 16 publications were in a general population (i.e. defined by age), 12 were among pregnant women, and 6 were among individuals with chronic health conditions. While several data sources used continuous health insurance enrollment to define the study population, doing so limited generalizability to stably insured populations. Methods for obtaining race and ethnicity data were complex and potentially subject to bias. None of the reviewed studies presented any formal assessment of vaccine data validity. EXPERT OPINION: While multiple non-survey-based data sources have been used to assess adult vaccination coverage in the United States, important limitations exist, including related to generalizability, data validity, and risk of bias.

INTRODUCTION: The association between various disparity factors and cardiovascular disease (CVD) prevalence among older US adults with diabetes has not been comprehensively explored. We examined disparities in CVD prevalence among Medicare beneficiaries with diabetes. METHODS: Data were from the 2015-2019 Medicare Current Beneficiary Survey. Diabetes and CVD conditions - myocardial infarction (MI), stroke, and heart failure - were self-reported. We estimated the adjusted prevalence ratios (APRs) of CVD by race and ethnicity, education, income-to-poverty ratio (IPR), urbanicity, food insecurity, and social vulnerability using logistic regressions that controlled for these factors as well as age and sex. RESULTS: Annually, an estimated 9.2 million Medicare beneficiaries aged 65 years or older had diabetes. Among them, 16.7% had MI, 13.7% had stroke, and 12.5% had heart failure. Beneficiaries who were food insecure, socially vulnerable, with an IPR less than or equal to 135%, and residing in rural areas had a higher crude CVD prevalence. After controlling for other factors, low IPR and food insecurity were linked to a higher prevalence of CVD. Hispanic beneficiaries had lower stroke and heart failure prevalence than non-Hispanic (NH) White and NH Black beneficiaries. NH Black beneficiaries had lower MI prevalence but higher heart failure prevalence compared with NH White beneficiaries. Female respondents with an IPR less than or equal to 135% had higher MI and stroke prevalence; this was not seen in male respondents. CONCLUSION: Low IPR and food insecurity were associated with higher MI, stroke, and heart failure prevalence among Medicare beneficiaries with diabetes. Our findings can inform targeted interventions to reduce CVD disparities in these populations.

BACKGROUND: The U.S.'s National HIV/AIDS Strategy (NHAS) prioritizes improving QoL among people with HIV (PWH) but co-occurrence of different aspects of QoL is not well described. We developed and applied a novel, multi-item assessment of poor quality of life (QoL) among PWH, and examined associations with selected outcomes. SETTING: 2018-2021 CDC Medical Monitoring Project data on 15,855 U.S. PWH. METHODS: The poor QoL index, measured by the number of indicators of poor QoL experienced included: poor/fair self-rated health, unmet needs for mental health services, and subsistence needs (hunger/food insecurity, unstable housing/homelessness, unemployment). Score distributions were analyzed alongside data on individual QoL indicators. Associations with selected adverse outcomes were assessed, including not being retained in care, missing ≥1 HIV medical appointments, missing ≥1 ART dose, not having sustained viral suppression, and having ≥1 emergency room visit or ≥1 hospitalization. RESULTS: Overall, 55.1% of PWH had ≥1 indicator of poor QoL; 8.4% had ≥3 indicators. Over a quarter (26.5%) of people who inject drugs experienced ≥3 indicators of poor QoL. A large percentage of people aged 18-24 years and transgender women had subsistence needs; 36.4% of cisgender Black women had poor/fair self-rated health. After adjusting for age, race/ethnicity, and gender, higher poor QoL index scores-and each indicator of poor QoL-were associated with worse outcomes. CONCLUSIONS: We demonstrated the utility in using the poor QoL index to identify those at higher risk of experiencing health challenges. Expanding national recommendations to include this QoL assessment could help in meeting NHAS goals for improving PWH's well-being.

OBJECTIVES: To identify associations between perceived neighborhood walkability and sleep across racial and ethnic groups of US adults. METHODS: Data from the 2020 National Health Interview Survey (N=27,521) were used to assess self-reported measures of walkability (pedestrian access, accessible amenities, unsafe walking conditions) and sleep (short and long duration; frequency of waking up unrested, trouble falling and staying asleep, sleep medication use). Stratified by racial and ethnic group, we calculated the age-adjusted prevalence of neighborhood walkability features and sleep measures and estimated prevalence ratios assessing associations between neighborhood walkability and sleep while adjusting for sociodemographic and health covariates. RESULTS: The prevalence of unsafe walking conditions due to crime was lowest among non-Hispanic White adults (6.9%), and access to places to relax was lowest among non-Hispanic Black adults (72.5%). The prevalence of short sleep duration was highest among non-Hispanic Black adults (37.9%). Neighborhood environment features had differential associations with sleep when stratified by race and ethnicity. For example, walking path access was related to lower sleep medication use among non-Hispanic Asian adults (adjusted prevalence ratio (aPR): 0.42, 95% CI: 0.19-0.91) but greater use among non-Hispanic White adults (aPR: 1.24, 95% CI: 1.05-1.46). More associations were observed among non-Hispanic White adults than other groups; and the strongest magnitude of association was observed among non-Hispanic Asian adults (traffic and sleep medication aPR: 0.31, 95% CI: 0.12-0.84). CONCLUSIONS: Associations between the neighborhood environment and sleep vary and may be inconsistent by race and ethnicity. Future research may help identify determinants.

PURPOSE: The Autism and Developmental Disabilities Monitoring (ADDM) Network estimates the prevalence of autism spectrum disorder (ASD) throughout the United States. Reports through 2010 found higher prevalence in areas of higher socioeconomic status. Reports since 2018 indicate a pattern change. We used CDC's Social Vulnerability Index (SVI) to examine the association of ASD prevalence and social vulnerability in ADDM Network sites. METHODS: Cases of ASD among 8-year-old children in 2020 were linked to SVI measures and population estimates. Tracts were categorized into tertiles (high, medium, and low) and prevalence, prevalence ratios (PRs), and 95 % confidence intervals (CIs) were calculated. RESULTS: Among 5998 children with ASD, we saw higher ASD prevalence in areas with high versus low vulnerability overall (26.18 per 1000; PR=1.06 (1.00-1.13)) and in areas with more minority residents (28.28 per 1000; PR=1.29 (1.21-1.38)), less transportation (27.32 per 1000; PR=1.13 (1.06-1.20)), and greater disability (26.83 per 1000; PR=1.09 (1.02-1.17)). This pattern was observed among White children (PR=1.48 {1.36-1.60}) but reversed among Black (PR=0.61 {0.53-0.70}), Asian (PR=0.58 {0.46-0.73}), and Hispanic (PR=0.83 {0.72-0.95}) children. CONCLUSIONS: Disparities in prevalence of ASD by neighborhood-level social vulnerability persist. Directing resources toward providing equitable access to healthcare and support services could help close this gap.

BACKGROUND: Parent-reported surveys are commonly used in child health research. However, few national surveys have examined concordance between parent- and teen-reported Adverse Childhood Experiences (ACEs). OBJECTIVE: To examine concordance between parent- and teen-reported ACEs among a nationally representative sample of teens and understand sociodemographic correlates of concordance. PARTICIPANTS AND SETTING: Data were collected as part of the National Health Interview Survey (NHIS), an annual nationally representative survey of the United States, with parent-reported interviews and its follow-back survey, the National Health Interview Survey-Teen (NHIS-Teen), a self-administered web survey of youth aged 12-17 years. METHODS: Parent- and teen-reported ACEs, and several measures of concordance (e.g. weighted Cohen's kappa, prevalence adjusted bias adjusted kappa (PABAK)) are presented. Unadjusted logistic regressions tested associations between sociodemographic characteristics and likelihood of concordance for each ACE. RESULTS: ACEs prevalence based on parent report were lower compared to teen report (e.g. victim of or witnessed violence in the neighborhood, 6.5 % parent-reported vs. 15.5 %, teen-reported). Weighted Cohen's kappa statistics showed fair to moderate agreement (ks ranging from 0.27 to 0.53), with PABAK statistics showing slightly higher levels (ks ranging from 0.41 to 0.88). CONCLUSIONS: There is discordance in ACEs reporting between teens and their parents, with parents less likely to report that their teen experience an ACE than teens are. This emphasizes the importance of collecting information directly from teenagers, which may help inform intervention work.

OBJECTIVES/BACKGROUND: We evaluated patterns of serum concentrations of endocrine disrupting chemicals (EDCs), namely polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), and polybrominated diphenyl ethers (PBDEs), in a U.S. military sample by race/ethnicity (R/E) and sex. METHODS: Twenty-three EDCs were measured in stored serum samples obtained between 1995 and 2010 for 708 service members from the Department of Defense Serum Repository. For each EDC, geometric means (GM) were estimated using log-transformed concentrations in a linear regression model, for eight combined R/E/sex groups: non-Hispanic White (NHW), non-Hispanic Black (NHB), non-Hispanic Asian (NHA), and Hispanic men and women, adjusted for age and service branch and stratified by age tertile ("younger age": 17-23, "middle age": 24-30, and "older age": 31-52 years). Comparisons were made between our military sample and the National Health and Nutrition Examination Survey (NHANES) 2003-2004 data for NHW and NHB groups. RESULTS: Within our military sample, the highest PCB concentrations were among older age NHB men and women and highest OCP concentrations among older age NHB women and NHA men. PBDE concentrations were generally highest in middle age Hispanic women and NHA men, though based on small sample size. Generally, NHB men and women had higher concentrations of EDCs in both the military and NHANES. CONCLUSIONS: We found patterns of elevated EDC concentrations among NHB, NHA, and Hispanic groups in the military sample and for NHB men and women in NHANES. There were no consistent patterns of higher or lower EDCs comparing the military to NHANES. Future studies of EDCs and health outcomes should stratify by R/E/sex to account for potential disparities in EDC concentrations.

BACKGROUND: Daily oral pre-exposure prophylaxis (PrEP) use among gay, bisexual, and other men who have sex with men (GBMSM) remains suboptimal. Assessing behavioral readiness for PrEP use among GBMSM who can benefit and offering PrEP may increase uptake among GBMSM. We measured 4-item readiness for taking PrEP among GBMSM who have not been offered PrEP by a provider. METHODS: GBMSM in Atlanta, Chicago, and Raleigh-Durham reporting recent condomless anal sex were assessed for "readiness" to discuss PrEP with a provider, test for HIV, take a daily pill, attend provider appointments, and a 4-component composite score for PrEP readiness. Chi-square tests and multivariable logistic regression were applied to examine factors associated with readiness to use PrEP. RESULTS: Study sample (n=187) was 51% Black, 15% Hispanic, 30% identified as bisexual or straight or other, and 29% had no health insurance. 55% said they were ready to discuss PrEP with a provider, 88% were ready to get an HIV test, 45% were ready to take a daily pill, 48% were ready to attend appointments, and 37% reported overall PrEP readiness. Having no health insurance was associated with readiness for a daily pill (AOR=2.78, CI=1.34-5.78) and 4-item PrEP readiness (AOR=2.34, CI=1.13-4.85). Self-identification as gay (vs bisexual/straight) was associated with readiness to discuss PrEP (AOR=2.14, CI=1.05-4.36). CONCLUSION: Only 37% of GBMSM with recent condomless anal sex were ready for PrEP based on the 4-item readiness. Readiness may differ based on sexual identity, insurance status, and other characteristics. Efforts are needed to increase readiness across behavioral components of PrEP use.

BACKGROUND: The One Health approach aims to balance and optimize the health of humans, animals, and ecosystems, recognizing that shared health outcomes are interdependent. A One Health approach to disease surveillance, control, and prevention requires infrastructure for coordinating, collecting, integrating, and analyzing data across sectors, incorporating human, animal, and environmental surveillance data, as well as pathogen genomic data. However, unlike data interoperability problems faced within a single organization or sector, data coordination and integration across One Health sectors requires engagement among partners to develop shared goals and capacity at the response level. Successful examples are rare; as such, we sought to develop a framework for local One Health practitioners to utilize in support of such efforts. METHODS: We conducted a systematic scientific and gray literature review to inform development of a One Health data integration framework. We discussed a draft framework with 17 One Health and informatics experts during semi-structured interviews. Approaches to genomic data integration were identified. RESULTS: In total, 57 records were included in the final study, representing 13 pre-defined frameworks for health systems, One Health, or data integration. These frameworks, included articles, and expert feedback were incorporated into a novel framework for One Health data integration. Two scenarios for genomic data integration were identified in the literature and outlined. CONCLUSIONS: Frameworks currently exist for One Health data integration and separately for general informatics processes; however, their integration and application to real-time disease surveillance raises unique considerations. The framework developed herein considers common challenges of limited resource settings, including lack of informatics support during planning, and the need to move beyond scoping and planning to system development, production, and joint analyses. Several important considerations separate this One Health framework from more generalized informatics frameworks; these include complex partner identification, requirements for engagement and co-development of system scope, complex data governance, and a requirement for joint data analysis, reporting, and interpretation across sectors for success. This framework will support operationalization of data integration at the response level, providing early warning for impending One Health events, promoting identification of novel hypotheses and insights, and allowing for integrated One Health solutions.

OBJECTIVES: This project aimed to understand the experiences and preferences for social risk factor screening among racially, ethnically, and linguistically diverse cancer survivors in the Washington, DC, region. METHODS: Semi-structured interviews were conducted with English, Spanish, and Amharic-speaking breast and prostate cancer survivors. Data were inductively coded to identify themes, and differences by race and preferred language were evaluated. FINDINGS: Twenty-two interviews in English (n = 14), Spanish (n = 7), and Amharic (n = 1) among participants who identified as Black (n = 8), White (n = 5), Asian (n = 1), Other (n = 6), and multiracial (n = 2) were completed. Participants reported unresolved needs during treatment including transportation, healthful food, mental health care, financial help, and employment assistance. COVID-19 exacerbated many needs. Most participants did not recall discussing needs with oncology teams, but all participants were open to having these conversations. CONCLUSION(S): This research reveals that cancer survivors might benefit from culturally appropriate strategies that address social needs.

PURPOSE: Surveillance of traumatic brain injury (TBI) in the United States has historically relied on healthcare administrative datasets, but these sources likely underestimate the true burden of TBI. Surveys that ask individuals to self- or proxy-report their experiences with their injuries are an alternative source for surveillance. This paper provides results from a large national survey that ascertained TBI among sampled adults and children. METHODS: Data from the 2023 National Health Interview Survey, a nationally representative household survey of the civilian non-institutionalized US population, were examined. Descriptive and bivariate statistics of demographic and injury characteristics of children and adults who sustained a TBI in the past 12 months were calculated. RESULTS: Analyses reveal that 3.0% (n=9,757,000) of Americans (3.3% of adults and 2.2% of children (aged ≤17 years)) reported a TBI in the past year. Among children who sustained a TBI in the past year, over half (55.5%) sustained their TBI during a sport or recreational activity, and 62.4% were evaluated by a medical professional. The prevalence of TBI and injury characteristics varied by select demographics. CONCLUSION: These findings demonstrate that TBI affects a large number of Americans and highlight the value of TBI surveillance through nationally representative surveys, providing a broad picture of prevalence, healthcare utilization, and setting of injury.

BACKGROUND: While evidence suggests Medicaid expansion can reduce overdose, some expressed concern expansion fueled the US opioid overdose crisis by increasing access to low-cost prescription opioids diverted for non-prescribed use. Ecologic studies find a protective relationship or no relationship between expansion and area-level opioid prescribing. Little is known about the relationship between expansion and opioid use among people experiencing poverty who inject drugs (PWID), a population at heightened risk of overdose likely to benefit from Medicaid expansion. We examined whether expansion was associated with prescription opioid and benzodiazepine misuse among PWID experiencing poverty and whether associations varied by race/ethnicity and HIV status. METHODS: This serial cross-sectional observational study used generalized difference-in-differences models to analyze data (2012, 2015, 2018) from 19,728 PWID aged 18-64 with income ≤138 % of federal poverty line from 13 states in the CDC's National HIV Behavioral Surveillance. Outcomes included past 12-month non-injection and injection prescription opioid misuse and benzodiazepine misuse. RESULTS: The sample (N = 19,728) was 40 % non-Latinx Black persons and 22 % Latinx persons. Past 12-month non-injection prescription opioid misuse was 33 %, injection prescription opioid misuse was 16 %, and benzodiazepine use was 40 %. Across all models, there was no association between expansion and prescription opioid misuse (confidence intervals included 0) or prescription benzodiazepine misuse (confidence intervals included 0). Associations did not vary by race/ethnicity or HIV status. CONCLUSIONS: We found no association between Medicaid expansion and opioid or benzodiazepine misuse overall, by race/ethnicity, or HIV status among a large, geographically diverse sample of PWID. These findings provide empirical evidence that expansion is not associated with prescription opioid or benzodiazepine misuse in a population likely to benefit from expansion.

BACKGROUND: HIV coinfection worsens health outcomes for persons with chronic hepatitis C virus (HCV) infection; however, access to comprehensive Ryan White (RW) HIV care may improve the health of persons with HIV and HCV. METHODS: In a retrospective cohort study, we used surveillance data from Philadelphia's hepatitis and HIV registries for newly reported HCV infections from November 2015 to October 2021. We plotted Kaplan-Meier curves and performed Cox regressions on time to HCV clearance by HIV coinfection status, adjusting for demographic characteristics and HCV report year. RESULTS: A total of 10 251 persons with newly reported HCV infection were included, of whom 9898 (96.6%) had HCV monoinfection and 353 (3.4%) had HIV coinfection. HCV reports were mostly among residents who were non-Hispanic/Latine White (n = 3609, 35.2%) and non-Hispanic/Latine Black (n = 3221, 31.4%) and assigned male sex at birth (n = 6931, 67.8%). At every month of follow-up, having HIV was associated with a higher likelihood of HCV clearance as compared with HCV monoinfection (adjusted hazard ratio, 1.2; 95% CI, 1.1-1.4; P < .05). For persons with HIV coinfection, participation in RW support services 2 to 6 times monthly was associated with an increased likelihood (adjusted hazard ratio, 1.7-3.1) of HCV clearance at every month of follow-up as compared with persons without RW participation (P < .05). CONCLUSIONS: Among newly reported HCV infections, the likelihood of HCV clearance was higher among persons with HIV coinfection who participated in RW support services. Frequent receipt of supportive services, such as those provided by the national, federally funded RW system, is crucial for HCV elimination.

BACKGROUND: Wilms tumor (WT) is the most common pediatric malignancy of the kidney. Past studies describing WT incidence and survival used surveillance data with < 30% of the US population. We evaluated differences in WT incidence and survival comparing demographic groups and tumor characteristics. METHODS: We analyzed new cases of WT among patients aged < 20 years at diagnosis by using incidence data from US Cancer Statistics (USCS) for 2003-2020 and 5-year relative survival (RS) data from the National Program of Cancer Registries (NPCR) for 2001-2019. To assess incidence trends, average annual percent change (AAPC) was calculated by using joinpoint regression. Relative survival (RS) and all-cause survival were calculated overall and by demographic and clinical variables. RESULTS: During 2003-2020, 8218 cases of WT were reported in USCS, which represented an age-adjusted incidence rate of 5.7 cases per million. Rates were the highest among females (6.3), children aged 0-4 years (17.2), and non-Hispanic Black patients (7.1). Overall, trends remained stable (AAPC = -0.4, 95% CI: -1.4 to 0.4). Among 7567 cases of WT in NPCR, 5-year RS was 92.6%. Patients with the lowest survival include the following: those aged 10-19 years (hazard ratio [HR] = 1.65, 95% CI: 1.02-2.65); non-Hispanic Black patients (HR = 1.39, 95% CI: 1.11-1.76); those with regional stage (HR = 1.93, 95% CI: 1.47-2.54) or distant stage (HR = 5.12, 95% CI: 3.99-6.57); and patients from nonmetropolitan counties (HR = 1.46, 95% CI: 1.09-1.96). Individuals diagnosed during 2011-2019 (HR = 0.64, 95% CI: 0.53-0.77) had higher survival than those diagnosed during 2001-2010. CONCLUSIONS: The highest WT incidence rates were patients who were female, 0-4 years, and non-Hispanic Black. Survival improved during the study period; survival differed by race, ethnicity, metropolitan status, and age. Further studies to delineate the causes of these disparities may improve outcomes.

Transgender youth are disproportionately affected by HIV, particularly minoritized youth in the US south. To understand HIV service use among transgender youth, we interviewed 25 young racial and ethnic minority clients of four southern community-based HIV service organizations (CBOs), and CBO staff (n = 12), about service access and use. Participants were assigned male at birth and identified as female (n = 8), transgender (n = 11) or gender-fluid or nonbinary (n = 6). The majority were Black/African American or mixed race; four were Hispanic or Latino/a. Most were unemployed; nearly half were unstably housed or homeless during the prior year. Four service types were each used by approximately two-thirds of participants: counseling/support, HIV/STD testing/education, pre-exposure prophylaxis education/prescriptions, and transgender-related medical services (primarily hormone provision). Just over a quarter used social services (e.g., housing, employment). Key facilitators to service use included a non-stigmatizing CBO atmosphere, and easy and convenient access. Poor access (e.g., inconvenient hours, location), lack of transportation or parking, social service needs, and lack of money were barriers. Qualitative reports highlighted unmet social service needs, particularly housing, especially for those without HIV. To reduce disparities, HIV prevention for racial and ethnic minoritized transgender youth should simultaneously address hormone provision, HIV risk reduction and social service needs.

IMPORTANCE: The degree that in-home cannabis smoking can be detected in the urine of resident children is unclear. OBJECTIVE: Test association of in-home cannabis smoking with urinary cannabinoids in children living at home. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used baseline data from Project Fresh Air, a 2012-2016 randomized clinical trial to reduce fine particulate matter levels. Eligible participants were recruited from households in San Diego County, California, with children under age 14 years and an adult tobacco smoker in residence. Children's urine samples were analyzed in 2022. EXPOSURES: In-home cannabis smoking, measured by: parent or guardian report of in-home cannabis smoking; number of daily nonspecific smoking events computed via an air particle count algorithm; and number of daily cannabis smoking events ascertained by residualization, adjusting for air nicotine, tobacco smoking, and other air particle generating or ventilating activities. MAIN OUTCOMES AND MEASURES: Levels of the cannabis biomarker Δ9-tetrahydrocannabinol (THC) and its major metabolites, 11-hydroxy-Δ9-tetrahydrocannabinol and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol. Biomarker molar equivalents were summed to represent total THC equivalents (TTE) in urine. Logistic regression assessed whether in-home smoking was associated with cannabis biomarker detection. For children with detectable urinary cannabinoids, linear regression assessed in-home smoking association with quantity of urinary TTE. RESULTS: A total of 275 children were included in analysis (mean [SD] age, 3.6 [3.6] years; 144 male [52.4%]; 38 Black [13.8%], 132 Hispanic [48.0%], and 52 White [18.9%]). Twenty-nine households (10.6%) reported in-home cannabis smoking in the past 7 days; 75 children [27.3%] had detectable urinary cannabinoids. Odds of detectable TTE in children's urine were significantly higher in households with reported in-home cannabis smoking than households without (odds ratio [OR], 5.0; 95% CI, 2.4-10.4) and with each additional ascertained daily cannabis smoking event (OR, 2.5; 95% CI, 1.6-3.9). Although the point estimate for TTE levels was higher among children with detectable urinary cannabinoids and exposure to more daily cannabis smoking events (increase per event, 35.68%; 95% CI, -7.12% to 98.21%), the difference was not statistically significant. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, in-home cannabis smoking was associated with significantly increased odds of child exposure to cannabis smoke, as assessed by urinary cannabinoid biomarkers. As young children spend most of their time at home, reducing in-home cannabis smoking could substantially reduce their exposure to the toxic and carcinogenic chemicals found in cannabis smoke.