Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 42 Records) |
Query Trace: Briss P[original query] |
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Modernizing CDC's Practices and Culture for Better Data Sharing, Impact, and Transparency
Wiltz JL , Lee B , Kaufmann R , Carney TJ , Davis K , Briss PA . Prev Chronic Dis 2024 21 E18 |
The role of U.S public health agencies in addressing long COVID
Patel PR , Desai JR , Plescia M , Baggett J , Briss P . Am J Prev Med 2024 ![]() ![]() Long COVID (or post-COVID conditions) refers to symptoms or health conditions that persist or occur ≥4 weeks after SARS-CoV-2 infection.1 Symptoms such as brain fog, fatigue, pain, dyspnea, depression, and a wide range of other manifestations can occur and may be debilitating. The mechanism(s) of these outcomes are poorly understood, creating challenges to prevention and treatment. The study of Long COVID is rapidly evolving and approaches to describe its burden vary. However, prevalence estimates of activity- or work-limiting Long COVID among U.S. adults in the 3-5 million range have been reported.2,3 The vast number of individuals at risk of, or with symptoms of Long COVID underscores the urgency of addressing this complex public health issue. | | In April 2022, the Biden Administration launched a U.S. government-wide response to Long COVID.4 In that same year, the Department of Health and Human Services published three Long COVID reports: the National Research Action Plan5; Services and Supports for Longer-Term Impacts of COVID-196; and Health+ Long COVID Human-Centered Design Report7. These reports help direct federal efforts and identify priorities, including several that align with core public health activities (as outlined in the 10 Essential Public Health Services8). However, they do not describe the role of public health organizations in addressing Long COVID. We aimed to identify key areas in which an enhanced public health approach to Long COVID is needed. |
Advancing chronic disease practice through the CDC Data Modernization Initiative
Carney TJ , Wiltz JL , Davis K , Briss PA , Hacker K . Prev Chronic Dis 2023 20 E110 Chronic disease affects 6 in 10 adults in the US, while 4 in 10 adults live with multiple chronic diseases (1). Chronic diseases represent one of the nation’s leading causes of disability and drivers of the nation’s $4.1 trillion in annual health care spending (1). Chronic conditions including heart disease, cancer, stroke, diabetes, and chronic kidney disease dominate the leading causes of death. Furthermore, leading lifestyle risk factors in the US include tobacco use, poor nutrition, physical inactivity, and excessive alcohol use (1). | | Chronic disease prevention and control necessitates a comprehensive strategy to prevent disease (2–4), which is needed now more than ever (5). Information systems innovations are needed to advance health activities and outcomes and to allow decision makers and practitioners to act (4,6–8). Chronic disease data are a foundation that can inform interventions to promote healthy communities, support healthy behaviors and lifestyles, and facilitate effective and coordinated chronic disease prevention and health promotion (5,9). The benefits of an improved chronic disease data landscape include improved management of chronic disease programs, enhanced communication, data exchange, and coordination between federal, state, tribal, local, and territorial health departments and their partners. Additionally, efforts aimed at enhancing chronic disease surveillance practices will better enable a learning health system, precision public health, and improved situational awareness that will ultimately allow people across the US to live longer, healthier lives (10–12). |
Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions - United States, January-May 2020.
Lange SJ , Ritchey MD , Goodman AB , Dias T , Twentyman E , Fuld J , Schieve LA , Imperatore G , Benoit SR , Kite-Powell A , Stein Z , Peacock G , Dowling NF , Briss PA , Hacker K , Gundlapalli AV , Yang Q . Am J Transplant 2020 20 (9) 2612-2617 This article describes a significant decline in emergency department visits for acute life-threatening conditions during the COVID-19 pandemic, suggesting that patients may be delaying or avoiding care or unable to access care during the pandemic. |
Impacts of the COVID-19 Pandemic on Nationwide Chronic Disease Prevention and Health Promotion Activities.
Balasuriya L , Briss PA , Twentyman E , Wiltz JL , Richardson LC , Bigman ET , Wright JS , Petersen R , Hannan CJ , Thomas CW , Barfield WD , Kittner DL , Hacker KA . Am J Prev Med 2022 64 (3) 452-458 The coronavirus disease 2019 (COVID-19) pandemic has underscored the need to prevent chronic disease and promote health.1 , 2 More than a million American lives have been lost to COVID-19, and life expectancy decreased between 2018 and 2020.3 , 4 Chronic diseases are major risk factors for COVID-19 morbidity and mortality.5 In addition, COVID-19 morbidity and mortality have been higher among persons from racial and ethnic groups such as those who are African American, Hispanic or Latino, and American Indian or Alaska Native as well as those living at lower SES.6 This has magnified pre-existing health inequities in chronic disease.1 , 2 , 7 |
COVID-19 and Chronic Disease: The Impact Now and in the Future.
Hacker KA , Briss PA , Richardson L , Wright J , Petersen R . Prev Chronic Dis 2021 18 E62 Chronic diseases represent 7 of the top 10 causes of death in the United States (1). Six in 10 Americans live with at least 1 chronic condition, such as heart disease, stroke, cancer, or diabetes (2). Chronic diseases are also the leading causes of disability in the US and the leading drivers of the nation’s $3.8 trillion annual health care costs (2,3). | | The COVID-19 pandemic has resulted in enormous personal and societal losses, with more than half a million lives lost (4). COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can result in respiratory distress. In addition to the physical toll, the emotional impact has yet to be fully understood. For those with chronic disease, the impact has been particularly profound (5,6). Heart disease, diabetes, cancer, chronic obstructive pulmonary disease, chronic kidney disease, and obesity are all conditions that increase the risk for severe illness from COVID-19 (7). Other factors, including smoking and pregnancy, also increase the risk (7). Finally, in addition to COVID-19–related deaths since February 1, 2020, an increase in deaths has been observed among people with dementia, circulatory diseases, and diabetes among other causes (8). This increase could reflect undercounting COVID-19 deaths or indirect effects of the virus, such as underutilization of, or stresses on, the health care system (8). |
Validation of the prevention impacts simulation model (PRISM)
Yarnoff B , Honeycutt A , Bradley C , Khavjou O , Bates L , Bass S , Kaufmann R , Barker L , Briss P . Prev Chronic Dis 2021 18 E09 INTRODUCTION: Demonstrating the validity of a public health simulation model helps to establish confidence in the accuracy and usefulness of a model's results. In this study we evaluated the validity of the Prevention Impacts Simulation Model (PRISM), a system dynamics model that simulates health, mortality, and economic outcomes for the US population. PRISM primarily simulates outcomes related to cardiovascular disease but also includes outcomes related to other chronic diseases that share risk factors. PRISM is openly available through a web application. METHODS: We applied the model validation framework developed independently by the International Society of Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making modeling task force to validate PRISM. This framework included model review by external experts and quantitative data comparison by the study team. RESULTS: External expert review determined that PRISM is based on up-to-date science. One-way sensitivity analysis showed that no parameter affected results by more than 5%. Comparison with other published models, such as ModelHealth, showed that PRISM produces lower estimates of effects and cost savings. Comparison with surveillance data showed that projected model trends in risk factors and outcomes align closely with secular trends. Four measures did not align with surveillance data, and those were recalibrated. CONCLUSION: PRISM is a useful tool to simulate the potential effects and costs of public health interventions. Results of this validation should help assure health policy leaders that PRISM can help support community health program planning and evaluation efforts. |
An Ounce of Prevention Is Still Worth a Pound of Cure, Especially in the Time of COVID-19.
Hacker KA , Briss PA . Prev Chronic Dis 2021 18 E03 Before the coronavirus disease 2019 (COVID-19) pandemic, about 6 in 10 adults in the United States had a chronic condition; 90% of the nation’s health care expenditures were for people with chronic and mental health conditions, and chronic conditions accounted for 7 of the 10 leading causes of death in the United States (1–3). |
E-cigarette, or vaping, product use-associated lung injury: Looking back, moving forward
King BA , Jones CM , Baldwin GT , Briss PA . Nicotine Tob Res 2020 22 S96-s99 Implications In this commentary, we describe the evidence-based approach used to identify the primary cause of EVALI and to curb the 2019 outbreak. We also discuss future research opportunities and public health practice considerations to prevent a resurgence of EVALI. |
Pathological findings in suspected cases of e-cigarette, or vaping, product use-associated lung injury (EVALI): a case series
Reagan-Steiner S , Gary J , Matkovic E , Ritter JM , Shieh WJ , Martines RB , Werner AK , Lynfield R , Holzbauer S , Bullock H , Denison AM , Bhatnagar J , Bollweg BC , Patel M , Evans ME , King BA , Rose DA , Baldwin GT , Jones CM , Krishnasamy V , Briss PA , Weissman DN , Meaney-Delman D , Zaki SR . Lancet Respir Med 2020 8 (12) 1219-1232 BACKGROUND: Since August, 2019, US public health officials have been investigating a national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). A spectrum of histological patterns consistent with acute to subacute lung injury has been seen in biopsies; however, autopsy findings have not been systematically characterised. We describe the pathological findings in autopsy and biopsy tissues submitted to the US Centers for Disease Control and Prevention (CDC) for the evaluation of suspected EVALI. METHODS: Between Aug 1, 2019, and Nov 30, 2019, we examined lung biopsy (n=10 individuals) and autopsy (n=13 individuals) tissue samples received by the CDC, submitted by 16 US states, from individuals with: a history of e-cigarette, or vaping, product use; respiratory, gastrointestinal, or constitutional symptoms; and either pulmonary infiltrates or opacities on chest imaging, or sudden death from an undetermined cause. We also reviewed medical records, evaluated histopathology, and performed infectious disease testing when indicated by histopathology and clinical history. FINDINGS: 21 cases met surveillance case definitions for EVALI, with a further two cases of clinically suspected EVALI evaluated. All ten lung biopsies showed histological evidence of acute to subacute lung injury, including diffuse alveolar damage or organising pneumonia. These patterns were also seen in nine of 13 (69%) autopsy cases, most frequently diffuse alveolar damage (eight autopsies), but also acute and organising fibrinous pneumonia (one autopsy). Additional pulmonary pathology not necessarily consistent with EVALI was seen in the remaining autopsies, including bronchopneumonia, bronchoaspiration, and chronic interstitial lung disease. Three of the five autopsy cases with no evidence of, or a plausible alternative cause for acute lung injury, had been classified as confirmed or probable EVALI according to surveillance case definitions. INTERPRETATION: Acute to subacute lung injury patterns were seen in all ten biopsies and most autopsy lung tissues from individuals with suspected EVALI. Acute to subacute lung injury can have numerous causes; however, if it is identified in an individual with a history of e-cigarette, or vaping, product use, and no alternative cause is apparent, a diagnosis of EVALI should be strongly considered. A review of autopsy tissue pathology in suspected EVALI deaths can also identify alternative diagnoses, which can enhance the specificity of public health surveillance efforts. FUNDING: US Centers for Disease Control and Prevention. |
Potential Indirect Effects of the COVID-19 Pandemic on Use of Emergency Departments for Acute Life-Threatening Conditions - United States, January-May 2020.
Lange SJ , Ritchey MD , Goodman AB , Dias T , Twentyman E , Fuld J , Schieve LA , Imperatore G , Benoit SR , Kite-Powell A , Stein Z , Peacock G , Dowling NF , Briss PA , Hacker K , Gundlapalli AV , Yang Q . MMWR Morb Mortal Wkly Rep 2020 69 (25) 795-800 On March 13, 2020, the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, states enacted stay-at-home orders to slow the spread of SARS-CoV-2, the virus that causes COVID-19, and reduce the burden on the U.S. health care system. CDC* and the Centers for Medicare & Medicaid Services (CMS)(dagger) recommended that health care systems prioritize urgent visits and delay elective care to mitigate the spread of COVID-19 in health care settings. By May 2020, national syndromic surveillance data found that emergency department (ED) visits had declined 42% during the early months of the pandemic (1). This report describes trends in ED visits for three acute life-threatening health conditions (myocardial infarction [MI, also known as heart attack], stroke, and hyperglycemic crisis), immediately before and after declaration of the COVID-19 pandemic as a national emergency. These conditions represent acute events that always necessitate immediate emergency care, even during a public health emergency such as the COVID-19 pandemic. In the 10 weeks following the emergency declaration (March 15-May 23, 2020), ED visits declined 23% for MI, 20% for stroke, and 10% for hyperglycemic crisis, compared with the preceding 10-week period (January 5-March 14, 2020). EDs play a critical role in diagnosing and treating life-threatening conditions that might result in serious disability or death. Persons experiencing signs or symptoms of serious illness, such as severe chest pain, sudden or partial loss of motor function, altered mental state, signs of extreme hyperglycemia, or other life-threatening issues, should seek immediate emergency care, regardless of the pandemic. Clear, frequent, highly visible communication from public health and health care professionals is needed to reinforce the importance of timely care for medical emergencies and to assure the public that EDs are implementing infection prevention and control guidelines that help ensure the safety of their patients and health care personnel. |
Hospitalizations and deaths associated with EVALI
Werner AK , Koumans EH , Chatham-Stephens K , Salvatore PP , Armatas C , Byers P , Clark CR , Ghinai I , Holzbauer SM , Navarette KA , Danielson ML , Ellington S , Moritz ED , Petersen EE , Kiernan EA , Baldwin GT , Briss P , Jones CM , King BA , Krishnasamy V , Rose DA , Reagan-Steiner S . N Engl J Med 2020 382 (17) 1589-1598 BACKGROUND: As of January 7, 2020, a total of 2558 hospitalized patients with nonfatal cases and 60 patients with fatal cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) had been reported to the Centers for Disease Control and Prevention (CDC). METHODS: In a national study, we compared the characteristics of patients with fatal cases of EVALI with those of patients with nonfatal cases to improve the ability of clinicians to identify patients at increased risk for death from the condition. Health departments reported cases of EVALI to the CDC and included, when available, data from medical-record abstractions and patient interviews. Analyses included all the patients with fatal or nonfatal cases of EVALI that were reported to the CDC as of January 7, 2020. We also present three case reports of patients who died from EVALI to illustrate the clinical characteristics common among such patients. RESULTS: Most of the patients with fatal or nonfatal cases of EVALI were male (32 of 60 [53%] and 1666 of 2498 [67%], respectively). The proportion of patients with fatal or nonfatal cases was higher among those who were non-Hispanic white (39 of 49 [80%] and 1104 of 1818 [61%], respectively) than among those in other race or ethnic groups. The proportion of patients with fatal cases was higher among those 35 years of age or older (44 of 60 [73%]) than among those younger than 35 years, but the proportion with nonfatal cases was lower among those 35 years of age or older (551 of 2514 [22%]). Among the patients who had an available medical history, a higher proportion of those with fatal cases than those with nonfatal cases had a history of asthma (13 of 57 [23%] vs. 102 of 1297 [8%]), cardiac disease (26 of 55 [47%] vs. 115 of 1169 [10%]), or a mental health condition (32 of 49 [65%] vs. 575 of 1398 [41%]). A total of 26 of 50 patients (52%) with fatal cases had obesity. Half the patients with fatal cases (25 of 54 [46%]) were seen in an outpatient setting before hospitalization or death. CONCLUSIONS: Chronic conditions, including cardiac and respiratory diseases and mental health conditions, were common among hospitalized patients with EVALI. |
The EVALI and youth vaping epidemics - implications for public health
King BA , Jones CM , Baldwin GT , Briss PA . N Engl J Med 2020 382 (8) 689-691 Since entering the U.S. marketplace in 2007, e-cigarette, or vaping, products have evolved into a diverse class of inhaled aerosol devices. Earlier generations of these products were disposable, resembled conventional cigarettes in shape, and were designed to deliver nicotine to the user. Newer generations are rechargeable, don’t resemble conventional cigarettes, and can be used to deliver various substances, including nicotine and tetrahydrocannabinol (THC, the psychoactive ingredient in marijuana).1 The U.S. markets for both nicotine- and THC-containing vaping products have dramatically expanded. Recently, there has been an unprecedented increase in the use of nicotine-containing products by young people (see graph).2 Simultaneously, an increasing number of U.S. states have legalized marijuana use, a shift that coincided with changes in the public perception of risk, the availability of a wide variety of products containing THC or cannabidiol (CBD, a nonpsychoactive ingredient in marijuana), and increases in marijuana use among adults, especially young adults.3 |
Update: Characteristics of a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury - United States, August 2019-January 2020
Krishnasamy VP , Hallowell BD , Ko JY , Board A , Hartnett KP , Salvatore PP , Danielson M , Kite-Powell A , Twentyman E , Kim L , Cyrus A , Wallace M , Melstrom P , Haag B , King BA , Briss P , Jones CM , Pollack LA , Ellington S . MMWR Morb Mortal Wkly Rep 2020 69 (3) 90-94 Since August 2019, CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders have been investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). This report updates patient demographic characteristics, self-reported substance use, and hospitalization dates for EVALI patients reported to CDC by states, as well as the distribution of emergency department (ED) visits related to e-cigarette, or vaping, products analyzed through the National Syndromic Surveillance Program (NSSP). As of January 14, 2020, a total of 2,668 hospitalized EVALI cases had been reported to CDC. Median patient age was 24 years, and 66% were male. Overall, 82% of EVALI patients reported using any tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product (including 33% with exclusive THC-containing product use), and 57% of EVALI patients reported using any nicotine-containing product (including 14% with exclusive nicotine-containing product use). Syndromic surveillance indicates that ED visits related to e-cigarette, or vaping, products continue to decline after sharply increasing in August 2019 and peaking in September 2019. Clinicians and public health practitioners should remain vigilant for new EVALI cases. CDC recommends that persons not use THC-containing e-cigarette, or vaping, products, especially those acquired from informal sources such as friends, family members, or from in-person or online dealers. Vitamin E acetate is strongly linked to the EVALI outbreak and should not be added to any e-cigarette, or vaping, products (2). However, evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC- or non-THC-containing products, in some reported EVALI cases. |
Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI
Blount BC , Karwowski MP , Shields PG , Morel-Espinosa M , Valentin-Blasini L , Gardner M , Braselton M , Brosius CR , Caron KT , Chambers D , Corstvet J , Cowan E , De Jesus VR , Espinosa P , Fernandez C , Holder C , Kuklenyik Z , Kusovschi JD , Newman C , Reis GB , Rees J , Reese C , Silva L , Seyler T , Song MA , Sosnoff C , Spitzer CR , Tevis D , Wang L , Watson C , Wewers MD , Xia B , Heitkemper DT , Ghinai I , Layden J , Briss P , King BA , Delaney LJ , Jones CM , Baldwin GT , Patel A , Meaney-Delman D , Rose D , Krishnasamy V , Barr JR , Thomas J , Pirkle JL . N Engl J Med 2019 382 (8) 697-705 BACKGROUND: The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung. METHODS: BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes. RESULTS: State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%). CONCLUSIONS: Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. (Funded by the National Cancer Institute and others.). |
Update: Interim guidance for health care professionals evaluating and caring for patients with suspected e-cigarette, or vaping, product use-associated lung injury and for reducing the risk for rehospitalization and death following hospital discharge - United States, December 2019
Evans ME , Twentyman E , Click ES , Goodman AB , Weissman DN , Kiernan E , Hocevar SA , Mikosz CA , Danielson M , Anderson KN , Ellington S , Lozier MJ , Pollack LA , Rose DA , Krishnasamy V , Jones CM , Briss P , King BA , Wiltz JL . MMWR Morb Mortal Wkly Rep 2020 68 (5152) 1189-1194 What is already known on this topic? In a recent examination of rehospitalization and death among previously hospitalized patients with e-cigarette or vaping, product use–associated lung injury (EVALI), at least one quarter of rehospitalizations and deaths occurred within 2 days of discharge; comorbidities were common among patients who were rehospitalized or who died after discharge. What is added by this report? Updated guidance recommends posthospitalization outpatient follow-up, optimally within 48 hours of discharge, and emphasizes the importance of preparation for hospital discharge and postdischarge care coordination to reduce risk of rehospitalization and death among hospitalized EVALI patients. What are the implications for public health practice? Incorporating this updated guidance into the management of hospitalized EVALI patients might reduce EVALI-associated morbidity and mortality. © 2020 Department of Health and Human Services. All rights reserved. |
Syndromic surveillance for e-cigarette, or vaping, product use-associated lung injury
Hartnett KP , Kite-Powell A , Patel MT , Haag BL , Sheppard MJ , Dias TP , King BA , Melstrom PC , Ritchey MD , Stein Z , Idaikkadar N , Vivolo-Kantor AM , Rose DA , Briss PA , Layden JE , Rodgers L , Adjemian J . N Engl J Med 2019 382 (8) 766-772 On August 1, 2019, the first cases of electronic cigarette (e-cigarette), or vaping, product use–associated lung injury (EVALI) were reported to the Centers for Disease Control and Prevention (CDC).1 The cluster was an initial signal of an outbreak that by December 17, 2019, had resulted in 2506 cases involving hospitalized patients being reported to the CDC. Most patients with EVALI have been men and adolescent boys (67%), have been younger than 35 years of age (78%), and have reported using e-cigarette products containing tetrahydrocannabinol (THC) (80%).2 |
Update: Demographic, product, and substance-use characteristics of hospitalized patients in a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injuries - United States, December 2019
Lozier MJ , Wallace B , Anderson K , Ellington S , Jones CM , Rose D , Baldwin G , King BA , Briss P , Mikosz CA . MMWR Morb Mortal Wkly Rep 2019 68 (49) 1142-1148 What is already known about this topic? Patients with e-cigarette, or vaping, product use–associated lung injury (EVALI) in Illinois and Wisconsin reported using a variety of tetrahydrocannabinol (THC)-containing products in the 3 months preceding illness; a product labeled “Dank Vapes” was most commonly reported. What is added by this report? Nationally, Dank Vapes were the most commonly reported THC-containing product by hospitalized EVALI patients, but a wide variety of products were reported, with regional differences. Data suggest the outbreak might have peaked in mid-September. What are the implications for public health practice? These data further support the association of EVALI with THC-containing products; it is unlikely that one brand is responsible for the outbreak. CDC recommends that persons not use e-cigarette, or vaping, products that contain THC. © 2019 Department of Health and Human Services. All rights reserved. |
Characteristics of patients experiencing rehospitalization or death after hospital discharge in a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury - United States, 2019
Mikosz CA , Danielson M , Anderson KN , Pollack LA , Currie DW , Njai R , Evans ME , Goodman AB , Twentyman E , Wiltz JL , Rose DA , Krishnasamy V , King BA , Jones CM , Briss P , Lozier M , Ellington S . MMWR Morb Mortal Wkly Rep 2020 68 (5152) 1183-1188 Summary What is already known about this topic? Some patients hospitalized for e-cigarette, or vaping, product use–associated lung injury (EVALI) have been rehospitalized or have died after hospital discharge. What is added by this report? Compared with other EVALI patients, rehospitalized patients and patients who died after hospital discharge were more likely to have one or more chronic conditions, including cardiac disease, chronic pulmonary disease, and diabetes, and to be older. At least one quarter of rehospitalizations and deaths occurred within 2 days after discharge. What are the implications for public health practice? Intensive discharge planning, ensuring clinical stability before discharge, optimized case management, and follow-up optimally within 48 hours after hospital discharge might minimize EVALI patients’ risk for rehospitalization and death, especially among patients with chronic conditions. © 2020 Department of Health and Human Services. All rights reserved. |
Update: Interim guidance for health care providers for managing patients with suspected e-cigarette, or vaping, product use-associated lung injury - United States, November 2019
Jatlaoui TC , Wiltz JL , Kabbani S , Siegel DA , Koppaka R , Montandon M , Adkins SH , Weissman DN , Koumans EH , O'Hegarty M , O'Sullivan MC , Ritchey MD , Chatham-Stephens K , Kiernan EA , Layer M , Reagan-Steiner S , Legha JK , Shealy K , King BA , Jones CM , Baldwin GT , Rose DA , Delaney LJ , Briss P , Evans ME . MMWR Morb Mortal Wkly Rep 2019 68 (46) 1081-1086 CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). CDC has published recommendations for health care providers regarding EVALI (2-4). Recently, researchers from Utah and New York published proposed diagnosis and treatment algorithms for EVALI (5,6). EVALI remains a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis, and evaluation should be guided by clinical judgment. Because patients with EVALI can experience symptoms similar to those associated with influenza or other respiratory infections (e.g., fever, cough, headache, myalgias, or fatigue), it might be difficult to differentiate EVALI from influenza or community-acquired pneumonia on initial assessment; EVALI might also co-occur with respiratory infections. This report summarizes recommendations for health care providers managing patients with suspected or known EVALI when respiratory infections such as influenza are more prevalent in the community than they have been in recent months (7). Recommendations include 1) asking patients with respiratory, gastrointestinal, or constitutional symptoms about the use of e-cigarette, or vaping, products; 2) evaluating those suspected to have EVALI with pulse oximetry and obtaining chest imaging, as clinically indicated; 3) considering outpatient management for clinically stable EVALI patients who meet certain criteria; 4) testing patients for influenza, particularly during influenza season, and administering antimicrobials, including antivirals, in accordance with established guidelines; 5) using caution when considering prescribing corticosteroids for outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections; 6) recommending evidence-based treatment strategies, including behavioral counseling, to help patients discontinue using e-cigarette, or vaping, products; and 7) emphasizing the importance of annual influenza vaccination for all persons aged >/=6 months, including patients who use e-cigarette, or vaping products. |
Characteristics of hospitalized and nonhospitalized patients in a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury - United States, November 2019
Chatham-Stephens K , Roguski K , Jang Y , Cho P , Jatlaoui TC , Kabbani S , Glidden E , Ussery EN , Trivers KF , Evans ME , King BA , Rose DA , Jones CM , Baldwin G , Delaney LJ , Briss P , Ritchey MD . MMWR Morb Mortal Wkly Rep 2019 68 (46) 1076-1080 CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). As of November 13, 2019, 49 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands) have reported 2,172 EVALI cases to CDC, including 42 (1.9%) EVALI-associated deaths. To inform EVALI surveillance, including during the 2019-20 influenza season, case report information supplied by states for hospitalized and nonhospitalized patients with EVALI were analyzed using data collected as of November 5, 2019. Among 2,016 EVALI patients with available data on hospitalization status, 1,906 (95%) were hospitalized, and 110 (5%) were not hospitalized. Demographic characteristics of hospitalized and nonhospitalized patients were similar; most were male (68% of hospitalized versus 65% of nonhospitalized patients), and most were aged <35 years (78% of hospitalized versus 74% of nonhospitalized patients). These patients also reported similar use of tetrahydrocannabinol (THC)-containing products (83% of hospitalized versus 84% of nonhospitalized patients). Given the similarity between hospitalized and nonhospitalized EVALI patients, the potential for large numbers of respiratory infections during the emerging 2019-20 influenza season, and the potential difficulty in distinguishing EVALI from respiratory infections, CDC will no longer collect national data on nonhospitalized EVALI patients. Further collection of data on nonhospitalized patients will be at the discretion of individual state, local, and territorial health departments. Candidates for outpatient management of EVALI should have normal oxygen saturation (>/=95% while breathing room air), no respiratory distress, no comorbidities that might compromise pulmonary reserve, reliable access to care, strong social support systems, and should be able to ensure follow-up within 24-48 hours of initial evaluation and to seek medical care promptly if respiratory symptoms worsen. Health care providers should emphasize the importance of annual influenza vaccination for all persons aged >/=6 months, including persons who use e-cigarette, or vaping, products (2,3). |
Evaluation of bronchoalveolar lavage fluid from patients in an outbreak of e-cigarette, or vaping, product use-associated lung injury - 10 states, August-October 2019
Blount BC , Karwowski MP , Morel-Espinosa M , Rees J , Sosnoff C , Cowan E , Gardner M , Wang L , Valentin-Blasini L , Silva L , De Jesus VR , Kuklenyik Z , Watson C , Seyler T , Xia B , Chambers D , Briss P , King BA , Delaney L , Jones CM , Baldwin GT , Barr JR , Thomas J , Pirkle JL . MMWR Morb Mortal Wkly Rep 2019 68 (45) 1040-1041 CDC, the Food and Drug Administration (FDA), state and local health departments, and multiple public health and clinical partners are investigating a national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). Based on data collected as of October 15, 2019, 86% of 867 EVALI patients reported using tetrahydrocannabinol (THC)-containing products in the 3 months preceding symptom onset (1). Analyses of THC-containing product samples by FDA and state public health laboratories have identified potentially harmful constituents in these products, such as vitamin E acetate, medium chain triglyceride oil (MCT oil), and other lipids (2,3) (personal communication, D.T. Heitkemper, FDA Forensic Chemistry Center, November 2019). Vitamin E acetate, in particular, might be used as an additive in the production of e-cigarette, or vaping, products; it also can be used as a thickening agent in THC products (4). Inhalation of vitamin E acetate might impair lung function (5-7). |
Risk factors for e-cigarette, or vaping, product use-associated lung injury (EVALI) among adults who use e-cigarette, or vaping, products - Illinois, July-October 2019
Navon L , Jones CM , Ghinai I , King BA , Briss PA , Hacker KA , Layden JE . MMWR Morb Mortal Wkly Rep 2019 68 (45) 1034-1039 The United States is experiencing an unprecedented outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). All EVALI patients have used e-cigarette, or vaping, products, and most (>/=85%) have reported using products containing tetrahydrocannabinol (THC) (2,3), the principal psychoactive component of cannabis. To examine whether e-cigarette, or vaping, product use behaviors differed between adult EVALI patients and adults who use these products but have not developed lung injury, the Illinois Department of Public Health (IDPH) conducted an online public survey during September-October 2019 targeting e-cigarette, or vaping, product users in Illinois. Among 4,631 survey respondents, 94% reported using any nicotine-containing e-cigarette, or vaping, products in the past 3 months; 21% used any THC-containing products; and 11% used both THC-containing products and nicotine-containing products. Prevalence of THC-containing product use was highest among survey respondents aged 18-24 years (36%) and decreased with increasing age. E-cigarette, or vaping, product use behaviors of 66 EVALI patients aged 18-44 years who were interviewed as part of the ongoing outbreak investigation were compared with a subset of 519 survey respondents aged 18-44 years who reported use of THC-containing e-cigarette, or vaping, products. Compared with these survey respondents, EVALI patients had higher odds of reporting exclusive use of THC-containing products (adjusted odds ratio [aOR] = 2.0, 95% confidence interval [CI] = 1.1-3.6); frequent use (more than five times per day) of these products (aOR = 3.1, 95% CI = 1.6-6.0), and obtaining these products from informal sources, such as a dealer, off the street, or from a friend (aOR = 9.2, 95% CI = 2.2-39.4). The odds of using Dank Vapes, a class of largely counterfeit THC-containing products, was also higher among EVALI patients (aOR = 8.5, 95% CI = 3.8-19.0). These findings reinforce current recommendations not to use e-cigarette, or vaping, products that contain THC and not to use any e-cigarette, or vaping, products obtained from informal sources. In addition, because the specific compound or ingredient causing lung injury is not yet known, CDC continues to recommend that persons consider refraining from use of all e-cigarette, or vaping, products while the outbreak investigation continues (1). |
Update: Characteristics of patients in a national outbreak of e-cigarette, or vaping, product use-associated lung injuries - United States, October 2019
Moritz ED , Zapata LB , Lekiachvili A , Glidden E , Annor FB , Werner AK , Ussery EN , Hughes MM , Kimball A , DeSisto CL , Kenemer B , Shamout M , Garcia MC , Reagan-Steiner S , Petersen EE , Koumans EH , Ritchey MD , King BA , Jones CM , Briss PA , Delaney L , Patel A , Polen KD , Sives K , Meaney-Delman D , Chatham-Stephens K . MMWR Morb Mortal Wkly Rep 2019 68 (43) 985-989 CDC, the Food and Drug Administration, state and local health departments, and other public health and clinical stakeholders are investigating a national outbreak of electronic-cigarette (e-cigarette), or vaping, product use-associated lung injury (EVALI) (1). As of October 22, 2019, 49 states, the District of Columbia (DC), and the U.S. Virgin Islands have reported 1,604 cases of EVALI to CDC, including 34 (2.1%) EVALI-associated deaths in 24 states. Based on data collected as of October 15, 2019, this report updates data on patient characteristics and substances used in e-cigarette, or vaping, products (2) and describes characteristics of EVALI-associated deaths. The median age of EVALI patients who survived was 23 years, and the median age of EVALI patients who died was 45 years. Among 867 (54%) EVALI patients with available data on use of specific e-cigarette, or vaping, products in the 3 months preceding symptom onset, 86% reported any use of tetrahydrocannabinol (THC)-containing products, 64% reported any use of nicotine-containing products, and 52% reported use of both. Exclusive use of THC-containing products was reported by 34% of patients and exclusive use of nicotine-containing products by 11%, and for 2% of patients, no use of either THC- or nicotine-containing products was reported. Among 19 EVALI patients who died and for whom substance use data were available, 84% reported any use of THC-containing products, including 63% who reported exclusive use of THC-containing products; 37% reported any use of nicotine-containing products, including 16% who reported exclusive use of nicotine-containing products. To date, no single compound or ingredient used in e-cigarette, or vaping, products has emerged as the cause of EVALI, and there might be more than one cause. Because most patients reported using THC-containing products before symptom onset, CDC recommends that persons should not use e-cigarette, or vaping, products that contain THC. In addition, because the specific compound or ingredient causing lung injury is not yet known, and while the investigation continues, persons should consider refraining from the use of all e-cigarette, or vaping, products. |
Health systems approaches to preventing chronic disease: New partners, new tools, and new strategies
Michener JL , Briss P . Prev Chronic Dis 2019 16 E136 The shift from acute to chronic illness as the major source of premature death in the United States and recent developments in health care, such as payments based on results rather than volume alone, are driving fundamental changes in public health and health care. Chronic diseases account for the bulk of morbidity, mortality, and health care costs in the United States. Risk factors for chronic illness are multiple and interrelated; have roots in individuals, families, and communities; and require coordinated strategies across multiple levels and sectors for improvement. These issues are driving substantial change in how health care systems, public health, and other sectors are addressing the chronic disease epidemic. Evolving approaches include coordinating care for people with complex illness; extending the scope of health care systems to new settings; addressing health behaviors and social determinants of health in health care settings and in partnerships with community organizations; using social media to quickly test and disseminate health messages; providing financial incentives and feedback to motivate behavior; and building larger partnerships between public health, health care, and other sectors. Although there are no best practices yet, there are “better practices.” |
Characteristics of a multistate outbreak of lung injury associated with e-cigarette use, or vaping - United States, 2019
Perrine CG , Pickens CM , Boehmer TK , King BA , Jones CM , DeSisto CL , Duca LM , Lekiachvili A , Kenemer B , Shamout M , Landen MG , Lynfield R , Ghinai I , Heinzerling A , Lewis N , Pray IW , Tanz LJ , Patel A , Briss PA . MMWR Morb Mortal Wkly Rep 2019 68 (39) 860-864 Electronic cigarettes (e-cigarettes), also called vapes, e-hookas, vape pens, tank systems, mods, and electronic nicotine delivery systems (ENDS), are electronic devices that produce an aerosol by heating a liquid typically containing nicotine, flavorings, and other additives; users inhale this aerosol into their lungs (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis (1). Use of e-cigarettes is commonly called vaping. Lung injury associated with e-cigarette use, or vaping, has recently been reported in most states (2-4). CDC, the Food and Drug Administration (FDA), state and local health departments, and others are investigating this outbreak. This report provides data on patterns of the outbreak and characteristics of patients, including sex, age, and selected substances used in e-cigarette, or vaping, products reported to CDC as part of this ongoing multistate investigation. As of September 24, 2019, 46 state health departments and one territorial health department had reported 805 patients with cases of lung injury associated with use of e-cigarette, or vaping, products to CDC. Sixty-nine percent of patients were males, and the median age was 23 years (range = 13-72 years). To date, 12 deaths have been confirmed in 10 states. Among 514 patients with information on substances used in e-cigarettes, or vaping products, in the 30 days preceding symptom onset, 76.9% reported using THC-containing products, and 56.8% reported using nicotine-containing products; 36.0% reported exclusive use of THC-containing products, and 16.0% reported exclusive use of nicotine-containing products. The specific chemical exposure(s) causing the outbreak is currently unknown. While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, particularly those containing THC. CDC will continue to work in collaboration with FDA and state and local partners to investigate cases and advise and alert the public on the investigation as additional information becomes available. |
Severe pulmonary disease associated with electronic-cigarette-product use - interim guidance
Schier JG , Meiman JG , Layden J , Mikosz CA , VanFrank B , King BA , Salvatore PP , Weissman DN , Thomas J , Melstrom PC , Baldwin GT , Parker EM , Courtney-Long EA , Krishnasamy VP , Pickens CM , Evans ME , Tsay SV , Powell KM , Kiernan EA , Marynak KL , Adjemian J , Holton K , Armour BS , England LJ , Briss PA , Houry D , Hacker KA , Reagan-Steiner S , Zaki S , Meaney-Delman D . MMWR Morb Mortal Wkly Rep 2019 68 (36) 787-790 On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available. |
Health care industry insights: Why the use of preventive services is still low
Levine S , Malone E , Lekiachvili A , Briss P . Prev Chronic Dis 2019 16 E30 Chronic diseases are a tremendous burden to both patients and the health care system. In 2014, 60% of adult Americans had at least one chronic disease or condition, and 42% had multiple diseases (1). Chronic diseases, including heart disease, cancer, chronic lung disease, stroke, Alzheimer’s disease, diabetes, osteoarthritis, and chronic kidney disease, are the leading causes of poor health, long-term disability, and death in the United States (2,3). One-third of all deaths in this country are attributable to heart disease or stroke, and every year, more than 1.7 million people receive a diagnosis of cancer (2). During the past several decades, the prevalence of diabetes increased dramatically; in 2015 more than 29 million Americans had diabetes and another 86 million adults had prediabetes, increasing their chance of developing type 2 diabetes (3). Diabetes increases the risk of developing other chronic diseases, including heart disease, stroke, and hypertension, and is the leading cause of end-stage renal failure (4). |
Good practices for the design, analysis, and interpretation of observational studies on birth spacing and perinatal health outcomes
Hutcheon JA , Moskosky S , Ananth CV , Basso O , Briss PA , Ferre CD , Frederiksen BN , Harper S , Hernandez-Diaz S , Hirai AH , Kirby RS , Klebanoff MA , Lindberg L , Mumford SL , Nelson HD , Platt RW , Rossen LM , Stuebe AM , Thoma ME , Vladutiu CJ , Ahrens KA . Paediatr Perinat Epidemiol 2018 33 (1) O15-O24 BACKGROUND: Meta-analyses of observational studies have shown that women with a shorter interpregnancy interval (the time from delivery to start of a subsequent pregnancy) are more likely to experience adverse pregnancy outcomes, such as preterm delivery or small for gestational age birth, than women who space their births further apart. However, the studies used to inform these estimates have methodological shortcomings. METHODS: In this commentary, we summarise the discussions of an expert workgroup describing good practices for the design, analysis, and interpretation of observational studies of interpregnancy interval and adverse perinatal health outcomes. RESULTS: We argue that inferences drawn from research in this field will be improved by careful attention to elements such as: (a) refining the research question to clarify whether the goal is to estimate a causal effect vs describe patterns of association; (b) using directed acyclic graphs to represent potential causal networks and guide the analytic plan of studies seeking to estimate causal effects; (c) assessing how miscarriages and pregnancy terminations may have influenced interpregnancy interval classifications; (d) specifying how key factors such as previous pregnancy loss, pregnancy intention, and maternal socio-economic position will be considered; and (e) examining if the association between interpregnancy interval and perinatal outcome differs by factors such as maternal age. CONCLUSION: This commentary outlines the discussions of this recent expert workgroup, and describes several suggested principles for study design and analysis that could mitigate many potential sources of bias. |
Report of the Office of Population Affairs' expert work group meeting on short birth spacing and adverse pregnancy outcomes: Methodological quality of existing studies and future directions for research
Ahrens KA , Hutcheon JA , Ananth CV , Basso O , Briss PA , Ferre CD , Frederiksen BN , Harper S , Hernandez-Diaz S , Hirai AH , Kirby RS , Klebanoff MA , Lindberg L , Mumford SL , Nelson HD , Platt RW , Rossen LM , Stuebe AM , Thoma ME , Vladutiu CJ , Moskosky S . Paediatr Perinat Epidemiol 2018 33 (1) O5-O14 BACKGROUND: The World Health Organization (WHO) recommends that women wait at least 24 months after a livebirth before attempting a subsequent pregnancy to reduce the risk of adverse maternal, perinatal, and infant health outcomes. However, the applicability of the WHO recommendations for women in the United States is unclear, as breast feeding, nutrition, maternal age at first birth, and total fertility rate differs substantially between the United States and the low- and middle-resource countries upon which most of the evidence is based. METHODS: To inform guideline development for birth spacing specific to women in the United States, the Office of Population Affairs (OPA) convened an expert work group meeting in Washington, DC, on 14-15 September 2017 among reproductive, perinatal, paediatric, social, and public health epidemiologists; obstetrician-gynaecologists; biostatisticians; and experts in evidence synthesis related to women's health. RESULTS: Presentations and discussion topics included the methodological quality of existing studies, evaluation of the evidence for causal effects of short interpregnancy intervals on adverse perinatal and maternal health outcomes, good practices for future research, and identification of research gaps and priorities for future work. CONCLUSIONS: This report provides an overview of the presentations, discussions, and conclusions from the expert work group meeting. |
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