BACKGROUND: Efforts to increase opioid use disorder (OUD) treatment have focused on primary care. We assessed primary care physicians' preparedness to identify and treat individuals with OUD and barriers to increasing buprenorphine prescribing. METHODS: We conducted a cross-sectional survey from January-August 2020 which assessed perceptions of the opioid epidemic; comfort screening, diagnosing, and treating individuals with OUD with medications; and barriers to obtaining a buprenorphine waiver and prescribing buprenorphine in their practice. Primary care physicians were sampled from the American Medical Association Physician Master File (n = 1000) and contacted up to 3 times, twice by mail and once by e-mail. RESULTS: Overall, 173 physicians (adjusted response rate 27.3 %) responded. While most were somewhat or very comfortable screening (80.7 %) and diagnosing (79.3 %) OUD, fewer (36.9 %) were somewhat or very comfortable treating OUD with medications. One third of respondents were in a practice where they or a colleague were waivered and 10.7 % of respondents had a buprenorphine waiver. The most commonly cited barriers to both obtaining a waiver and prescribing buprenorphine included lack of access to addiction, behavioral health, or psychiatric co-management, lack of experience treating OUD, preference not to be inundated with requests for buprenorphine, and the buprenorphine training requirement. CONCLUSIONS: While most primary care physicians reported comfort screening and diagnosing OUD, fewer were comfortable treating OUD with medications such as buprenorphine and even fewer were waivered to do so. Addressing provider self-efficacy and willingness, and identifying effective, coordinated, and comprehensive models of care may increase OUD treatment with buprenorphine.

INTRODUCTION: Children at highest obesity risk include those from certain racial/ethnic groups, from low-income families, with disabilities, or living in high-risk communities. However, a 2013 review of the National Collaborative for Childhood Obesity Research Measures Registry identified few measures focused on children at highest obesity risk. The objective is to (1) identify individual and environmental measures of diet and physical activity added to the Measures Registry since 2013 used among high-risk populations or settings and (2) describe methods for their development, adaptation, or validation. METHODS: Investigators screened references in the Measures Registry from January 2013 to September 2017 (n=351) and abstracted information about individual and environmental measures developed for, adapted for, or applied to high-risk populations or settings, including measure type, study population, adaptation and validation methods, and psychometric properties. RESULTS: A total of 38 measures met inclusion criteria. Of these, 30 assessed individual dietary (n=25) or physical activity (n=13) behaviors, and 11 assessed the food (n=8) or physical activity (n=7) environment. Of those, 17 measures were developed for, 9 were applied to (i.e., developed in a general population and used without modification), and 12 were adapted (i.e., modified) for high-risk populations. Few measures were used in certain racial/ethnic groups (i.e., American Indian/Alaska Native, Hawaiian/Pacific Islander, and Asian), children with disabilities, and rural (versus urban) communities. CONCLUSIONS: Since 2013, a total of 38 measures were added to the Measures Registry that were used in high-risk populations. However, many of the previously identified gaps in population coverage remain. Rigorous, community-engaged methodologic research may help researchers better adapt and validate measures for high-risk populations.

CONTEXT: Hypertension is a common and costly risk factor for cardiovascular disease, but just over half of all adults with hypertension have their blood pressure controlled nationally. In Minneapolis-St Paul, Minnesota, the rate of hypertension control is approximately 70% despite a rate of hypertension control similar to the national average as recently as the first half of the 1990s. OBJECTIVE: The purposes of this study were to identify factors in Minneapolis-St Paul and state-level policies and programs in Minnesota that may have contributed to the more rapid increase in blood pressure control there than that in the rest of the nation and to identify factors that can potentially be replicated in other jurisdictions. DESIGN, SETTING, PARTICIPANTS: The study included analysis of trends in hypertension control since 1980 based on the Minnesota Heart Survey and the National Health and Nutrition Examination Survey, as well as interviews with health care and public health leaders in Minnesota. MAIN OUTCOME MEASURE: Prevalence of hypertension control. RESULTS: Probable contributing factors identified include a focus on collaborative and continuous quality improvement; a forum for setting statewide clinical guidelines and measures; the willing participation from the largest health systems, purchasers, and nonprofit health plans; and the use of widely accepted mechanisms for providing feedback to clinicians and reporting performance. The relatively high rate of insurance coverage and socioeconomic status may have contributed but do not fully explain the difference in hypertension control as compared with the rest of the United States. CONCLUSIONS: The experience in Minnesota demonstrates that it is possible to dramatically increase hypertension control at the population level, across health systems, and health plans in a relatively short period of time. Lessons learned may be helpful to informing local, state, and national efforts to improve hypertension control.

Adecade ago, we called for applying public health principles to the human immunodeficiency virus (HIV) epidemic in the United States.1 Over the past decade, U.S. health departments, community organizations, and health care providers have expanded HIV screening and targeted testing, and as a result a greater proportion of HIV-infected people are now aware of their infection2,3; the number of reported new diagnoses of HIV infection has decreased4,5; and people with HIV infection are living longer.6 We have more sensitive diagnostic tests; more effective medications and medications with better side-effect profiles; rigorous confirmation that treatment prevents the spread of HIV and improves the health of infected people; and documentation of the potential benefit of preexposure prophylaxis for some high-risk people.7-12 | Despite this progress, most people living with HIV infection in the United States are not receiving antiretroviral treatment (ART)3; notification of partners of infected people remains the exception rather than the norm; and several high-risk behaviors have become more common. Anal sex without a condom has become more common among gay and bisexual men13 and there appears to be an increased number of people sharing needles and other injection paraphernalia.14,15 The number of new infections has increased among younger gay and bisexual men, particularly black men. Although surveillance has improved, data-driven targeted interventions are not being rapidly and effectively implemented in most geographic areas. Much more progress is possible through further application of public health principles by public health departments and the health care system and, most important, through closer integration of health care and public health action.

OBJECTIVE: To examine associations of problem behaviors and victimization with nondiet soda intake among a national sample of 16,188 US high school students. METHODS: We used the 2009 national Youth Risk Behavior Survey. The outcome measure was daily nondiet soda intake. RESULTS: Smoking, having any sex partners, not always wearing a seat belt, being bullied/threatened/ injured on school property, and being physically hurt by their boyfriend/girlfriend were significantly associated with daily nondiet soda intake after adjustment for age, sex, race/ethnicity, and weight status. CONCLUSIONS: Our findings suggest a need to examine why nondiet soda intake is associated with these behaviors to understand potential mechanisms. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract).

High consumption of sugar-sweetened drinks has been associated with obesity and other adverse health consequences. This cross-sectional study examined the association of demographic characteristics, weight status, self-reported academic grades, and behavioral factors with sugar-sweetened soda intake among a nationally representative sample of US high school students. Analysis was based on the 2009 national Youth Risk Behavior Survey and included 16,188 students in grades 9 through 12. The main outcome measure was daily sugar-sweetened soda intake (eg, drank a can, bottle, or glass of soda [excluding diet soda] at least one time per day during the 7 days before the survey). Nationally, 29.2% of students reported drinking sugar-sweetened soda at least one time per day. Logistic regression analyses showed factors significantly associated with sugar-sweetened soda intake at least one time per day included male sex (adjusted odds ratio [OR]=1.47), Hispanic ethnicity (vs whites; OR=0.81), earning mostly B, C, and D/F grades (vs mostly As; OR=1.26, 1.66, and 2.19, respectively), eating vegetables fewer than three times per day (OR=0.72), trying to lose weight (OR=0.72), sleeping 8 hours (OR=1.18), watching television >2 hours/day (OR=1.71), playing video or computer games or using a computer for other than school work >2 hours/day (OR=1.53), being physically active at least 60 minutes/day on 5 days during the 7 days before the survey (OR=1.19), and current cigarette use (OR=2.01). The significant associations with poor self-reported academic grades, inadequate sleep, sedentary behaviors, and cigarette smoking suggest research should examine why soda consumption is associated with these behaviors to inform the design of future nutrition interventions.

BACKGROUND: Insufficient sleep among adolescents is common and has adverse health and behavior consequences. Understanding associations of physical activity and sedentary behaviors with sleep duration could shed light on ways to promote sufficient sleep. PURPOSE: The purpose of this study is to determine whether physical activity and sedentary behaviors are associated with sufficient sleep (8 or more hours of sleep on an average school night) among U.S. high school students. METHODS: Data were from the 2009 national Youth Risk Behavior Survey and are representative of 9th-12th-grade students nationally (n=14,782). Associations of physical activity and sedentary behaviors with sufficient sleep were determined using logistic regression models controlling for confounders. Data were analyzed in October 2010. RESULTS: Students who engaged in ≥60 minutes of physical activity daily during the 7 days before the survey had higher odds of sufficient sleep than those who did not engage in ≥60 minutes on any day. There was no association between the number of days students were vigorously active ≥20 minutes and sufficient sleep. Compared to their respective referent groups of 0 hours on an average school day, students who watched TV ≥4 hours/day had higher odds of sufficient sleep and students who played video or computer games or used a computer for something that was not school work ≥2 hours/day had lower odds of sufficient sleep. CONCLUSIONS: Daily physical activity for ≥60 minutes and limited computer use are associated with sufficient sleep among adolescents.

BACKGROUND: To monitor priority health risk behaviors and school health policies and practices, respectively, the Centers for Disease Control and Prevention (CDC) developed the Youth Risk Behavior Surveillance System (YRBSS) and the School Health Profiles (Profiles). CDC is often asked about the use and application of these survey data to improve adolescent and school health. The purpose of this article is to describe the importance and potential impact of Youth Risk Behavior Survey (YRBS) and Profiles data based on examples from participating sites. METHODS: The authors spoke with representatives from 25 state and 8 local agencies funded by CDC to learn how data from the YRBS, Profiles, and other data sources are used. The authors identified common themes in the responses and categorized the responses accordingly. RESULTS: Representatives indicated survey data are used to describe risk behaviors and school health policies and practices, inform professional development, plan and monitor programs, support health-related policies and legislation, seek funding, and garner support for future surveys. Examples presented highlight the range of possible uses of survey data. CONCLUSIONS: State and local agencies use YRBS and Profiles data in many ways to monitor and address issues related to adolescent and school health. Innovative uses of survey data are encouraged, although it is also crucial to continue the more fundamental uses of survey data. If the data are not disseminated, the current health needs of students may not be adequately addressed.

The objective of this study was to identify factors that may account for the disproportionately high prevalence of suicidal behaviors among Hispanic/Latina youth by examining whether associations of health risk behaviors with suicidal ideation and suicide attempts vary by race/ethnicity among female students. Data from the school-based 2007 national Youth Risk Behavior Survey were analyzed. Analyses were conducted among female students in grades 9 through 12 and included 21 risk behaviors related to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus; physical activity; obesity and weight control; and perceived health status. With the exception of physical activity behaviors and obesity, all risk behaviors examined were associated with suicidal ideation and suicide attempts. Associations of risk behaviors with suicidal ideation varied by race/ethnicity for 5 of 21 behaviors, and for 0 of 21 behaviors for suicide attempts. Stratified analyses provided little insight into factors that may account for the higher prevalence of suicidal behaviors among Hispanic/Latina female students. These results suggest that the increased risk of suicidal behaviors among Hispanic/Latina female students cannot be accounted for by differential associations with these selected risk behaviors. Other factors, such as family characteristics, acculturation, and the socio-cultural environment, should be examined in future research.

Self-rated health status (SRHS) reflects both objective information about physical and mental health and subjective interpretation of that information.1,2 Although SRHS may differ from physician ratings of health status, among adults, SRHS is a valuable predictor of health-care utilization1 and has been shown in numerous studies to predict subsequent morbidity and mortality, independent of known medical risk factors.3–5 | While the determinants and predictive value of SRHS among adults have been studied extensively, adolescent SRHS is not as well understood. Despite having much lower rates of chronic disease and disability, adolescents report only marginally better SRHS than adults.6 This discrepancy suggests that adolescent SRHS may be influenced by factors more salient to adolescents, such as health risk behavior participation,2 psychological well-being, and competence in areas such as school achievement, sports, and exercise.6–8 Patterns of health risk behaviors are often established during adolescence, extend into adulthood, and are precursors for health-care use, morbidity, and mortality among young people and adults.9,10 Adolescence is also a crucial period in the formation of health status ratings,7,10,11 which studies show remain moderately stable into young adulthood; for example, during a one- or four-year period, adolescents' initial SRHS was a stronger predictor of future SRHS than initial physical or mental health or changes in physical or mental health.12,13 Therefore, it is important to identify factors associated with adolescent SRHS, as they may have implications for current and future health-care utilization, morbidity, and mortality.

OBJECTIVE: To examine trends in perceived overweight among US adolescents, including trends in perceived overweight among overweight and nonoverweight adolescents overall and by sex and race/ethnicity. DESIGN: Trend analyses of serial cross-sectional data. SETTING: National Youth Risk Behavior Surveys conducted in 1999, 2001, 2003, 2005, and 2007. PARTICIPANTS: Nationally representative samples of US high school students in each survey year. MAIN OUTCOME MEASURES: All students with a body mass index at or higher than the 85th percentile were considered "overweight," while those with a body mass index lower than the 85th percentile were considered "nonoverweight." Students who perceived themselves as "slightly overweight" or "very overweight" were considered to perceive themselves as overweight. RESULTS: Among all students and among most subgroups, the prevalence of overweight increased from 1999 to 2007. The prevalence of perceived overweight did not change. Among nonoverweight students, the prevalence of perceived overweight decreased overall, among white males, and among white, black, and Hispanic females. Among overweight students, few trends in the prevalence of perceived overweight were detected; only among overweight black males did the prevalence of perceived overweight increase. CONCLUSIONS: Weight perception is an important predictor of diet and weight management behaviors. Decreases in the prevalence of perceived overweight among nonoverweight students have positive implications for reducing unhealthy weight control behaviors. Among overweight students, interventions are needed to increase their recognition of being overweight because those who do not perceive themselves as overweight are unlikely to engage in weight control practices.