Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 48 Records) |
Query Trace: Hacker K[original query] |
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Chronic disease mapping, an important strategy and tool for health promotion
Hacker K , Kaufmann R . Prev Chronic Dis 2024 21 E28 |
Racial and ethnic differences in social determinants of health and health-related social needs among adults - Behavioral Risk Factor Surveillance System, United States, 2022
Town M , Eke P , Zhao G , Thomas CW , Hsia J , Pierannunzi C , Hacker K . MMWR Morb Mortal Wkly Rep 2024 73 (9) 204-208 Social determinants of health (SDOH) are a broad array of social and contextual conditions where persons are born, live, learn, work, play, worship, and age that influence their physical and mental wellbeing and quality of life. Using 2022 Behavioral Risk Factor Surveillance System data, this study assessed measures of adverse SDOH and health-related social needs (HRSN) among U.S. adult populations. Measures included life satisfaction, social and emotional support, social isolation or loneliness, employment stability, food stability/security, housing stability/security, utility stability/security, transportation access, mental well-being, and health care access. Prevalence ratios were adjusted for age, sex, education, marital status, income, and self-rated health. Social isolation or loneliness (31.9%) and lack of social and emotional support (24.8%) were the most commonly reported measures, both of which were more prevalent among non-Hispanic (NH) American Indian or Alaska Native, NH Black or African American, NH Native Hawaiian or other Pacific Islander, NH multiracial, and Hispanic or Latino adults than among NH White adults. The majority of prevalence estimates for other adverse SDOH and HRSN were also higher across all other racial and ethnic groups (except for NH Asian) compared with NH White adults. SDOH and HRSN data can be used to monitor needed social and health resources in the U.S. population and help evaluate population-scale interventions. |
The burden of chronic disease
Hacker K . Mayo Clin Proc Innov Qual Outcomes 2024 8 (1) 112-119 Chronic diseases like diabetes, heart disease, stroke, and cancer have been and continue to be some of the major causes of worldwide morbidity and mortality. A transition between infectious and noncommunicable diseases occurred in the early 1900s as a result of improved public health and has persisted ever since. Now, as individuals live longer, the prevalence and cost of chronic disease continue to grow. The estimated cost of chronic disease is expected to reach $47 trillion worldwide by 2030. Individual lifestyle and behaviors and community factors play important roles in the development and management of chronic diseases. Many of these conditions (diabetes, heart disease, and respiratory diseases) are preventable, and their leading risk factors are physical inactivity, poor nutrition, tobacco use, and excessive alcohol. Unfortunately, the investment in prevention remains small compared with treatment, both from a lifestyle perspective and a social determinants of health perspective. Given the future trajectory of chronic disease, innovation in technology and pharmaceuticals with a concomitant investment in prevention will be required. Our future depends on it. |
Treatment of Mpox with suspected tecovirimat resistance in immunocompromised patient, United States, 2022
Contag CA , Mische L , Fong I , Karan A , Vaidya A , McCormick DW , Bower W , Hacker JK , Johnson K , SanJuan P , Crebbin L , Temmins C , Sahni H , Bogler Y , Cooper JD , Narasimhan S . Emerg Infect Dis 2023 29 (12) 2520-2523 Reports of tecovirimat-resistant mpox have emerged after widespread use of antiviral therapy during the 2022 mpox outbreak. Optimal management of patients with persistent infection with or without suspected resistance is yet to be established. We report a successfully treated case of severe mpox in California, USA, that had suspected tecovirimat resistance. |
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). |
Community spread of a human monkeypox virus variant with a tecovirimat resistance-associated mutation
Garrigues JM , Hemarajata P , Espinosa A , Hacker JK , Wynn NT , Smith TG , Gigante CM , Davidson W , Vega J , Edmondson H , Karan A , Marutani AN , Kim M , Terashita D , Balter SE , Hutson CL , Green NM . Antimicrob Agents Chemother 2023 67 (11) e0097223 Tecovirimat, also known as TPOXX or ST-246, is a drug available for the treatment of mpox. Tecovirimat targets the conserved orthopoxvirus VP37 protein (also known as F13) required for extracellular virus particle generation (1, 2). Multiple VP37 mutations associated with tecovirimat resistance have been reported within the current global mpox outbreak in immunocompromised individuals with advanced HIV infection (3 – 5). In many of these cases, resistance mutation heterogeneity was observed following tecovirimat exposure, suggesting resistance emerged under selective pressure during treatment. | To monitor circulating monkeypox virus (MPXV) within California, a genomic surveillance network was established whereby clinical and commercial laboratories provided positive specimens for whole-genome sequencing using an amplicon-based protocol and subsequent analysis (6 – 9). Through this surveillance, 11 mpox cases were identified in southern California with the same tecovirimat resistance-associated mutation (Table 1): a three-nucleotide deletion in the vaccinia virus Copenhagen F13L gene homolog (OPG057) resulting in asparagine removed from position 267 in the VP37 protein (VP37:N267del) (5) (https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/fda-mpox-response#therapeutics). VP37:N267del was the only tecovirimat resistance-associated mutation detected in identified specimens and had allele frequencies greater than 89% in all instances, suggesting infections may have occurred with predominantly mutant virus. Phenotypic testing in vitro (3 – 5) confirmed tecovirimat resistance in ten identified specimens with EC50 values ranging from 1.488 to 3.977 µM, corresponding to an 85- to 230-fold change compared to wild-type isolates. |
State insurance mandates and racial and ethnic inequities in assisted reproductive technology utilization
Korkidakis A , DeSantis CE , Kissin DM , Hacker MR , Koniares K , Yartel A , Adashi EY , Penzias AS . Fertil Steril 2023 121 (1) 54-62 OBJECTIVE: To examine whether the (1) scope of state-mandated insurance coverage for assisted reproductive technology (ART), and (2) proportion of the population eligible for this coverage, are associated with reductions in racial/ethnic inequities in ART utilization. DESIGN: National cross-sectional, ecologic study. SUBJECTS: We employed estimates from the U.S. Census Bureau of all women 20-44 years of age living in the U.S. in 2018. The number of women who initiated an ART cycle during that year that was reported to the U.S. Centers for Disease Control and Prevention (CDC) was obtained from the National ART Surveillance System (NASS). EXPOSURE: State mandates were classified by scope of required coverage for fertility services: Comprehensive, Limited, and No Mandate. MAIN OUTCOMES MEASURES: Race and ethnic-specific ART utilization rates, defined as number of women undergoing ≥1 ART cycles per 10,000 women, were the primary outcome. As state mandates do not apply to all insurance plans, Comprehensive Mandate utilization rates were recalculated using denominators corrected for the estimated proportions of populations eligible for coverage. RESULTS: Across all mandate categories, Non-Hispanic (NH) Asian and NH White populations had the highest ART utilization rates, whereas the lowest rates were among Hispanic, NH Black, and NH Other/Multiple Races populations. As compared to the NH Asian reference group, the NH Black population had smaller inequities in the Comprehensive Mandate group than the No Mandate group (Rate Ratio [RR 0.33 [0.28-0.38] versus RR 0.23 [0.22-0.24]). Using the Comprehensive Mandate group for each race/ethnicity as reference, the NH Black and NH Other/Multiple Races populations had the largest relative differences in utilization between the No Mandate and Comprehensive Mandate groups (RR 0.39 [0.37-0.41] and 0.33 [0.28-0.38], respectively). Within the Comprehensive Mandate group, the disparities in the Hispanic and NH Black populations moved towards the null after correcting for state-mandated insurance eligibility. CONCLUSIONS: Racial/ethnic inequities in ART utilization were reduced in states with comprehensive infertility coverage mandates. Inequities were further attenuated after correcting for mandate eligibility. Mandates alone, however, were not sufficient to eliminate disparities. These findings can inform future strategies aimed at improving ART access under a social justice framework. |
Fleaborne typhus-associated deaths - Los Angeles County, California, 2022
Alarcón J , Sanosyan A , Contreras ZA , Ngo VP , Carpenter A , Hacker JK , Probert WS , Terashita D , Balter S , Halai UA . MMWR Morb Mortal Wkly Rep 2023 72 (31) 838-843 Fleaborne typhus (also known as murine typhus), a widely distributed vectorborne zoonosis caused by Rickettsia typhi, is a moderately severe, but infrequently fatal illness; among patients who receive doxycycline, the case-fatality rate is <1%. Fleaborne typhus is a mandated reportable condition in California. Reported fleaborne typhus cases in Los Angeles County have been increasing since 2010, with the highest number (171) reported during 2022. During June-October 2022, Los Angeles County Department of Public Health learned of three fleaborne typhus-associated deaths. This report describes the clinical presentation, illness course, and methods used to diagnose fleaborne typhus in these three cases. Severe fleaborne typhus manifestations among these cases included hemophagocytic lymphohistiocytosis, a rare immune hyperactivation syndrome that can occur in the infection setting; myocarditis; and septic shock with disseminated intravascular coagulation. Increased health care provider and public health awareness of the prevalence and severity of fleaborne typhus and of the importance of early doxycycline therapy is essential for prevention and treatment efforts. |
Using the prevention impacts simulation model to estimate long-term impacts of multisector community partnerships' efforts to address social determinants of health
Honeycutt AA , Yarnoff B , Tayebali Z , Glasgow L , Hacker K . Prev Chronic Dis 2023 20 E62 Public health plays a key role in addressing social determinants of health (SDOH) through multisector community partnerships (MCPs), which contribute to community changes that promote healthy living; however, little is known about the longer-term impact of MCP-driven interventions. We used the Prevention Impacts Simulation Model (PRISM) in a rapid evaluation to better understand the implementation and potential impact of MCPs' SDOH initiatives. Results suggest that, if sustained, initiatives implemented by the 27 included MCPs may prevent 880 premature deaths and avert $125.7 million in medical costs over 20 years. As a validated model that estimates impact by using available implementation data, PRISM is a useful tool for evaluating SDOH initiatives. |
Key insights on multisector community partnerships from real-world efforts to address social determinants of health
Glasgow L , Clayton M , Honeycutt A , Bayer EM , Plescia M , Holtgrave PL , Hacker K . Eval Program Plann 2023 99 102298 PURPOSE: To better understand and inform how multisector community partnerships (MCPs) perform meaningful work to prevent chronic disease and advance health equity by addressing social determinants of health (SDOH). METHODS: We conducted a rapid retrospective evaluation of SDOH initiatives implemented within the past three years by 42 established MCPs across the United States. The mixed methods evaluation included document review and coding of available outcomes data, virtual discussions, and Prevention Impacts Simulation Model (PRISM) analysis. RESULTS: All 42 MCPs built community capacity for addressing SDOH through new or strengthened data systems, leveraged resources, or engaged residents, for example. Most MCPs (N = 38, 90%) reported contributions to community changes that promote healthy living. More than half of the MCPs (N = 22) reported health outcomes data for their SDOH initiatives, including improved health behaviors and clinical outcomes. Based on reach data provided by 27 MCPs, PRISM analysis results suggest that sustained initiatives could save over $633 million in productivity and medical costs cumulatively through 20 years. CONCLUSIONS: With sufficient technical assistance and funding resources, MCPs are a key component of the public health strategy to address SDOH. |
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. |
Changes in sales of e-cigarettes, cigarettes, and nicotine replacement therapy products before, during, and after the EVALI outbreak
Wang X , Kim Y , Trivers KF , Tynan MA , Shrestha SS , Emery S , Borowiecki M , Hacker K . Prev Chronic Dis 2022 19 E86 INTRODUCTION: In 2019, an outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) occurred in the US. We used Nielsen retail sales data to assess trends in sales of e-cigarettes, cigarettes, and nicotine replacement therapy (NRT) products before, during, and after the EVALI outbreak. METHODS: Monthly unit sales of e-cigarettes, cigarettes, and NRT products overall and by product type were assessed during January 2019 through June 2020 by using an interrupted time series model. Two time points were specified at the period ending July 13, 2019, and the period ending February 22, 2020, to partition before, during, and after the outbreak period. Sales trends by aggregated state-level EVALI case prevalence (low, medium, and high) were assessed to investigate interstate variations in changes of sales coinciding with the EVALI outbreak. RESULTS: Monthly e-cigarette sales increased 3.5% (P < .001) before the outbreak and decreased 3.1% (P < .001) during the outbreak, with no significant changes after the outbreak. Monthly cigarette sales increased 1.6% (P < .001) before the outbreak, decreased 1.8% (P < .001) during the outbreak, and increased 2.7% (P < .001) after the outbreak. NRT sales did not change significantly before or during the outbreak but decreased (2.8%, P = .01) after the outbreak. Sales trends by state-level EVALI case prevalence were similar to national-level sales trends. CONCLUSION: Cigarette and e-cigarette sales decreased during the EVALI outbreak, but no changes in overall NRT sales were observed until after the outbreak. Continued monitoring of tobacco sales data can provide insight into potential changes in use patterns and inform tobacco prevention and control efforts. |
Health departments' role in addressing social determinants of health in collaboration with multisector community partnerships
Emery KJ , Durocher B , Arena LC , Glasgow L , Bayer EM , Plescia M , Holtgrave PL , Hacker K . J Public Health Manag Pract 2023 29 (1) 51-55 Multisector community partnerships (MCPs) are key component of the public health strategy for addressing social determinants of health (SDOH) and promoting health equity. Governmental public health agencies are often members or leaders of MCPs, but few studies have examined the role of health departments in supporting MCPs' SDOH initiatives. We engaged 42 established MCPs in a rapid retrospective evaluation to better understand how MCPs' SDOH initiatives contribute to community changes that promote healthy living and improved health outcomes. As part of this work, we gained insights into how health departments support MCPs' SDOH initiatives, as well as opportunities for enhanced collaboration. Results indicate that health departments can support MCPs' SDOH initiatives through the provision of funding and technical assistance, data sharing, and connecting community organizations with shared missions, for example. Findings can be used to inform the development of funding opportunities and technical assistance for MCPs and health department partners. |
Getting further faster: Illuminating opportunities for health departments to support community-driven social determinants of health interventions
Hacker K , Glasgow L , Bayer EM , Holtgrave P . J Public Health Manag Pract 2023 29 (1) 105-107 Since 1980, the Healthy People initiative has developed measurable 10-year objectives to guide and evaluate our nation's efforts to improve the health and well-being of all people. Healthy People 2030 includes an overarching goal that focuses on social determinants of health (SDOH): “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”1 As we recover from an unprecedented pandemic, we have an opportunity to leverage recent investments in the US public health system to advance this national SDOH goal. Multisector community partnerships (MCPs) are a key component of the public health approach to addressing SDOH and promoting health equity.2 In 2020, the Centers for Disease Control and Prevention's (CDC's) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), National Association of County and City Health Officials (NACCHO), and Association of State and Territorial Health Officials (ASTHO) launched the Improving SDOH—Getting Further Faster (GFF) initiative, partnering with 42 established MCPs and RTI International to rapidly generate practice-based evidence that could inform and strengthen future community-driven SDOH interventions.3 GFF focuses on 5 SDOH domains with links to chronic disease: (1) built environment, (2) community-clinical linkages, (3) food and nutrition security, (4) social connectedness, and (5) tobacco-free policies. This column provides a progress update on the GFF initiative, including a brief description of ongoing work to illuminate opportunities for health departments and health care systems to support community-driven SDOH interventions. |
Five priority public health actions to reduce chronic disease through improved nutrition and physical activity
O'Toole TP , Blanck HM , Flores-Ayala R , Rose K , Galuska DA , Gunn J , O'Connor A , Petersen R , Hacker K . Health Promot Pract 2022 23 5s-11s Welcome to this supplemental issue of Health Promotion Practice (HPP), “Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field” (https://journals.sagepub.com/toc/hppa/23/1_suppl), which is entirely devoted to practice-based wisdom from the field of nutrition, physical activity, and obesity programs. The specific aims of this supplement are to advance public health research and practice by showcasing innovative community-centered interventions, implementation, adaptations, and evaluations employed by the Centers for Disease Control and Prevention (CDC), Division of Nutrition, Physical Activity, and Obesity (DNPAO) (www.cdc.gov/nccdphpd/dnpao/index.html) cooperative agreement recipients: State Physical Activity and Nutrition Program (SPAN, DP18-1807) (www.cdc.gov/nccdphp/dnpao/state-local-programs/span-1807/index.html), Racial and Ethnic Approaches to Community Health (REACH, DP18-1813) (www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm), and the High Obesity Programs (HOP, DP18-1809) (www.cdc.gov/nccdphp/dnpao/state-local-programs/hop-1809/high-obesity-program-1809.html). |
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 |
Social determinants of health-an approach taken at CDC
Hacker K , Auerbach J , Ikeda R , Philip C , Houry D . J Public Health Manag Pract 2022 28 (6) 589-594 In the last decade, there has been an increasing awareness of the importance of addressing the social determinants of health (SDOH), the nonmedical conditions that influence health outcomes,1 as a systemic strategy for improving health, particularly among groups that are disproportionally affected by SDOH.2 While health care is important, it is estimated that these conditions, ranging from structural racism to socioeconomic factors, drive as much as 50% of health outcomes.3 |
Exploring and mitigating plague for One Health purposes
Eads DA , Biggins DE , Wimsatt J , Eisen RJ , Hinnebusch BJ , Matchett MR , Goldberg AR , Livieri TM , Hacker GM , Novak MG , Buttke DE , Grassel SM , Hughes JP , Atiku LA . Curr Trop Med Rep 2022 9 (4) 169-184 Purpose of Review: In 2020, the Appropriations Committee for the U.S. House of Representatives directed the CDC to develop a national One Health framework to combat zoonotic diseases, including sylvatic plague, which is caused by the flea-borne bacterium Yersinia pestis. This review builds upon that multisectoral objective. We aim to increase awareness of Y. pestis and to highlight examples of plague mitigation for One Health purposes (i.e., to achieve optimal health outcomes for people, animals, plants, and their shared environment). We draw primarily upon examples from the USA, but also discuss research from Madagascar and Uganda where relevant, as Y. pestis has emerged as a zoonotic threat in those foci. Recent Findings: Historically, the bulk of plague research has been directed at the disease in humans. This is not surprising, given that Y. pestis is a scourge of human history. Nevertheless, the ecology of Y. pestis is inextricably linked to other mammals and fleas under natural conditions. Accumulating evidence demonstrates Y. pestis is an unrelenting threat to multiple ecosystems, where the bacterium is capable of significantly reducing native species abundance and diversity while altering competitive and trophic relationships, food web connections, and nutrient cycles. In doing so, Y. pestis transforms ecosystems, causing “shifting baselines syndrome” in humans, where there is a gradual shift in the accepted norms for the condition of the natural environment. Eradication of Y. pestis in nature is difficult to impossible, but effective mitigation is achievable; we discuss flea vector control and One Health implications in this context. Summary: There is an acute need to rapidly expand research on Y. pestis, across multiple host and flea species and varied ecosystems of the Western US and abroad, for human and environmental health purposes. The fate of many wildlife species hangs in the balance, and the implications for humans are profound in some regions. Collaborative multisectoral research is needed to define the scope of the problem in each epidemiological context and to identify, refine, and implement appropriate and effective mitigation practices. © 2022, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply. |
A forty-year review of Rocky Mountain spotted fever cases in California shows clinical and epidemiologic changes
Kjemtrup AM , Padgett K , Paddock CD , Messenger S , Hacker JK , Feiszli T , Melgar M , Metzger ME , Hu R , Kramer VL . PLoS Negl Trop Dis 2022 16 (9) e0010738 Rocky Mountain spotted fever (RMSF) is a life-threatening tick-borne disease documented in North, Central, and South America. In California, RMSF is rare; nonetheless, recent fatal cases highlight ecological cycles of the two genera of ticks, Dermacentor and Rhipicephalus, known to transmit the disease. These ticks occur in completely different habitats (sylvatic and peridomestic, respectively) resulting in different exposure risks for humans. This study summarizes the demographic, exposure, and clinical aspects associated with the last 40 years of reported RMSF cases to the California Department of Public Health (CDPH). Seventy-eight RMSF cases with onsets from 1980 to 2019 were reviewed. The incidence of RMSF has risen in the last 20 years from 0.04 cases per million to 0.07 cases per million (a two-fold increase in reports), though the percentage of cases that were confirmed dropped significantly from 72% to 25% of all reported cases. Notably, Hispanic/Latino populations saw the greatest rise in incidence. Cases of RMSF in California result from autochthonous and out-of-state exposures. During the last 20 years, more cases reported exposure in Southern California or Mexico than in the previous 20 years. The driver of these epidemiologic changes is likely the establishment and expansion of Rhipicephalus sanguineus sensu lato ticks in Southern California and on-going outbreaks of RMSF in northern Mexico. Analysis of available electronically reported clinical data from 2011 to 2019 showed that 57% of reported cases presented with serious illness requiring hospitalization with a 7% mortality. The difficulty in recognizing RMSF is due to a non-specific clinical presentation; however, querying patients on the potential of tick exposure in both sylvatic and peridomestic environments may facilitate appropriate testing and treatment. |
Social Needs and Social Determinants: The Role of the Centers for Disease Control and Prevention and Public Health.
Hacker K , Houry D . Public Health Rep 2022 137 (6) 333549221120244 The COVID-19 pandemic has been a long and tragic public health crisis. More than 1 million people have died in the United States. Some segments of our population, including those who are African American, Hispanic, American Indian/Alaska Native, and living in low socioeconomic areas, have borne a disproportionate burden of morbidity and mortality. 1 Preexisting health disparities have been exacerbated as people delayed care, deferred prevention, and isolated at home. |
Impact of Age and Symptom Development on SARS-CoV-2 Transmission in Households With Children-Maryland, New York, and Utah, August 2020-October 2021.
Sumner KM , Karron RA , Stockwell MS , Dawood FS , Stanford JB , Mellis A , Hacker E , Thind P , Castro MJE , Harris JP , Deloria Knoll M , Schappell E , Hetrich MK , Duque J , Jeddy Z , Altunkaynak K , Poe B , Meece J , Stefanski E , Tong S , Lee JS , Dixon A , Veguilla V , Rolfes MA , Porucznik CA . Open Forum Infect Dis 2022 9 (8) ofac390 BACKGROUND: Households are common places for spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We investigated factors associated with household transmission and acquisition of SARS-CoV-2. METHODS: Households with children age <18 years were enrolled into prospective, longitudinal cohorts and followed from August 2020 to August 2021 in Utah, September 2020 to August 2021 in New York City, and November 2020 to October 2021 in Maryland. Participants self-collected nasal swabs weekly and with onset of acute illness. Swabs were tested for SARS-CoV-2 using reverse transcription polymerase chain reaction. We assessed factors associated with SARS-CoV-2 acquisition using a multilevel logistic regression adjusted for household size and clustering and SARS-CoV-2 transmission using a logistic regression adjusted for household size. RESULTS: Among 2053 people (513 households) enrolled, 180 people (8.8%; in 76 households) tested positive for SARS-CoV-2. Compared with children age <12 years, the odds of acquiring infection were lower for adults age ≥18 years (adjusted odds ratio [aOR], 0.34; 95% CI, 0.14-0.87); however, this may reflect vaccination status, which protected against SARS-CoV-2 acquisition (aOR, 0.17; 95% CI, 0.03-0.91). The odds of onward transmission were similar between symptomatic and asymptomatic primary cases (aOR, 1.00; 95% CI, 0.35-2.93) and did not differ by age (12-17 years vs <12 years: aOR, 1.08; 95% CI, 0.20-5.62; ≥18 years vs <12 years: aOR, 1.70; 95% CI, 0.52-5.83). CONCLUSIONS: Adults had lower odds of acquiring SARS-CoV-2 compared with children, but this association might be influenced by coronavirus disease 2019 (COVID-19) vaccination, which was primarily available for adults and protective against infection. In contrast, all ages, regardless of symptoms and COVID-19 vaccination, had similar odds of transmitting SARS-CoV-2. Our findings underscore the importance of SARS-CoV-2 mitigation measures for persons of all ages. |
Modifiable risk factors for Alzheimer disease and related dementias among adults aged 45 years - United States, 2019
Omura JD , McGuire LC , Patel R , Baumgart M , Lamb R , Jeffers EM , Olivari BS , Croft JB , Thomas CW , Hacker K . MMWR Morb Mortal Wkly Rep 2022 71 (20) 680-685 Alzheimer disease,* the most common cause of dementia, affects an estimated 6.5 million persons aged ≥65 years in the United States (1). A growing body of evidence has identified potential modifiable risk factors for Alzheimer disease and related dementias (ADRD) (1-3). In 2021, the National Plan to Address Alzheimer's Disease (National Plan) introduced a new goal to "accelerate action to promote healthy aging and reduce risk factors for Alzheimer's disease and related dementias" to help delay onset or slow the progression of ADRD (3). To assess the status of eight potential modifiable risk factors (i.e., high blood pressure, not meeting the aerobic physical activity guideline, obesity, diabetes, depression, current cigarette smoking, hearing loss, and binge drinking), investigators analyzed data from the cognitive decline module that was administered to adults aged ≥45 years in 31 states and the District of Columbia (DC)(†) in the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Among the risk factors, prevalence was highest for high blood pressure (49.9%) and lowest for binge drinking (10.3%) and varied by selected demographic characteristics. Adults with subjective cognitive decline (SCD),(§) an early indicator of possible future ADRD (4), were more likely to report four or more risk factors than were those without SCD (34.3% versus 13.1%). Prevalence of SCD was 11.3% overall and increased from 3.9% among adults with no risk factors to 25.0% among those with four or more risk factors. Implementing evidence-based strategies to address modifiable risk factors can help achieve the National Plan's new goal to reduce risk for ADRD while promoting health aging.(¶)(,)*. |
Provider perceptions of medication for opioid used disorder (MOUD): A qualitative study in communities with high opioid overdose death rates
Paul N , Kennedy AJ , Taubenberger S , Chang JC , Hacker K . Subst Abus 2022 43 (1) 742-748 BACKGROUND: Medication for Opioid Use Disorder (MOUD) has been shown to be a safe, cost-effective intervention that successfully lowers risk of opioid overdose. However, access to and use of MOUD has been limited. Our objective was to explore attitudes, opinions, and beliefs regarding MOUD among healthcare and social service providers in a community highly impacted by the opioid overdose epidemic. METHODS: As part of a larger ethnographic study examining neighborhoods in Allegheny County, PA, with the highest opioid overdose death rates, semi-structured qualitative in-person and telephone interviews were conducted with forty-five providers treating persons with opioid use disorders in these communities. An open coding approach was used to code interview transcripts followed by thematic analysis. RESULTS: Three major themes were identified related to MOUD from the perspectives of our provider participants. Within a variety of health and substance use service roles and settings, provider reflections revealed: (1) different opinions about MOUD as a transition to abstinence or as a long-term treatment; (2) perceived lack of uniformity and dissemination of accurate information of MOUD care, permitting differences in care, and (3) observed barriers to entry and navigation of MOUD, including referrals as a "word-of-mouth insider system" and challenges of getting patients MOUD services when they need it. CONCLUSIONS: Even in communities hard hit by the opioid overdose epidemic, healthcare providers' disagreement about the standard of care for MOUD can be a relevant obstacle. These insights can inform efforts to improve MOUD treatment and access for people with opioid use disorders. |
Change in self-reported health: A signal for early intervention in a Medicare population
Antol DD , Hagan A , Nguyen H , Li Y , Haugh GS , Radmacher M , Greenlund KJ , Thomas CW , Renda A , Hacker K , Shrank WH . Healthc (Amst) 2021 10 (1) 100610 BACKGROUND: Health plans and risk-bearing provider organizations seek information sources to inform proactive interventions for patients at risk of adverse health events. Interventions should take into account the strong relationship between social context and health. This retrospective cohort study of a Medicare Advantage population examined whether a change in self-reported health-related quality of life (HRQOL) signals a subsequent change in healthcare needs. METHODS: A retrospective longitudinal analysis of administrative claims data was conducted for participants in a Medicare Advantage plan with prescription drug coverage (MAPD) who responded to 2 administrations of the Centers for Disease Control and Prevention 4-item Healthy Days survey within 6-18 months during 2015-2018. Changes in HRQOL, as measured by the Healthy Days instrument, were compared with changes in utilization and costs, which were considered to be a reflection of change in healthcare needs. RESULTS: A total of 48,841 individuals met inclusion criteria. Declining HRQOL was followed by increases in utilization and costs. An adjusted analysis showed that every additional unhealthy day reported one year after baseline was accompanied by an $8 increase in monthly healthcare costs in the subsequent six months for the average patient. CONCLUSIONS: Declining HRQOL signaled subsequent increases in healthcare needs and utilization. IMPLICATIONS: Findings suggest that HRQOL assessments in general, and the Healthy Days instrument in particular, could serve as a leading indicator of the need for interventions designed to mitigate poor health outcomes and rising healthcare costs. LEVEL OF EVIDENCE: III. |
Incidence Rates, Household Infection Risk, and Clinical Characteristics of SARS-CoV-2 Infection Among Children and Adults in Utah and New York City, New York.
Dawood FS , Porucznik CA , Veguilla V , Stanford JB , Duque J , Rolfes MA , Dixon A , Thind P , Hacker E , Castro MJE , Jeddy Z , Daugherty M , Altunkaynak K , Hunt DR , Kattel U , Meece J , Stockwell MS . JAMA Pediatr 2021 176 (1) 59-67 IMPORTANCE: Data about the risk of SARS-CoV-2 infection among children compared with adults are needed to inform COVID-19 risk communication and prevention strategies, including COVID-19 vaccination policies for children. OBJECTIVE: To compare incidence rates and clinical characteristics of SARS-CoV-2 infection among adults and children and estimated household infection risks within a prospective household cohort. DESIGN, SETTING, AND PARTICIPANTS: Households with at least 1 child aged 0 to 17 years in selected counties in Utah and New York City, New York, were eligible for enrollment. From September 2020 through April 2021, participants self-collected midturbinate nasal swabs for reverse transcription-polymerase chain reaction testing for SARS-CoV-2 and responded to symptom questionnaires each week. Participants also self-collected additional respiratory specimens with onset of COVID-19-like illness. For children unable to self-collect respiratory specimens, an adult caregiver collected the specimens. MAIN OUTCOMES AND MEASURES: The primary outcome was incident cases of any SARS-CoV-2 infection, including asymptomatic and symptomatic infections. Additional measures were the asymptomatic fraction of infection calculated by dividing incidence rates of asymptomatic infection by rates of any infection, clinical characteristics of infection, and household infection risks. Primary outcomes were compared by participant age group. RESULTS: A total of 1236 participants in 310 households participated in surveillance, including 176 participants (14%) who were aged 0 to 4 years, 313 (25%) aged 5 to 11 years, 163 (13%) aged 12 to 17 years, and 584 (47%) 18 years or older. Overall incidence rates of SARS-CoV-2 infection were 3.8 (95% CI, 2.4-5.9) and 7.7 (95% CI, 4.1-14.5) per 1000 person-weeks among the Utah and New York City cohorts, respectively. Site-adjusted incidence rates per 1000 person-weeks were similar by age group: 6.3 (95% CI, 3.6-11.0) for children 0 to 4 years, 4.4 (95% CI, 2.5-7.5) for children 5 to 11 years, 6.0 (95% CI, 3.0-11.7) for children 12 to 17 years, and 5.1 (95% CI, 3.3-7.8) for adults (≥18 years). The asymptomatic fractions of infection by age group were 52%, 50%, 45%, and 12% among individuals aged 0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 years or older, respectively. Among 40 households with 1 or more SARS-CoV-2 infections, the mean risk of SARS-CoV-2 infection among all enrolled household members was 52% (range, 11%-100%), with higher risks in New York City compared with Utah (80% [95% CI, 64%-91%] vs 44% [95% CI, 36%-53%]; P < .001). CONCLUSIONS AND RELEVANCE: In this study, children had similar incidence rates of SARS-CoV-2 infection compared with adults, but a larger proportion of infections among children were asymptomatic. |
Setting the stage for reimbursable pediatric healthy weight programs
Blanck HM , Hacker K , Petersen R . Child Obes 2021 17 S1-s2 Childhood obesity is putting America's children at risk for poor health during childhood and into adulthood. Having obesity has been found to increase the hospitalization risk of COVID-19 for children 18 years or younger. Among hospitalized patients aged 12 to 18 years, obesity is a risk factor for severe COVID-19 illness.1 Obesity in the United States disproportionately impacts children from low-income households and racial and ethnic minority groups.2 Although early prevention is key, we cannot turn our backs on the one in five US children who already have obesity. |
Public Health Approaches to Social Determinants of Health: Getting Further Faster
Hacker KA , Alleyne EO , Plescia M . J Public Health Manag Pract 2021 27 (5) 526-528 In the wake of the significant health disparities in communities of color highlighted during the COVID-19 pandemic, a national commitment to address long-standing systemic health and social inequities has emerged. Addressing the underlying causes of poor health outcomes and inequity including poverty, education, housing, and access to affordable, quality health care can drive meaningful change. These social determinants of health (SDoH) are critical factors that can limit or enhance our opportunities to lead healthy lives. |
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). |
Tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product use behaviors among adults after the onset of the 2019 outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI)
Trivers KF , Watson CV , Neff LJ , Jones CM , Hacker K . Addict Behav 2021 121 106990 INTRODUCTION: During the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) outbreak, patient data on tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product (EVP) use was collected, but data on non-affected adult product use after the onset of the EVALI outbreak is limited. This study describes adult THC-EVP use after EVALI began. METHODS: THC-EVP use data came from an 18-state web-based panel survey of adult THC- and nicotine-containing EVP users conducted February 2020. Unweighted descriptive statistics were calculated; logistic regression assessed correlates of use. RESULTS: Among 3,980 THC-EVP users, 23.5% used THC-EVPs daily. Common brands of THC-EVPs used were Dank Vapes (47.7%) and Golden Gorilla (38.7%). Reported substances used included THC oils (69.6%), marijuana herb (63.6%) and THC concentrate (46.4%). Access sources included: recreational dispensaries (41.1%), friend/family member (38.6%) and illicit dealers (15.1%). Respondents aged 45-64 years had lower odds for daily use compared with those aged 25-34 years (aOR = 0.73; 95% CI = 0.60, 0.90). Compared with White respondents, Asian respondents had lower odds (aOR = 0.55; 95% CI = 0.36, 0.84) and Black respondents higher odds (aOR = 1.48; 95% CI = 1.17, 1.86) of daily use. Respondents odds of daily use and accessing THC-EVPs through commercial sources were higher among states with legalized nonmedical adult marijuana use compared to states without. CONCLUSIONS: Almost half of respondents reported daily or weekly THC-EVP use, and accessed products through both informal and formal sources, even after EVALI began. Given the potential for future EVALI-like conditions to occur, it is important to monitor the use of THC-EVPs and ensure effective education activities about associated risk. |
Characteristics of e-Cigarette Use Behaviors Among US Youth, 2020
Wang TW , Gentzke AS , Neff LJ , Glidden EV , Jamal A , Park-Lee E , Ren C , Cullen KA , King BA , Hacker KA . JAMA Netw Open 2021 4 (6) e2111336 IMPORTANCE: Comprehensive surveillance of e-cigarette use behaviors among youth is important for informing strategies to address this public health epidemic. OBJECTIVE: To characterize e-cigarette use behaviors among US youth in 2020. DESIGN, SETTING, AND PARTICIPANTS: The 2020 National Youth Tobacco Survey, a nationally representative, cross-sectional, school-based survey of middle school (grades 6-8) and high school (grades 9-12) students, was conducted from January 16, 2020, to March 16, 2020. A total of 14 531 students from 180 schools participated in the 2020 survey, yielding a corresponding student-level participation rate of 87.4% and school-level participation rate of 49.9%. The overall response rate, a product of the school-level and student-level participation rates, was 43.6%. EXPOSURES: Current (past 30-day) e-cigarette use. MAIN OUTCOMES AND MEASURES: Self-reported current e-cigarette use behaviors (frequency of use, usual e-cigarette brand, and access source) by school level and flavored e-cigarette use and flavor types among current e-cigarette users by school level and device type. Prevalence estimates were weighted to account for the complex survey design. RESULTS: Overall, 14 531 students completed the survey, including 7330 female students and 7133 male students with self-reported grade level and sex. In 2020, 19.6% (95% CI, 17.2%-22.2%) of high school students and 4.7% (95% CI, 3.6%-6.0%) of middle school students reported current e-cigarette use. Among them, 38.9% (95% CI, 35.2%-42.6%) of high school users and 20.0% (95% CI, 16.0%-24.8%) of middle school users reported e-cigarette use on 20 to 30 days within the past 30 days. Among current users, JUUL was the most commonly reported usual brand (high school: 25.4%; 95% CI, 18.8%-33.4%; middle school: 35.1%; 95% CI, 27.9%-43.1%). Among current users, the most common source of obtaining e-cigarettes was from a friend (high school: 57.1%; 95% CI, 52.6%-61.4%; middle school: 58.9%; 95% CI, 51.4%-66.1%). Among current users, 84.7% (95% CI, 82.2%-86.9%) of high school students and 73.9% (95% CI, 66.9%-79.8%) of middle school students reported flavored e-cigarette use. Fruit-flavored e-cigarettes were the most commonly reported flavor among current exclusive e-cigarette users of prefilled pods or cartridges (67.3%; 95% CI, 60.9%-73.0%), disposable e-cigarettes (85.8%; 95% CI, 79.8%-90.3%), and tank-based devices (82.7%; 95% CI, 68.9%-91.1%), followed by mint-flavored e-cigarettes. CONCLUSIONS AND RELEVANCE: These results suggest that although current e-cigarette use decreased during 2019 to 2020, overall prevalence, frequent use, and flavored e-cigarette use remained high. Continued actions are warranted to prevent and reduce e-cigarette use among US youth. |
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