BACKGROUND: The prevalence of cardiometabolic risk factors may vary by disaggregated race and ethnicity categories, and by acculturation-related factors. We evaluated the association between nativity and length of US residence, and prevalence of diabetes, hypertension, and hypercholesterolemia by select disaggregated race and ethnicity groups. METHODS: We conducted a pooled cross-sectional study of 218 158 US adults from the Medical Expenditure Panel Survey (2013-2022). Nativity (US born, non-US born) and length of US residence (>/=15 years or <15 years) were used as select proxies for acculturation. Self-reported cardiometabolic risk factors included diabetes, hypertension, and hypercholesterolemia. RESULTS: Results showed substantial heterogeneity among both aggregated and disaggregated racial and ethnic groups. Nativity (US born versus non-US born) was significantly associated with increased hypertension prevalence among Hispanic adults (odds ratio [OR], 1.26 [95% CI, 1.15-1.39]), whereas among detailed categories the OR varied from 0.68 (95% CI, 0.51-0.93) among Puerto Rican adults to 1.34 (95% CI, 1.18-1.52) among Mexican adults. For the association between length of US residence and hypercholesterolemia, the OR for all Non-Hispanic Asian adults was 1.18 (95% CI, 0.92-1.51), whereas results varied in detailed categories from 1.00 (95% CI, 0.64-1.57) among Indian adults to 1.69 (95% CI, 1.08-2.64) among Chinese adults. CONCLUSION: The association between US nativity or length of US residence and cardiometabolic risk factors varies by disaggregated race and ethnicity among Hispanic and Non-Hispanic Asian adults. Future studies may evaluate comprehensive measures of acculturation and assess other race and ethnicity groups to inform tailored efforts to improve cardiometabolic risk factor prevention and treatment.

Ticks and tickborne diseases are of increasing concern in the United States, and the burden is high in certain focal areas. While the acceptability of various tick control and disease prevention methods has been studied, the public's willingness to pay for environmental interventions at the individual or community level is less well described. Using data collected as part of a larger survey, we performed an additional analysis of residents of Lyme disease-endemic counties of Michigan, Minnesota, and Wisconsin to assess their willingness to support and pay annually for various methods of property-based tick control and examined demographic characteristics that might influence willingness to pay. Seventy-nine percent of respondents were willing to perform some form of tick control on their property, with most preferring self-application. Landscaping and natural pesticide application were the most popular options, with people willing to pay an estimated $78 and $61 annually, respectively. High income, a high perceived prevalence of disease, and a high perceived likelihood of disease were all associated with a willingness to pay more. When asked about a community control option, 97 % of respondents indicated interest, with respondents being willing to pay $52/year for a community-based program regardless of household characteristics. These results suggest a moderate demand in the Upper Midwest for tick control efforts at both the individual property level and for local, publicly funded, community-based programs. These findings provide a starting point for assessing community characteristics, cost structure, environmental attributes, and efficacy needed to generate net benefits for community-based tick control programs.

BACKGROUND: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a complex, chronic condition affecting the urinary bladder. Symptoms commonly associated with IC/BPS include painful urination, pain during intercourse, a persistent or recurrent sensation of bladder discomfort or pressure that often worsens as the bladder fills and eases after urination, urgency, frequent urination with little warning, nighttime urination disrupting sleep, and burning or other unusual urinary sensations. These symptoms can profoundly impact emotional and mental health, hinder participation in daily activities, disrupt social interactions, and strain personal relationships. OBJECTIVE: This study aimed to compare the experiences of different races and ethnicities with IC/BPS regarding symptoms, diagnosis, treatment status, and treatment methods. We hypothesized that there would be differences in racial and ethnic minority groups. METHODS: A cross-sectional web-based survey was administered between June and August 2022 through the Interstitial Cystitis Association and the Inspire web-based health community. Eligible adults resided in the United States, self-reported IC/BPS symptoms, and completed the survey in English. The instrument gathered demographic information, details regarding age at symptom onset, formal diagnosis status, and treatment use. Validated symptom and problem indices (the O'Leary-Sant Interstitial Cystitis Symptom Index and Problem Index) captured symptom severity and quality-of-life impact. Comparative analyses, including Fisher exact and median tests, were conducted across racial or ethnic groups (minority or multiple-race vs White and Hispanic vs non-Hispanic), and multivariable logistic regression assessed predictors of race or ethnicity on IC/BPS diagnosis status and treatment outcomes. RESULTS: In total, 1631 individuals completed the survey. Racial or ethnic minority or multiple-race respondents constituted 11.6% (n=189) of the sample. Although IC/BPS symptom severity (Interstitial Cystitis Symptom Index or Interstitial Cystitis Problem Index scores) did not significantly differ by race or ethnicity, minority or multiple-race respondents were 50% less likely to have a formal medical diagnosis of IC/BPS than White respondents (adjusted odds ratio 0.50, 95% CI 0.30-0.83). Overall, 86.7% (n=1408) of participants reported having received a formal IC/BPS diagnosis, and the single strongest determinant of receiving any form of treatment was having a formal diagnosis (odds ratio 29.67, 95% CI 18.32-48.05). Over 25% (n=385) of all respondents reported using narcotic or opioid medications, indicating the challenging nature of IC/BPS symptom management. CONCLUSIONS: Minority or multiple-race participants were significantly less likely to have ever been diagnosed with IC/BPS by a health care professional, and those who were not diagnosed with IC/BPS were less likely to have used self-care behavioral and nonpharmacological treatments for their symptoms. Streamlining the diagnostic process and public health awareness campaigns outlining treatment options may help individuals manage IC/BPS symptoms.

INTRODUCTION: There is high interest in long-acting injectable antiretroviral therapy (LAI-ART) among people with HIV (PWH), with many conveniences for uptake and persistence. However, both patients and clinicians have expressed important barriers to effective implementation, including concerns about frequent clinic visits and strain on clinic resources. Administration of LAI-ART by a trained layperson injector (such as family, friend or partner of the patient) can help mitigate some of these patient-identified and clinician-identified barriers. Alternative LAI-ART delivery methods have the potential to increase the PWH and layperson injector's confidence, empowerment, convenience, privacy and self-management skills and ultimately facilitate LAI-ART uptake and persistence. METHODS AND ANALYSIS: INVITE-Home (innovative administration of long-acting injectables for HIV treatment enhancement at home) will support the expansion of LAI-ART in non-clinical settings by developing, implementing and evaluating a comprehensive, theory-informed training to support the administration of LAI-ART by a trained layperson injector. First, INVITE-Home will design and develop an innovative, theory-based layperson injector training to improve acceptability and uptake of LAI-ART in home-based settings, grounded in qualitative evaluation of training barriers and needs of PWH, layperson injectors and clinicians to develop the training. In Aim 2, INVITE-Home will enhance understanding of home-based LAI-ART using the training, by examining implementation and effectiveness of home-based LAI-ART injections. ETHICS AND DISSEMINATION: This study and its protocols have been approved by the University of California, San Francisco (UCSF) Institutional Review Board and the scientific staff of HIV Research Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, at the Centers for Disease Control and Prevention. Study staff will disseminate findings locally (eg, to partnering clinics, via the UCSF Center for AIDS Prevention Studies' Community Engagement Core), statewide (eg, the California Department of Public Health's Office of AIDS) and nationally at conferences related to HIV. TRIAL REGISTRATION NUMBER: NCT06488846.

OBJECTIVES: Homelessness increased by 31% from 2022 to 2023 in Denver, Colorado. We surveyed people experiencing homelessness in Denver to evaluate their health conditions and service needs and to identify factors associated with new or worsening health conditions after housing loss. METHODS: From October 28 through November 15, 2023, we surveyed 356 people experiencing homelessness in Denver. We fit multivariable logistic regression models using backward-fitting procedures to identify factors associated with reporting new or worsening health conditions after housing loss. RESULTS: The mean (SD) age of participants was 46.0 (13.7) years, 227 (63.7%) reported physical health conditions, and 207 (58.1%) reported mental health conditions that were new or worsening after experiencing homelessness. Chronic pain (n = 61; 17.1%) and depression (n = 123; 34.6%) were the most reported conditions. Eye care (n = 131; 36.8%), dental care (n = 95; 26.7%), and pain management (n = 54; 15.2%) were among the top service needs. Self-rated health declined by 22% after housing loss, from 3.4 (good or very good) before experiencing homelessness to 2.7 (fair or good) at the time of the survey, with a larger decline among those experiencing unsheltered homelessness than among those who were sheltered (0.95 vs 0.57; P = .006). As compared with men, women had higher odds of reporting new or worsening health conditions, whether physical (adjusted odds ratio [AOR] = 1.93; 95% CI, 1.14-3.29) or mental (AOR = 2.14; 95% CI, 1.23-3.81). Experiencing violence was associated with reporting new or worsening mental health conditions (AOR = 2.01; 95% CI, 1.20-3.37) after housing loss. CONCLUSION: Targeted interventions are needed to address the unique needs of unhoused women and those experiencing unsheltered homelessness in Denver.

BACKGROUND: There is limited knowledge on the extent of antimicrobial stewardship program (ASP) implementation in health care facilities (HCFs) in Latin America. METHODS: We performed an evaluation of ASPs in Latin American HCFs from March 2022 to February 2023 using a structured self-assessment survey associated with a scoring system that evaluated leadership support and accountability, resources, antibiotic stewardship actions, education, and antibiotic use (AU) monitoring and reporting. Additionally, we collected monthly AU data (antibiotic consumption and point prevalence surveys) and number of multidrug-resistant infections in medical-surgical intensive care units. Self-assessment scores were correlated with AU through multivariable regression models adjusting for bed size, country of HCF, and incidence of infections (when appropriate). RESULTS: Of the 39 HCFs recruited for the study, all completed the self-assessment, 36 performed the point prevalence survey, and 29 collected antibiotic consumption data. The overall median self-assessment score was 252.5 (IQR, 212.5-285) for a maximum possible score of 335. A high self-assessment score (top quartile) was associated with higher guideline-compliant AU (odds ratio [OR], 8.63; 95% CI, 3.03-24.6; P < .001), higher use of directed therapy (OR, 2.11; 95% CI, 1.41-3.1; P < .001), and less consumption of anti-methicillin-resistant Staphylococcus aureus agents (OR, -8.59; SE = 4.12; P = .037) after adjusting for bed size, country, and incidence of methicillin-resistant S aureus infections. CONCLUSIONS: Higher-level ASP implementation in Latin American HCFs correlated with better compliance with AU guidelines and decreased the use of vancomycin in the intensive care unit, supporting the need to improve resources for ASPs.

PURPOSE: The purpose of this study was to describe an exploratory partner approach to enrolling in the National Diabetes Prevention Program (National DPP), a proven 12-month lifestyle change program (LCP) for people at risk for developing type 2 diabetes. FHI360 and the University of Maryland Horowitz Center for Health Literacy created a "partner approach" to investigate whether people at risk for developing diabetes might be willing to join, complete, and be successful in the LCP if they intentionally go through the program with a partner who influences their lifestyle choices. METHODS: The research team analyzed aggregated participant self-reported weight and physical activity data, participant survey and focus group data, and lifestyle coach in-depth interview data to assess the retention, motivation, and acceptability of the partner approach. RESULTS: Across sites, retention of participants at risk of developing type 2 diabetes at the end of the year-long program was at 79%. Participants at the partner approach sites reported being motivated and successful. Lifestyle coaches reported that participants stayed in the program longer and adapted their lifestyle more than participants at other sites that did not offer the partner approach. CONCLUSIONS: People at risk of developing type 2 diabetes may respond positively to participating in a National DPP LCP when they can join with engaged partners. Based on study results, the partner approach may be a way to attract people at risk for type 2 diabetes who are more comfortable joining with a partner.

PURPOSE: We used data from the All of Us Research Program to examine sociodemographic differences in family health history (FHH) survey access, availability of electronic health records (EHR) data, FHH knowledge, FHH in the survey and EHR data, and concordance of FHH in survey and EHR data for breast cancer, colorectal cancer, and diabetes. METHODS: We calculated percentages and standard errors of participants who accessed the FHH survey, reported no FHH knowledge, had EHR data available, had FHH data in the survey and EHR, and had FHH in the survey or EHR that was not captured in the other data source for breast cancer, colorectal cancer, and diabetes. We stratified by age, race and ethnicity, sex, sexual orientation, household income, employment status, education level, marital status, and health insurance status. To determine significant differences, we calculated absolute and relative disparity, Z-tests, and P values with the significance threshold adjusted for multiple comparisons using the Bonferroni correction. RESULTS: We found significant disparities in accessing the survey and reporting no FHH knowledge across almost all sociodemographic subgroups. Most FHH reported in the survey was not captured in the EHR data, most significantly for participants who were aged 20 to 29, were students, did not graduate high school, were never married, or had no health insurance. CONCLUSION: Our study showed significant sociodemographic disparities in FHH survey access, FHH knowledge, and FHH captured in EHR structured data, which could widen inequities in access to FHH-based interventions.

BACKGROUND: Next-generation pneumococcal conjugate vaccines (PCVs) target an expanding array of serotype antigens. We assessed the proportions of invasive pneumococcal disease (IPD) and pneumococcal acute respiratory infections (ARIs) caused by serotypes targeted by existing and pipeline PCVs, and annual U.S. pneumococcal disease burdens potentially preventable by these products. METHODS: We estimated serotype distribution and proportions of pneumococcal ARIs (acute otitis media [AOM; children only], sinusitis, non-bacteremic pneumonia) and IPD attributable to serotypes targeted by each PCV using Markov chain Monte Carlo approaches incorporating data from epidemiological studies and Active Bacterial Core Surveillance. We then estimated annual numbers of outpatient-managed ARIs, non-bacteremic pneumonia hospitalizations, and IPD cases potentially preventable by PCVs by multiplying disease incidence rates by PCV-targeted disease proportions and vaccine effectiveness estimates. RESULTS: In children, PCV15, PCV20, PCV24, PCV25, and PCV31 serotypes account for 16% (95% confidence interval: 15-17%), 31% (30-32%), 34% (32-35%), 43% (42-44%), and 68% (67-69%) of pneumococcal AOM, respectively. In adults, PCV15, PCV20, PCV21, PCV24, PCV25, and PCV31 serotypes account for 43% (38-47%), 52% (47-57%), 69% (64-73%), 65% (61-70%), 62% (57-67%), and 87% (83-90%) of pneumococcal non-bacteremic pneumonia. For IPD, 42-85% of pediatric and 42-94% of adult cases were due to PCV-targeted serotypes. PCV-preventable burdens encompassed 270,000-3,300,000 outpatient-managed ARIs, 2,000-17,000 pneumonia hospitalizations, and 3,000-14,000 IPD cases annually. CONCLUSIONS: Across pneumococcal conditions, coverage and preventable burdens were lowest for PCV15 and highest for PCV31, with PCV21 also targeting sizeable burdens of adult disease. Comparative estimates of preventable disease burden may inform future policy.

OBJECTIVE: To examine the association between experiencing emotional or physical intimate partner violence (IPV) around the time of pregnancy and having a postpartum visit. METHODS: We conducted a secondary analysis of data from 2016 to 2021 from PRAMS (Pregnancy Risk Assessment Monitoring System), a population-based surveillance system that collects self-reported information about experiences before, during, and after pregnancy among women with a recent live birth. We used multivariable logistic regression to estimate the prevalence of experiencing emotional or physical IPV around the time of pregnancy and associations with having a postpartum visit. RESULTS: In seven jurisdictions with information on emotional IPV (n=30,333), 3.3% (95% CI, 3.0-3.6) of women with a recent live birth reported experiencing any emotional violence 12 months before pregnancy, during pregnancy, or after pregnancy; for these women, the prevalence of having a postpartum visit was 91.4% (95% CI, 90.9-91.9). Any emotional IPV was associated with lower odds of having a postpartum visit (adjusted odds ratio [aOR] 0.74; 95% CI, 0.55-0.99). In 48 jurisdictions with information on physical IPV (n=224,957), 3.3% (95% CI, 3.2-3.5) of women with a recent live birth reported physical violence 12 months before pregnancy or during pregnancy; for these women, the prevalence of having a postpartum visit was 90.2% (95% CI, 90.0-90.4). Any physical IPV was associated with lower odds of having a postpartum visit (aOR 0.63; 95% CI, 0.57-0.69). Among women who had a postpartum visit, 34.2% (95% CI, 29.0-39.0) of those who experienced emotional IPV and 35.1% (95% CI, 33.2-37.1) of those who experienced physical IPV were not asked about IPV by a health care professional during the visit. CONCLUSION: Experiencing emotional or physical IPV around the time of pregnancy was associated with lower odds of having a postpartum visit. Conducting screenings at various encounters such as telehealth, pediatric visits, or home health visits and ensuring availability of standard protocols and trainings for IPV screening and referrals may increase support for and identification of women experiencing IPV.

Child sex trafficking (CST) is a worldwide public health and social justice issue. Evaluations of prevention program effectiveness have been limited by the lack of validated measures to assess CST-related constructs. We drew from theory to adapt measures of adult sex trafficking and intimate partner violence precursors or risk factors to develop measures assessing CST constructs including CST myths, self-confidence to address CST, and comfort in asking and reporting students among middle school staff. The two measures that were validated (CST myths and self-confidence) can be used to evaluate the effectiveness of CST prevention programs. Reducing the prevalence of CST is an essential component of promoting gender equality.

BACKGROUND: Healthcare workers (HCWs) have been disproportionately affected by coronavirus disease 2019 (COVID-19). This study assessed HCW severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence trends and indicators' effectiveness for infection monitoring in the Philippine healthcare setting during 2021 and 2022-2023. METHODS: We obtained data on HCW demographics at 2 facilities, and COVID-19 symptoms recall and absenteeism at one facility. We collected and tested blood specimens with a SARS-CoV-2 spike and nucleocapsid protein-based serological assay. We calculated crude prevalence ratios (PRs) and 95% confidence intervals (CIs) for risk factors. RESULTS: A total of 253 HCWs were included. Seroprevalence of SARS-CoV-2 infection among HCWs was 34% from September to October 2021 and 92% from October 2022 to April 2023 during the Delta and the Omicron variant surges, respectively, at one facility. At the other facility, seroprevalence was 31% in September-October 2021. Of the 33 seropositive HCWs with questionnaire completed, 14 (42%) did not recall COVID-19-like symptoms in the past year. Serological evidence of SARS-CoV-2 infection was statistically more likely among HCWs who recalled COVID-19-like symptoms in the past year (PR, 2.69 [95% CI: 1.53-4.72]; P < .05). Of the seropositive HCWs, 7 (21%) had no hospital documentation of missed work. Of the 24 HCWs with a positive SARS-CoV-2 test, 12 (50%) tested because of symptoms, 4 (17%) tested after exposure, and 5 (21%) tested following employment screening. CONCLUSIONS: Self-reported symptoms may be used to track SARS-CoV-2 prior infections within resource-limited healthcare settings. Occupational health services should consider these findings when developing infection monitoring strategies among HCWs. Combining surveillance strategies may strengthen infection monitoring.

BACKGROUND: This study aimed to evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific binding and neutralizing antibody responses in healthcare workers (HCWs) who received coronavirus disease 2019 (COVID-19) vaccines, with or without postvaccination infections. METHODS: We conducted a prospective, observational cohort study of HCW in 2 hospitals in Manaus, Brazil. From 31 March through 31 May 2021, HCWs had nasal swabs collected and questionnaires administered weekly for 4 visits. Nasal swabs were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (rRT-PCR). Blood specimens were obtained at visits 1 and 4 unless the HCW was found to be infected. If infected, a blood specimen was collected on days 14 and 28 after symptom onset or date of positive specimen, if asymptomatic. COVID-19 vaccination cards, state immunization records, and self-reported history of previous SARS-CoV-2 infection were obtained. Fully vaccinated HCWs who tested SARS-CoV-2 rRT-PCR positive were classified as postvaccination infections. RESULTS: A total of 771 HCWs were enrolled, with 73.7% (568/771) fully vaccinated. Anti-SARS-CoV-2 S1 immunoglobulin G and neutralizing antibody levels showed steep decay within the first 50 days after COVID-19 vaccination. HCWs with prior SARS-CoV-2 infection had slower visible decay after 50 days compared with those without prior infection. We identified 12 postvaccination infections of 16 HCWs who were SARS-CoV-2 rRT-PCR+, including 4 who also reported previous infection. Those positive for SARS-CoV-2 had lower baseline neutralizing antibody levels against Gamma and Delta variants preinfection (median log10 titers [interquartile range]: Gamma, 1.5 [3]; Delta: 0 [0.25]) compared to those who remained rRT-PCR negative (median log10 titers [interquartile range]: Gamma, 3 [2]; Delta, 1 [2]). CONCLUSIONS: Our findings highlight the importance of routine antibody surveillance, targeted boosters, and hybrid immunity in low and middle income countries. Timely booster doses for HCWs and the development of new vaccines against emerging variants can help sustain immunity and prevent workforce shortages, strengthening healthcare resilience in resource-limited settings.

Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other poorly understood post-acute infection syndromes (PAIS) can present with unexplained symptoms or conditions that may be misunderstood by healthcare providers, causing delays in diagnosis and care. To address these issues, the Centers for Disease Control and Prevention (CDC) funded the Long COVID and Fatiguing Illness Recovery Program (LC&FIRP), initiated as a pilot project to assess whether providing tele-mentoring and other online education for primary care providers could help them improve the quality of life and support the recovery of their patients with these conditions. The LC&FIRP multi-disciplinary team-based care approach is built on the Extension for Community Healthcare Outcomes (ECHO) learning model, which is an evidence-based virtual learning framework developed by the University of New Mexico and designed to disseminate and implement best practices, especially in under-resourced areas. A distinctive feature of LC&FIRP was the inclusion of lived-experience experts. To explore the influence of lived-experience experts on the care patients received, we collected the educational recommendations provided by the lived-experience experts during webinar sessions (January 2022-March 2024) and grouped these by themes. The major themes that emerged included validation of patients' illness experience; attitudes and beliefs about Long COVID, ME/CFS, and PAIS; understanding patients' challenges and communicating with empathy; navigating referrals; recognizing and supporting disability; and supporting self-care. Investigators also interviewed patients of the Family Health Centers of San Diego (FHCSD) about their experiences receiving care from participating primary care providers and employed content analysis methods to code interview transcripts to identify themes among patients' perspectives. Positive comments from the patients about topics emphasized by the lived-experience experts provided evidence of providers' uptake and application of the experts' recommendations and support the value of involving lived-experience experts in medical education to improve health services.

INTRODUCTION: Associations between screen time and health outcomes among teenagers are well established. However, most studies use parent-reported information, which may misrepresent the magnitude or nature of these associations. In addition, timely nationally representative estimates are needed to correspond with evolving screen use. This study aimed to address these gaps by using data from a nationally representative survey of teenagers. METHODS: Data came from the 2021-2023 National Health Interview Survey-Teen (NHIS-Teen), a follow-back web-based survey designed to collect health information directly from teenagers aged 12 to 17 years. NHIS-Teen provides a unique opportunity to assess teenagers' self-reported health in conjunction with a rich set of parent-reported covariates, including family income, from the National Health Interview Survey. This study examines associations between high daily non-schoolwork screen time, defined as 4 or more hours of daily screen time, and adverse health outcomes across the domains of physical activity, sleep, weight, mental health, and perceived support. RESULTS: Teenagers with higher non-schoolwork screen use were more likely to experience a series of adverse health outcomes, including infrequent physical activity, infrequent strength training, being infrequently well-rested, having an irregular sleep routine, weight concerns, depression symptoms, anxiety symptoms, infrequent social and emotional support, and insufficient peer support. CONCLUSION: Results of this study include associations between high screen time and poor health among teenagers using self-reported data. Future work may further investigate these associations and their underlying mechanisms, including the content viewed on screens and the interactions taking place across screens.

INTRODUCTION: Timely access to stroke care reduces death and disability due to stroke. Studies have investigated disparities in access by sociodemographic characteristics but not comorbidity prevalence. We used updated data to assess both types of disparities in drive times to certified stroke centers nationwide. METHODS: We conducted a cross-sectional spatial analysis of drive time from each contiguous US census tract (N = 72,517), using population-weighted centroids, to any certified stroke care (n = 1,825) or advanced (ie, endovascular-capable) stroke care (n = 426), using 2022 data from multiple state and nationwide databases. We compared median comorbidity prevalence and sociodemographic characteristics for census tracts within versus beyond a 60-minute drive time, using US Centers for Disease Control and Prevention PLACES 2020 data. RESULTS: Median (interquartile range) drive time was 11.8 (7.6-21.6) minutes to any certified stroke care, and 23.0 (12.6-53.9) minutes to advanced stroke care. Approximately 20% of the US adult population (n = 49 million) resided in census tracts beyond a 60-minute drive from advanced stroke care; most (65%) were rural. Census tracts more than 60 minutes from advanced stroke care had significantly higher prevalence of stroke, high blood pressure, coronary heart disease, high cholesterol, diabetes, chronic kidney disease, fair or poor self-rated health status, smoking, and obesity. They also had higher poverty rates, lower educational attainment, lower median income, and higher proportions of non-Hispanic White people and people older than 65 years. CONCLUSION: Residents in census tracts lacking timely access to stroke care have higher prevalence of health risk factors. The results highlight areas where education, telehealth infrastructure, and facility placement could improve stroke systems of care.

Objective: To compare clinical and socioeconomic characteristics of U.S. Medicare beneficiaries overall and with diagnosed diabetes by age group (18–64 years and ≥65 years) and insurance type (traditional fee-for-service [FFS] vs Medicare Advantage [MA]) and to compare the prevalence of diabetes among beneficiaries by age group and type of insurance. Methods: In this retrospective, cross-sectional study from the U.S. Medicare Current Beneficiary Survey (MCBS), we combined data from 2017 to 2022 and conducted an unadjusted, pooled analysis of administrative and survey data, weighted to represent U.S. Medicare beneficiaries. We used logistic regression to assess difference by insurance type in care satisfaction. Results: Beneficiaries more likely to enroll in MA than FFS were the same groups at high risk of diabetes, including non-Hispanic Black (18–64: 21.2 % vs 15.9 %; ≥65: 11.4 % vs 6.5 %) and Hispanic (18–64: 14.4 % vs 8.9 %; ≥65: 11.0 % vs 5.4 %) populations, those with less than a high school education (≥65: 16.4 % vs 9.2 %) or annual income <$25,000 (18–64: 69.0 % vs 64.0 %; ≥65: 34.5 % vs 21.6 %), and full dual-eligible beneficiaries (≥65: 10.5 % vs 6.1 %). Beneficiaries with diabetes enrolled in MA did not differ from those enrolled in FFS in diabetes self-management or satisfaction with healthcare. Conclusions: Subgroups of people at highest risk of diabetes were more likely to enroll in MA. Our findings support studies reporting that people with diabetes self-select into MA, and their lack of difference in satisfaction between FFS and MA may support studies that report MA is no less effective than FFS in diabetes care. © 2025 The Authors

Objective: Ototoxic chemicals in the workplace can pose a risk to hearing and balance functions. Our objective was to identify evidence-based practices for occupational health settings in managing ototoxicity. This resulted in the document, Health Management of Workers Exposed to Ototoxic Chemicals, created by the International Ototoxicity Management Group. Design: To develop a practical approach for any workplace, we reviewed a variety of sources and used an international panel of interdisciplinary experts. Evidence included data from experimental, observational, and review studies. Thirty-two subject matter experts were invited to review the document; twenty-two completed the review and unanimously endorsed the ototoxicity management system as proposed. Results: Six key action steps were proposed to: (1) identify workers exposed to ototoxic chemicals, (2) perform auditory and vestibular assessments, (3) follow-up after monitoring health, (4) document worker data, (5) maintain healthy safety culture, and (6) review ototoxicity management approach. These steps focus on the management of workers who are at-risk for workplace ototoxic chemical exposure at any level (with or without concurrent noise exposures). Conclusions: Early identification strategies include self-report questionnaires; auditory testing; vestibular screening; referrals for diagnosis; management of cases; and monitoring of exposure scenarios to prevent further cases. © 2025 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society.

Mozambique's National Blood Transfusion Services (NBTS) is tasked with providing safe and available blood but also conducting systematic screening of at-risk potential donors, notifying seropositive blood donors, and linking them to HIV care and treatment services. Potential blood donors who were deferred from donating following a behavioral risk screening and all blood donors who screened seropositive for HIV were notified and offered linkage to HIV testing, care, and treatment services by community-based organizations. A prospective study among HIV-positive blood donors and deferred donors was conducted from May 2019 to July 2020 at Maputo Central Hospital Blood Bank and the National Reference Blood Center. The associations between testing, initiating care and treatment services among HIV-positive blood donors and prospective deferred donors were estimated using fully Bayesian multivariable logistic models and odds ratios. Among 885 prospective blood donors enrolled, 173 (20%) were deferred due to self-reported high-risk behaviors identified through a screening questionnaire, and 712 (80%) passed the behavioral-risk screening tool, donated, and the blood donation tested positive for HIV. There were more than 2.5 times as many male donors as female donors with a positive HIV test, and among the deferred donors, more than 84% were males. 36% (256/712) of seropositive donors and 35% (61/173) of deferred donors were referred to HIV testing services. 62% (158/256) of seropositive donors and 4.9% (3/61) of deferred donors who were successfully referred were linked to care and treatment services, and 96% (152/158) of these seropositive donors and 100% (3/3) of deferred as high-risk donors initiated antiretroviral therapy (ART). Of the three service organizations used, one outperformed the other two in linking seropositive donors to ART treatment. The NBTS can serve as a critical entry point for identifying HIV-positive persons. Improved implementation of risk behavior screening tools is needed and could contribute to early identification and initiation of ART for potential donors. Innovative strategies and solutions by community-based organizations can be used to improve blood donor notification and linkage to HIV testing and treatment services.

INTRODUCTION: Arthritis is a common chronic disease, affecting an estimated 53.2 million adults (21.2%) in the US. "Arthritis" is a general term, describing over 100 conditions with different etiologies, pathogeneses, symptoms, and treatments. Few studies have examined the prevalence and distribution of arthritis subtypes in the US. METHODS: We used National Health and Nutrition Examination Survey data from 2017 to March 2020 to estimate the prevalence of arthritis subtypes overall and by sociodemographic characteristics. RESULTS: The overall prevalence of any type of diagnosed arthritis among US adults aged 20 years or older in this study was 27.9% (67.1 million). Among adults with diagnosed arthritis, osteoarthritis (49.6%, 33.2 million) was the most common arthritis subtype, followed by rheumatoid arthritis (15.8%, 10.6 million) and psoriatic arthritis (1.4%, 1.0 million). More than 1 in 10 reported some other type of unlisted arthritis (11.5%, 7.7 million), and 1 in 5 did not know their arthritis subtype (21.6%, 14.4 million). Prevalence of not knowing arthritis type was approximately 1 in 4 for adults identifying as non-Hispanic Black (26.7%) or other Hispanic (29.5%) and for adults who reported low family income (26.7%) and was approximately 1 in 3 for adults identifying as Mexican American (31.9%), having less than a high school education (31.8%), or not having health insurance (36.1%). CONCLUSION: Understanding arthritis type is important for improving treatment, self-management, and health outcomes associated with arthritis. Improving organizational and personal health literacy are potential strategies that may reduce the prevalence of not knowing arthritis type.

The Centers for Disease Control and Prevention's (CDC) Well-Integrated Screening and Evaluation for WOMen Across the Nation (WISEWOMAN) program funded 24 recipients to provide cardiovascular disease screenings and healthy behavior support services to uninsured and underinsured women aged 40-64 years. In 2018 and throughout the COVID-19 pandemic, WISEWOMAN recipients implemented evidence-based strategies to reduce participants' risk for cardiovascular disease, including team-based care through medication therapy management (MTM) and self-measured blood pressure (SMBP) monitoring, as well as other clinical and health behavior support services. Our primary analysis assessed the implementation of MTM and SMBP and changes in implementation. To contextualize implementation, we analyzed participants' engagement in MTM and SMBP. We analyzed data from 108 semi-structured interviews with WISEWOMAN staff and partners, program survey responses from 22 of 24 funded recipients, and participant-level data from 5,541 participants. Interview respondents noted the value of MTM and SMBP, especially during the COVID-19 pandemic, while also describing challenges arising from implementing strategies (e.g., integrating MTM into clinic workflows, time and resources needed for SMBP). In 2023, 71% of recipients reported referring participants to MTM, compared to 41% of recipients in 2020. The percentage of hypertensive participants who reported monitoring their blood pressure at least weekly increased from 36% at the first screening to 44% at the second screening (p < .01). Health systems seeking to implement team-based care for hypertension management and control can draw upon experiences from 24 recipients who have successfully implemented MTM and SMBP to address cardiovascular disease.

BACKGROUND: Randomized control trials in sub-Saharan countries found male circumcision may prevent high-risk human papillomavirus (HR-HPV) acquisition. Using 2013-2016 National Health and Nutrition Examination Survey data, we explored the association between circumcision and HR-HPV among sexually experienced 18-59-year-old males. METHODS: Self-collected penile specimens were tested for HPV DNA. We estimated weighted HR-HPV prevalence (positivity to ≥1 HR type: HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68) by circumcision status. The association between circumcision and HR-HPV was assessed using multivariable logistic regression models. Effect modification by circumcision on the association between number of lifetime sex partners and HR-HPV was explored. RESULTS: Overall, 77.7% of males reported being circumcised, with large variation by race/ethnicity and country of birth. HR-HPV prevalence was significantly higher among circumcised (25.7%) than uncircumcised (20.4%) males; this was attenuated after adjustment for lifetime and new past-year sex partners (adjusted prevalence ratio: 1.10, 95%CI: 0.92-1.32). There was evidence circumcision modified the association between lifetime partners and HR-HPV, but HR-HPV prevalence increased with increasing number of partners in circumcised and uncircumcised males. CONCLUSIONS: Our observed lack of statistical association between circumcision and HR-HPV may differ from randomized trial results due to the differences between circumcised and uncircumcised males or differences in anatomic site sampled or timing of circumcision.

BACKGROUND: Healthcare workers (HCWs) play a pivotal role in preventing healthcare-associated infections by adhering to infection prevention and control (IPC) practices. This study assessed IPC knowledge, attitudes, and practices (KAP) among HCWs at tertiary care hospitals in Bangladesh during the coronavirus disease 2019 pandemic. METHODS: From September 2020 to January 2021, semistructured questionnaires were administered to physicians, nurses, and cleaning staff at 11 tertiary care hospitals in Bangladesh. KAP components were classified into "good," "fair," and "poor" based on the frequency of favorable responses (>75%, 50%-75%, <50%). Multivariate logistic regression was used to assess the relationship between knowledge, attitudes, and self-reported practices. RESULTS: We enrolled 1728 HCWs, including 526 physicians (30.4%), 934 nurses (54.1%), and 268 cleaning staff (15.5%). Physicians and nurses demonstrated "good" IPC knowledge (median 94.8% and 96.6% favorable responses, respectively) and self-reported IPC practices (median 76.2% and 80.4% favorable responses). However, most cleaning staff exhibited "poor" IPC knowledge (median 47.3% favorable responses) and practices (21.3% favorable responses). Across all categories of HCWs, the median attitude score was "fair" (range 60.0%-71.2% favorable responses). Having a positive attitude toward IPC was associated with increased IPC knowledge (adjusted odds ratio 3.0, P < .001) and good IPC practices (adjusted odds ratio 16.3, P < .001). CONCLUSIONS: HCW's KAP toward IPC was found to be suboptimal, especially among cleaning staff. However, the strong association noted between favorable attitudes toward IPC and adherence to safe IPC practices demonstrates the need for hospital leadership to promote a positive IPC culture, in addition to training and resources, to improve IPC practices and enhance healthcare resiliency beyond the coronavirus disease 2019 pandemic.

The purpose of this experiment was to investigate the effect of robot arm size, movement speed, and degrees of freedom on perceived safety, trust, mental workload, human behaviors, and task performance in a collaborative pick-and-place task. Fifty-six participants completed the experiment in a virtual reality environment where they interacted with a robot manipulator. Robot arm speed had a greater impact on self-reported measures, compared to task performance and human behavior. Overall, mean ratings of surprise and fear significantly increased across speed levels of 60 deg/s (surprise = 1.19/6; fear = 1.18/6), 120 deg/s (surprise = 1.37/6; fear = 1.33/6), and 180 deg/s (surprise = 1.65/6; fear = 1.67/6). Conversely, robot arm size and degrees of freedom had a greater influence on task performance and human behavior than on the self-reported outcomes. These findings may provide insights for robot manufacturers and standard committees to improve perceived safety in the workplace.

INTRODUCTION: Increasing walking for transportation is a strategy to integrate physical activity into daily life. We examined reported environmental, access, and individual reasons for not walking to places near home among US adults, by sociodemographic characteristics and geographic location. METHODS: We used data from the 2022 SummerStyles survey on 3,967 US adults aged 18 years or older. We calculated prevalence of reporting 11 selected reasons for not walking to places within 10 minutes of home, overall and by sex, race or ethnicity, age, education, income, US census region, and metropolitan residence (an area with at least 1 urban area of ≥50,000 inhabitants) versus nonmetropolitan residence. We used Bonferroni-corrected pairwise comparisons and orthogonal polynomial contrasts (ordered groups) to compare prevalence by subgroup. RESULTS: Overall, 79.0% of respondents identified at least 1 reason for not walking to places near home (within 10 minutes). Commonly reported reasons were hot and humid conditions (36.0%), no places to walk within 10 minutes (24.9%), a preference for driving (22.1%), and inconvenience (21.5%). The reasons varied significantly across sociodemographic and geographic subgroups. The prevalence of reporting none of the listed reasons was higher among males than females, higher among non-Hispanic Black and non-Hispanic Asian adults than non-Hispanic White adults, and higher among adults from the Northeast versus the South. CONCLUSION: Eight of 10 US adults reported at least 1 environmental, access, or individual reason for not walking to places near home. Designing communities to make walking for transportation more accessible, convenient, and desirable may help address the leading reasons reported, which may support adults in adding more physical activity to their daily lives.

AIM: Our goal was to develop and externally validate oral health self-report measures for predicting periodontitis in a representative U.S. adult population (30-79 years old) and to evaluate a predictive scoring tool for periodontitis constructed from the best performing model parameter estimates. METHODS: The predictive models for periodontitis using demographic characteristics and self-reported oral health measures were developed and tested with the National Health and Nutrition Examination Survey (NHANES) 2009-2012 data (development 2009-2010, validation 2011-2012). The best performing model was externally validated against clinical periodontitis cases defined by measurements from a full-mouth periodontal examination at six sites around all teeth excluding third molars. A predictive scoring tool derived from the transformed sum of the model coefficient estimates was also externally validated. Model performances were evaluated by their sensitivity, specificity, predictive accuracy, and area under the receiver-operating characteristic curve (AUROC). RESULTS: Our best model used self-reported oral health, smoking, and demographics. Predictive Risk Scores (PRS) of ≥65 captured about 98% of the true periodontitis cases. Three forms of the model (1-individual risk factor variables, 2-continuous PRS, and 3-PRS categories) were applied to the development and validation data sets. Overall, all three forms had high sensitivity (>84%) in both the development and validation data sets and had similar AUROC (around 80%). Specificity was low to moderate. When externally validated, the model incorporating PRS as a continuous measure had high sensitivity (84.0%) and low specificity (57.5%), with AUROC of 79.5% and predictive accuracy of 71.6%. Similarly, when PRS as a categorical variable was externally validated, the model had a high sensitivity (82.8%) and low specificity (59.9%), with an AUROC of 79.3% and predictive accuracy of 72.0%. CONCLUSION: Overall, modeling of four self-report oral health measures, combined with smoking and demographic characteristics, performs well in predicting clinical periodontitis in a nationally representative sample of the adult dentate US adult population. Compared with clinical periodontal examination, this approach is promising as a viable, non-clinical, and much less resource-intensive alternative method for estimating the burden of periodontitis.

PURPOSE: Research has shown that the prevalence of vision difficulty is higher among US adults with low income than among those with higher income. We aimed to examine the trends in income-related inequalities in vision difficulty and to identify the contributions of explanatory factors. DESIGN: A cross-sectional and trend study. METHODS: Our study estimated income-related inequalities in self-reported vision difficulty among US adults aged 18 years or older using data from the National Health Interview Survey (NHIS) during 1999-2018. The concentration index was used to measure income-related inequality in vision difficulty and was decomposed into contributing factors. We examined temporal changes in income-related vision difficulty inequalities and contributors to those changes from 1999 to 2018. RESULTS: We found that vision difficulty was concentrated among lower income groups and the degree of income-related inequality in vision difficulty widened between 1999 and 2018. Decomposition analysis revealed that poverty-to-income ratio and public health insurance coverage were important contributors to income-related inequalities in vision difficulty, with smaller contributions made by smoking, physical inactivity, and female sex. Among all variables, non-White race/ethnicity, lower physical activity, and poverty-to-income ratio were important factors explaining the change in income-related inequality in vision difficulty. CONCLUSION: Vision difficulty was more prevalent in low-income populations. Our study enhances the understanding of socioeconomic disparities in vision difficulty, which could inform how to best target the deployment of eye care resources to maximize the visual potential of the US population.

BACKGROUND: School professionals, including classroom teachers, school administrators, psychologists, teachers' aides, and nurses, often interact with students with concussions. To ensure they have the knowledge to identify and manage concussions, the U.S. Centers of Disease Control and Prevention developed the HEADS UP to Schools online training. METHODS: The HEADS UP to Schools training includes a pre-test and post-test consisting of 16 knowledge questions in three areas (symptom recognition, school support and accommodation, and guidance and recommendations for school staff) and five self-efficacy questions. Pre- and post-test responses of 8750 individuals were compared and analyzed to evaluate the effectiveness of the training. RESULTS: Respondent scores significantly improved between pre- and post-test responses for all knowledge questions and self-efficacy questions. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Schools and school districts may consider offering this training to staff to help ensure that at least one person at each school is trained on concussion and to increase awareness of evidence-based practices. CONCLUSIONS: Knowledge and self-efficacy on concussion identification and management improved among school professionals who completed the HEADS UP to Schools training. Future research to assess whether concussion knowledge and self-efficacy are maintained long term may be beneficial.

OBJECTIVE: Overall, police officers have higher rates of several adverse health conditions (e.g., cardiovascular health profiles and post-traumatic stress disorder (PTSD)) compared to persons in many other occupations. Our objective was to conduct a comparative study of occupational exposures and health outcomes among police officers across: (a) a 7-year period, from the baseline examination (2004-2009) to the 1st follow-up examination (2011-2015) and (b) a 12-year period, from baseline to the 2nd follow-up examination (2015-2019). METHODS: Participants were from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. Variables were assessed through self-report, standardized validated questionnaires, or standardized medical procedures. We computed the 7- and 12-year changes in mean values (for continuous/numeric variables) or prevalence (for categorical variables) and the corresponding 95% confidence intervals (CIs) using MIXED and GENMOD procedures in SAS. RESULTS: Occupational stress significantly increased over 12 years [3.4; (95% CI 1.2, 5.6)]. The percentage of officers who reported excellent/very good health significantly decreased across both time periods: [- 11.8%; (- 17.8, - 5.9)] across seven years and [- 17.3%; (- 24.2, - 10.4)] across 12 years. The prevalence of metabolic syndrome increased over seven years [10.7%; (5.3-16.0)] and over 12 years [7.4%; (0.1-14.0)]. Abdominal obesity and glucose intolerance significantly increased over both time periods while hypertension and elevated triglyceride levels increased slightly but not significantly over both time periods. CONCLUSION: Occupational stressors and some health outcomes of officers worsened over time indicating the need for self-health monitoring and wellness programs for police.

INTRODUCTION: Prior research has observed increased risks for numerous chronic conditions among individuals with Long COVID. Chronic conditions have been associated with employment limitations and increased economic hardships. Data from the Behavioral Risk Factor Surveillance System (BRFSS) present an opportunity to examine changes by employment status in the prevalence of a range of chronic conditions between 2019 (pre-pandemic) and, in 2022, by self-reported COVID-19 or Long COVID. METHODS: We assessed the prevalence of chronic conditions in 2022 by employment status and self-reported COVID-19 and Long COVID history using data from BRFSS for adults of prime working age (25-54 years) who were employed for wages, self-employed, unemployed less than 1 year, unemployed 1 year or more, or unable to work. For each chronic condition (coronary heart disease and myocardial infarction [combined], stroke, ever and current asthma, chronic obstructive pulmonary disease, kidney disease, diabetes, and arthritis), we generated adjusted prevalence ratios (aPRs) comparing 2022 prevalence by COVID-19/Long COVID category to prevalences among respondents in that employment status before the pandemic (2019). RESULTS: The prevalence of both asthma and diabetes increased significantly between 2019 and 2022 among respondents in all included employment categories and COVID-19/Long COVID histories combined. Among employed respondents with Long COVID in 2022, aPRs using 2019 prevalence figures for all employed respondents as a baseline for comparison had statistically significant elevations for every chronic condition assessed. CONCLUSIONS: The increased prevalence of a range of chronic conditions between 2019 and 2022 among adults with Long COVID may present a burden for individuals, the workplace, the healthcare system, and the economy. Additional research in a longitudinal context could better quantify these associations. Efforts to prevent, identify, and treat Long COVID can reduce this burden.