OBJECTIVE: Co-administration of most adult vaccines is recommended to increase uptake, including recombinant zoster vaccine (RZV), which is recommended for all adults aged ≥50 years in the United States. METHODS: This re...OBJECTIVE: Co-administration of most adult vaccines is recommended to increase uptake, including recombinant zoster vaccine (RZV), which is recommended for all adults aged ≥50 years in the United States. METHODS: This retrospective study used administrative claims data from the Optum Research Database for patients aged ≥50 years. Patients with ≥1 claim for RZV during 2017-2023 were divided into two cohorts based on whether their first RZV dose was co-administered with influenza, pneumococcal, and/or tetanus-diphtheria/tetanus-diphtheria-acellular pertussis vaccines. Geospatial analysis visualized co-administration at county and zip code levels. Multivariable logistic regression compared characteristics across cohorts and assessed relationships between co-administration and other factors with RZV series completion and dosing schedule adherence. RESULTS: RZV was co-administered in 24.2% of 1,622,250 patients who received RZV and was most common with influenza vaccine (65.1%), peaking in fall each year. Geospatial analysis revealed the lowest levels of co-administration in the Northeast. Logistic regression identified age ≥ 70 years, Asian race, higher education and household income, fewer comorbidities, and administration in a pharmacy as associated with lower odds of RZV co-administration. RZV co-administration was associated with lower odds of series completion and dosing schedule adherence. CONCLUSIONS: Opportunities exist to increase co-administration of RZV with other recommended vaccines.
OBJECTIVE: Impact of breastfeeding duration on the presence of organochlorine pesticides (OCP) in offspring remains poorly understood. Therefore, we aimed to assess the association between breastfeeding duration and seru...OBJECTIVE: Impact of breastfeeding duration on the presence of organochlorine pesticides (OCP) in offspring remains poorly understood. Therefore, we aimed to assess the association between breastfeeding duration and serum concentrations of 21 OCP in individuals between 2.5 and 19 years old from central-southern states of Mexico. METHODS: We included 317 individuals that participated as controls in a population-based study in Puebla and Tlaxcala, Mexico (2021-2024). We directly interviewed parents/guardians to collect data on breastfeeding duration and sociodemographic characteristics. Serum OCP were measured using gas chromatography. We categorized breastfeeding duration in months: 0, 1-12, and > 12. We used adjusted linear regression models to assess the associations between serum OCP and breastfeeding duration, also stratifying by sex and participant's age. RESULTS: Compared with individuals who were never breastfed, those breastfed ≤12 months showed a positive but non-significant association with p,p'-DDE (β = 0.65; 95% CI: -0.08, 1.38), while those breastfed >12 months had a significant association (β = 0.76; 95% CI: 0.04, 1.49), that remained only among males and individuals ≤124 months of age. We did not observe significant associations for other OCP. CONCLUSIONS: Although breastfeeding offers well-known health benefits, in high-risk populations it may also contribute to exposure to persistent environmental contaminants such as p,p'-DDE.
OBJECTIVES: To evaluate the effects of interrupting sedentary behavior on postprandial metabolic outcomes in healthy adults. METHODS: We systematically searched seven databases (PubMed, Embase, Scopus, Cochrane, Web of S...OBJECTIVES: To evaluate the effects of interrupting sedentary behavior on postprandial metabolic outcomes in healthy adults. METHODS: We systematically searched seven databases (PubMed, Embase, Scopus, Cochrane, Web of Science, SPORTDiscus, and CINAHL Complete) from inception to June 6, 2025, for eligible randomized controlled trials. Primary outcomes included total and incremental areas under the curve for glucose, insulin, and triglycerides. Study quality (Cochrane Risk of Bias version 2) and overall evidence quality (Grading of Recommendations, Assessment, Development, and Evaluations) were assessed. Data were pooled using random-effects meta-analysis in Stata 18.0, with effects expressed as standardized mean difference (SMD) and 95% confidence interval (95% CI). RESULTS: Seventeen randomized controlled trials comprising 337 healthy adults were included. Meta-analysis showed that interrupting sedentary behavior significantly reduced glucose incremental area under the curve (SMD = -0.35; 95% CI: -0.56, -0.15) and insulin incremental area under the curve (SMD = -0.37; 95% CI: -0.56, -0.18), but had no significant effect on total area under the curve for glucose, insulin, and triglycerides, nor on the incremental area for triglycerides. CONCLUSIONS: Interrupting sedentary behavior improves postprandial metabolism by specifically reducing the spike in blood glucose and insulin after a meal, without affecting overall metabolic exposure or lipid levels.
OBJECTIVE: It is unclear whether Child Access Prevention (CAP) laws influence firearm storage.We sought to analyze the association of CAP laws with loaded and unlocked firearm storage. METHODS: We used logistic regressio...OBJECTIVE: It is unclear whether Child Access Prevention (CAP) laws influence firearm storage.We sought to analyze the association of CAP laws with loaded and unlocked firearm storage. METHODS: We used logistic regressions to analyze survey data of 2264 firearm owners from a 2023 nationally representative U.S. SAMPLE: Secondary analyses disaggregated CAP laws by stringency (i.e., liability thresholds for negligent storage) and examined associations by parental status and county social vulnerability. RESULTS: Nearly one-third of U.S. firearm owners reported storing at least one firearm loaded and unlocked (unsecure storage). Residence in a CAP law state was only associated with lower odds of unsecure storage in unadjusted models; however, firearm-owning adults in states with the most stringent CAP laws were less likely to report unsecure storage than those in non-CAP law states even after covariate adjustment. In analyses stratified by county social vulnerability, CAP laws were only associated with lower odds of unsecure storage in the least vulnerable counties. CONCLUSION: Our results suggest that the relationship between CAP laws and firearm storage varies depending on the stringency of the law and county social vulnerability. Understanding how these and other factors drive effect heterogeneity will inform CAP laws and implementation efforts.
OBJECTIVE: This study aims to provide a comparative overview of school food provision models in 17 cities across 12 European countries. It explores the operational, infrastructural, and financial dimensions of these mode...OBJECTIVE: This study aims to provide a comparative overview of school food provision models in 17 cities across 12 European countries. It explores the operational, infrastructural, and financial dimensions of these models, identifying key trade-offs, challenges and opportunities for promoting healthy and sustainable school food environments. METHODS: Data were collected via an electronic questionnaire administered to SchoolFood4Change project partners in 2022. The questionnaire covered meal types and costs, operational and manufacturing models, and kitchen infrastructure. Supplementary desk research was conducted to clarify responses and gain a deeper understanding of the findings' context. RESULTS: The analysis reveals that school food provision models are more influenced by institutional, historical, and policy contexts than by city size. Contract catering dominates, yet in-house systems persist where welfare traditions and nutrition education policies emphasise child health and learning. Centralised kitchens often reflect historical planning or socialist legacies, while mixed systems arise in decentralised governance contexts. CONCLUSIONS: Organisational diversity stems from the interaction of governance structures, policy priorities, and infrastructure, illustrating how Europe's school food systems balance economic efficiency with social and educational goals for children's wellbeing. This study contributes to a deeper understanding of school food provision models in Europe.
OBJECTIVE: Forgone healthcare is associated with worsening health, higher mortality, and increasing healthcare costs. Everyday discrimination is associated with fewer preventive care screenings and poorer health. Yet pri...OBJECTIVE: Forgone healthcare is associated with worsening health, higher mortality, and increasing healthcare costs. Everyday discrimination is associated with fewer preventive care screenings and poorer health. Yet prior research has not investigated whether everyday discrimination is associated with forgone healthcare in a nationally representative sample of US adults. We used longitudinal panel data to investigate the role of everyday discrimination in predicting forgone healthcare among US adults at midlife. METHODS: Data are from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative panel study of US adults beginning in 1994-1995. Data were collected across six waves, with the most recent wave including data from 2022 to 2025. We used logistic regression and a lagged measure of everyday discrimination to predict forgone care. Analyses were conducted in 2025. RESULTS: As everyday discrimination increased, so did the odds of forgone healthcare. These results persisted when limiting the sample to the insured and after adjusting for socioeconomic status and diagnosed health conditions. CONCLUSIONS: Everyday discrimination and forgone care are associated with worsening health. Future research should continue to investigate how these experiences exacerbate health disparities at midlife.
OBJECTIVE: Hormonal contraceptives increase nicotine absorption. Their joint effect with smoking on inflammatory bowel disease remains unclear. We assessed independent and joint associations of smoking and hormonal contr...OBJECTIVE: Hormonal contraceptives increase nicotine absorption. Their joint effect with smoking on inflammatory bowel disease remains unclear. We assessed independent and joint associations of smoking and hormonal contraception with Crohn's disease and ulcerative colitis. METHODS: In 2021, we conducted a nested case-control study with cumulative sampling of controls, in Quebec, Canada. Cases were identified with health services-based validated algorithms. Smoking, hormonal contraception, and covariates were self-reported. Time-dependent exposures were analyzed in 2024 using weighted Cox models to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) and assess additive and multiplicative interactions. RESULTS: The study included 1718 women (591 controls, 790 Crohn's disease, 337 ulcerative colitis cases). Compared with non-smokers non-users of hormonal contraception, former smokers using hormonal contraceptives had increased Crohn's disease (HR = 2.45; 95% CI: 1.51, 3.96) and ulcerative colitis risks (HR = 2.88; 95% CI: 1.65, 5.02). Current smokers using hormonal contraceptives had elevated risks of Crohn's disease (HR = 2.62; 95% CI: 1.93, 3.56) but not ulcerative colitis (HR = 0.72; 95% CI: 0.42, 1.17). A negative additive interaction was observed for ulcerative colitis with no multiplicative interactions. CONCLUSIONS: Smoking and hormonal contraception are independently associated with Crohn's disease, but not ulcerative colitis, with implications for inflammatory bowel disease risk assessment in women.
OBJECTIVE: Suboptimal breastfeeding in the U.S. carries substantial health and economic costs and is marked by persistent disparities. The 2022 formula shortage coincided with disruptions in infant feeding practices. Thi...OBJECTIVE: Suboptimal breastfeeding in the U.S. carries substantial health and economic costs and is marked by persistent disparities. The 2022 formula shortage coincided with disruptions in infant feeding practices. This study documents changes in breastfeeding during the shortage period and projects associated infant illness and healthcare costs. METHODS: Using 2017-2022 Pregnancy Risk Assessment Monitoring System data, we applied Bayesian structural time-series models to estimate deviations in breastfeeding initiation and duration during the shortage period relative to prior trends. We then used Monte Carlo simulation to project infant illness and healthcare costs. RESULTS: During the 2022 formula shortage, breastfeeding for at least four months was higher by 3.43 percentage points (95% credible interval [CrI]: 1.11, 5.74). Breastfeeding at one, two, and three months postpartum was 2.49 to 3.55 percentage points higher, and initiation was higher by 1.54 percentage points (95% CrI: 0.46, 2.59). Estimates varied across sociodemographic groups and were larger among less advantaged mothers, corresponding with smaller observed breastfeeding disparities. The simulation projects annual healthcare costs approximately $420 million lower. CONCLUSIONS: During the formula shortage groups with historically lower breastfeeding rates exhibited higher breastfeeding levels, highlighting the relevance of breastfeeding trends for discussions of infant disease and healthcare costs.
PURPOSE: This study aimed to investigate the incidence and risk factors of running-related injuries (RRIs) among Chinese marathon runners. METHODS: A nationwide cross-sectional survey was conducted in China from January...PURPOSE: This study aimed to investigate the incidence and risk factors of running-related injuries (RRIs) among Chinese marathon runners. METHODS: A nationwide cross-sectional survey was conducted in China from January to December 2024, with 5668 marathon runners participating in full or half marathons. Data on demographics, training characteristics, and RRIs in the past six months were collected through validated questionnaires. Logistic regression was used to identify predictors of RRIs. RESULTS: The overall incidence of RRIs was 46.5%, with a higher prevalence in males compared to females (p < 0.01). The most frequently affected areas were the knee (29.6%), the toe (22.9%), and the ankle (19.4%).Multivariable analysis showed that increasing age (OR = 0.98), longer running experience (≥7 years: OR = 0.71), and lower training levels (Public L1: OR = 0.74, Public L2: OR = 0.66, Unclassified: OR = 0.53) were protective factors. Higher body mass index (BMI) (24 ≤ BMI < 28: OR = 1.49; ≥28: OR = 1.67) and elite-level training were associated with increased injury risk. CONCLUSION: This study highlights a high burden of RRIs among Chinese marathon runners, with key modifiable risk factors including BMI and training intensity, while age and running experience offer protective effects.
OBJECTIVE: To examine associations between exposure to risk communication, risk perception, and critical health literacy, and their associations with public preparedness and preventive behaviors during the Chikungunya ep...OBJECTIVE: To examine associations between exposure to risk communication, risk perception, and critical health literacy, and their associations with public preparedness and preventive behaviors during the Chikungunya epidemic in China. METHODS: We conducted a cross-sectional survey in August 2025 among 1102 residents across three Chinese provinces, stratified by epidemiological risk. Among participants aware of the outbreak (n = 761), multivariable logistic regression models assessed associations between risk communication, risk perception, critical health literacy, and preventive behaviors, adjusting for sociodemographic characteristics. RESULTS: Among participants, 69.06% reported awareness of Chikungunya. Higher exposure to risk communication was associated with increased adoption of all preparedness and preventive behaviors (aORs 1.31-1.50). Perceived environmental risk was associated with using mosquito nets [aOR = 1.37, 95% CI (1.14, 1.64)], screening windows [aOR = 1.45, 95%CI (1.18, 1.78)], and purchasing medications, including paracetamol, antibiotics, and antivirals (aORs up to 1.73). Higher critical health literacy was associated with reduced likelihood of purchasing inappropriate medications, specifically antibiotics [aOR = 0.72, 95% CI (0.56, 0.92)] and antivirals [aOR = 0.58, 95% CI (0.45, 0.75)]. CONCLUSIONS: Governmental risk communication and critical health literacy were strongly associated with public preventive behaviors. Findings suggest interventions to improve critical health literacy and risk communication could enhance preparedness and safer practices in future epidemics.
OBJECTIVE: To investigate the effectiveness of the Life! program-a prevention initiative for type 2 diabetes, heart disease, and stroke-on behavioural and anthropometric outcomes in women with a history of gestational di...OBJECTIVE: To investigate the effectiveness of the Life! program-a prevention initiative for type 2 diabetes, heart disease, and stroke-on behavioural and anthropometric outcomes in women with a history of gestational diabetes mellitus, across diverse sociodemographic backgrounds. METHODS: This study analysed the data collected from women who participated in the Life! program in Victoria, Australia from 2014 to 2022. Logistic regression analysis was undertaken to assess the associations of socioeconomic status, place of residence, employment status and country of birth with behavioural and anthropometric outcomes six months after enrolment. RESULTS: There were significant improvements in anthropometric and behavioural outcomes. Women with low income were least likely to improve fat (AOR = 0.64, 95% CI: 0.50, 0.83) and fibre (AOR = 0.70, 95% CI: 0.54, 0.91) intakes compared to women with middle income. Being 40 to 59 years old was associated with a greater improvement in fat intake compared with being under 30 years (AOR = 1.72, 95% CI: 1.06, 2.80). CONCLUSION: While the Life program is effective in reducing risks in women with a history of gestational diabetes, less dietary improvements were seen in those with lower incomes or younger, which needs to be addressed to reduce disparities in type 2 diabetes prevalence.
OBJECTIVE: To evaluate the associations between recreational cannabis legalization in the United States and primary mode of cannabis use (smoking, eating/drinking, vaporizing/dabbing) overall and across groups. METHODS:...OBJECTIVE: To evaluate the associations between recreational cannabis legalization in the United States and primary mode of cannabis use (smoking, eating/drinking, vaporizing/dabbing) overall and across groups. METHODS: We linked data on 69,109 adults reporting past month cannabis use from 37 states in the 2017-2023 Behavioral Risk Factor Surveillance System with recreational cannabis legalization and retail sales. Using multinomial logit regression models, we examined the associations between legalization and primary mode of cannabis use overall and by demographic and higher-risk strata, with demographic and policy controls and state and year fixed effects. RESULTS: Among cannabis users, smoking declined but remained the most prevalent mode of cannabis use in 2023 (62.7%), followed by eating/drinking (21.5%), and vaporizing/dabbing (15.8%). Compared to smoking and vaping/dabbing cannabis, the likelihood of eating/drinking cannabis increased by 35% (adjusted relative risk ratio 1.35; 95% CI 1.20, 1.52) and 33% (1.33; 1.14, 1.55), respectively, post-legalization. Similar patterns emerged in response to retail sales. There was evidence of larger increases in eating/drinking cannabis among males than females post-legalization, and among middle-aged and older adults than younger adults after retail store openings. CONCLUSION: Recreational cannabis legalization and retail sales led to more frequent use of cannabis in edible and drinkable forms.
OBJECTIVES: Site-specific cancer risks in vitiligo patients remain inconsistent, with paradoxical evidence for individual malignancies and no synthesis. METHODS: Systematic searches in PubMed (1996-February 2025), Embase...OBJECTIVES: Site-specific cancer risks in vitiligo patients remain inconsistent, with paradoxical evidence for individual malignancies and no synthesis. METHODS: Systematic searches in PubMed (1996-February 2025), Embase (1947-February 2025), Web of Science (1997-February 2025), Cochrane Library (1996-February 2025) (pre-inception retroactively indexed studies, January 1900-February 2025); 13 included in our meta-analysis. Stata 18.0 computed pooled RRs (95% CIs); heterogeneity assessed via publication bias, subgroup and sensitivity analyses. RESULTS: The study incorporated thirteen studies. It is evident that there is a statistically significant correlation between the occurrence of vitiligo and an elevated risk of developing thyroid cancer (RR = 1.59, 95% CI [1.19, 2.12]). Conversely, a significant reduction in risk was observed for overall cancer (RR = 0.77, 95% CI [0.66, 0.90]), cancers of the respiratory system (RR = 0.75, 95% CI [0.66, 0.84]), digestive system (RR = 0.74, 95% CI [0.63, 0.87]), and skin cancers (RR = 0.58, 95% CI [0.36, 0.93]). CONCLUSIONS: This study demonstrates a dual cancer risk profile in vitiligo: increased risk for thyroid cancer, but decreased risk for overall cancer, internal malignancies (respiratory and digestive systems) and skin cancers. These findings suggest the potential need for customized cancer surveillance strategies and investigation into preventive interventions.
OBJECTIVES: To synthesize theoretical and conceptual frameworks in firearm injury research, identify gaps across contexts, and inform applications for researchers and practitioners. METHODS: We conducted a scoping review...OBJECTIVES: To synthesize theoretical and conceptual frameworks in firearm injury research, identify gaps across contexts, and inform applications for researchers and practitioners. METHODS: We conducted a scoping review following PRISMA guidelines, searching seven databases for United States-based studies (1999-2024) that applied theoretical or conceptual frameworks to firearm injury research. After piloting the extraction form, reviewers charted study characteristics, firearm injury context (community, mass shootings, police, suicide, partner/dating, school, or multiple contexts), theoretical or conceptual framework, and social ecological level. Data were summarized using descriptive counts. RESULTS: Among 213 studies, most were non-intervention (82%) and observational (84%), conducted in urban settings with predominantly male, non-White adolescents and young adults. Most studies applied criminological theories (Routine Activities, Social Disorganization), while only 22% applied conceptual models. Critical and equity-focused theories were absent despite demographic disparities. Few studies empirically test theories; only 21 developed or adapted frameworks. Significant gaps existed in online contexts, rural settings, and among children and older adults. Theoretical-methodological misalignment was evident. CONCLUSIONS: Although theoretical frameworks are foundational to firearm research, current work remains variable across populations and contexts. Theory development must move beyond siloed approaches through transdisciplinary collaboration, empirical testing, and community co-creation to guide effective prevention strategies.
OBJECTIVE: To examine how country-level gender inequality relates to adolescent chronic pain prevalence and sex disparities. METHODS: We linked country-level Gender Inequality Index (GII) and lifetime prevalence of intim...OBJECTIVE: To examine how country-level gender inequality relates to adolescent chronic pain prevalence and sex disparities. METHODS: We linked country-level Gender Inequality Index (GII) and lifetime prevalence of intimate partner violence (IPV) against women to 2017/18 Health Behavior in School-aged Children data from 244,097 adolescents ages 11-15 in 47 countries. Relative sex disparities in pain prevalence (female:male prevalence ratio [PR]) were examined with modified Poisson regression with country-cluster-robust standard errors; absolute disparities (prevalence difference [PD]) with multilevel linear probability models. RESULTS: Chronic pain prevalence ranged from 32.30% to 58.72% across countries (overall 44.32%; I = 98.36%). Female-male PDs ranged from 0.29 to 18.26 percentage points (pooled 13.28; I = 79.80%); PRs ranged from 1.01 to 1.69 (pooled 1.36; I = 83.71%). Higher GII was associated with greater pain prevalence (PR = 1.11, 95% CI: 1.04, 1.19) yet smaller sex disparities, due to steeper increase in boys' pain prevalence as GII increases. Higher IPV prevalence, though unrelated to overall pain prevalence, was associated with larger female-male percentage-point differences (β = 1.28%, 95% CI: 0.16%, 2.39%). CONCLUSIONS: Structural gender inequality shapes both the population burden of adolescent chronic pain and sex disparities, underscoring the relevance of structural context and the need for more research in lower-income countries.
OBJECTIVE: To explore evidence on physical activity counseling for people living with HIV (PLHIV). METHODS: Searches covered earliest records in PubMed (1946), Embase (1947), Web of Science (1900), Scopus (1788), and LIL...OBJECTIVE: To explore evidence on physical activity counseling for people living with HIV (PLHIV). METHODS: Searches covered earliest records in PubMed (1946), Embase (1947), Web of Science (1900), Scopus (1788), and LILACS (1982) up to August 31, 2024. Studies investigating physical activity counseling in healthcare settings were included. Extracted data comprised author, year, country, sample characteristics, study design, objectives, theoretical framework, type and intensity, frequency, duration, strategies, professionals involved, and outcomes. RESULTS: Sixteen studies were included, most in the United States (n = 8; 50 %), predominantly involving adults (n = 12; 75 %) and both sexes (n = 12; 75 %), with a sample of 1458 participants. Motivational interviewing was the most frequent theoretical (n = 6; 37.5 %). Walking was the most counseled (n = 6; 37.5 %), usually recommended weekly (n = 9; 56.3 %), with sessions ranging from 15 to 90 min. Counseling intensity varied across light, moderate, and moderate-to-vigorous physical activity. More than half of the studies (n = 11; 68.8 %) reported increases in physical activity levels. CONCLUSIONS: Counseling shows potential to promote active lifestyles among PLHIV, particularly when based on behavioral theories, though challenges remain regarding the description of strategies and adaptation to this population.