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200 papers
Rural-urban differences in the symptoms, side effects, and physical activity of cancer survivors in the United States.
Zahnd WE, Gorzelitz J, Charlton ME … +3 more , Reisinger HS, Nash SH, Seaman AT
Prev Med · 2025 Oct · PMID 40754290 · Publisher ↗
OBJECTIVE: To evaluate rural-urban differences in cancer-related symptoms, side effects, activities of daily living, and physical activity among cancer survivors in the United States. METHODS: We analyzed the Health Info...
OBJECTIVE: To evaluate rural-urban differences in cancer-related symptoms, side effects, activities of daily living, and physical activity among cancer survivors in the United States. METHODS: We analyzed the Health Information National Trends Survey -Surveillance Epidemiology End Results (HINTS -SEER; n = 1054 cancer survivors) from the Greater San Francisco Bay Area, Iowa, and New Mexico between January - August 2021. Respondents were surveyed on cancer-related symptoms and side effects along with their activities of daily living (ADL) and physical activity (PA). We calculated weighted percentages and Rao-Scott chi-square tests for reported differences between rural and urban survivors. Rural/urban status was determined using Rural Urban Continuum Codes. RESULTS: Rural and urban cancer survivors did not differ in their reporting of symptoms or side effects, with each group reporting approximately 20 % or greater prevalence of each assessed symptom or side effect. For ADLs, rural cancer survivors more frequently reported difficulty dressing/bathing compared to their urban counterparts (7.7 % vs. 3.1 %, p = 0.02), but there were no statistically significant differences for other ADLs. A higher percentage of urban cancer survivors compared to rural reported meeting aerobic PA recommendations of ≥150 minutes moderate intensity activity per week (47.9 % vs. 33.8 %, p < 0.001). CONCLUSIONS: While many cancer survivors report symptoms and side effects of cancer treatment, no substantial variations existed by rurality. Important exceptions to this was that rural cancer survivors reported greater difficulty with bathing and dressing, and lower PA. Interventions and research to address these rural-urban differences will be critical to ensure rural cancer survivors have optimal long-term outcomes.
Changes in health behaviors and risk of cardiovascular disease among midlife and aging municipal employees with and without metabolic risk factors: A register-linkage cohort study in Finland.
Harkko J, Pietiläinen O, Jousilahti P … +5 more , Etholén A, Vähäsarja L, Teppo E, Novartis Foundation AI4HealthyCities Group, Lallukka T
Prev Med · 2025 Oct · PMID 40754289 · Publisher ↗
OBJECTIVE: To investigate associations between changes in health behaviors and cardiovascular disease (CVD) risk among municipal employees, stratified by baseline metabolic risk factors (hypertension, hypercholesterolemi...
OBJECTIVE: To investigate associations between changes in health behaviors and cardiovascular disease (CVD) risk among municipal employees, stratified by baseline metabolic risk factors (hypertension, hypercholesterolemia, obesity, diabetes). METHODS: We followed 4470 municipal employees in Helsinki, Finland (74 % women; median age 56.1 years) for an average of 11 years (2007-2022) to assess incident CVD. Survival curves estimated median survival differences, and hazard ratios (HRs) evaluated CVD risk related to changes in smoking, physical activity, alcohol consumption, diet, and sleep. RESULTS: During the follow-up, 1879 (42 %) individuals developed CVD. Among those without metabolic risk factors, improvement in health behavior score was linked to reduced CVD risk and an 8.1-year longer median survival (HR = 0.59, 95 % CI = 0.41-0.86). Across metabolic risk-factor groups, the most considerable reductions were observed in the transition from physical inactivity to activity among individuals with hypertension (HR = 0.66, 95 % CI = 0.49-0.87), diabetes (HR = 0.51, 95 % CI = 0.30-0.87), and obesity (HR = 0.63, 95 % CI = 0.43-0.93). CONCLUSIONS: Changes in health behaviors were associated with CVD risk, varying by metabolic factors. Findings support targeted interventions to promote behavior change, particularly increasing physical activity in those with metabolic risks.
Cigarette smoking and chronic disease in the United States, 2021-2023.
Kasza KA, O'Connor RJ, Cummings KM … +1 more , Mahoney MC
Prev Med · 2025 Dec · PMID 40721112 · Publisher ↗
OBJECTIVE: To quantify and describe the U.S. population of adults who smoke cigarettes daily and have chronic disease, determine their use of various products, and determine whether use of each product is associated with...
OBJECTIVE: To quantify and describe the U.S. population of adults who smoke cigarettes daily and have chronic disease, determine their use of various products, and determine whether use of each product is associated with cigarette quitting. METHODS: PATH Study data collected in 2021 (Wave 6) and 2022/23 (Wave 7) were analyzed. Participants were adults who smoked cigarettes daily ages 40+ who were diagnosed with chronic obstructive pulmonary disease, chronic bronchitis, emphysema, congestive heart failure, heart attack, stroke, cancer, and/or diabetes as of 2021 (N = 1261). We determined in 2022/23 their past 12-month use of e-cigarettes, nicotine pouches, nicotine replacement therapy (NRT), and bupropion or varenicline; we evaluated whether use differed by several characteristics, and whether use was associated with cigarette quitting. RESULTS: Among adults who smoked with chronic disease, 40 % were not recently advised by a clinician to quit smoking and 27 % did not plan to ever quit. Between 2021 and 2022/23, 16 % used e-cigarettes, 14 % used NRT, 8 % used bupropion or varenicline, 3 % used nicotine pouches. Overall, <6 % quit smoking in 2022/23; quit rates were higher for those who used e-cigarettes (9 %) and those who used NRTs (12 %) than those who did not use each respective product (5 % and 5 %). CONCLUSIONS: There are 9.9 million people with chronic disease who smoke cigarettes daily in the U.S; findings highlight opportunity for healthcare providers to enhance efforts to help people quit smoking, opportunity to improve low use rates of FDA-approved smoking cessation pharmacotherapies, and potential for e-cigarettes as a smoking cessation tool.
Disability and receipt of the Papanicolaou test for cervical cancer screening: A systematic review and meta-analysis.
Beglaryan H, Khattar J, Kassee C … +4 more , Barrett K, Bronskill SE, Lofters A, Brown HK
Prev Med · 2025 Oct · PMID 40716719 · Publisher ↗
OBJECTIVE: To synthesize literature comparing Papanicolaou (Pap) test receipt between women with and without disabilities. METHODS: We searched the following databases from inception to March 1, 2024: OVID Medline (1946-...
OBJECTIVE: To synthesize literature comparing Papanicolaou (Pap) test receipt between women with and without disabilities. METHODS: We searched the following databases from inception to March 1, 2024: OVID Medline (1946-), EBSCO CINAHL Plus (1981-), OVID EMBASE (1974-), and OVID APA PsycINFO (1806-). Eligible studies were peer-reviewed and compared receipt of Pap tests in women with physical, hearing, vision, or intellectual/developmental disability versus those without disabilities. We extracted data using a standardized form; study quality was appraised using the Newcastle-Ottawa Scale; and results were synthesized using random-effects meta-analyses, where possible. Findings that could not be meta-analyzed were summarized following Synthesis Without Meta-analysis guidelines. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the strength of evidence. RESULTS: Of 1946 unique studies screened, 43 were included in the review, and 21 were meta-analyzed. Studies were primarily cross-sectional (65.1 %), used survey data (76.7 %), and were conducted in the United States (60.5 %). Quality was rated high (30.2 %), medium (55.8 %), and low (14.0 %). Women with disabilities had a lower likelihood of receiving a Pap test (adjusted pooled OR 0.78, 95 % CI: 0.66-0.91). Disparities were more pronounced among those with physical (adjusted pooled OR 0.74, 95 % CI: 0.68-0.80) and intellectual/developmental disabilities (adjusted ORs ranging from 0.21 to 0.37). The overall strength of evidence was low. CONCLUSIONS: Women with disabilities could benefit from efforts to improve cervical cancer screening receipt. Future studies should continue to explore this association, including using population-based data that may better capture the needs of this group.
Examining US adolescent cigarette smoking prevalence by rurality and gender, 2002-2019.
Erath TG, Chen FF, DeSarno M … +1 more , Higgins ST
Prev Med · 2025 Dec · PMID 40716718 · Full text
OBJECTIVE: Examine changes in cigarette smoking prevalence among US adolescents by rural-urban residence, gender, and time. METHODS: We compared trends in smoking prevalence by rural-urban residence and gender using 18 y...
OBJECTIVE: Examine changes in cigarette smoking prevalence among US adolescents by rural-urban residence, gender, and time. METHODS: We compared trends in smoking prevalence by rural-urban residence and gender using 18 years of cross-sectional data (2002-2019) from 298,530 respondents aged 12-17 in the US National Survey on Drug Use and Health. The two primary outcomes were past-month and daily smoking prevalence. Weighted logistic regression models tested whether smoking prevalence varied by rural-urban residence, gender, and time along with two-way and three-way interactions of these variables. RESULTS: Past-month and daily smoking declined over time for all four rural-urban residence and gender combinations. Regarding past-month smoking, there was a significant rural-urban residence by time interaction (p < .001) with higher prevalence and slower rates of decline among rural (adjusted odds ratio [AOR] = 0.86; 95 %CI = 0.85,0.87) versus urban participants (AOR = 0.83; 95 %CI = 0.82,0.84). A significant gender by time interaction (p < .001) was also observed. The rate of decline was faster among females (AOR = 0.82; 95 %CI = 0.81,0.83) versus males (AOR = 0.85; 95 %CI = 0.84,0.86) with prevalence initially higher (2002-2003) yet ending lower (2018-2019) among females. Regarding daily smoking, there was a significant rural-urban residence by time interaction (p = .005) with higher prevalence and slower rates of decline among rural (AOR = 0.82; 95 %CI = 0.80,0.85) versus urban participants (AOR = 0.79; 95 %CI = 0.78,0.80). CONCLUSIONS: Findings provide novel evidence of shrinking yet persistent rural disparities in both past-month and daily smoking, and less declines in past-month smoking among males over time. Together, findings support continued need for tobacco control and regulatory efforts to reduce adolescent smoking and specific efforts to reduce rural and gender disparities.
Response to commentary by Akhter et al. titled, "Beyond biomarkers: Underexplored considerations in SREC trials for people with HIV who smoke".
Cioe PA, Lechner WV, Stang GS … +4 more , Kahler CW, Tashima KT, Eissenberg T, Tidey JW
Prev Med · 2025 Dec · PMID 40714020 · Full text
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Human-centred design thinking as a co-creation process: A commentary.
Romero V, Rivera E
Prev Med · 2025 Oct · PMID 40712981 · Publisher ↗
OBJECTIVE: Co-creation, a collaborative process of engaging with stakeholders to define complex problems and design solutions that are contextually relevant to stakeholders' needs, has gained traction in public health an...
OBJECTIVE: Co-creation, a collaborative process of engaging with stakeholders to define complex problems and design solutions that are contextually relevant to stakeholders' needs, has gained traction in public health and preventive medicine to address "wicked problems" through meaningful engagement with stakeholders. The way in which co-creation approaches are used and/or described in public health are not always entirely clear. How might we enhance co-creation processes to improve health? The objective of this commentary is to argue for the integration of human-centred design thinking (HCDT) to direct co-creation processes by defining its framework and use of empathetic perspectives and iterative problem framing. METHODS: This commentary defines human-centred design thinking HCDT as a framework for co-creation with an emphasis on divergent and convergent thinking and introduces designer mindsets. The role of empathy and problem framing is explored using examples from the field. RESULTS: This commentary argues for the added value of applying HCDT as an approach to co-creation in public health and provides tools associated with this process that can complement traditional co-creation processes, such as the Double Diamond model, HCDT field guides with detailed and established activities, "designerly ways of knowing", empathy mapping, and problem reframing. CONCLUSIONS: By integrating HCDT into co-creation processes, we can foster deeper empathetic responses and problem framing through collaboration.
Beyond biomarkers: Underexplored considerations in standardized research electronic cigarette trials for people with HIV who smoke.
Akhter J, Iqbal J, Ali SM
Prev Med · 2025 Dec · PMID 40712980 · Publisher ↗
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Associations between behavior cognition-social influence and pregnancy planning behavior in China: An integrated individual-couple analysis.
Sun R, Yang T, Wang M … +3 more , Ying X, Li L, Zhang W
Prev Med · 2025 Oct · PMID 40701192 · Publisher ↗
OBJECTIVE: Pregnancy planning is a critical opportunity to enhance preconception health. "Beiyun," a culturally rooted concept in China, encompasses traditional and modern practices for preparing for pregnancy. This stud...
OBJECTIVE: Pregnancy planning is a critical opportunity to enhance preconception health. "Beiyun," a culturally rooted concept in China, encompasses traditional and modern practices for preparing for pregnancy. This study used the comprehensive idea of "Beiyun" to examine the mechanisms of pregnancy planning behavior among women and men through an integrated individual-couple analysis based on the Behavior Cognition - Social Influence Theory. METHODS: Using multistage stratified sampling, we recruited reproductive-aged individuals in Zhejiang, China between July and September 2023. A cross-sectional survey collected data on pregnancy planning behavior. Analyses were conducted at both individual (Study 1, all participants) and couple levels (Study 2, coupled participants) using path analysis, specifically employing the actor-partner interdependence model in Study 2. RESULTS: Study 1 included 1086 women and 905 men, with 57.6 % and 67.7 % reporting pregnancy planning, respectively. Study 2 comprised 458 heterosexual couples. At the individual level, perceived susceptibility (women: β = 0.09, p = 0.01; men: β = 0.09, p = 0.04) and behavioral norms (women: β = 0.37, p < 0.01; men: β = 0.45, p < 0.01) were significantly associated with planning behavior. Couple-level analysis revealed that women's pregnancy planning was associated with their perceived susceptibility (β = 0.13, p = 0.02), behavioral norms (β = 0.29, p < 0.01), and their partner's behavioral norms (β = 0.30, p < 0.01), while men's behavior was associated with their norms (β = 0.35, p < 0.01) and partner's perceived susceptibility (β = 0.13, p = 0.03). CONCLUSIONS: This study yielded new insights into pregnancy planning behavior, highlighting the role of individual factors and partner dynamics. Future interventions should enhance risk awareness among women and shape behavioral norms in men, considering partner dynamics in public health campaigns.
Secondary analysis of a randomized clinical trial of very low nicotine cigarettes: Outcomes across social and demographic groups.
Said RJ, Carroll DM, Luo X … +6 more , Hu J, Cao Q, Tessier KM, Bittencourt L, Hatsukami DK, Center for Evaluation of Nicotine in Cigarettes (CENIC)
Prev Med · 2025 Dec · PMID 40701191 · Full text
OBJECTIVE: To examine whether the impact of a nicotine reduction standard (NRS) varies by socio-demographics. METHODS: Secondary analysis of a 12-week trial (2018-2022) with 438 people who smoke (PWS) comparing very low...
OBJECTIVE: To examine whether the impact of a nicotine reduction standard (NRS) varies by socio-demographics. METHODS: Secondary analysis of a 12-week trial (2018-2022) with 438 people who smoke (PWS) comparing very low nicotine content (VLNC) vs. normal nicotine content (NNC) cigarettes. Moderation by education, race, and age on cigarettes per day (CPD), smoke-free days, and biomarkers (CEMA, NNAL) was assessed using interaction models. RESULTS: For race and education, interaction tests for moderation were not significant (ps > 0.05). In subgroup analyses, VLNC condition reduced CPD and biomarkers and increased smoke-free days with the following exception: no difference in CEMA was observed by condition among those of lower education (Geometric mean ratio [GMR] = 0.72, 95 % confidence interval [CI] = 0.39, 1.33). For age, multiple interaction tests were significant. In subgroup analyses, older but not younger adults, had no VLNC vs. NNC differences for CEMA (GMR: 0.85 [CI = 0.51, 1.41] vs 0.47 [CI = 0.35, 0.62]) or smoke-free days (rate ratio: 1.85 [CI = 0.63, 5.55] vs 5.85 [CI = 3.12, 10.89]). CONCLUSION: Age and potentially education moderate NRS effects among PWS. POLICY IMPLICATIONS: Targeted support for older adults and those with lower education may maximize NRS benefits. TRIAL REGISTRATION: NCT03272685.
Compliance with smoke-free policies in outdoor settings: a realist review.
Jooren SJA, Garritsen HH, Troelstra S … +4 more , van Dijk W, Jansen MWJ, Willemsen MC, Bommelé J
Prev Med · 2025 Oct · PMID 40695414 · Publisher ↗
OBJECTIVE: Although smoke-free outdoor environments are increasingly implemented to reduce adolescent smoking and de-normalize the behaviour, compliance is often low. To better understand compliance of people who smoke,...
OBJECTIVE: Although smoke-free outdoor environments are increasingly implemented to reduce adolescent smoking and de-normalize the behaviour, compliance is often low. To better understand compliance of people who smoke, we conducted a realist review. METHODS: A realist review, a type of literature review, uses existing evidence to make a program theory, outlining mechanisms and contexts, that provides an explanatory analysis of compliance of people who smoke with outdoor smoke-free environments. The search was conducted in PubMed, Web of Science, Embase, and PsycINFO. Studies were included that had been published from January 1, 2000, to September 1, 2023. Twenty-five peer-reviewed English-language articles were included. Evidence was extracted about contexts and mechanisms that influence the compliance of smokers. RESULTS: Compliance with smoke-free outdoor environments increases if people who smoke accept the policy, have sufficient knowledge and when the policy affects their motivation to quit smoking. However, these mechanisms may be hindered by feelings of people who smoke, such as low confidence in the policy's effectiveness and enforcement, feelings of stigma, and a lack of understanding. The context in which these environments are implemented, such as communication about the smoke-free policy, the stop-smoking facilities, the presence of ashtrays and designated smoking areas, and the size of the environment, influences mechanisms and compliance. CONCLUSIONS: To increase acceptance and clarity of smoke-free policies, we recommend implementing smoke-free outdoor policies without designated smoking areas or ashtrays while actively promoting public awareness. To avoid stigmatisation, accessible cessation support is key. Lastly, proper enforcement training is essential.
The association between life's essential 8 health behavior component score and all-cause and cardiovascular mortality among U.S. adults with cardiovascular-kidney-metabolic syndrome stages 0-3.
Wang Y, Dong T, Wang B … +1 more , Zhang P
Prev Med · 2026 Jan · PMID 40675391 · Publisher ↗
OBJECTIVE: To investigate the association between Life's Essential 8 (LE8) health behavior component score and mortality outcomes among individuals with Cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3. METHODS:...
OBJECTIVE: To investigate the association between Life's Essential 8 (LE8) health behavior component score and mortality outcomes among individuals with Cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3. METHODS: 8067 U.S. adults from the National Health and Nutrition Examination Survey 2005-2018, aged 30-79 years with CKM syndrome stages 0-3, were analyzed. Mortality status was obtained via linkage to the National Death Index through December 31, 2019. Kaplan-Meier analysis, multivariable Cox regression, and restricted cubic splines (RCS) were used to examine associations between LE8 health behavior component score and mortality outcomes. RESULTS: CKM stages were distributed as follows: 7.8 % (stage 0), 21.0 % (stage 1), 64.0 % (stage 2), and 7.3 % (stage 3). Higher LE8 total score and health behavior component score were linked to reduction in all-cause mortality and cardiovascular mortality risk. RCS analysis showed a linear relationship between LE8 total score, health behavior component score and mortality outcomes. Interaction between health behavior component score and CKM syndrome stages was identified for all-cause mortality. CONCLUSIONS: Higher LE8 health behavior component score is associated with reduced all-cause and cardiovascular mortality among population with CKM syndrome stages 0-3. These findings support the potential value of behavior-targeted interventions tailored to CKM syndrome stages.
Examining rural disparities in cigarette smoking among U.S. women by chronological age: 2002-2022.
Higgins ST, Erath TG, Chen FF … +1 more , DeSarno MJ
Prev Med · 2025 Dec · PMID 40653176 · Full text
OBJECTIVE: This study investigated rural disparities in cigarette smoking among U.S. women by age (18-65+ years) across survey years (2002-2022). METHODS, DATA SOURCE: Data came from the National Survey on Drug Use and H...
OBJECTIVE: This study investigated rural disparities in cigarette smoking among U.S. women by age (18-65+ years) across survey years (2002-2022). METHODS, DATA SOURCE: Data came from the National Survey on Drug Use and Health. Women were categorized by rural-urban residence and age. We examined associations between residence, age, and time on current-smoking prevalence and quit ratios in two-year bins using weighted logistic-regression adjusting for race/ethnicity, education, annual income. RESULTS: Effects of residence on current-smoking prevalence interacted with time (t[df = 430,180] = 4.51, P < .001), with reductions over time among urban (AOR = 0.95, 95 %CI: 0.94-0.96, P < .001) but not rural residents (AOR = 0.99, 95 %CI: 0.98-1.01, P = .66). Residence interacted with age (t[df = 430,180] = -4.90, P < .001), with greater smoking among rural women in younger (AORs≥1.23, 95 %CI: 1.01-1.44, Ps ≤ 0.008), but not older age brackets (AORs ≤1.04, 95 %CI: 0.74-1.35, Ps ≥ 0.688). Rural residence predicted lower odds of quitting smoking (AOR = 0.80, 95 %CI: 0.71-0.91, P < .001). CONCLUSIONS: There is a growing disparity in smoking prevalence that disproportionately impacts rural women ages 18-49 years raising concerns about multigenerational adverse effects as this demographic is most likely to be pregnant or parenting young children. There is also a rural disparity in quitting smoking across age groups underscoring a need for greater access to smoking-cessation services among rural women.
Disparities in willingness to call the police in a 2023 survey of US adults: Implications for alternative crisis response programs.
Rouhani S, Machavariani E, McSorley AM … +2 more , Todd TL, Purtle J
Prev Med · 2025 Sep · PMID 40653175 · Full text
OBJECTIVE: To estimate willingness to call the police in an emergency among US adults to inform policies addressing emergency response and help-seeking. METHODS: We utilized cross-sectional data from a web-based 2023 Sur...
OBJECTIVE: To estimate willingness to call the police in an emergency among US adults to inform policies addressing emergency response and help-seeking. METHODS: We utilized cross-sectional data from a web-based 2023 Survey of Racism and Health of (N = 5059) adults in 12 Northeastern and Mid-Atlantic states and D.C. We estimated odds of willingness to call the police as a function of gender, race/ethnicity, and lifetime diagnosis with a behavioral health (substance use or mental health) condition using unadjusted and adjusted logistic regression. RESULTS: Most of the sample (80 %) reported willingness to call the police in an emergency. Dds were observed among Black (aOR 0.33; 95 % CI 0.27-0.41), American Indian/Native American (aOR 0.43; 95 % CI 0.27, 0.70), and Multiracial (aOR 0.36; 95 % CI 0.25-0.52) compared to White respondents, and those with behavioral health diagnoses (aOR 0.73; 95 % CI 0.61, 0.88). Women (aOR 1.23; 95 % CI 1.05, 1.43) and older adults (Age 55+: aOR 4.62; 95 % CI 3.70, 5.80) reported higher willingness to call the police. CONCLUSIONS: Findings highlight subpopulations for whom the police may not be a viable source of emergency response, particularly individuals who are racially minoritized and/or have behavioral health conditions. This has implications for alternative response programs which rely on 911 dispatch to triage calls and highlights a need for targeted messaging and alternative mechanisms to call for service in communities with police mistrust.
Sustainable chronic disease prevention at scale: Evaluation of the Get Healthy Service, a telephone and online coaching service.
Szewczyk Z, McGill B, Clare P … +5 more , Lee K, Davidson S, Jeong SY, Bauman A, O'Hara BJ
Prev Med · 2025 Sep · PMID 40645377 · Publisher ↗
OBJECTIVE: The Get Healthy Service (GHS) is a free telephone and online health coaching service for adults delivered across New South Wales, Australia, since 2009. The GHS was first evaluated over 10 years ago and was sh...
OBJECTIVE: The Get Healthy Service (GHS) is a free telephone and online health coaching service for adults delivered across New South Wales, Australia, since 2009. The GHS was first evaluated over 10 years ago and was shown to be effective. Using recent data, we investigated characteristics conducive to program completion and whether program impact has been sustained at scale. METHODS: This evaluation used data collected during program delivery between December 2017 and May 2023. Descriptive and inferential analysis was used to measure program completion, and pre-post health risk behaviour change. RESULTS: Of 53,566 participants enrolled in the GHS, 34 % completed the program. Multivariable analyses showed that men, people aged 50+ years, and those who did not identify as Aboriginal were more likely to complete the program. Program completers showed increased physical activity (43.5 mins/week; 95 % CI 40.55, 46.49), fruit intake (IRR 1.011; 95 % CI 1.08, 1.14) and vegetable intake (IRR 1.3; 95 % CI 1.27, 1.32); improvements in their BMI score (-0.51 kg/m; 95 % CI -0.56, -0.45) and waist circumference (-2.74 cm; 95 % CI -2.96, -2.52); and improvements in sweet drink and takeaway food consumption. Compared to earlier evaluations, the impact of the GHS on health risk behaviours had decreased. CONCLUSIONS: Since its launch almost 15 years ago, GHS continues to confer improved anthropometric and lifestyle risk factors in adults, however the magnitude of effect has decreased since earlier evaluations. Efforts to sustain and improve the impact of the program, particularly amongst participants from most disadvantaged backgrounds, is needed.
Barriers to healthcare utilization among adults engaging in heavy drinking: Results from the All of Us research program.
Fenton MP, Swacil K, Striley CW … +4 more , Cottler LB, Eder M, Cohen IP, Lopez-Quintero C
Prev Med · 2025 Sep · PMID 40639743 · Full text
OBJECTIVE: We examined sociodemographic factors associated with barriers to healthcare utilization (HCU) among a national sample of adults engaging in heavy drinking behavior (HDB). METHODS: A sample of 3257 participants...
OBJECTIVE: We examined sociodemographic factors associated with barriers to healthcare utilization (HCU) among a national sample of adults engaging in heavy drinking behavior (HDB). METHODS: A sample of 3257 participants from the All of Us program (2018-2022 Controlled Tier Dataset-v7) who reported HDB (i.e., six or more drinks on one occasion, at least weekly) was selected to examine the associations between socio-demographic factors and barriers to HCU (i.e., structural, competing social roles, attitudinal, and financial barriers). Multiple logistic regressions estimated adjusted Odds Ratios (aOR) for the associations of interest. RESULTS: Financial barriers (23.64 %) were the most common of the four barriers, followed by attitudinal (18.27 %), competing social roles (15.66 %), and structural (13.36 %) barriers. Females were more likely than males to report competing social roles (or = 1.56, 95 %CI = 1.28,1.90), attitudinal (aOR = 1.41, 95 %CI = 1.17,1.70), and financial (or = 1.41, 95 %CI = 1.19,1.68) barriers. Lower income (aOR = 6.71, 95 %CI = 4.77,9.56), and Non-Hispanic Black/African Americans (aOR = 1.39, 95 %CI = 1.04,1.85) showed higher odds of reporting structural barriers. CONCLUSIONS: As many as one in four individuals who engage in HDB experience at least one HCU barrier, particularly women, those with low-incomes, and Non-Hispanic Black/African Americans. The findings highlight the need for implementation of evidence-based strategies among the identified populations to reduce HCU barriers, and ultimately, alcohol-related disparities.
Travel distance to the general practitioner and women's participation in cervical cancer screening in Denmark - A population-based cohort study, 2017.
Plenborg RB, Ersbøll AK, Bihrmann K
Prev Med · 2025 Sep · PMID 40633736 · Publisher ↗
OBJECTIVES: Previous studies found disparities in utilization of cervical cancer screening programs. Geographical distance to the screening location may affect women's participation. The aim of this study was to investig...
OBJECTIVES: Previous studies found disparities in utilization of cervical cancer screening programs. Geographical distance to the screening location may affect women's participation. The aim of this study was to investigate the association between travel distance from residence to general practitioner, and invited women's participation in a national screening program for cervical cancer. METHODS: Data were obtained from Danish national registers including all women invited to the screening program in 2017 (n = 341,708). Travel distance from residence to the general practitioner was calculated based on geocoded addresses and the road network. Multilevel logistic regression was used to calculate odds ratios (ORs) of participation with 95 % confidence intervals (CI). RESULTS: Based on 271,959 women with complete information, screening participation decreased from 67.7 % among women with a travel distance of 1.0-4.9 km to 61.1 % among women with ≥15.0 km. Adjusted for ethnicity, education, and age, women with ≥15.0 km to the general practitioner had 22 % lower odds of participation compared to those living 1.0-4.9 km away (OR = 0.78, 95 %CI [0.75;0.81]). Women with <1.0 km to the general practitioner had 10 % lower odds of participation (OR = 0.90, 95 %CI [0.88;0.93]). Sensitivity analysis indicated an exposure-response relationship when distance was ≥5 km, implying lower odds of participation with increasing distance above 5 km. CONCLUSION: Travel distance to the general practitioner was associated with participation in screening. Future initiatives should promote equal access to preventive health services focusing on women having a long travel distance to their general practitioner, as well as those living very close to their general practitioner.
E-cigarette use frequency mediates effects in three randomized controlled trials of reduced nicotine cigarettes with tobacco vs preferred flavor e-cigarettes in high-risk populations in the U.S.
Klemperer EM, DeSarno MJ, Tidey JW … +5 more , Gaalema DE, Nolder KA, Feinstein MJP, Wiley RC, Higgins ST
Prev Med · 2025 Dec · PMID 40628358 · Full text
OBJECTIVES: The U.S. Food and Drug Administration is authorized to implement a nicotine-reducing standard to decrease smoking. Three recent trials found switching to very low nicotine content (VLNC) cigarettes produced t...
OBJECTIVES: The U.S. Food and Drug Administration is authorized to implement a nicotine-reducing standard to decrease smoking. Three recent trials found switching to very low nicotine content (VLNC) cigarettes produced the greatest reduction in cigarettes/day and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL, a tobacco-specific carcinogen) among adults from high-risk populations when participants also received preferred- vs tobacco-flavored e-cigarettes. This pooled secondary analysis investigates e-cigarette use frequency as a mechanism driving these effects. METHODS: Participants (U.S. adults with affective disorders, adults with opioid use disorder, and reproductive-age females with ≤high-school education) were randomized to 16 weeks of VLNC cigarettes with preferred-flavored e-cigarettes selected from eight options (VLNC+PF; n = 84) or VLNC cigarettes with tobacco-flavored e-cigarettes (VLNC+TF; n = 74) from October 2020-November 2023. General linear models explored whether e-cigarette use frequency (days/week) between Weeks 1-15 mediated effects on Week-16 cigarettes/day and NNAL. RESULTS: Participants were 40.4 (mean) years old (SD = 11.5), 69.0 % female, 81.0 % white, and smoked 17.3 (mean) cigarettes/day (SD = 9.0) at baseline. The VLNC+PF condition reported more e-cigarette use days/week (LSmean[SEM]): 4.3[±0.4]) than the VLNC+TF condition (LSMean[SEM]: 3.4[±0.5]; F[1151] = 3.9, p < .05) across weeks 1-15. More e-cigarette use days/week predicted greater reductions in mean cigarettes/day (β[SE]: -0.32[±0.05)]; F[1106] = 50.5, p < .01) and NNAL (β[SE]: -0.14[±0.04]; F[1,92] = 12.2, p < .01) at Week-16. E-cigarette use frequency fully mediated the effects of condition on cigarettes/day and partially mediated effects on NNAL. CONCLUSIONS: Greater frequency of e-cigarette use was a mechanism by which preferred-flavor e-cigarettes led to reductions in smoking and tobacco-toxicant exposure, demonstrating the potential for appealing e-cigarettes to reduce harm among high-risk populations who smoke.
Pilot randomized clinical trial examining use of very low nicotine content cigarettes during pregnancy in the United States.
Heil SH, Kock LS, Harfmann RF … +5 more , Ashford KB, Barnett J, McCubbin A, DeSarno MJ, Higgins ST
Prev Med · 2025 Dec · PMID 40623557 · Full text
OBJECTIVE: Randomized controlled trials have shown that reducing the nicotine content of cigarettes decreases the number of cigarettes smoked per day (CPD) without engendering compensatory smoking. The present study exam...
OBJECTIVE: Randomized controlled trials have shown that reducing the nicotine content of cigarettes decreases the number of cigarettes smoked per day (CPD) without engendering compensatory smoking. The present study examined whether those effects extend to smoking during pregnancy. METHODS: Pregnant participants (≤25 weeks gestational age) in the U.S. with less than an Associate's degree and not planning to quit smoking were randomly assigned to smoke their usual brand (UB) cigarettes or very low nicotine content (VLNC) cigarettes (0.4 mg nicotine/g of tobacco) for 12 weeks. The primary outcome was total CPD at 12 weeks. RESULTS: Baseline characteristics did not differ between conditions (14 UB, 16 VLNC), but smoking-related variables were indicative of heavy smoking and moderate-high nicotine dependence. Mean (±SE) total CPD at 12 weeks among completers (11 UB, 12 VLNC) did not differ between conditions (18.4 ± 2.3 and 16.3 ± 2.6, respectively), nor did it vary over time. VLNC cigarette use did not lead to compensatory smoking, greater withdrawal or craving, or any severe or serious adverse events, and birth outcomes were within normal ranges on average. CONCLUSIONS: Results suggest this sample of pregnant participants did not realize the same benefits of VLNC cigarettes that other not-pregnant samples have, although there was also no evidence of harm in the form of compensatory smoking or other adverse events. The sample's smoking characteristics suggest they were especially resistant to changing their smoking and it remains possible that those with more representative smoking patterns during pregnancy will respond to VLNC cigarettes as other populations have. CLINICALTRIALS: govID:NCT04033237.
Relationship between an adult-use Cannabis law and Cannabis use by type in a cohort of New Jersey young adults.
Glasser AM, Villanti AC, Gundersen DA … +2 more , Schroth KRJ, Hrywna M
Prev Med · 2025 Sep · PMID 40618906 · Full text
OBJECTIVES: Limited research has evaluated the impact of cannabis policies on young adult cannabis use, after full implementation (retail outlets opened), nor on cannabis product type. This study examined the relationshi...
OBJECTIVES: Limited research has evaluated the impact of cannabis policies on young adult cannabis use, after full implementation (retail outlets opened), nor on cannabis product type. This study examined the relationship between adult-use cannabis retail sales in New Jersey (United States) and young adult cannabis use by type. METHODS: Data on New Jersey young adults (18-23 years) were from the Policy Communication and Evaluation (PACE) New Jersey Study. Generalized estimating equations models estimated differences in prevalence of ever and past 30-day use of cannabis and sub-types before (Waves 1-3 [March-November 2021], n = 1439) and after (Wave 4 [June-July 2022], n = 1127) adult-use retail sales began. RESULTS: Ever cannabis use among New Jersey young adults was higher in the post-retail sales period than pre-sales (58.1 % vs. 48.9 %, p < 0.01). The odds of ever cannabis use were 42 % higher (95 % CI = 32 %-54 %) in the post-retail period. Ever use of dried herb (post vs. pre: 44.4 % vs. 38.5 %, p < 0.01), drinks (7.0 % vs. 4.8 %, p < 0.01), edibles (45.9 % vs. 35.6 %, p < 0.01), and topicals (6.4 % vs. 4.6 %, p < 0.05), and past 30-day edible use (11.8 % vs. 9.0 %, p = 0.01) were higher post-retail; use of other product types did not differ. CONCLUSIONS: Cannabis use overall and among certain subtypes (e.g., edibles) increased among New Jersey young adults in the three months after adult-use cannabis retail sales began, demonstrating that increased access to legal cannabis for sale may encourage use. Continued monitoring is needed over longer follow-up periods in New Jersey and other states legalizing cannabis.
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