Kava CM, Dai S, Siegel DA
… +4 more, Sabatino SA, Qin J, Tangka FKL, Henley SJ
Public Health Rep
· 2026 Jan · PMID 41605243
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OBJECTIVES: Common data sources that examine cancer survival provide limited information on health behaviors or social determinants of health. We linked individual-level cancer registry data to county-level data to exami...OBJECTIVES: Common data sources that examine cancer survival provide limited information on health behaviors or social determinants of health. We linked individual-level cancer registry data to county-level data to examine differences in survival among people diagnosed with lung cancer. METHODS: We linked 2010-2020 National Program of Cancer Registries survival data from 40 registries, covering 85% of the US population, to county-level data on current age-adjusted cigarette smoking prevalence, average daily density of fine particulate matter (PM) in µg/m (fine particulate pollution), and overall social vulnerability. We generated Kaplan-Meier survival curves and used multivariable Cox proportional hazards regression to examine overall and cause-specific survival among people aged ≥20 years diagnosed with lung cancer. RESULTS: Survival was significantly lower among people who lived in counties with a higher prevalence of cigarette smoking of 14.3% to <17.0% (adjusted hazard ratio [AHR] = 1.06), 17.0% to <20.2% (AHR = 1.08), and 20.2% to 34.8% (AHR = 1.14) compared with 6.7% to <14.3%; fine particulate pollution >12.0 µg/m versus ≤12.0 µg/m (AHR = 1.04); and social vulnerability scores in the second (AHR = 1.01), third (AHR = 1.02), and fourth (AHR = 1.03) quartiles versus first quartile. Individual-level covariates significantly associated with rates of survival included sex, age at diagnosis, race and ethnicity, histology, stage at diagnosis, receiving surgery during first course of treatment, year of diagnosis, and US Census region. CONCLUSIONS: Multiple characteristics were associated with lower 5-year lung cancer survival rates. Interventions that address these characteristics (eg, promoting tobacco cessation, reducing exposure to fine particulate pollution) may lead to longer survival after lung cancer diagnosis.
Snyder AB, Zhou M, Valle J
… +3 more, Boudreaux J, Yamashita R, Lal A
Public Health Rep
· 2026 Jan · PMID 41605240
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OBJECTIVE: An accurate estimate of the prevalence, demographic characteristics, and geographic distribution of thalassemia in the United States is needed to plan for the health care needs of people with this disease. We...OBJECTIVE: An accurate estimate of the prevalence, demographic characteristics, and geographic distribution of thalassemia in the United States is needed to plan for the health care needs of people with this disease. We developed and evaluated the predictive value of administrative case definitions for correctly identifying people living with thalassemia. METHODS: We conducted a retrospective study of the diagnostic accuracy of 3 claims-based case definitions to identify people with thalassemia in Medicaid administrative data from 2012 through 2019. Case definition 1 was ≥5 encounters with a code for thalassemia; case definition 2 was ≥1 encounter with a code for thalassemia and ≥6 encounters with a transfusion code; and case definition 3 was ≥2 encounters with a code for thalassemia and a transfusion code occurring on the same encounters. We validated our findings by using confirmatory laboratory assessment and expert review by clinicians at thalassemia treatment centers in Georgia (Children's Healthcare of Atlanta) and California (University of California San Francisco) as the gold standard. RESULTS: Of the 327 people identified, thalassemia was confirmed in 173 (52.9%), excluded in 68 (20.7%), and found indeterminate in 86 (26.2%) people. Case definition 1 had the lowest positive predictive value (PPV) (range, 55%-77%). For case definition 2, the PPV range was 80% to 86%. For case definition 3, the PPV range was the highest (82%-96%) but also captured more indeterminate cases. CONCLUSIONS: Accurately identifying patients with thalassemia using a case definition based on administrative claims data is feasible. Extending our method to other health care databases beyond Medicaid may allow for an estimate of the national prevalence of transfusion-dependent thalassemia. However, cases of nontransfusion-dependent thalassemia were difficult to define with sufficient precision.
Miranda-Vicente AK, Zevallos-Villanueva NK, Fernández-Ahumada AC
… +1 more, Bernabe-Ortiz A
Public Health Rep
· 2026 · PMID 41605239
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OBJECTIVES: Physical inactivity is associated with socioeconomic and social levels; thus, individuals of low socioeconomic status are less likely than individuals of high socioeconomic status to exercise. We assessed the...OBJECTIVES: Physical inactivity is associated with socioeconomic and social levels; thus, individuals of low socioeconomic status are less likely than individuals of high socioeconomic status to exercise. We assessed the association between socioeconomic status and changes in physical activity levels among children from 2002 to 2017 in Peru. METHODS: We conducted a secondary data analysis of the Young Lives Study (n = 2052 children aged 8 years [at baseline] and 15 years [at the end of follow-up]), a cohort with data collected in Peru. The outcomes were insufficient physical activity (<5 days of physical activity per week) and physical inactivity (<1 day of physical activity per week), and the exposure variable consisted of 2 socioeconomic indicators (maternal education and wealth index). We assessed the association between outcomes and exposures by using Poisson regression models and reported relative risks (RRs) and 95% CIs. RESULTS: Of 1888 participants at baseline, the mean (SD) age was 7.9 (0.3) years and 946 (50.1%) were male. The prevalence of physical inactivity and insufficient physical activity was 9.1% (n = 172) and 59.4% (n = 1122), respectively. After 7.0 (SD = 0.1) years of follow-up, in the multivariable model, a high wealth index was associated with low levels of physical activity, but maternal education was not. Thus, children with a high (vs low) level of wealth index had higher rates of physical inactivity (RR = 2.11; 95% CI, 1.47-3.03) and insufficient physical activity (RR = 1.11; 95% CI, 1.03-1.19). CONCLUSIONS: Wealth index was associated with insufficient physical activity and physical inactivity, but maternal education was not. Our results suggest the need to promote physical activity levels according to social context.
Beeson AM, White JL, Gates AL
… +3 more, McCormick DW, Hinckley AF, Marx GE
Public Health Rep
· 2026 · PMID 41592709
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OBJECTIVES: Lyme carditis is a rare, potentially fatal manifestation of Lyme disease. Although Lyme disease is nationally notifiable, data on clinical manifestations are not collected systematically in the United States....OBJECTIVES: Lyme carditis is a rare, potentially fatal manifestation of Lyme disease. Although Lyme disease is nationally notifiable, data on clinical manifestations are not collected systematically in the United States. We developed a syndromic surveillance definition to identify patients with Lyme carditis in New York State during 2017-2021. METHODS: We developed a definition of Lyme carditis by using diagnostic codes and keywords to identify emergency department visits related to Lyme carditis through the National Syndromic Surveillance Program's BioSense Platform. We systematically abstracted information for each identified patient by reviewing medical records in New York State's regional health information exchange system. Physician reviewers independently assigned a clinical case status to each record. We mapped cases of Lyme carditis by county and described their characteristics. RESULTS: We identified records for 173 individuals; 32% (n = 55) were classified as confirmed, 16% (n = 27) as probable, and 53% (n = 91) as not a case of Lyme carditis. In total, we identified 82 cases of confirmed or probable Lyme carditis; the positive predictive value of the definition was 47%. Cases occurred in 49% of New York State counties and peaked annually in July and August. Among patients with confirmed and probable Lyme carditis, age distribution was bimodal, with incidence peaking at about ages 32 and 70 years; 71% were male. Eighty-four percent had positive 2-tiered serologic test results for Lyme disease, and second- or third-degree atrioventricular block was present in two-thirds of patients (67%). PRACTICAL IMPLICATIONS: This definition may be a useful tool to detect changing patterns of Lyme carditis in areas with a high incidence of Lyme disease.
White CM, Sedensky A, Belcourt J
… +1 more, Kulkarni P
Public Health Rep
· 2026 · PMID 41587771
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The Dietary Supplement Health and Education Act of 1994 specified that dietary supplements must be swallowed. In this study, we investigated whether kratom-derived products are being sold to consumers in nonswallowed for...The Dietary Supplement Health and Education Act of 1994 specified that dietary supplements must be swallowed. In this study, we investigated whether kratom-derived products are being sold to consumers in nonswallowed formulations. Kratom is the fresh or dried leaf powder of the tree. We identified 49 kratom-derived products being sold in the form of sublingual strips (24%), buccal pouches (8%), and vaping products (67%). Most contained 7-hydroxymitragynine (an alkaloid that the US Food and Drug Administration seeks to make a controlled substance), but we also identified mitragynine extract and mitragynine pseudoindoxyl products. The majority had flavoring or a scent, and some had mascots, pictures of fruit or mint, or formulation colors or packaging that could appeal to children. Most products were not sold in child-resistant packaging. Several kratom vaping products additionally contained intoxicating hemp cannabinoids. With no clinical, safety, or pharmacokinetic data for kratom-derived products that bypass first-pass metabolism (ie, where a chemical absorbed through the stomach or intestines is metabolized in the liver before reaching the general bloodstream), people should be advised to avoid these products, and regulatory action is needed to prevent their sale to consumers.
Chansky MC, Hood N, Price SM
… +7 more, Chen PM, Ferg R, Johnson LE, Carrington K, Stinson N, Zhang X, Mensah GA
Public Health Rep
· 2026 · PMID 41580918
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OBJECTIVE: In 2020, the National Institutes of Health (NIH) established the Community Engagement Alliance (CEAL) to ensure that communities experiencing health disparities had a voice in finding effective solutions. This...OBJECTIVE: In 2020, the National Institutes of Health (NIH) established the Community Engagement Alliance (CEAL) to ensure that communities experiencing health disparities had a voice in finding effective solutions. This mixed-methods study evaluated processes and outcomes of CEAL. METHODS: We used the National Academy of Medicine's Assessing Meaningful Community Engagement conceptual model to guide our evaluation. Data sources for the evaluation included interviews, programmatic data, community surveys, and partner surveys. We assessed the domains of strengthened partnerships, expanded knowledge, and improved health, health programs, and policies. RESULTS: CEAL teams built a robust partnership network that reached populations most affected by COVID-19, facilitated knowledge increases among community members and partner organizations, and positively affected COVID-19 vaccination rates. CONCLUSIONS: This evaluation suggests that the infrastructure built by CEAL teams could be leveraged to address additional topics and populations of interest and enhance future National Institutes of Health-funded efforts in community-engaged research.
Public Health Rep
· 2026 · PMID 41580915
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Despite Alzheimer disease and related dementias/disorders (ADRD) being a substantial public health concern, the Deaf community remains underrepresented in ADRD research. We examined the extent and nature of existing lite...Despite Alzheimer disease and related dementias/disorders (ADRD) being a substantial public health concern, the Deaf community remains underrepresented in ADRD research. We examined the extent and nature of existing literature on ADRD in the Deaf community. We conducted a scoping review following Arksey and O'Malley's framework, adhering to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched 7 databases for peer-reviewed studies published in English, with no restrictions on publication date or study design. Inclusion studies addressed ADRD within the Deaf community and examined aspects such as diagnosis, care, and communication. Our search identified 435 articles, of which 16 met the inclusion criteria. Studies primarily originated from the United Kingdom and Finland, followed by the United States. Most used qualitative methodologies and explored lived experiences and communication barriers. Common themes included limited access to culturally competent care and caregiving challenges. Few studies highlighted diagnostic interventions but noted a general scarcity of resources tailored to Deaf populations. Notable gaps emerged in geographic focus, the range of studied variables, and the lack of validated sign language-based diagnostic instruments and interventions. We recommend expanding research beyond the Global North (ie, higher-income industrialized countries with greater access to resources), incorporating more longitudinal and intersectional approaches, and tailoring resources for Deaf communities. The review underscores the need for culturally competent care, improved diagnostic tools, and policy reforms to address ADRD-related disparities in the Deaf community. Future research should prioritize inclusive methodologies and community-driven interventions to enhance health outcomes and equity for Deaf individuals affected by ADRD.
Chatrath S, Kudis A, Shanmugam P
… +3 more, Barham C, Coles C, Kable J
Public Health Rep
· 2026 · PMID 41574654
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OBJECTIVES: Fetal alcohol syndrome (FAS) is frequently undiagnosed or misdiagnosed, particularly among populations at elevated risk of the condition. We examined the prevalence of FAS among children aged 0 to 5 years enr...OBJECTIVES: Fetal alcohol syndrome (FAS) is frequently undiagnosed or misdiagnosed, particularly among populations at elevated risk of the condition. We examined the prevalence of FAS among children aged 0 to 5 years enrolled in Medicaid, described characteristics of affected children, and evaluated diagnostic timing between children in foster care and children not in foster care. METHODS: We conducted a retrospective analysis of Medicaid Transformed Analytic Files for children born from 2015 through 2017 with FAS diagnoses (n = 771), following each birth cohort for 5 years. We used descriptive statistics to examine prevalence rates and demographic characteristics. Multivariate linear regression models assessed differences in diagnostic timing between children in foster care and children not in foster care, controlling for demographic factors. RESULTS: The overall FAS prevalence per 100 000 children aged 0 to 5 years enrolled in Medicaid was 7.7, increasing from 5.1 in 2015 to 11.4 in 2017. Children in foster care represented 60.2% (n = 464) of the FAS cohort. Although behavioral assessments occurred at similar ages for both groups, children in foster care received FAS diagnoses 4.6 to 5.4 months later than children not in foster care ( < .001). The time between the first behavioral assessment and FAS diagnosis was 2.1 to 3.9 months longer for children in foster care than for children not in foster case. CONCLUSIONS: Children in foster care had substantial delays in diagnosis compared with children not in foster care. Initial access to behavioral assessment appears equitable; however, barriers exist in the progression from assessment to diagnosis for children in foster care. Implementing targeted screening protocols, improving cross-system information sharing, and enhancing health care provider training could reduce diagnostic delays and improve outcomes for this population.
Public Health Rep
· 2026 · PMID 41553719
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OBJECTIVE: Most people in the United States are unaware that alcohol causes cancer and increases heart disease risk. Warning labels on alcohol containers can increase knowledge about these harms. Yet, it is unclear if Am...OBJECTIVE: Most people in the United States are unaware that alcohol causes cancer and increases heart disease risk. Warning labels on alcohol containers can increase knowledge about these harms. Yet, it is unclear if Americans support this policy. We assessed attitudes toward cancer and heart disease warning labels on alcohol containers. METHODS: In May 2024, we surveyed 1095 adults (aged ≥18 y) participating in AmeriSpeak, a nationally representative panel of the US noninstitutionalized civilian adult population. We analyzed support for warning labels overall and by sociodemographic characteristics by using descriptive statistics weighted to represent the US population. RESULTS: Overall, 4 in 10 respondents supported cancer or heart disease warning labels on alcohol containers. Fewer than 10% opposed warning labels; many were neutral. More young adults (aged 18-29 y; 57.9% [95% CI, 44.6%-70.0%]) than older adults (aged ≥60 y; 36.0% [95% CI, 30.3%-42.1%]) supported cancer warning labels ( = .04). More women (50.8%; 95% CI, 45.0%-56.6%) than men (40.5%; 95% CI, 34.1%-47.2%) supported heart disease warning labels ( = .03). CONCLUSIONS: Most people in the United States are neutral about or support cancer and heart disease warning labels on alcohol containers. Leveraging warning labels is a cost-effective way to inform the public about alcohol's link to cancer and heart disease.
Walker BH, Jackson EK, Hargrove KL
… +2 more, Heitman E, Reneker JC
Public Health Rep
· 2026 · PMID 41548946
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OBJECTIVES: During the past century, the age of menarche (onset of the first menstrual cycle) has dropped worldwide, with a decline of 2 or 3 months every 10 years in the United States. The adverse health effects of this...OBJECTIVES: During the past century, the age of menarche (onset of the first menstrual cycle) has dropped worldwide, with a decline of 2 or 3 months every 10 years in the United States. The adverse health effects of this change are just starting to be understood. Little is known about how the age of menarche affects the future health of African American women. Our objective was to examine the association between early menarche and cardiovascular disease in African American women. METHODS: The study sample included 2397 African American women in the Jackson Heart Study (64% of the total original cohort). We examined the association of early menarche (at age <12 y) with prevalent coronary heart disease, myocardial infarction, stroke, hypertension, diabetes, general obesity, and abdominal obesity. RESULTS: The mean (SD) baseline age of participants was 55.2 (12.5) years, with a mean (SD) age of menarche of 12.8 (1.8) years; 20.6% of these women experienced early menarche. After adjustment for relevant covariates, early menarche was significantly associated with increased odds of coronary heart disease (odds ratio [OR] = 2.16; 95% CI, 1.44-3.22), myocardial infarction (OR = 1.90; 95% CI, 1.17-3.08), hypertension (prevalence ratio [PR] = 1.15; 95% CI, 1.07-1.24), general obesity (PR = 1.22; 95% CI, 1.14-1.31), and abdominal obesity (PR = 1.14; 95% CI, 1.08-1.20). CONCLUSIONS: Among this cohort, early menarche was a risk factor for the development of cardiovascular disease among African American women. Addressing this risk requires policies and clinical guidelines that recognize early menarche as a marker for early intervention.
Public Health Rep
· 2026 · PMID 41548945
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OBJECTIVES: It is unclear how the incidence of each pediatric diabetes subtype changed during the COVID-19 pandemic. We assessed changes in the incidence of pediatric type 1 diabetes, pediatric type 2 diabetes, and predi...OBJECTIVES: It is unclear how the incidence of each pediatric diabetes subtype changed during the COVID-19 pandemic. We assessed changes in the incidence of pediatric type 1 diabetes, pediatric type 2 diabetes, and prediabetes during the COVID-19 pandemic. METHODS: We analyzed data from young people aged <19 years without prior diabetes in a large integrated US health care system from March 2017 through February 2023 using interrupted time-series analyses to compare prepandemic and pandemic rates and trends in the incidence of type 1 diabetes, type 2 diabetes, and prediabetes. RESULTS: Of 288 574 pediatric patients, 242 were diagnosed with type 1 diabetes, 239 with type 2 diabetes, and 4438 with prediabetes. The incidence of type 1 diabetes did not change after pandemic onset in the interrupted time-series analysis. Although the incidence of type 2 diabetes and prediabetes changed with a single interruption analysis, an exploratory model of 2 interruptions revealed a better fit for each: for type 2 diabetes, the model showed a significant rise (128%; < .001) and subsequent decrease after the early pandemic period; for prediabetes, it revealed a 142% increase ( = .005) with a rising trend (12% per month) early in the pandemic, followed by a 9% monthly downward trend. CONCLUSION: Among this population, the COVID-19 pandemic did not affect the incidence of pediatric type 1 diabetes but was associated with significant increases in the incidence of type 2 diabetes and prediabetes, particularly early in the pandemic. Future work can build on these results to better understand how pandemic-related factors, including activity restrictions and COVID-19 disease, affected rates of pediatric type 2 diabetes and prediabetes and inform future public health practices.
Public Health Rep
· 2026 · PMID 41548940
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OBJECTIVES: Concern is growing about rising opioid use disorder (OUD) rates and limited knowledge of how socioeconomic status (SES) and health factors interact. We examined whether health status moderates the relationshi...OBJECTIVES: Concern is growing about rising opioid use disorder (OUD) rates and limited knowledge of how socioeconomic status (SES) and health factors interact. We examined whether health status moderates the relationship between SES and OUD among individuals with nonmedical opioid use. METHODS: We analyzed data from 10 984 adults aged ≥18 years in the 2015-2019 National Survey on Drug Use and Health. Logistic regression estimated odds of OUD using self-reported health (good/very good/excellent vs fair/poor) and SES indicators (education, income, employment, and marital status). Interaction terms tested whether health status modified SES-OUD associations. RESULTS: Fair/poor health increased OUD odds, whereas college graduation and employment were linked to lower odds. Interaction analyses showed that among those with fair/poor health, higher SES corresponded to increased OUD odds. Those with fair/poor health and a college degree had substantially higher odds of OUD (odds ratio [OR] = 3.35; < .001) than less educated peers. Among those with fair/poor health, individuals with annual family incomes ≥$75 000 also had higher OUD odds (OR = 1.84; = .03) than those with incomes <$20 000, and employment was associated with increased OUD odds (OR = 1.61; = .008). Individuals who were widowed/divorced/separated (OR = 0.36; < .001) and never married (OR = 0.48; = .001) had lower OUD odds than married individuals. CONCLUSIONS: Health status significantly moderated SES-OUD associations. Among those in poor health, higher SES was linked to greater OUD odds. Prevention and treatment efforts should consider how SES and health jointly shape OUD vulnerability.
Public Health Rep
· 2026 · PMID 41546482
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Lifestyle medicine is an evidence-based approach that uses therapeutic lifestyle interventions as the primary method for preventing, treating, and reversing chronic diseases. According to the Centers for Disease Control...Lifestyle medicine is an evidence-based approach that uses therapeutic lifestyle interventions as the primary method for preventing, treating, and reversing chronic diseases. According to the Centers for Disease Control and Prevention, 6 in 10 adults have at least 1 chronic condition and 4 in 10 adults have 2 or more chronic conditions, contributing to substantial morbidity, mortality, and escalating health care costs. Chronic conditions are responsible for 8 of the 10 leading causes of death in the United States, with lifestyle factors playing a critical role in their prevalence. This topical review synthesizes current literature on the integration of lifestyle medicine into primary care, emphasizing its 6 core pillars: optimal nutrition, physical activity, restorative sleep, risky substance avoidance, connectedness, and stress management. This review discusses evidence for the effectiveness of lifestyle medicine in chronic disease prevention and management, outlines barriers to its widespread adoption, and explores implementation strategies. This review also discusses the public health implications of scaling lifestyle medicine within primary care settings, underscoring its potential to reduce the risk of noncommunicable diseases and enhance quality of life. Although lifestyle medicine presents a promising strategy to address the growing chronic disease epidemic, achieving its full potential requires policy support, interdisciplinary collaboration, and improved training for health care professionals. By addressing the root causes of chronic diseases, lifestyle medicine offers a pathway toward improved population health and health equity.
Public Health Rep
· 2026 · PMID 41546479
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OBJECTIVES: Nonprobability sampling, commonly used in disaster research, can lead to incorrect estimates or limit the generalizability of results. We collected data through the Texas Flood Registry (TFR) and used raking...OBJECTIVES: Nonprobability sampling, commonly used in disaster research, can lead to incorrect estimates or limit the generalizability of results. We collected data through the Texas Flood Registry (TFR) and used raking and propensity score weighting to provide insight into the effect of Hurricane Harvey (hereinafter, Harvey) on Harris County, Texas. METHODS: From April 2018 through October 2020, residents of areas affected by Harvey enrolled in the TFR completed a survey on their storm-related experiences (n = 20 653). Using logistic regression, we assessed the relationship between Harvey-related exposures and distress among Harris County residents (n = 12 279). We used raking to adjust the sample distribution to reflect demographic characteristics of Harris County and propensity scores to address confounding. RESULTS: Of respondents, 56% and 43% reported home damage and income loss due to Harvey, respectively. From April 2018 through April 2020, respondents completed the Impact of Event Scale questionnaire (n = 10 631), with 23% reporting symptoms consistent with severe distress related to Harvey. The raking-adjusted odds ratio of greater Harvey-related distress was 6.21 (95% CI, 5.44-7.09) times higher among residents who had home damage than among those who did not and 2.92 (95% CI, 2.59-3.30) times higher among those who had economic loss than among those who did not. CONCLUSIONS: We found consistent associations between adverse storm experiences and Harvey-related distress across unweighted and weighted approaches. We recommend using raking to adjust a nonprobability sample to better reflect population demographic characteristics and obtain general trends of postdisaster exposures and outcomes. We recommend using propensity scores when outcomes may be related to unmeasured confounding.