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Background: Heart failure affects people of all ages and is a leading cause of death for both men and women in most racial and ethnic groups in the United States. Infections are common causes of hospitalizations in heart failure, with respiratory infections as the most frequent diagnosis. Vaccinations provide significant protection against preventable respiratory infections. Despite being an easily accessible intervention, prior studies suggest vaccines are underused in patients with heart failure., Methods: An observational study of 5089 adults with heart failure was conducted using data from an integrated, multicenter, academic health system in Southern California from 2019 to 2022. Logistic regression models were used to determine the rates of influenza, pneumococcal, and COVID-19 vaccination among a population of patients with heart failure (heart failure preserved ejection fraction [HFpEF], heart failure mildly reduced ejection fraction [HFmrEF], and heart failure reduced ejection fraction [HFrEF], and identify whether heart failure phenotype is associated with vaccination status., Results: Vaccination rates varied between influenza, pneumococcal, and COVID-19 vaccines. Of the three respiratory vaccines, 58.0 % of patients had received an influenza vaccine, 76.2 % had received a pneumococcal vaccine, and 83.3 % had received a COVID-19 vaccine. There were no sex-based differences by vaccination status. Differences were seen within age, race/ethnicity, insurance type, whether the patient was a member of an Accountable Care Organization (ACO), primary language, Social Vulnerability Index (SVI) score, clinician type, and number of comorbidities. Patients with HFpEF and HFmrEF had higher vaccination rates than HFrEF. In adjusted models, patients with HFrEF had lower odds of being vaccinated for influenza (aOR = 0.75, 95 % CI = 0.66-0.86), pneumococcal (aOR = 0.65, 95 % CI = 0.55-0.75), and COVID (aOR = 0.74, 95 % CI = 0.62-0.89) compared to patients with HFpEF., Conclusions: Patients with HFrEF had the lowest levels of respiratory vaccination compared to other specified heart failure categories. Interventions are needed to increase vaccination education and offerings, especially to patients with HFrEF., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Abbott that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Amgen Inc that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with AstraZeneca that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Bayer Corporation that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Boehringer Ingelheim Ltd that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Cytokinetics Inc that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Eli Lilly that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Johnson & Johnson Vision that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Medtronic that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Merck & Co Inc that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Novartis Pharmaceuticals Corporation that includes: consulting or advisory. Gregg C. Fonarow, MD, FACC, FAHA, FHSA reports a relationship with Pfizer Inc that includes: consulting or advisory. Chidinma Chima-Melton, MD, MBA, FCCP, CPHQ reports a relationship with AstraZeneca that includes: consulting or advisory. Chidinma Chima-Melton, MD, MBA, FCCP, CPHQ reports a relationship with Boehringer Ingelheim Corp USA that includes: consulting or advisory. Chidinma Chima-Melton, MD, MBA, FCCP, CPHQ reports a relationship with Gilead Sciences Inc that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

The COVID-19 pandemic caused disruption to health services. It is unclear if there were inequalities in the continuity of mental health care in the years around the COVID-19 pandemic. We used electronic health records (EHR) to detect mental health care gaps of more than six months in psychiatric appointments across demographic and socioeconomic characteristics among patients with depression. The analysis included patients with depression who were seen at one of two mental health clinics every year of 2018, 2019, 2021, and 2022 (n = 783 patients). First, we found that the odds of mental health care gaps significantly decreased in the post-pandemic period (2021-2022) relative to the pre-pandemic period (2018-2019). Second, in the pre-pandemic period, patients who lived in areas in the highest tertile of deprivation had greater odds of gaps in mental health care relative to those in the lowest tertile (aOR: 2.18 [95 % CI: 1.02, 4.68]). Males had higher odds of gaps in care than females in the post-pandemic period (aOR: 2.22 [1.13, 4.37]) and the pooled pre- and post-pandemic study period (aOR: 1.58 [1.04, 2.40]). Third, interactions between patient characteristics and time were not significant, suggesting that the change in the odds of gaps of mental health care before relative to after the COVID-19 pandemic did not differ significantly based on patient characteristics. Overall, gaps in care decreased in the post-pandemic period relative to the pre-pandemic period among almost all patient groups., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Dr. Mojtabai reports having received royalties and consulting fees from UpToDate, Medscape, and MindMed and providing expert consultation regarding social media litigation on behalf of the plaintiffs. The other authors report no financial relationships with commercial interests., (Copyright © 2025. Published by Elsevier B.V.)

Background: Postpartum hypertension is a key factor in racial-ethnic inequities in maternal mortality. Emerging evidence suggests that experiences of racism, both structural and interpersonal, may contribute to disparities. We examined associations between gendered racial microaggressions (GRMs) during obstetric care with postpartum blood pressure (BP)., Methods: We conducted a prospective postpartum cohort of 373 Asian, Black, and Hispanic people in New York City and Philadelphia. At delivery, we administered the GRM in obstetrics scale. We measured BP for 3 months using text-based monitoring. We estimated place-based structural racism with the Structural Racism Effect Index. We used mixed models to estimate associations between GRM and mean postpartum systolic BP and diastolic BP. We adjusted for race-ethnicity, education, body mass index, chronic hypertension (diagnosed at <20 weeks of gestation), age, and the Structural Racism Effect Index. We examined effect modification by hypertensive disorder of pregnancy and place-based structural racism., Results: A total of 4.6% of participants had chronic hypertension, 20.9% had pregnancy hypertension, and 13.4% had preeclampsia, comprising a hypertensive disorder of pregnancy subgroup (n=117). A total of 37.5% of participants experienced ≥1 GRM. Participants who experienced ≥1 GRM versus none had 1.88 mm Hg higher systolic BP from days 1 to 10 (95% CI, -0.19 to 3.95) and 2.19 mm Hg higher systolic BP from days 11 to 85 (95% CI, 0.17-4.22). Associations followed a similar pattern for diastolic BP and were stronger among the hypertensive disorder of pregnancy subgroup. Participants experiencing GRM and a high Structural Racism Effect Index had systolic BP 7.55 mm Hg (95% CI, 3.41-11.69) and diastolic BP 6.03 mm Hg (95% CI, 2.66-9.41) higher than those with neither., Conclusions: Structural racism and interpersonal racism are associated with increased postpartum BP, potentially contributing to inequities in postpartum morbidity and mortality and lifecourse cardiovascular disease., Competing Interests: None.

Objectives. To estimate the effect of influenza vaccination disparities. Methods. We compared symptomatic influenza cases between Black and White races in 2 scenarios: (1) race- and age-specific vaccination coverage and (2) equal vaccination coverage. We also compared differences in household composition between races. We used the Framework for Reconstructing Epidemiological Dynamics, an agent-based model that assigns US Census‒based age, race, households, and geographic location to agents (individual people), in US counties of varying racial and age composition. Results. Influenza cases were highest in counties with higher proportions of children. Cases were up to 30% higher in Black agents with both race-based and race-equal vaccination coverage. Compared with corresponding categories of White households, cases in Black households without children were lower and with children were higher. Conclusions. Racial disparities in influenza cases persisted after equalizing vaccination coverage. The proportion of children in the population contributed to the number of influenza cases regardless of race. Differences in household composition may provide insight into racial differences and offer an opportunity to improve vaccination coverage to reduce influenza burden for both races. ( Am J Public Health . 2025;115(2):209-216. https://doi.org/10.2105/AJPH.2024.307878).

Objectives. To map US state Supplemental Nutrition Assistance Program (SNAP) bans for individuals with felony drug convictions between 2004 and 2021. Methods. Using standard legal-mapping methodology, we categorized states as maintaining the lifetime ban imposed by federal law, modifying the lifetime ban, or fully opting out of the lifetime ban in each year. Among states with modified bans in 2021, we coded types of modifications. Results. As of 2021, 26 states and the District of Columbia fully opted out of the lifetime ban, 23 states modified bans, and 1 state maintained a lifetime ban. Among states with modified bans in 2021, 13 states required compliance with parole and probation, 12 states required drug treatment, 7 states required drug testing, and 9 states limited eligibility to certain populations. Conclusions. Most states effectively de-implemented the federal lifetime ban on SNAP for people with felony drug convictions by fully opting out or modifying bans over time. However, some states still had stringent modified ban provisions. Public Health Implications. These findings underscore the need to study the effects of this patchwork of drug conviction-related ban policies on substance use and nutrition-related outcomes. ( Am J Public Health . 2025;115(2):170-177. https://doi.org/10.2105/AJPH.2024.307873).

Older Latino adults (aged 65+years) comprise the fastest growing minoritized group among the older population in the United States and experience a disproportionate burden of kidney failure as well as disparities in kidney care compared with non-Hispanic White individuals. Despite significant need and barriers uniquely faced by this population, few educational resources or decision aids are available to meet the language and cultural needs of Latino patients. Decision aids are designed to improve knowledge and empower individuals to engage in shared decision making and have been shown to improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). In this commentary, we examine the barriers faced by older Latino people with CKD who must make dialysis initiation decisions. We conclude that there is a need for culturally concordant decision aids tailored for older Latino patients with CKD to overcome barriers in access to care and improve patient-centered care for older Latino CKD patients., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The present study describes juveniles injured in fatal and nonfatal shootings by the police from 2015 to 2020, compares characteristics of juvenile victimizations to adult victimizations, and estimates the odds of a shooting victim being a juvenile v. adult, given known characteristics., Methods: From July 2021 to April 2023, we manually reviewed publicly available records on all 2015-2020 injurious shootings by the US police, identified from Gun Violence Archive. We first calculated counts and proportions of victim, incident, and response characteristics among juvenile and adult injured people, then estimated the odds of juvenile (vs. adult) victimization associated with each characteristic in multilevel logistic regression models with random intercepts to account for state- and incident-level correlation., Results: 97 percent of shootings involved presumed on-duty officers and victims whose categorical age status (i.e., juvenile or adult) was reported (n = 10,382). Included among these injured people were 317 juveniles, 33% of whom were fatally injured (mean reported juvenile age = 15.5 years). Several patterns differentiated juveniles from adult police shooting victims, including multiple demographic characteristics (e.g., race or ethnicity and gender) and the outcomes of and circumstances surrounding these events (e.g., fatality, victim weapon status, and single-officer response)., Discussion: Findings point to a critical need to identify and implement public health and policing strategies that greatly reduce the number of juveniles shot by the police every year, so that all children have the opportunity to thrive into adulthood., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the effects of socioeconomic factors, including insurance status, on treatment and survival for patients with testicular cancer., Patients and Methods: We extracted a retrospective cohort from the National Cancer Database that included patients diagnosed with testicular cancer 2004-2020. Competing-risks and Cox regression multivariate models including demographic, pathological, and socioeconomic covariates were constructed to evaluate receipt of treatment and death, respectively., Results: A total of 95 955 patients with testicular cancer were identified. Compared with private insurance, Medicaid (sub-distribution hazard ratio [SHR] 0.70, P < 0.001), Medicare (SHR 0.73, P < 0.001), and uninsured (SHR 0.72, P < 0.001) patients were associated with decreased likelihood of receiving chemotherapy. Compared with private insurance, Medicaid (SHR 0.55, P < 0.001), Medicare (SHR 0.76, P-value <0.001), uninsured (SHR 0.63, P-value < 0.001), and other government insurance (SHR 0.71, P = 0.010) was associated with decreased likelihood of receiving radiation. Medicaid insurance status (reference private, HR 2.60, P < 0.001) conferred the second largest hazard of death, behind having Stage III disease (reference Stage 0). Compared with private insurance, Medicare (HR 2.20, P < 0.001), no insurance (HR 2.32, P < 0.001), and other government insurance (HR 1.53, P = 0.027) statuses had higher risk of death. Patients diagnosed in Medicaid-expansion states had lower all-cause mortality (11.4% vs 13.6%, P < 0.001)., Conclusions: Testicular cancer care relies on early diagnosis and treatment. It is critically important to have a healthcare system where individuals have access to insurance and are served equitably., (© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)

Objectives: To assess the cost-effectiveness of a digital Diabetes Prevention Program (dDPP) in preventing type 2 diabetes mellitus among prediabetic patients from a health system perspective over a 10-year time horizon., Methods: A Markov cohort model was constructed to assess the cost-effectiveness of dDPP compared to a small group education (SGE) intervention. Transition probabilities for the first year of the model were derived from two clinical trials on dDPP. Transition probabilities for longer-term effects were derived from meta-analyses on lifestyle and Diabetes Prevention Program interventions. Cost and health utilities were derived from published literature. Partial completion of interventions was incorporated to provide a robust prediction of a real-world deployment. Parameter uncertainties were assessed using univariate and probabilistic sensitivity analyses. Cost-effectiveness was measured by an incremental cost-effectiveness ratio (ICER) between dDPP and SGE from a health system perspective over a 10-year time horizon., Results: The dDPP dominated the SGE at the $50,000, $100,000, and $150,000 willingness-to-pay thresholds per quality-adjusted life years (QALYs). The base case analysis at the $100,000 willingness-to-pay threshold (WTP) revealed a dominated ICER, with the SGE costing $1332 more and accruing an average of 0.04 fewer QALYs. Probabilistic sensitivity analysis showed that the dDPP was preferred in 64.4% of simulations across the $100,000 WTP thresholds., Conclusions: The findings comparing a dDPP to an SGE suggest that a dDPP can be cost-effective for patients with a high risk of developing type 2 diabetes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Amidst an ongoing surge of opioid use disorder (OUD) incidence, clinicians and policymakers are seeking partnerships with faith communities - including with faith-affiliated treatment centers (FATCs) - to expand access to evidence-based OUD treatment. However, little is known whether FATCs differentially offer such evidence-based treatment services, particularly medications for opioid use disorder (MOUD) and co-occurring mental health care., Methods: We use the 2021 National Substance Use and Mental Health Services Survey (N-SUMHSS) to examine differences in provision of several OUD services, including MOUD, psychological treatments, mental health services, medical services, recovery support services, and services related to treatment accessibility, between self-identified FATCs and non-FATCs. We also explored differences in characteristics related to insurance, licensure, and accreditation., Results: FATCs were less likely than non-FATCs to offer almost all measure of MOUD and more likely to refuse to accept clients who use MOUD. They were also less likely to report using telemedicine. However, they were more likely to offer residential treatment, Twelve Step facilitation, and transitional housing. We find little evidence that FATCs offer co-occurring mental health treatments at different rates than non-FATCs., Conclusion: More research is needed to examine the factors that drive these differences, especially in MOUD and transitional housing. When partnering with FATCs, clinicians and policymakers should seek common ground with FATCs and recognize the philosophies, values, and concerns that may potentially be driving these differences., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Chain restaurants are ubiquitous in the U.S. While restaurants are increasingly promoting health- and climate-conscious menu options, few studies have examined whether restaurants are increasing availability of menu items with lower climate impact and whether these offerings are healthier. This study examines trends in the availability and nutritional profile of food items featuring different meat sources on menus at 75 large chain restaurants in the U.S. from 2013 to 2021., Methods: Longitudinal data on menu items from 75 large U.S. chain restaurants from 2013 to 2021 were obtained from MenuStat.org, an online database of menu items from the largest-grossing restaurant chains in the U.S. Annual counts and proportions of food items featuring different meat sources were calculated overall, by food category, and by restaurant type. Differences in predicted mean calories between meat-based items and meat-free items were calculated (overall, by restaurant type, by year) using linear regression models with clustered standard errors., Results: Availability and calorie content of meat-based versus meat-free items were generally stable over time. Availability of chicken-containing items increased and there was an absolute reduction in the availability of beef-containing menu items (p-trends<0.001). Total calories and calories from protein, unsaturated fat, and saturated fat were lower among meat-free items versus meat-based items. However, calories from sugar were higher for meat-free items., Conclusions: While meat-free items had fewer calories and some aspects of nutritional profile were more favorable, the availability of meat-free menu items has not increased in large chain restaurants, suggesting limited improvement on reducing climate impact., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Characterize the association between Medicare Accountable Care Organizations' (ACOs) behavioral health integration capability and quality and utilization among adults with serious mental illness (SMI)., Background: Controlled research supports the efficacy of integrating physical and mental health care for adults with SMI, yet little is known about the organizations integrating care and associations between integration capability and quality., Methods: We surveyed Medicare ACOs (2017-2018 National Survey of ACOs, response rate 69%) and linked responses to 2016-2017 fee-for-service Medicare claims for beneficiaries with SMI. We examined the cross-sectional association between ACO-reported integration capability (tertiles of a 14-item index) and 7 patient-level quality and utilization outcomes. We fit generalized linear models for each outcome as a function of ACO integration capability, adjusting for ACO and beneficiary characteristics., Results: Study sample included 274,928 beneficiary years (199,910 unique beneficiaries) attributed to 265 Medicare ACOs. ACOs with high behavioral health integration capability (top-tertile) served more dual-eligible beneficiaries (67.8%) than bottom-tertile (63.7%) and middle-tertile ACOs (63.3%). Most beneficiaries received follow-up 30 days after mental health hospitalization and chronic disease monitoring-exceeding national quality benchmarks-but beneficiaries receiving care from top-tertile (vs bottom-tertile) ACOs were modestly less likely to receive follow-up [-2.17 percentage points (pp), P < 0.05], diabetes monitoring (-2.19 pp, P < 0.05), and cardiovascular disease monitoring (-6.07 pp, P < 0.05). Integration capability was not correlated with utilization., Conclusions: ACOs serving adults with substantial physical and mental health needs were more likely to report comprehensive integration capability but were not yet meeting the primary care needs of many adults with SMI., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To highlight the often overlooked role of user interface (UI) design in mitigating bias in artificial intelligence (AI)-based clinical decision support (CDS)., Materials and Methods: This perspective paper discusses the interdependency between AI-based algorithm development and UI design and proposes strategies for increasing the safety and efficacy of CDS., Results: The role of design in biasing user behavior is well documented in behavioral economics and other disciplines. We offer an example of how UI designs play a role in how bias manifests in our machine learning-based CDS development., Discussion: Much discussion on bias in AI revolves around data quality and algorithm design; less attention is given to how UI design can exacerbate or mitigate limitations of AI-based applications., Conclusion: This work highlights important considerations including the role of UI design in reinforcing/mitigating bias, human factors methods for identifying issues before an application is released, and risk communication strategies., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: To determine the incidence and risk factors of tracheostomy-related pressure injuries (TRPI) and examine the COVID-19 pandemic's impact on TRPI incidence., Design: Secondary analysis of Global Tracheostomy Collaborative database and a multi-center hospital system's electronic medical records., Setting: 27 hospitals, primarily in the United States, United Kingdom, and Australasia., Patients: 6,400 adults and 2,405 pediatric patients hospitalized with tracheostomy between 1 January 2019 and 31 December 2021., Measurement: TRPI as a binary outcome, reported as odds ratios., Results: TRPI incidence was 4.69 % in adults and 5.65 % in children. For adults, associated risks were female sex (OR: 0.64), severe obesity (OR: 2.62), ICU admission (OR: 2.05), cuffed tracheostomy (OR: 1.49), fenestrated tracheostomy (OR: 15.37), percutaneous insertion (OR: 2.03) and COVID-19 infection (OR: 1.66). For children, associated risks were diabetes mellitus (OR: 4.31) and ICU admission (OR: 2.68). TRPI odds increased rapidly in the first 60 days of stay. Age was positively associated with TRPI in adults (OR: 1.014) and children (OR: 1.060). Black patients had higher TRPI incidence than white patients; no moderating effects of race were found. Hospital cluster effects (adults ICC: 0.227; children ICC: 0.138) indicated unmeasured hospital-level factors played a significant role., Conclusions: Increasing age and length of stay up to 60 days are TRPI risk factors. Other risks for adults were female sex, severe obesity, cuffed/fenestrated tracheostomy, percutaneous insertion, and COVID-19; for children, diabetes mellitus and FlexTend devices were risks. Admission during the COVID-19 pandemic had contrasting effects for adults and children. Additional research is needed on unmeasured hospital-level factors., Implications for Clinical Practice: These findings can guide targeted interventions to reduce TRPI incidence and inform tracheostomy care during public health crises. Hospital benchmarking of tracheostomy-related pressure injuries is needed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Purpose: This study examines (a) whether disability registration has anticipatory, immediate, and delayed effects on depressive symptoms and (b) how these effects differ by gender., Research Method/design: Using data from the Korea Welfare Panel Study spanning over 16 waves between 2005 and 2020, this study employed the individual-level fixed effects models to estimate the trajectories of depressive symptoms before and after the registration of physical disability, for a cohort of 20,054 individuals. Furthermore, gender-stratified fixed effects models were used to examine gender differences., Results: Compared to the preregistration reference period (i.e., 4 or more years before disability registration), there was a sustained rise in depressive symptoms leading up to the year of registration, indicating the presence of anticipatory effects. After disability registration, depressive symptoms consistently remained at a statistically higher level than during the initial reference period, with a gradual return to the baseline level of depressive symptoms over time. These anticipatory, immediate, and delayed effects of disability registration were notably more pronounced among men than women., Conclusion/implications: To develop more effective mental health interventions for people with disability, policymakers should consider gendered trajectories of depressive symptoms before and after disability registration. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: The purpose of this study was to simulate potential changes in dietary intake and food costs by replacing juice with whole fruit among children ages 1-5 years attending U.S. early care and education settings between 2008 and 2020., Methods: Estimated mean changes in daily intake of calories, sugar, fiber, calcium, vitamin C and overall food costs under plausible scenarios of replacing juice with whole fruit. Researchers fit hierarchical regression with children nested within early care and education nested within studies, adjusting for potential confounders., Results: The sample consisted of 6,304 days of direct observation (90% aged 2 years or older, 51% female, 38% Black/African American) in 846 early care and education facilities (73% centers, 75% Child and Adult Care Food Program participants). Replacing juice with whole fruit would reduce energy intake by 8.2-27.3 kcal/day, reduce sugar by 3.4-5.6 g/d, increase fiber by 0.5-1.3 g/d, and have negligible impact on vitamin C and calcium. Replacing juice with whole fruit in early care and education would increase per-child daily food costs between $0.44 and 0.49, representing an increase from 3.8% for juice to approximately 9.8%-10.7% for whole fruit as a percent of total food costs., Conclusions: Replacing juice with whole fruit in early care and education would result in increased fiber intake and decreased sugar and calories. A policy to replace juice with whole fruit in early care and education would likely cause an increased daily food cost and given the potential broad benefit of this dietary intervention, there may be reason to expand funding within nutrition assistance programs in early care and education., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: State and local public health departments (LHDs) are encouraged to collaborate with community-based organizations (CBOs) to enhance communication and promote protective practices with communities made vulnerable during emergencies, but there is little evidence-based understanding of practical approaches to fostering collaboration in this context. This research focuses on how collaboration enhances LHD capacity for effective communication for people with limited English proficiency (LEP) during infectious disease outbreaks specifically and strategies to facilitate productive LHD-CBO collaboration., Design: Qualitative, telephone interviews, conducted March-October 2021., Setting: Rural and urban jurisdictions with Chinese-speaking or Spanish-speaking populations across the United States., Participants: 36 LHD and 31 CBO staff working on outreach to Chinese and Spanish speakers during COVID-19., Method: Interviews were audio-recorded, transcribed verbatim, and analyzed using a team-based, codebook approach to thematic analysis., Results: During COVID-19, CBOs extended LHD capacity to develop and disseminate effective communication, meaning communication that is rapidly in-language, culturally resonant, locally relevant, and trusted. Practical strategies to enable and sustain effective collaboration were needed to address operational dimensions (eg, material and administrative) and relational dimensions (eg, promoting trust and respect)., Conclusion: Policies and financing to support LHD-CBO collaborations are critical to improving communication with people with LEP and addressing long-standing inequities in outcomes during outbreaks., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: GKS’s husband is part owner of a consulting firm that has done work for a pharmaceutical company within the past 3 years.

Introduction: The rapid advancement of artificial intelligence (AI) has led to significant transformations in health and healthcare. As AI technologies continue to evolve, there is an urgent need to establish a unified framework that guides the design, implementation, and evaluation of AI-driven interventions across individual and population health contexts., Approach: In response to this need, the National Academy of Medicine (NAM) has initiated the development of an AI code of conduct (AICC) through its Digital Health Action Collaborative. This code of conduct is grounded in shared principles and commitments, aiming to actualize ethical and effective AI practices within the broader health and healthcare ecosystem. Given its specialized expertise and insight, the biomedical informatics (BMI) community plays a pivotal role in shaping and applying these guidelines., Recommendations: We, as members of the AICC Steering Committee and the NAM Digital Health Action Collaborative, urge BMI educators, researchers, and practitioners to engage actively in refining and implementing the AICC. This involvement is critical to ensuring that the code is robust, applicable, and continuously improved to meet the evolving challenges facing health and healthcare., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: Although publicly available cancer-related information online and offline could help patients make informed decisions, it also poses challenges due to prevalent misinformation. Patients need proper provider guidance to ensure they use valid and relevant information in decisions. We identify effective communication approaches for providers when (1) discussing patient-identified information and (2) disagreeing with it., Methods: From June to August 2023, people living with cancer were reached via online communities and asked first about their actual experiences discussing patient-identified information with their providers. Respondents were then randomly assigned into an experiment with three hypothetical scenarios where providers disagreed with patient-identified information. Provider responses included (1) dismissal, (2) explanation, and (3) explanation with relationship-building elements. Pearson correlation and multivariable analysis of variance were used to evaluate differences in patient perceptions., Results: One hundred seventy-five respondents completed the survey. Mean age: 53 years; 45% female; and 88% White, 10% Black, and 2% others. Forty-six percent held Bachelor's degrees or higher, 11% lived rurally, 36% reported financial difficulties, and 46% rated their health as good/excellent. Between 31% and 37% of respondents reported their provider used communication approaches that negatively correlated with discussion outcomes. The approaches included avoidance of such conversations due to limited time, discouragement of future information searches, or judgmental comments. In the experiment, respondents randomly assigned to receive relationship-building elements were significantly more comfortable sharing information, felt more satisfied, respected, and trusted their provider's opinion more than those receiving the dismissal scenario. The explanation scenario was not perceived differently compared with the dismissal scenario., Conclusion: More than a third of respondents reported negative communication when sharing patient-identified information with their provider. Provider prioritization of relationship-building alongside explanations could foster trust and facilitate open information exchange, supporting informed decisions.

Background: Permanent supportive housing (PSH) is an evidence-based practice for reducing homelessness that subsidizes permanent, independent housing and provides case management-including linkages to health services. Substance use disorders (SUDs) are common contributing factors towards premature, unwanted ("negative") PSH exits; little is known about racial/ethnic differences in negative PSH exits among residents with SUDs. Within the nation's largest PSH program at the Department of Veterans Affairs (VA), we examined relationships among SUDs and negative PSH exits (for up to five years post-PSH move-in) across racial/ethnic subgroups., Methods: We used VA administrative data to identify a cohort of homeless-experienced Veterans (HEVs) (n = 2,712) who were housed through VA Greater Los Angeles' PSH program from 2016-2019. We analyzed negative PSH exits by HEVs with and without SUDs across racial/ethnic subgroups (i.e., African American/Black, Non-Hispanic White, Hispanic/Latino, and Other/Mixed [Asian, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander, and mixed race/ethnicity]) in controlled models and accounting for competing risk of death., Results: In competing risk models, HEVs with at least one SUD had 1.3 times the hazard of negative PSH exits compared to those without SUDs (95% CI: 1.00, 1.61). When stratifying by race/ethnicity, Other/Mixed race residents with at least one SUD had 6.4 times the hazard of negative PSH exits compared to their peers without SUDs (95% CI: 1.61-25.50). Hispanic/Latino residents with at least one SUD had 1.9 times the hazard compared to those without SUDs; however, this association was not statistically significant (95% CI: 0.85-4.37). African American/Black residents with at least one SUD had 1.2 times the hazard compared to those without SUDs (95% CI: 0.85-1.64), indicating no evidence of an association with negative PSH exits. Non-Hispanic White residents with at least one SUD had 1.1 times the hazard compared to those without SUDs (95% CI: 0.75-1.66), similarly indicating no evidence to suggest an association with negative PSH exits., Conclusions: These findings suggest relationships between SUDs and negative PSH exits differ between racial/ethnic groups and suggest there may be value in culturally specific tailoring and implementation of SUD services for these subgroups., Competing Interests: Declarations. Ethics approval and consent to participate: All study procedures were reviewed and approved by Department of Veteran Affairs Greater Los Angeles’ Institutional Review Board (IRB) (Reference number: 1630424–1) as constituting quality improvement. The present study involved secondary analysis of existing data from Veteran medical records and no more than minimal risk; as such, the need for participant informed consent to participate was waived by the IRB. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objective: To identify distinct patterns in consumer willingness to share health data with various stakeholders and analyze characteristics across consumer groups., Materials and Methods: Data from the Rock Health Digital Health Consumer Adoption Survey from 2018, 2019, 2020, and 2022 were analyzed. This study comprised a Census-matched representative sample of U.S. adults. Latent class analysis (LCA) identified groups of respondents with similar data-sharing attitudes. Groups were compared by sociodemographics, health status, and digital health utilization., Results: We identified three distinct LCA groups: (1) Wary (36.8%), (2) Discerning (47.9%), and (3) Permissive (15.3%). The Wary subgroup exhibited reluctance to share health data with any stakeholder, with predicted probabilities of willingness to share ranging from 0.07 for pharmaceutical companies to 0.34 for doctors/clinicians. The Permissive group showed a high willingness, with predicted probabilities greater than 0.75 for most stakeholders except technology companies and government organizations. The Discerning group was selective, willing to share with healthcare-related entities and family (predicted probabilities >0.62), but reluctant to share with other stakeholders (predicted probabilities <0.29). Individual characteristics were associated with LCA group membership., Discussion: Findings highlight a persistent trust in traditional healthcare providers. However, the varying willingness to share with non-traditional stakeholders suggests that while some consumers are open to sharing, others remain hesitant and selective. Data privacy policies and practices need to recognize and respond to multifaceted and stakeholder-specific attitudes., Conclusion: LCA reveals significant heterogeneity in health data-sharing attitudes among U.S. consumers, providing insights to inform the development of data privacy policies., (© The Author(s) 2025. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: To investigate the impact of COVID-19 on hospitalization and consequent diabetes-related complications in patients with type 2 diabetes mellitus (diabetes)., Methods: We conducted a retrospective cohort study of patients with diabetes. Interrupted time series analysis (ITS) was used to analyze the monthly trends in diabetes-related hospitalization rates, including short- and long-term complications, 1-year before and after onset of COVID-19., Results: Persons with diabetes experienced a significant ( p  < 0.001) rapid drop in monthly hospital admission rates at onset of COVID-19, then rose significantly ( p  = 0.003) to higher than pre-COVID-19 levels. Older age, lower education, and income levels were associated with higher base-level monthly hospital admission rates and a greater rate reduction at COVID-19 onset. ITS analysis showed monthly hospital admission rates from short-term complications surged to higher level 6 months after COVID-19 onset. Hospital admissions due to long-term complications decreased immediately post-COVID-19, but rose significantly ( p  < 0.001) to higher than pre-COVID levels, with patients experiencing higher nephropathy, angiography, and dermatological complications post-COVID-19., Conclusion: COVID-19 had a negative impact on diabetes-related hospitalization access, resulting in increased short- and long-term complications. Long-term effects of deferred care due to COVID-19 on diabetes-related complications may persist, emphasizing the need for continued education toward improved diabetes self-management.

Abstract: Lymphoma is the third leading cause of cancer among children and adolescents/young adults (AYAs) in the United States, with later-stage diagnoses often being linked to worse outcomes. Continuous health insurance coverage is crucial for facilitating early cancer detection and diagnosis. Among Medicaid-insured children and AYAs diagnosed with lymphoma, this study examines whether the timing of Medicaid enrollment and coverage continuity are associated with stage at diagnosis. Using the Surveillance, Epidemiology, and End Results-Medicaid data, we identified children and AYAs (aged 0-39 years) newly diagnosed with lymphoma between 2007 and 2013 in 12 states that were linked to the administrative Medicaid data. Medicaid enrollment patterns were categorized into continuous Medicaid (preceding and through diagnosis), newly gained Medicaid (at or shortly after diagnosis), and other Medicaid enrollment patterns. Late-stage disease was defined as Ann Arbor stage IV (vs stage I-III). Multiple logistic regressions were estimated, with marginal effects (MEs) reported. Of 3524 patients identified, 37.8% had continuous Medicaid, followed by newly gained Medicaid (35.2%) and other Medicaid enrollment patterns (27.0%). Compared with patients continuously enrolled in Medicaid, those with newly gained Medicaid and with other Medicaid enrollment patterns were 54% (ME, 13.9 percentage points [ppt]; 95% confidence interval [CI], 8.5-19.2; P < .001) and 18% (ME, 4.6 ppt; 95% CI, 2.2-7.0; P < .001) more likely to present with stage IV lymphoma, respectively. Overall, having continuous Medicaid coverage before diagnosis was associated with a lower likelihood of late-stage lymphoma at diagnosis; however, only 3 in 8 Medicaid-insured children and AYAs with lymphoma were continuously enrolled in Medicaid before their diagnosis., (© 2025 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

Objective: To conduct a scoping review to summarize the state of the evidence on associations between participation in nonfood social safety net programs (eg, income assistance, housing assistance) in the United States and food- and nutrition insecurity-related outcomes., Background: Food and nutrition insecurity are persistent public health challenges in the United States that increase chronic disease risk and exacerbate health disparities. Several food assistance programs enhance food and nutrition security. Nonfood social safety net programs, however, may also improve these outcomes by relieving households' financial strain. Understanding the scope of research on nonfood social safety net programs' associations with not only food insecurity but also nutrition insecurity is needed to understand their potential to reduce the burden of diet-related chronic disease., Methods: Six databases were systematically searched for peer-reviewed articles. Articles were included if they were published between 1995 and 2023; conducted in the United States; available in English; included a dependent variable of food- and/or nutrition insecurity-related measures; and included an independent variable of participation in a federally funded, nonfood social safety net program., Results: Included articles (n = 65) reported on studies that examined 10 unique social safety net programs; 8 studies examined program interactions. Twenty studies focused on COVID-19 pandemic-era programs. Fifty-eight studies used food insecurity, food insufficiency, or food hardship as outcomes, and 11 studies used nutrition insecurity-related outcomes. Overall, results suggest that participation in nonfood social safety net programs is associated with reductions in food insecurity. Current evidence for an association between program participation and nutrition insecurity-related outcomes is limited., Conclusion: Further research is warranted on the association between nonfood social safety net programs and nutrition insecurity; potential interactions between social safety net programs; associations between the expiration of pandemic-era programs and food and nutrition insecurity; and how program impacts might differ among populations with persistent disparities in food and nutrition insecurity., (© The Author(s) 2025. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Physician databases constitute an essential component of health workforce planning. However, while some countries have established functioning national physician databases, others have failed to do so. We compared the healthcare systems of two technologically and economically developed countries, Canada and Israel, which represent cases of respective success and failure in establishing physician databases. A comparative analysis was conducted using a historical-institutionalist approach to examine contemporary health policy outcomes. White papers, studies on healthcare human resources, and reports by professional committees were examined to explore the aims, interests, positions, and actions of stakeholders. In Canada, state-medical profession cooperation, deep-rooted in a longstanding regulatory bargain between the two parties, has facilitated the creation and management of physician databases, albeit limited and in need of urgent improvement, on national and jurisdictional levels. The lack of such regulatory arrangement coupled with enduring conflicted relations between stakeholders due to particular historical developments have hindered the development of an Israeli equivalent database so far. Finally, health policy outcomes may be explained against the backdrop of broader political, governance, and organisational contexts. How medical organisations respond to governmental healthcare initiatives is heavily influenced by their institutional position vis-à-vis the state, shaped by historical processes and regulatory arrangements.

Background: While bedside teaching offers invaluable clinical experience, its availability is limited. Challenges such as a shortage of clinical placements and qualified teaching physicians, coupled with increasing medical student numbers, exacerbate this issue. Simulation-based learning encompasses varied educational values and has the potential to serve as an important tool in medical students' education., Objectives: In this study, we evaluate a new Clinical Decision Making Integrated Digital Simulation (CDMIDS) method that was developed in order to enhance the clinical decision-making competency and self-confidence of medical students early in their clinical training through practicing fundamental core skills., Methods: The study compares 108 4th-year medical students' questionnaire responses pre-/postself-assessments following practice of a new clinical decision-making simulation methodology., Results: Results indicate a positive participant experience, with the simulation perceived as a valuable platform for practicing integrated bedside decision making. Notably, participants demonstrated a statistically significant increase in willingness to make clinical decisions. The simulation contributed to enhanced knowledge, professional skills, and self-confidence in clinical decision making., Conclusion: The use of a CDMIDS method integrates clinical decision making as part of early medical school curriculum. Moreover, the method boosts learners' professional confidence, self-directed learning, and additional experiences. The method is flexible and can be applied in any medical school, especially those with limited resources, by making specific, localized modifications., Competing Interests: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2025.)

Background: Uncertainty in the diagnosis of lung nodules is a challenge for both patients and physicians. Artificial intelligence (AI) systems are increasingly being integrated into medical imaging to assist diagnostic procedures. However, the accuracy of AI systems in identifying and measuring lung nodules on chest computed tomography (CT) scans remains unclear, which requires further evaluation., Objective: This study aimed to evaluate the impact of an AI-assisted diagnostic system on the diagnostic efficiency of radiologists. It specifically examined the report modification rates and missed and misdiagnosed rates of junior radiologists with and without AI assistance., Methods: We obtained effective data from 12,889 patients in 2 tertiary hospitals in Beijing before and after the implementation of the AI system, covering the period from April 2018 to March 2022. Diagnostic reports written by both junior and senior radiologists were included in each case. Using reports by senior radiologists as a reference, we compared the modification rates of reports written by junior radiologists with and without AI assistance. We further evaluated alterations in lung nodule detection capability over 3 years after the integration of the AI system. Evaluation metrics of this study include lung nodule detection rate, accuracy, false negative rate, false positive rate, and positive predictive value. The statistical analyses included descriptive statistics and chi-square, Cochran-Armitage, and Mann-Kendall tests., Results: The AI system was implemented in Beijing Anzhen Hospital (Hospital A) in January 2019 and Tsinghua Changgung Hospital (Hospital C) in June 2021. The modification rate of diagnostic reports in the detection of lung nodules increased from 4.73% to 7.23% (χ 2 =12.15; P<.001) at Hospital A. In terms of lung nodule detection rates postimplementation, Hospital C increased from 46.19% to 53.45% (χ 1 =25.48; P<.001) and Hospital A increased from 39.29% to 55.22% (χ 2 1 =25.48; P<.001) and Hospital A increased from 39.29% to 55.22% (χ 2 =53.48; P<.001). The detection accuracy demonstrated a decrease from 93.33% to 92.23% for Hospital A and from 95.27% to 92.77% for Hospital C. Regarding the changes in lung nodule detection capability over a 3-year period following the integration of the AI system, the detection rates for lung nodules exhibited a modest increase from 54.6% to 55.84%, while the overall accuracy demonstrated a slight improvement from 92.79% to 93.92%.1 =122.55; P<.001). At Hospital A, the false negative rate decreased from 8.4% to 5.16% (χ 2 1 =9.85; P=.002), while the false positive rate increased from 2.36% to 9.77% (χ 2 1 =53.48; P<.001). The detection accuracy demonstrated a decrease from 93.33% to 92.23% for Hospital A and from 95.27% to 92.77% for Hospital C. Regarding the changes in lung nodule detection capability over a 3-year period following the integration of the AI system, the detection rates for lung nodules exhibited a modest increase from 54.6% to 55.84%, while the overall accuracy demonstrated a slight improvement from 92.79% to 93.92%., Conclusions: The AI system enhanced lung nodule detection, offering the possibility of earlier disease identification and timely intervention. Nevertheless, the initial reduction in accuracy underscores the need for standardized diagnostic criteria and comprehensive training for radiologists to maximize the effectiveness of AI-enabled diagnostic systems., (©Weiqi Liu, You Wu, Zhuozhao Zheng, Mark Bittle, Wei Yu, Hadi Kharrazi. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.01.2025.)

Objective: The purpose of this study is to examine whether differences in self-reported core competency skill gaps among U.S. governmental public health workers with and without a formal degree in public health have changed since the last assessment in 2017., Design: This cross-sectional study utilizes data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate relationships were analyzed by conducting chi-square tests of respondents' supervisory level and reported skill gaps. Multivariate logistic regressions of reported skill gaps were performed holding gender, age, race/ethnicity, public health certificate attainment, role type, current employer, and tenure in public health practice constant., Setting: A nationally representative sample of U.S. government public health employees., Participants: 36,752 U.S. governmental public health employees across local and state health agencies representing 47 states., Main Outcome Measures: Self-reported competency skills gaps., Results: In 2021, among both nonsupervisors and supervisors, having a formal public health degree (bachelors, masters, or doctorate) was significantly associated with reduced odds of reporting a skill gap across more than half of the competency skills assessed (14 of 23 skills and 17 of 24 skills, respectively). Nonsupervisors and supervisors with a formal public health degree had fewer skill gaps in 2021 than in 2017. Furthermore, whereas in 2017, when having a public health degree had no effect on executives reporting a skill gap, in 2021, having a public health degree was significantly associated with reduced odds of reporting 2 skill gaps., Conclusions: Overall, across all position levels (ie, nonsupervisory, supervisor, executive), public health workers with a public health degree experienced fewer competency skill gaps in 2021 than in 2017. These findings from PHWINS 2021 illustrate that formal public health education generally decreases competency gaps across numerous competency domains. However, the variability in reported gaps across supervisory levels shows the need for ongoing evaluation and adaptation of formal public health degree programs., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Characterise US residents' exposure to restrictions on sales of flavoured electronic nicotine delivery system (ENDS), cigars and menthol cigarettes across states and time, and assess correlations between these policies., Methods: From 2022 to 2024, we compiled flavour policy locations from advocacy groups and online searches, located corresponding legal texts and reviewed these to identify policy details, including effective dates. Using census data, we calculated the proportion of state residents covered by each policy quarterly from 2009 to 2024 and estimated correlations between them and cigarette taxes., Results: By January 2024, menthol cigarettes, flavoured cigars and flavoured ENDS sales restrictions covered 17.6%, 18.1% and 28.1% of US residents. About 1 in 10 US residents is subject to flavoured ENDS restrictions without concurrent restrictions on flavoured cigar and menthol cigarette sales. Strong correlations between flavour policy coverage and cigarette tax rates indicate a need to adjust for exposure to a range of tobacco control policies in analyses evaluating any one of these regulations' effects., Conclusions: While state and local adoption of restrictions on flavoured tobacco product sales has proliferated, flavour policy coverage for combustible tobacco products lags well behind that for ENDS. If this leads some people who vape flavoured ENDS to substitute towards flavoured cigars and/or menthol cigarettes, this policy combination could harm population health., Policy Implications: Rapid implementation of proposed US Food and Drug Administration rules barring flavoured cigar and menthol cigarette sales is needed to ensure that regulation of more lethal, combustible tobacco products is not more lenient than restrictions on less harmful nicotine products., Competing Interests: Competing interests: No, there are no competing interests., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Family physician program is one of the effective reforms of the health system in Iran, but despite the implementation of this program in rural areas and the passage of ten years since its implementation in two provinces of Fars and Mazandaran, its implementation has faced problems. The aim of this study is to identify and prioritize implementation solutions related to the challenges of the family physician program in Iran., Methods: This is a qualitative study using semi-structured interviews with 22 snowball-sampled experts and managers of basic health insurers to extract problems and executive solutions through coding and data analysis using Atlas Ti software and content analysis in the first stage. The combined criteria were used to report qualitative studies (COREQ). In the second stage, the extracted executive solutions were ranked using multi-criteria decision-making (MADM) and a hybrid approach combining Shannon entropy with simple aggregation weighting (SAW)., Results: Main themes were identified, including financing, management, human resources, structure, culture building, payment mechanism information systems, monitoring & control, performance of insurance organisations, and implementation. Out of these, priority was given to the information system, along with 41 sub-themes prioritising comprehensive, community-oriented physician training., Conclusion: The findings of the study provide remedies for the problems of the Iranian Urban Family Physician Programme at the executive level and in priority order, from the standpoint of the insurance organisations. Making crucial decisions entails handling matters relating to funding, administration, personnel, architecture, ethos, remuneration, IT systems, oversight, insurance organization output, and execution., Competing Interests: Declarations. Ethics approval and consent to participate: The research purpose and methodology were reviewed and approved by the Internal Research Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.SME.REC.1400.025). Informed consent was obtained from all the participants. The informants gave written informed consent to participate after receiving written and verbal information about the study. Participation was voluntary, and the participants could withdraw at any time before publication without consequences. The study was conducted in accordance to relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Maternal mental health can impact health care access and utilization for both the birthing parent and infant. We examined the association between prenatal depressive symptoms (episodic and chronic) and receipt of the postpartum 6-week visit and infant vaccinations in the first year postpartum., Methods: Postpartum individuals (N = 672) who attended Expect With Me group prenatal care in Nashville, Tennessee and Detroit, Michigan completed surveys during the second and third trimesters of pregnancy, as well as 6- and 12- months postpartum. We conducted multiple logistic regression to examine associations between prenatal depressive symptoms and attendance at the six-week postpartum check-up, and infant receipt of recommended vaccinations by 12 months, controlling for potential confounders., Results: During pregnancy, 17.0 % of individuals experienced episodic depression, and 6.4 % experienced chronic depression. Individuals with chronic prenatal depression were less likely to receive their six-week postpartum check-up compared to those without chronic prenatal depression (Adjusted Odds Ratio [AOR] 0.55; 95 % confidence interval [CI] = 0.31, 0.99). No significant association was found for patients with episodic or chronic prenatal depression and the likelihood of infants receiving all recommended vaccines by 12 months old., Conclusions: Chronic prenatal depression was associated with not receiving recommended six-week postpartum healthcare, which is essential to detect postpartum complications and address family planning. We did not observe impacts of maternal depression on infant receipt of vaccines. Maternal mental health intervention is warranted to ensure birthing parents receive the necessary support and treatment for overall well-being., Competing Interests: Declaration of competing interest This research was generously supported by a grant from UnitedHealth Foundation, with additional in-kind support from UnitedHealth Group. UnitedHealth Group contributed to study design and data collection protocols. UnitedHealth Foundation and UnitedHealth Group had no role in data analysis and interpretation nor writing of this report. There are no other conflicts of interest to report., (Copyright © 2025. Published by Elsevier B.V.)

We examined the impacts of interior border checkpoints on access to higher-level medical care via ground ambulance for undocumented immigrants in South Texas. Using purposive sampling, we conducted interviews (n = 30) with ground ambulance personnel in the lower Rio Grande Valley, Texas. Procedures implemented in 2018 mandate that hospitals notify Border Patrol of a patient's legal status before transfer. Undocumented immigrants cannot access higher-level medical care through ground ambulance transport without notifying Border Patrol. ( Am J Public Health . Published online ahead of print January 23, 2025:e1-e4. https://doi.org/10.2105/AJPH.2024.307927).

Objectives. To assess the impact of state COVID-19 vaccine mandates for health care workers (HCWs) on health sector employment in the United States. Methods. Using monthly state-level employment data from the Quarterly Census of Employment and Wages between January and October 2021, we employed a partially pooled synthetic control method that accounted for staggered mandate adoption and heterogeneous treatment effects. We conducted analyses separately for the 4 health care subsectors-ambulatory health care services, hospitals, nursing and residential care, and social assistance-with an additional analysis of 2 industry groups-skilled nursing care and community care for the elderly-under the nursing and residential care subsector. We further explored possible heterogeneous impacts according to the test-out option availability. Results. Mandate impact estimates were statistically indistinguishable from zero. Results further ruled out a mandate-associated decrease in employment larger than 2.1% of premandate employment levels for the 6 health care domains examined and for states with no test-out option. Conclusions. State COVID-19 vaccine mandates for HCWs were not found to be associated with significant adverse impacts on health sector employment even in states without a testing alternative to vaccination. The findings support vaccine mandates as a viable preventive measure without material disruption to the health care workforce, including in times of public health emergencies. ( Am J Public Health . Published online ahead of print January 23, 2025:e1-e5. https://doi.org/10.2105/AJPH.2024.307906).

Background: State opioid prescribing cap laws, mandatory prescription drug monitoring programme query or enrolment laws and pill mill laws have been implemented across US states to curb high-risk opioid prescribing. Previous studies have measured the impact of these laws on opioid use and overdose death, but no prior work has measured the impact of these laws on fatal crashes in a multistate analysis., Methods: To study the association between state opioid prescribing laws and fatal crashes, 13 treatment states that implemented a single law of interest in a 4-year period were identified, together with unique groups of control states for each treatment state. Augmented synthetic control analyses were used to estimate the association between each state law and the overall rate of fatal crashes, and the rate of opioid-involved fatal crashes, per 100 000 licensed drivers in the state. Fatal crash data came from the Fatality Analysis Reporting System., Results: Results of augmented synthetic control analyses showed small-in-magnitude, non-statistically significant changes in all fatal crash outcomes attributable to the 13 state opioid prescribing laws. While non-statistically significant, results attributable to the laws varied in either direction-from an increase of 0.14 (95% CI, -0.32 to 0.60) fatal crashes per 100 000 licensed drivers attributable to Ohio's opioid prescribing cap law, to a decrease of 0.30 (95% CI, -1.17 to 0.57) fatal crashes/100 000 licensed drivers attributable to Mississippi's pill mill law., Conclusion: These findings suggest that state-level opioid prescribing laws are insufficient to help address rising rates of fatally injured drivers who test positive for opioids. Other options will be needed to address this continuing injury problem., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objective: Tobacco smoking is the leading cause of preventable death among individuals with serious mental illness (SMI) but few persons with SMI are offered smoking cessation treatment. The purpose of this study was to pilot-test a multicomponent intervention to increase the delivery of evidence-based smoking cessation treatment in community mental health clinics (CMHCs)., Method: This study was carried out at five CMHCs in Maryland involving clinicians who participated in training in smoking cessation. Other implementation activities included the provision of a treatment protocol, coaching, expert consultation, and organizational strategy meetings. The primary outcome was a change in clinicians' knowledge and self-efficacy about smoking cessation. Secondary outcomes included documentation of evidence-based smoking cessation practices including assessment of smoking status and readiness to quit, and provision of smoking cessation treatment over the course of the 12-month intervention period., Results: A total of 91 clinicians participated in the study. Data were available on 6,011 clients. Clinicians' scores on the knowledge and self-efficacy measures increased modestly over the course of the implementation period. Overall, 57% of clients had their smoking status assessed; 81% of current smokers were evaluated about their willingness to quit; 82% of those willing to quit within 90 days received behavioral counseling, and 36% were prescribed or given smoking cessation pharmacotherapy. Clinicians rated the smoking cessation program highly in terms of acceptability, appropriateness, and feasibility., Conclusions: Clinicians at CMHCs were engaged by and participated in training and implementation activities around smoking cessation practices which they then delivered to a substantial portion of clients in their care. The results of this study provide important data for the future planning of testing implementation strategies to scale up tobacco cessation treatment in this population in outpatient mental health settings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Observation-based verification of regional/national methane (CH 4 ) emission trends is crucial for transparent monitoring and mitigation strategy planning. Although surface observations track the global and sub-hemispheric emission trends well, their sparse spatial coverage limits our ability to assess regional trends. Dense satellite observations complement surface observations, offering a valuable means to validate emission trends, especially in regions where emissions changes are substantial but debated. The uncertainty surrounding the rate of increase in fugitive coal mine emissions in China and emissions from unconventional oil and natural gas (ONG) exploration in the United States underscores the need for rigorous validation. Here, we examine the time evolution of total column dry-air mole fractions of CH 4 (XCH 4 ) during 2010-2020 by comparing observations from the GOSAT satellite with simulations from an atmospheric chemistry-transport model (ACTM). This study analyzes emissions and XCH 4 trends in global totals and regions of India, China, the USA, and the global tropics. Our results suggest that GAINSv4 emission inventory overestimates the emission increase rate for the unconventional ONG sector of USA by about 3 times, while EDGARv6 inventory overestimates coal mine emissions in China. Emission increases in China and India agree with those estimated by GAINSv4. Analysis of spatially integrated XCH 4 statistics (mean, 1-σ standard deviation) reveals a slight systematic underestimation of total emissions in China and bias (in both directions) in different parts of USA. Our results suggest that long-term satellite observations and ACTM simulations can effectively validate emission inventories for CH 4 emissions and emission trends regionally.

Background: Hepatitis C virus (HCV) infections and injection drug use have concurrently increased in the last decade. Evidence supports simultaneously treating chronic HCV and opioid use disorder (OUD) with medication. Kentucky is a hard-hit state for both conditions that has undertaken policy and practice efforts to increase access to both types of medications., Objective: To examine receipt of direct-acting antivirals (DAAs) for patients living with HCV-OUD and received any vs. no medications for opioid use disorder (MOUD)., Design: We conducted a cross-sectional study using a proprietary dataset from HealthVerity of health claims between 1/1/2020 and 12/31/2021., Patients: Kentucky Medicaid beneficiaries aged ≥ 18 with concurrent chronic HCV-OUD diagnoses., Main Measures: Multivariable logistic regression models were used to calculate adjusted proportions of HCV DAA receipt based on receipt of MOUD, adjusting for patient characteristics and region., Key Results: Of 2149 patients, 36% (n = 780) received HCV DAAs; 84% (n = 1804) received any MOUD during the study period. Buprenorphine was the most common MOUD type used (n = 1414, 66%). Adjusting for covariates, HCV DAA receipt was lower among people who received any vs. no MOUD (33% vs. 46%, p < 0.0001). Methadone (vs. no MOUD, 29% vs. 46%, p = 0.0002) had the greatest difference in odds of HCV DAA receipt., Conclusions: Gaps in HCV treatment among Kentucky Medicaid recipients with OUD were pervasive. Despite evidence supporting HCV-OUD co-treatment, patients receiving MOUD were significantly less likely to receive curative HCV treatment., Competing Interests: Declarations:. Conflict of Interest:: Dr. Sugarman, Dr. Saloner, Dr. Harris, Dr. Bandara, and Ms. Flanagan reported receiving grants from Bloomberg Philanthropies during the conduct of the study. Dr. Bandara reported receiving grants from the National Institutes of Health and Centers for Disease Prevention and Control outside the submitted work. Dr. Irvin reported part-time work on federal detail at the National Institutes of Health on the national hepatitis C elimination plan outside the submitted work. Dr. Saloner reported personal fees from Susman Godfrey outside the submitted work., (© 2025. The Author(s), under exclusive licence to Society of General Internal Medicine.)