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Despite more than 30 years of public health programs to reduce tobacco use, smoking is still the leading preventable cause of death in the United States. In response to this continuing epidemic, voters in California (1988), Massachusetts (1992), Arizona (1994), and Oregon (19%) approved ballot initiatives that established state- wide tobacco control programs funded by cigarette excise tax revenues. Evaluating these innovative public health interventions is important, both to improve existing programs and to guide other states in developing and implementing similar interventions. In this paper we describe the methods being used to evaluate the statewide anti-tobacco campaigns in California and Massachusetts, and review the findings of process and outcome evaluations of both programs. Our review suggests that both programs have had a substantial impact on the public `s health by reducing cigarette consumption and stimulating the development of policies to reduce environmental tobacco smoke exposure. However, it does not appear that either program has reduced smoking initiation among adolescents. Our evaluation suggests three problems in pm gram implementation that future anti-tobacco campaigns must avoid in order to produce long-term, sustained effects: (1) the gradual erosion of program funding by the state legislatures and governors; (2) the lack of a consistent, supportive constituency within state government and (3) inconsistency in campaign themes, messages, and programs. We conclude by offering recommendations to correct these problems so that state- wide cigarette-tax -funded anti-tobacco campaigns can realize their potential to become one of the most effective public health interventions available. [ABSTRACT FROM AUTHOR]

Although the morbidity and mortality caused by cigarette smoking occur in adult- hood, the initiation of tobacco use and the development of nicotine addiction typically occur during adolescence. The purpose of this paper is to examine the determinants of nicotine addiction, focusing on the development of addiction in youth, and to explore implications for public health policy. An understanding of the pharmacological and nonpharmacological factors that determine the course of nicotine addiction is critical in developing rational policies regarding tobacco products. The Food and Drug Administration `s rule to regulate cigarettes and smokeless tobacco products is discussed. The fact that smokers typically make the transition from casual use to nicotine addiction during adolescence argues for developing and implementing effective prevention efforts and smoking cessation treatment programs that are youth-oriented. [ABSTRACT FROM AUTHOR]

The sight of homeless people in U.S. cities and countrysides has entered our national consciousness. Many writers blame the increase in homeless people on the deinstitutionalization movement that occurred in the last 30 years. This paper disputes that conclusion and suggests that solutions to the growing problem of homelessness will not be found in admission wards of state mental hospitals. Relaxing commitment laws, imposing mandatory outpatient commitment, or forcibly transporting homeless people to emergency wards of psychiatric hospitals will not end homelessness, nor will they provide homeless mentally ill people what they need most: a decent home and supportive services. [ABSTRACT FROM AUTHOR]

The increasing tendency to prohibit smoking in public places is examined in light of awareness of the health effects of smoking. Drawing from the Health Belief Model, this paper investigates the development of proscriptive norms for public smoking in two states. Survey data from Illinois and North Carolina show that while smoking prevalence is similar in the two states, Illinois residents are more likely to consider smoking harmful to the individual engaged in the act. Although no differences by state were observed in perceived effects of Environmental Tobacco Smoke (ETS) on health, Illinois respondents were more likely to support legal controls of public smoking. Awareness of the primary effects of smoking on health emerged as more important than awareness of ETS effects on health in predicting support for legal control. [ABSTRACT FROM AUTHOR]

This paper examines the effect of prospective payment for hospital care on adverse medical outcomes. In 1983, the federal government replaced its previous cost-based reimbursement method with a Prospective Payment System, under which reimbursement depends only on the diagnosis of the patient. Hospitals thus lost the marginal reimbursement they formerly received for providing additional treatments. In addition, the average price each hospital received for patients with different diagnoses changed. This paper relates each of these changes to adverse outcomes, with two conclusions. First, there is a change in the timing of deaths associated with changes in average prices. In hospitals with price declines, a greater share of deaths occur in the hospital or shortly after discharge, but by one year post-discharge, mortality is no higher. Second, there is a trend increase in readmission rates caused by the elimination of marginal reimbursement. This appears to be due to accounting changes on the part of hospitals, however, rather than true changes in morbidity. [ABSTRACT FROM AUTHOR]

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This paper examines the availability of subsidized family-planning services to poor and near-poor fertile women aged 18 to 44, not desiring pregnancy, in the United States. Examination of data leads to the conclusion that subsidized services are inadequate; that neither state nor local governments are meeting the need; that hospitals and other public health facilities are providing negligible services; that the federal government, despite stated policy favoring the availability of family-planning services to all who want them, is providing minimal funding for the initiation and support of programs. [ABSTRACT FROM AUTHOR]

A key public health measure has received far too little attention over the course of the Covid‐19 pandemic: paid sick leave policies that encourage people at risk of spreading disease to stay home rather than come to work. The United States is one of the only developed countries that fails to guarantee paid sick leave at the federal level, leaving a patchwork of state and private policies that undersupply time off when people are contagious and protect top wage earners at wildly disproportionate rates compared with what workers with lower incomes experience. Other countries have shown that sick leave mandates are neither unjustified burdens on employers nor gratuitous giveaways to employees. In fact, sick leave saves on health care costs by making employees less likely to infect coworkers, to be absent for longer themselves, or to need treatment in expensive hospital emergency departments. Nationally guaranteed sick leave is urgently needed to promote public health. [ABSTRACT FROM AUTHOR]

Upper respiratory illnesses due to viruses are the most common reason for pediatric emergency department (ED) visits in the United States. We explored the clinical characteristics, hospitalization risk, and symptom duration of children in an ED setting by respiratory pathogen including coinfections. A retrospective analysis was conducted from a randomized controlled trial evaluating a rapid molecular pathogen panel among 931 children 1 month to 18 years of age with acute respiratory illness. We assessed hospitalization risk by pathogen using multivariable Poisson regression with robust variance. Symptom duration was assessed using multivariable Cox proportional hazards models. Among 931 children, 702 (75%) were aged 0–5 years and 797 (85%) tested positive for a respiratory pathogen. Children with respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and human rhinovirus/enterovirus (HRV/EV) had higher hospitalization risk compared with influenza (adjusted risk ratio [aRR]: 2.95, 95% confidence interval [CI]: 1.17–7.45; 3.56, 95% CI: 1.05–12.02; aRR: 2.58, 95% CI: 1.05–6.35, respectively). Children with RSV, parainfluenza and atypical bacterial pathogens had longer illness duration compared with influenza (adjusted hazards ratio [aHR]: 2.16 95% CI: 1.41–3.29; aHR: 1.67, 95% CI:1.06–2.64; aHR: 2.60 95% CI: 1.30–5.19, respectively). Children with RSV, hMPV, and atypical bacterial pathogens had higher illness severity and duration compared with other respiratory pathogens. Coinfection was not associated with increased illness severity. [ABSTRACT FROM AUTHOR]

Understanding the factors that influence trust in public health information is critical for designing successful public health campaigns during pandemics such as COVID‐19. We present findings from a cross‐sectional survey of 454 US adults—243 older (65+) and 211 younger (18–64) adults—who responded to questionnaires on human values, trust in COVID‐19 information sources, attention to information quality, self‐efficacy, and factual knowledge about COVID‐19. Path analysis showed that trust in direct personal contacts (B = 0.071, p =.04) and attention to information quality (B = 0.251, p <.001) were positively related to self‐efficacy for coping with COVID‐19. The human value of self‐transcendence, which emphasizes valuing others as equals and being concerned with their welfare, had significant positive indirect effects on self‐efficacy in coping with COVID‐19 (mediated by attention to information quality; effect = 0.049, 95% CI 0.001–0.104) and factual knowledge about COVID‐19 (also mediated by attention to information quality; effect = 0.037, 95% CI 0.003–0.089). Our path model offers guidance for fine‐tuning strategies for effective public health messaging and serves as a basis for further research to better understand the societal impact of COVID‐19 and other public health crises. [ABSTRACT FROM AUTHOR]

During COVID‐19, misinformation on social media has affected people's adoption of appropriate prevention behaviors. Although an array of approaches have been proposed to suppress misinformation, few have investigated the role of disseminating factual information during crises. None has examined its effect on suppressing misinformation quantitatively using longitudinal social media data. Therefore, this study investigates the temporal correlations between factual information and misinformation, and intends to answer whether previously predominant factual information can suppress misinformation. It focuses on two prevention measures, that is, wearing masks and social distancing, using tweets collected from April 3 to June 30, 2020, in the United States. We trained support vector machine classifiers to retrieve relevant tweets and classify tweets containing factual information and misinformation for each topic concerning the prevention measures' effects. Based on cross‐correlation analyses of factual and misinformation time series for both topics, we find that the previously predominant factual information leads the decrease of misinformation (i.e., suppression) with a time lag. The research findings provide empirical understandings of dynamic relations between misinformation and factual information in complex online environments and suggest practical strategies for future misinformation management during crises and emergencies. [ABSTRACT FROM AUTHOR]

Objective: To provide guidelines to researchers measuring health expenditures by disease and compare these methodologies' implied inflation estimates.Data Source: A convenience sample of commercially insured individuals over the 2003 to 2007 period from Truven Health. Population weights are applied, based on age, sex, and region, to make the sample of over 4 million enrollees representative of the entire commercially insured population.Study Design: Different methods are used to allocate medical-care expenditures to distinct condition categories. We compare the estimates of disease-price inflation by method.Principal Findings: Across a variety of methods, the compound annual growth rate stays within the range 3.1 to 3.9 percentage points. Disease-specific inflation measures are more sensitive to the selected methodology.Conclusion: The selected allocation method impacts aggregate inflation rates, but considering the variety of methods applied, the differences appear small. Future research is necessary to better understand these differences in other population samples and to connect disease expenditures to measures of quality. [ABSTRACT FROM AUTHOR]

Falls among the older adults (64+ years old [YO]) are considered public health issues. However, fall prevention in middle adulthood (age 45–64) has received less attention. We studied the associations between the number of falls and fall‐related injuries and indicators for socio‐demographics, chronic diseases, and difficulties in conducting activities in two age groups, 45–64 YO and 64+. In this secondary data analysis, we used the Behavioral Risk Factor Surveillance System (BRFSS) 2018 data. The study showed respondents in the 45–64 YO have higher average falls and fall‐related injuries than those 64+ (P <.001). Variables that link to more falls and fall‐related injuries in 64+ correspond to more falls and fall‐related injuries in 45–64 YO. The finding indicates that the odds of falls and fall‐related injuries are comparable across age groups when considering demographic characteristics. However, odds of falling in the presence of arthritis and asthma are higher for respondents in 45–64 YO than the 64+ YO. The risk of falls and fall‐related injuries are not specific to older adults. Factors that matter to the number of falls and fall‐related injuries in the older adults also count in the younger age group. Nurses are asked to validate available fall assessment tools for adults 45–64 years old and evaluate all clients over 45 for fall risk. [ABSTRACT FROM AUTHOR]

Objectives: Healthcare (including dental care) service use is influenced by predisposing, enabling and need factors. One area with limited research is the association of acculturation (defined as behavioural changes in the adaptation to another culture) as a predisposing factor for dental care preventive service use. Preventive service use is a primary objective of Healthy People, 2030. The purpose of this study was to determine the association of acculturation with the preventive dental service use of dental pit‐and‐fissure sealant placement, among children in the United States, ages 6‐18 years. Methods: A cross‐sectional, secondary data analysis study was completed using National Health and Nutrition Examination Survey (NHANES), 2013‐2016 data. NHANES is a nationally representative survey of noninstitutionalized individuals across the United States. In the data set, children, ages 6‐18 years, had been evaluated for pit‐and‐fissure dental sealant use. Information that served as proxies for acculturation was length of stay in the United States (a citizen at the time of the survey; not a citizen and in the country <5 years; or not a citizen and in the country ≥5 years) and whether English was spoken at home (yes; no). Data were analysed for descriptive statistics. Multivariable logistic regressions were used to examine strength of the associations. Odds ratios for pit‐and‐fissure sealants among groups were determined. Results: There were 2220 children participants whose data were used for this study. Less than half (45.5%) had received dental pit‐and‐fissure sealants. A majority (53.3%) were white and were ages 12‐18 years (51.6%). The mean number of dental pit‐and‐fissure sealants among all children was 5.5. There was a lower percentage of children living in the United States <5 years who had received pit‐and‐fissure sealants than children who were citizens of the United States (22.2% vs 48.9%, respectively). The adjusted odds ratio was lower for dental pit‐and‐fissure sealants among children who were in the United States <5 years than children who were citizens of the United States (adjusted odds ratio, 0.38; 95% Confidence Interval: 0.24, 0.58). Conclusions: In this study, children who had lived in the United States <5 years were less likely to have pit‐and‐fissure sealants than children who were citizens of the United States. There is a need to reach all children with preventive services to improve dental quality of life, reduce the need for dental restorations and decrease overall financial burden regardless of time in the United States. [ABSTRACT FROM AUTHOR]

Background: We aimed to explore the association between periodontitis and lung function in the United States.Methods: The data was based on the National Health and Nutrition Examination Survey (NHANES) 2009 to 2012. Periodontitis was defined following the CDC/AAP (Centers for Disease Control and Prevention/American Academy of periodontology) classification. Lung function measurements included forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. Linear regression and binary logistic regression were used to explore the association between periodontitis and lung function measurements. Restricted cubic spline was used to assess the dose-response relationships between the mean attachment loss (AL), the mean probing depth (PD) and spirometry-defined airflow obstruction (FEV1/FVC <0.7).Results: A total of 6313 adults aged 30 years or older were included. Compared to those with non-periodontitis, the multivariate-adjusted odds ratios (ORs) of airflow obstruction for moderate and severe periodontitis were 1.38 (95% CI: 1.01 to 1.75) and 1.47 (95% CI: 1.06 to 2.01), the β coefficients of FEV1 for moderate and severe periodontitis were -130.16 (95% CI: -172.30 to -88.01) and -160.46 (95% CI: -249.94 to -70.97), the β coefficients of FVC for moderate and severe periodontitis were -100.96 (95% CI: -155.08 to -46.85) and -89.89 (95% CI: -178.45 to -1.33), the β coefficients of FEV1/FVC for moderate and severe periodontitis were -0.01 (95% CI: -0.02 to -0.01) and -0.02 (95% CI: -0.03 to -0.01). In stratified analyses, the multivariate-adjusted ORs of airflow obstruction for the moderate and severe periodontitis were 1.27 (95% CI: 0.84 to 1.93) and 2.31 (95% CI: 1.10 to 4.83) in former smokers, 1.84 (95% CI: 1.03 to 3.30) and 1.79 (95% CI: 1.02 to 3.16) in current smokers, with no significant association observed in never smokers. Mean clinical AL and mean PD were negatively associated with FEV1, FVC, and FEV1/FVC in never, former, and current smokers. Dose-response relationship analysis showed that the risk of airflow obstruction increased with increasing mean clinical AL and mean PD, and showed a non-linear dose-response relationship.Conclusion: Our study suggested that moderate and severe periodontitis might be associated with the decline of lung function in the United States of America. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the influence of the sonic device on the clinical performance of one‐step self‐etch adhesive systems in non‐carious cervical lesions (NCCLs) after 18 months. Materials and methods: Forty patients participated in this study. Eighty restorations were assigned to two groups (n = 40): Sonic application and Manual application. After the adhesive application (iBond Self‐Etch, Kulzer, Hanau, Germany), NCCLs were restored using composite resin (Charisma, Kulzer, Hanau, Germany). The restorations were evaluated at baseline and after 18 months both according to the Word Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Friedman repeated measures analysis of variance by rank and Wilcoxon test for significance in each pair were applied (α = 0.05). Results: After 18 months, 38 patients were evaluated. Twenty‐three restorations were lost (19 for manual vs. 4 for sonic application). The retention rates (95% confidence interval) were 50% (CI 34.8%–65.1%) for manual application and 84.2% (CI 69.6%–92.6%) for sonic application (p < 0.05). Twelve restorations showed marginal staining (nine for manual vs. three for sonic application; FDI, p < 0.05) and nine some marginal discrepancy (seven for manual vs. two for sonic application; FDI, p < 0.05). No restorations showed postoperative sensitivity and caries recurrence at the time. Conclusion: The sonic application increases the retention rate of iBond Self‐Etch after 18 months of clinical evaluation in NCCLs. Clinical relevance: The application of a simplified self‐etch adhesive (iBond Self‐Etch) associated to a sonic device seems to be an alternative to improve the clinical behavior in NCCLs. [ABSTRACT FROM AUTHOR]

Few studies have examined melanoma and non-melanoma skin cancer ( NMSC) incidence rates after a diagnosis of hairy cell leukaemia ( HCL). We assessed 267 HCL patients treated at Memorial Sloan Kettering Cancer Center ( MSKCC) and Surveillance, Epidemiology and End Results ( SEER) data for melanoma and NMSC incidence rates after HCL. Incidence data from MSKCC patients demonstrated a 10-year combined melanoma and NMSC skin cancer rate of 11·3%, melanoma 4·4% and NMSC 6·9%. Molecular analysis of skin cancers from MSKCC patients revealed activating RAS mutations in 3/9 patients, including one patient with melanoma. Of 4750 SEER patients with HCL, 55 (1·2%) had a subsequent diagnosis of melanoma. Standardized incidence ratios ( SIRs) did not show that melanoma was more common in HCL patients versus the general population ( SIR 1·3, 95% CI 0·78-2·03). Analysis of SEER HCL patients diagnosed before and after 1990 (approximately before and after purine analogue therapy was introduced) showed no evidence of an increased incidence after 1990. A better understanding of any potential association between HCL and skin cancer is highly relevant given ongoing trials using BRAF inhibitors, such as vemurafenib, for relapsed HCL, as RAS-mutant skin cancers could be paradoxically activated in these patients. [ABSTRACT FROM AUTHOR]

The author discusses the debate on lowering blood alcohol concentration (BAC) level to 0.05 in the U.S. He states that it has been difficult for planners and researchers outside the political climate of the states to understand the failure of the U.S. to follow the world best practice by reducing BAC level to 0.05. He relates that numerous epidemiological studies established risk of driving with higher 0.08 BAC.

Aims To discuss an historical episode in which obesity was conceptualized as an addictive disorder and declared to be a major epidemic in the early postwar United States. This history illuminates past consequences of framing obesity as an addiction in ways that may inform constructive policy responses today. Methods Review of secondary and primary sources, including archival documents, relating to obesity in biomedical and popular thought of the 1940s and 1950s. Results In the United States in the late 1940s and 1950s, new medical thinking about obesity reinterpreted overweight and obesity as chiefly the consequence of addiction (understood in the then dominant psychodynamic theory as a psychological defect, oral fixation). This new conception was rapidly taken up in popular discourse and clinical practice, with adverse effects through amplification of weight stigma. Further, in the conservative political context, the addiction concept contributed to an ineffective policy response to the alarming new epidemiological evidence about obesity's consequences. Despite a lack of evidence for efficacy of the intervention, public health efforts focused on correcting individual eating behaviour among obese people by encouraging self-help in lay groups modelled, in part, on Alcoholics Anonymous. Population-level intervention was neglected. Conclusions Current public health policy initiatives must be mindful of the risks of reframing obesity as an addiction. These include inadvertently reinforcing stigma, narrowing responses to those aiming to modify individual behaviour and biology and neglecting population policies aiming to reduce the consumption of energy-dense foods, as all occurred in the 1950s United States. [ABSTRACT FROM AUTHOR]

From hampering the ability of water utilities to fill their reservoirs to leaving forests parched and ready to burn, drought is a unique natural hazard that impacts many human and natural systems. A great deal of research and synthesis to date has been devoted to understanding how drought conditions harm agricultural operations, leaving other drought‐vulnerable sectors relatively under‐served. This review aims to fill in such gaps by synthesizing literature from a diverse array of scientific fields to detail how drought impacts nonagricultural sectors of the economy: public water supply, recreation and tourism, forest resources, and public health. We focus on the Intermountain West region of the United States, where the decadal scale recurrence of severe drought provides a basis for understanding the causal linkages between drought conditions and impacts. This article is categorized under:Human Water > Value of WaterScience of Water > Water Extremes [ABSTRACT FROM AUTHOR]

Objective. To develop a composite measure of state-level malpractice environment. Data Sources. Public use data from the National Practitioner Data Bank, Medical Liability Monitor, the National Conference of State Legislatures, and the American Bar Association. Study Design. Principal component analysis of state-level indicators (paid claims rate, malpractice premiums, lawyers per capita, average award size, and malpractice laws), with indirect validation of the composite using receiver-operating characteristic curves to determine how accurately the composite could identify states with high-tort activity and costs. Principal Findings. A single composite accounted for over 73 percent of total variance in the seven indicators and demonstrated reasonable criterion validity. Conclusion. An empirical composite measure of state-level malpractice risk may offer advantages over single indicators in measuring overall risk and may facilitate cross-state comparisons of malpractice environments. [ABSTRACT FROM AUTHOR]

Background: Binge drinking among adolescents and young adults has changed over time, but patterns differ by age and gender. Identifying high‐risk groups to target future efforts at reducing drinking in this population remains a public health priority. Forecasting methods can provide a better understanding of variation and determinants of future binge drinking prevalence. Methods: We implemented regression‐based forecasting models to estimate the prevalence and gender differences in binge drinking among cohort groups of U.S. young adults, ages 18, 23–24, and 29–30 through 2040. Forecasting models were adjusted for covariates accounting for changes in demographic, Big‐5 social roles (e.g., residential independence), and drinking norms and related substance use, to understand the drivers of forecasted binge drinking estimates. Results: From the last observed cohort group (years varied by age) through 2040, unadjusted binge drinking prevalence was forecasted to decrease from 26% (95% CI: 20, 33%) (2011–15) to 11% (95% CI: 4, 27%) at age 18, decrease from 38% (95% CI: 30, 45%) (2006–2010) to 34% (95% CI: 18, 55%) at ages 23/24, and increase from 32% (95% CI: 25, 40%) (2001–2005) to 35% (95% CI: 16, 59%) at ages 29/30. Gender‐stratified forecasts show a continuation in the narrowing of binge drinking prevalence between young men and women, though the magnitude of narrowing differs by age. Estimated trends were partially explained by changing norms regarding drinking and other substance use, though these indirect effects explained less of the total trend as age increased. Conclusions: Understanding how covariates influence binge drinking trends can guide public health policies to leverage the most important determinants of future binge drinking to reduce the harm caused by binge drinking from adolescence to adulthood. [ABSTRACT FROM AUTHOR]

Objective: To examine the association of social support with dental caries experience in Hispanics/Latinos living in the United States (US) and to assess whether the relationship is modified by nativity status. Methods: This cross‐sectional study analysed data for 4459 dentate men and women aged 18‐74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. At baseline (2008‐2011), dentists quantified dental caries experience as the number of decayed, missing, and filled permanent tooth surfaces (DMFS) for all teeth excluding third molars. Social support was assessed according to measures of structural support (Social Network Index) and functional support (Interpersonal Support Evaluation List). Covariate‐adjusted multiple linear regression estimated the relationship between social support and dental caries experience and tested whether the association was modified by nativity status (born within the 50 US states, foreign‐born <10 years in the United States, foreign‐born >10 years or more in the United States). Results: In covariate‐adjusted models, each additional role in the social network was associated with 1.39 fewer DMF tooth surfaces (95% CI: −2.21, −0.58) among foreign‐born Hispanics/Latinos with fewer than 10 years lived in the US. For foreign‐born Hispanics/Latinos with 10 years or more in the United States, each additional social network role was associated with 0.57 fewer DMF tooth surfaces (95% CI: −1.19, 0.04). No association was observed between functional social support and dental caries experience regardless of nativity status. Conclusions: Our findings suggest that structural social support is protective against dental caries experience among recent immigrants of Hispanic/Latino background. This association may reflect the importance of social support to integration into the medical and dental infrastructure and thus receipt of dental care. Future research that examines the behavioural and cultural factors that moderate the relationship between social support and dental caries experience will inform development of culturally sensitive dental caries prevention programs for Hispanics/Latinos in the United States. [ABSTRACT FROM AUTHOR]

Background: Children from Black and South Asian ethnic groups are at risk for childhood obesity in the United Kingdom. To inform local action for childhood obesity prevention, it is crucial to explore the basis of ethnic disparities and consider the perspectives of children. This study aimed to understand cultural and contextual factors influencing childhood obesity in an ethnically diverse population using child‐centred methodology. Methods: 'Draw, write and tell' interviews were held with children aged 9–10 years in Coventry, an urban, multi‐ethnic city in the United Kingdom. Data were analysed thematically using framework analysis. Results: Twenty‐six children participated (85% from Black or minority ethnic groups). Children's perspectives revealed universal themes around health, diet, physical activity and weight and highlighted issues specific to ethnic groups and those living in deprived areas. An underlying feature was weight‐based stigmatization and group stereotyping, and an emphasis on internal factors as the cause of obesity. Children described some experiences of social disadvantage but did not regard these as a barrier to being physically active. Children identified cultural or religious practices or experiences of migration that influenced diet and physical activity. Conclusions: These findings allow a broad range of children's perspectives to inform future intervention design. In addition, the study was able to identify the many similarities and small amount of diversity in children's perspectives across ethnic groups. [ABSTRACT FROM AUTHOR]

Objective: As labor markets in recent decades have become increasingly volatile and precarious, more workers are susceptible to working conditions threatening their economic security. COVID‐19 has further laid bare such economic insecurity from holding a precarious job. We examined the association between precarious employment and the probability of losing income or a job during COVID‐19 pandemic. Methods: A multivariate regression analysis was conducted using a cross‐sectional data set collected in May 2020 in the United States. Results: Our results confirm a strong positive association between precarious employment and losing work or income. Specifically, holding part‐time work in the service sector, and feeling disempowered in the workplace, receiving low material rewards, having few benefits, and experiencing obstacles in exercising rights all significantly doubled the probability of losing income or jobs. Conclusion: Our analysis underscores the increasing vulnerability faced by our workforce and how a public health crisis magnifies the dire consequences of a precarious job. [ABSTRACT FROM AUTHOR]

As COVID‐19 vaccine is being rolled out in the US, public health authorities are gradually reopening the economy. To date, there is no consensus on a common approach among local authorities. Here, a high‐resolution agent‐based model is proposed to examine the interplay between the increased immunity afforded by the vaccine roll‐out and the transmission risks associated with reopening efforts. The model faithfully reproduces the demographics, spatial layout, and mobility patterns of the town of New Rochelle, NY — representative of the urban fabric of the US. Model predictions warrant caution in the reopening under the current rate at which people are being vaccinated, whereby increasing access to social gatherings in leisure locations and households at a 1% daily rate can lead to a 28% increase in the fatality rate within the next three months. The vaccine roll‐out plays a crucial role on the safety of reopening: doubling the current vaccination rate is predicted to be sufficient for safe, rapid reopening. [ABSTRACT FROM AUTHOR]

This study synthesized current research on the relationships between type of insurance and emergency department usage for children with asthma in the United States. Thematic analysis is in the context of the Affordable Care Act (ACA). A systematic mapping review yielded 20 articles published in the last 10 years on topics of insurance, emergency department usage, and pediatric asthma. Analysis indicates continued trends of increased emergency department use among asthmatic children since enactment of the ACA, running counter to the goal of fiscal efficiency for the healthcare system and reduction of health inequities. Barriers to care persist, particularly among communities of color, despite provisions to improve access to primary and preventive care. Inadequate access to primary care is associated with poor adherence among asthmatic children with public insurance. Those with health insurance through their parents' employer experience barriers due to cost‐sharing expenses. This leads to increased asthma severity and low medication adherence, resulting in the need for emergency care. A disconnect between increased health insurance coverage and utilization of primary care in some populations implies unmet service needs that warrant further investigation. Findings inform policymakers and public health leaders of persistent health inequities resulting in preventable emergency department usage. [ABSTRACT FROM AUTHOR]

Taxes and subsidies are increasingly being considered as potential policy instruments to incentivize consumers to improve their food and beverage consumption patterns and related health outcomes. This study provided a systematic review of recent U. S. studies on the price elasticity of demand for sugar-sweetened beverages ( SSBs), fast food, and fruits and vegetables, as well as the direct associations of prices/taxes with body weight outcomes. Based on the recent literature, the price elasticity of demand for SSBs, fast food, fruits and vegetables was estimated to be −1.21, −0.52, −0.49 and −0.48, respectively. The studies that linked soda taxes to weight outcomes showed minimal impacts on weight; however, they were based on existing state-level sales taxes that were relatively low. Higher fast-food prices were associated with lower weight outcomes particularly among adolescents, suggesting that raising prices would potentially impact weight outcomes. Lower fruit and vegetable prices were generally found to be associated with lower body weight outcomes among both low-income children and adults, suggesting that subsidies that would reduce the cost of fruits and vegetables for lower-socioeconomic populations may be effective in reducing obesity. Pricing instruments should continue to be considered and evaluated as potential policy instruments to address public health risks. [ABSTRACT FROM AUTHOR]

In this article the author discusses aspects of the study conducted by Jeffrey H. Silber and colleagues on the ecological relationship between hospital's intensity, and rates of operative complications and failure-to-rescue from complications. The author relates that the study found a link between increased hospital intensity and lower postadmission mortality, and has implications for health care reform. Moreover, it highlights the importance of improving U.S. population health.

The article presents an examination of children's health in the United States in the early 20th century. It explores the relationship that existed between candy consumption and the fear of polio and discusses how American candy culture changed as a result of polio. Seen as a source of contagion, new candy wrappers began appearing that offered consumers a safer, higher-quality candy as opposed to cheaper or impure candies. The article examines socioeconomic issues related to candy consumption and explores how social issues such as hygiene and immigration became intertwined with candy consumption and the threat of polio.

We explain the recent increases in obesity in the United States with a model involving falling food prices, endogenous social body weight norms, and heterogeneous human metabolism. Calibrating an analytical choice model to American women in the 30- to 60-yr-old age bracket, we compare the predicted weight distributions to National Health and Nutrition Examination survey data spanning (intermittently) the years 1976–2000. The model, the first to describe explicitly complete weight distribution dynamics for this group, predicts average weights and obesity rates with considerable accuracy and captures a significant portion of the recent growth in upper quantile weights. ( JEL D11, I12, Z13) [ABSTRACT FROM AUTHOR]

The article focuses on the influence of the Milbank Memorial Fund on the health policy in the U.S. The Fund has been consistent in its goals, and in how its board and staff implemented them. The Fund sought improvement in the general level of public welfare and public health. The chronological history of the Fund's programs is presented.

This article focuses on developing effective evidence-based interventions for adolescents with alcohol use disorders in the U.S. The U.S. National Survey on Drug Use and Health (NSDUH) data on binge and heavy drinking indicate a public health problem of considerable proportions. Not only are these youths at high risk for serious accidents and negative social consequences, but some also are at risk for developing multiple behavioral disorders including alcohol abuse and alcoholism. Adolescent research to date suggests that there are two major types of adolescent developmental pathways that involve alcohol consumption. Although public and private systems of health care have emerged to provide a range of substance abuse treatments to adolescents, the treatments are often transported from adult care to adolescent care. Furthermore, until recently the efficacy of these treatments was rarely evaluated rigorously in adolescents. It argues for the integration of adolescent substance abuse treatment research and human development research, including both normative and psychopathological perspectives.

The format of the paper is to allow three authors to discuss what they believe are the most significant political issues facing emergency medicine (EM) in their country or region. Each author writes independently and does not see any other contributing author's work, therefore potential overlap of subject matter is inevitable. However, we were soliciting their individual opinions about the serious issues confronting us today, rather than a consensus. An additional author, well familiar with the topics being discussed, wrote the Commentary from an overview perspective on the writings of the other authors. This supplemental opinion was offered as a method for enhanced cohesiveness in describing the political situations impacting the specialty of emergency medicine. The three authors for the United States are James Hoekstra, Professor and Chair, Wake Forest University Health Sciences; Robert McNamara, Professor and Chair, Temple University School of Medicine, and Robert Schafermeyer, Associate Chair, Department of Emergency Medicine, North Carolina School of Medicine. Between them, they represent more than 50 years experience in clinical and academic emergency medicine. They write from a personal perspective. Their views are their own, and do not represent any organization(s) with which they may have or had affiliations. [ABSTRACT FROM AUTHOR]

Providing oral health care to rural populations in the United States is a major challenge. Lack of community water fluoridation, dental workforce shortages, and geographical barriers all aggravate oral health and access problems in the largely rural Northwest. Children from low-income and minority families and children with special needs are at particular risk. Family-centered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. In this project, dental, medical, and educational faculty at a large academic health center partnered to provide evidence-based, culturally competent pediatric oral health training to family medicine residents in five community-based training programs. The curriculum targets children birth to five years and covers dental development, the caries process, dental emergencies, and oral health in children with special needs. Outcome measures include changes in knowledge, attitudes, and self-efficacy; preliminary results are presented. The program also partnered with local dentists to ensure a referral network for children with identified disease at the family medicine training sites. Pediatric dentistry residents assisted in didactic and hands-on training of family medicine residents. Future topics for oral health training of family physicians are suggested. [ABSTRACT FROM AUTHOR]

Focuses on income inequality as a public health concern in the United States. Possible mechanisms that might relate income inequality with health outcomes; Summary of studies that have addressed the income inequality/health connection; Patterns of social spending that affect health.

Aim: To describe an outbreak of lung injuries in 2019 among people who vaped in the United States (type of injuries, people afflicted, substances vaped and cause of the injuries) and to analyse critically the regulatory responses of public health authorities and the media reporting of the outbreak. Methods: Case studies of the reporting of the e‐cigarette or vaping product use associated lung injury (EVALI) outbreak. We examined data on the number of cases of lung injury provided by the US Centers for Disease Control (CDC), public advice on the causes of the outbreak provided by the CDC and the Food and Drug Administration (FDA), major media reports of the outbreak and proposed regulatory responses by governments in the United States, Australia and the United Kingdom. Results: The CDC initially suggested that the cause of the outbreak was nicotine vaping because the outbreak followed a large increase in nicotine vaping among US adolescents. Case–control studies revealed that the majority of cases had vaped illicit cannabis oils that were contaminated by vitamin E acetate. The CDC's public advice and the media were slow to report the evidence on the role of cannabis vaping. Popular government regulatory proposals—bans on sales of nicotine flavours and vaporizers—were based on the assumption that nicotine vaping was the cause of the outbreak. Conclusions: Media reporting in the United States, Australia and the United Kingdom of the US Centers for Disease Control's analysis of the causes of the e‐cigarette or vaping product use associated lung injury outbreak contributed to regulatory over‐reactions to nicotine vaping by the public health community. [ABSTRACT FROM AUTHOR]

Wildfire smoke is a growing public health concern in the United States. Numerous studies have documented associations between ambient smoke exposure and severe patient outcomes for single‐fire seasons or limited geographic regions. However, there are few national‐scale health studies of wildfire smoke in the United States, few studies investigating Intensive Care Unit (ICU) admissions as an outcome, and few specifically framed around hospital operations. This study retrospectively examined the associations between ambient wildfire‐related PM2.5 at a hospital ZIP code with total hospital ICU admissions using a national‐scale hospitalization data set. Wildfire smoke was characterized using a combination of kriged PM2.5 monitor observations and satellite‐derived plume polygons from National Oceanic and Atmospheric Administration's Hazard Mapping System. ICU admissions data were acquired from Premier, Inc. and encompass 15%–20% of all U.S. ICU admissions during the study period. Associations were estimated using a distributed‐lag conditional Poisson model under a time‐stratified case‐crossover design. We found that a 10 μg/m3 increase in daily wildfire PM2.5 was associated with a 2.7% (95% CI: 1.3, 4.1; p = 0.00018) increase in ICU admissions 5 days later. Under stratification, positive associations were found among patients aged 0–20 and 60+, patients living in the Midwest Census Region, patients admitted in the years 2013–2015, and non‐Black patients, though other results were mixed. Following a simulated severe 7‐day 120 μg/m3 smoke event, our results predict ICU bed utilization peaking at 131% (95% CI: 43, 239; p < 10−5) over baseline. Our work suggests that hospitals may need to preposition vital critical care resources when severe smoke events are forecast. Plain Language Summary: Wildfire smoke negatively affects people's health. Heavy smoke has been linked to higher rates of hospital admissions, emergency room, admissions, and death. However, we do not know the impact of smoke on Intensive Care Unit (ICU) admissions or on limited hospital resources like ICU beds. To fill this knowledge gap, we linked hospital ICU admissions to smoke levels near those hospitals. We also predicted how many ICU admissions would occur during a simulated severe week‐long smoke event and how many ICU beds would be needed to care for the patients. We found that the link between smoke and ICU admissions was relatively modest, but a severe smoke event could more than double the number of ICU beds needed. Key Points: Associations between smoke PM2.5 and ICU admissions were estimated using a national‐scale cohortSmoke PM2.5 was associated with modest changes in ICU admissionsA simulated smoke wave was found to impose severe strain on ICU resources [ABSTRACT FROM AUTHOR]

Background: Suicide is a serious and growing public health concern, both for the United States (U.S.) and for the Department of Defense (DoD).Methods: Using the social-ecological framework, we provide examples of how three newly developed, DoD-funded pilots/programs have incorporated a public health approach to help prevent military suicide.Key Results: The first two programs demonstrate how non-clinical, community-based approaches can be tailored to specific military subgroups at the individual, relational, and community levels. These programs include a universal suicide prevention program developed for Special Operations service members, spouses, and mental health providers, and a selective suicide prevention program pilot developed for military chaplains to support them in their role as a "gateway" to care for distressed service members, improve mental health and chaplaincy collaboration, and prevent burnout. The third program illustrates how the creation of and policy of a methodology/infrastructure to conduct standardized, theory-driven suicide death reviews across the DoD may inform the DoD public health approach to surveillance, review, and synthesis of suicide data, informed by the social-ecological model. Potential program limitations and evaluation efforts are discussed.Conclusion: Future prevention approaches should enhance coordination and communication between DoD, VA, and community organizations to enhance multi-level suicide prevention programming for military personnel, veterans, and civilians. [ABSTRACT FROM AUTHOR]

Objective: To characterize patterns of weight‐related self‐monitoring (WRSM) among US undergraduate and graduate students and examine associations between identified patterns of WRSM and eating disorder symptomology. Method: Undergraduate and graduate students from 12 US colleges and universities (N = 10,010) reported the frequency with which they use WRSM, including self‐weighing and dietary self‐monitoring. Eating disorder symptomology was assessed using the Eating Disorder Examination Questionnaire. Gender‐specific patterns of WRSM were identified using latent class analysis, and logistic regressions were used to identify differences in the odds of eating disorder symptomology across patterns of WRSM. Results: Among this sample, 32.7% weighed themselves regularly; 44.1% reported knowing the nutrition facts of the foods they ate; 33.6% reported knowing the caloric content of the foods they ate; and 12.8% counted the calories they ate. Among women, four patterns of WRSM were identified: "no WRSM," "all forms of WRSM," "knowing nutrition/calorie facts," and "self‐weigh only." Compared with the "no WRSM" pattern, women in all other patterns experienced increased eating disorder symptomology. Among men, three patterns were identified: "no WRSM," "all forms of WRSM," and "knowing nutrition/calorie facts." Only men in the "all forms WRSM" pattern had increased eating disorder symptomatology compared with those in the "no WRSM" pattern. Discussion: In a large sample of undergraduate and graduate students, engaging in any WRSM was associated with increased eating disorder symptomology among women, particularly for those who engaged in all forms. Among men, engaging in all forms of WRSM was the only pattern associated with higher eating disorder symptomology. [ABSTRACT FROM AUTHOR]

Background: Kidney transplant is the best treatment for end‐stage renal disease (ESRD); however, access is limited by severe organ shortage. Public Health Service increased risk donors (PHS‐IRD) represent a significant portion of available organs which are discarded at disproportional rates. Methods: Pediatric nephrologists were surveyed regarding PHS‐IRD kidneys to understand attitudes and perceived barriers to the use of these grafts in children. We sought to elucidate what methods may help increase the likelihood of PHS‐IRD acceptance. Results: Twenty‐two responses were received from United States pediatric nephrologists representing 11 UNOS regions (response rate 5.9%). Of respondents, 50% had been practicing for 20+ years, 77% in academic hospitals, and 63% in cities with over 1 000 000 people. All respondents worked in an institution with a kidney transplant program. 41% reported that they would not accept PHS‐IRD kidneys under any circumstance, 45% would accept depending on the candidate's medical status, and 14% routinely accepted PHS‐IRD kidneys. Infectious transmission was the biggest disincentive reported (59%), with only 55% of respondents feeling comfortable counseling families on the associated risks. 82% of respondents did not perceive all PHS‐IRD as the same, and 90% supported stratifying PHS‐IRD into tiers based on risk, which would increase the likelihood of organ acceptance (82%) and assist in counseling families (91%). Conclusions: With improved utilization, PHS‐IRD kidneys offer a step toward decreasing the organ shortage. These findings suggest hesitance in use of PHS‐IRD kidneys for pediatric recipients. Further stratification of risk could aid in provider organ acceptance and counseling patients. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic reveals how the systems and structures of racism devastate the health and well‐being of people of color. The debate is an old one and the lesson we have yet to learn was tragically apparent a century ago during the 1918–1919 influenza pandemic. Any history of structural racism in America must begin with the chronicles of African Americans, Native Alaskans, and Indigenous North Americans as they were the originally enslaved and displaced people, subjected to overt and covert policies of oppression ever since. The experiences of Native Alaskans of Bristol Bay Alaska in 1918–1919 present a parallel, illuminating a wrenching example of structural racism that cost lives and impoverished society, then as now. Proven policy solutions exist to remove the structures that produce inequitable health outcomes, but implementing them will require public health officials and policymakers to take multidisciplinary policy actions, to find policy opportunities for change to be made, and, likely, a change in the political environment. The first exists now, the second is afforded because of the current pandemic and the urgent need for policy solutions, and the third is likely coming soon. [ABSTRACT FROM AUTHOR]

Background: Containment of the coronavirus disease 2019 (COVID‐19) pandemic requires the public to change behavior under social distancing mandates. Social media are important information dissemination platforms that can augment traditional channels communicating public health recommendations. The objective of the study was to assess the effectiveness of COVID‐19 public health messaging on Twitter when delivered by emergency physicians and containing personal narratives. Methods: On April 30, 2020, we randomly assigned 2,007 U.S. adults to an online survey using a 2 × 2 factorial design. Participants rated one of four simulated Twitter posts varied by messenger type (emergency physician vs. federal official) and content (personal narrative vs. impersonal guidance). The main outcomes were perceived message effectiveness (35‐point scale), perceived attitude effectiveness (PAE; 15‐point scale), likelihood of sharing Tweets (7‐point scale), and writing a letter to their governor to continue COVID‐19 restrictions (write letter or none). Results: The physician/personal (PP) message had the strongest effect and significantly improved all main messaging outcomes except for letter writing. Unadjusted mean differences between PP and federal/impersonal (FI) were as follows: perceived messaging effectiveness (3.2 [95% CI = 2.4 to 4.0]), PAE (1.3 [95% CI = 0.8 to 1.7]), and likelihood of sharing (0.4 [95% CI = 0.15 to 0.7]). For letter writing, PP made no significant impact compared to FI (odds ratio = 1.14 [95% CI = 0.89 to 1.46]). Conclusions: Emergency physicians sharing personal narratives on Twitter are perceived to be more effective at communicating COVID‐19 health recommendations compared to federal officials sharing impersonal guidance. [ABSTRACT FROM AUTHOR]

This essay looks to Thomas Jefferson and John Dewey, as well as a contemporary political theorist, Kevin O'Leary, for some guidance in confronting the present crisis in American democratic norms and practices—including that swirling around issues of public health. [ABSTRACT FROM AUTHOR]

Background and Objectives: Accurate, up‐to‐date estimates of the burden of migraine and severe headache are important for evidence‐based decision‐making about workforce needs and the distribution of health resources. We used data from US government health surveys to report the prevalence, trends, and impact of this condition by age, sex, and poverty status. Methods: We identified the most recent, publicly available summary statistics from the National Hospital Ambulatory Medical Care Survey, the National Ambulatory Medical Care Survey, and the National Health Interview Survey. We extracted and compiled relevant information from each study, with an emphasis on sex, age, and economic‐related statistics. Results: The age‐adjusted prevalence of migraine and severe headache in the United States has remained stable over many years. In 2018, the age‐adjusted prevalence was 15.9% across all adults. The sex ratio also remains stable, with 21% of women and 10.7% of men affected. Migraine continues to be an important public health problem, accounting for roughly 4 million emergency department (ED) visits in 2016, when headache was the fifth most common reason for an ED visit overall and the third most common reason for ED visits in females 15–64. Migraine also accounted for over 4.3 million office visits. Many adults with migraine or severe headaches are disadvantaged. In 2018, for example, roughly 40% of US adults with migraine were unemployed, and a similar proportion were classified as poor or "near poor." Roughly one in five had no health insurance and about a third had a high school education or less. Conclusions: Migraine and severe headaches are a serious public health issue in the United States, with the highest impact in women of childbearing age and those of lower socioeconomic status. Socioeconomic disadvantages also are highly prevalent among those with headaches. The economic consequences of the current coronavirus pandemic are likely to exacerbate all of these inequities. Increased attention to this high impact chronic pain condition, and improved funding for treatment provision and research, are warranted to reduce the future burden of disease. [ABSTRACT FROM AUTHOR]

The article presents a commentary on spatial approach to Identify priority rural areas requiring targeted health support with COVID-19 pandemic. Topics include compared to urban communities, rural communities typically face poorer access to health services; and lack of staff with the need for coordinated health services, and operational and facility issues.

Within the last decade, considerable attention has been given toward teen sexuality in the United States. Adolescent pregnancy and limited contraceptive use by teens are viewed as major health and social problems in the United States today. The purpose of this paper is to propose intervention strategies for delaying the onset of sexual behavior among teens and for increasing contraceptive use among teens who are sexually active. [ABSTRACT FROM AUTHOR]

This paper examines the United States policy toward people with AIDS (P WAs) using a theory of the social construction of target populations (Schneider and Ingram, 1993). A policy narrative is developed which focuses on the ways PWAs have been categorized throughout the epidemic and how the characterization of these constructed target populations has influenced the design of policies aimed at these groups. The Ryan White Act of 1990 and the debate surrounding its passage is examined and found to be consistent with the expectations of the theory. Propositions which extend the frame- work are offered as a guide for future research. [ABSTRACT FROM AUTHOR]

Within the last 35 years health care expenditures have increased from $12 billion to over $350 billion. Recent concern over these costs have led to a reevaluation of the health care delivery system in the United States. This paper reviews four emerging cost containment models. The discussion focuses on the "market-like" incentives introduced into the health care delivery system by such strategies. [ABSTRACT FROM AUTHOR]