Introduction:Despite concerns about the impact of marijuana on women's health, studies exploring factors influencing use are limited. We examined predictors and mediators of marijuana use among US women. Methods:Structural equation modeling analyzed data on women (n = 16,081) from the 2023 National Survey on Drug Use and Health, with marijuana use as dependent variable. Sociodemographic variables and covariates included age, race and ethnicity, marital status, education, poverty status, county type, criminal history, and binge drinking. Potential mediators were past-year major depressive episode (PY-MDE); past-year use of illicit drugs, tobacco, and alcohol (PY-IDTA); poverty status; and body mass index. Results:Marijuana use was frequently reported among women aged 26 to 34 years (35.6%), those who were non-Hispanic White (60.8%), never been married (62.5%), with some college-level education (38.1%), living in large metropolitan areas (56.7%), those who did not binge drink (53.8%), without a criminal history (83.7%), with no PY-MDE (74.8%), no PY-IDTA (73.4%), those who were living above the poverty threshold (58.5%), and those with obesity (37.5%). Criminal history (β = 0.188) and binge drinking (β = 0.404) had positive direct effects on marijuana use; age (β =-0.065) and race (β = -0.027) had negative direct effects on use. PY-MDE mediated the relationships between age, race and ethnicity, marital status, county, past criminal history, binge drinking, and marijuana use (indirect βs = -0.008 to 0.080). PY-IDTA mediated the relationships between race and ethnicity, marital status, education, past criminal history, binge drinking, and marijuana use (indirect βs = -0.013 to 0.378), with all P values <.05. Conclusion:Results suggest potential predictors and mediators of marijuana use, highlighting the need for multi-strategy targeted interventions among US women.
Higher education is correlated with healthy eating, which prevents chronic disease. Recent evidence suggests that racial and ethnic minority populations with higher education levels consume fewer healthy foods than their non-Hispanic White counterparts. We analyzed data on 19,591 participants of the National Health and Nutrition Examination Survey (2011-2018). Linear regression models identified racial and ethnic differences in Healthy Eating Index (HEI)-2015 scores within categories of education level. Non-Hispanic Black adults with a bachelor's degree or higher had lower HEI-2015 scores (β = -1.69; SE = 0.79; P = .03) compared with non-Hispanic White adults with the same education level. These findings suggest that non-Hispanic Black populations in the US may experience diminished returns on educational investment.
Cardiovascular disease and other chronic diseases contribute substantially to illness, death, and health inequities in the US. Despite medical advances and interventions to improve the health outcomes among people with chronic diseases, additional strategies are needed. Communities are a powerful driver of health promotion and disease prevention. When engaged meaningfully, communities can enact and sustain health-related changes starting at the individual level and expand these changes to system and policy levels. Grounded in the social action model and the principles of shared governance, learning collaboratives can promote community engagement, mutual accountability, and local capacity building. By aligning public health efforts with community priorities, learning collaboratives offer a way to build community trust, deepen community partnerships, and support sustainable health initiatives. They can position communities not merely as sites of intervention but as meaningful change agents in addressing health. This article explores the use of learning collaboratives, and in particular, the Healthy Hearts Learning Collaboratives in Virginia, as practical tools for advancing community-driven strategies to reduce the incidence of chronic disease and poor health outcomes. It provides guidance for entities looking to implement learning collaboratives focused on improving health and ensuring that people with lived experience have an opportunity to contribute to improving conditions to promote health in their communities.
Introduction:Changes in the availability of birthing hospitals may affect geographic access to obstetric care. Travel time to the nearest birthing hospital is a measurable indicator of access. We estimated changes in travel time in Illinois from 2016 to 2021 and described the distribution of populations living in census tracts with increased travel time. Methods:We used Illinois Department of Public Health hospital data (2016-2021), US Census population-weighted block group (PWBG) centroids, and American Community Survey data (2017-2021). We estimated driving time from PWBG centroids to the nearest in-state birthing hospital (driving time) by using ArcGIS network analysis and averaging to census tracts. We assessed changes overall and by rural-urban classification, race and ethnicity, and educational attainment. Results:The number of Illinois birthing hospitals decreased 16.9%, from 118 in 2016 to 98 in 2021. Average driving time increased from 12.1 to 13.2 minutes overall, from 9.5 to 10.4 minutes in urban areas, and from 24.1 to 25.9 minutes in rural areas. Overall, 18.3% of Illinois residents (2,288,738 of 12,502,452) lived in census tracts with increased driving time. Among residents living in rural areas, 23.7% lived in affected tracts, compared with 17.4% among those living in urban areas. Among non-Hispanic White residents in Illinois, 14.9% lived in affected tracts, compared with 32.1% of non-Hispanic Black residents. Among college graduates, 14.8% lived in affected tracts, compared with 23.3% of residents with less than a high school education. Conclusion:From 2016 to 2021, changes in the availability of birthing hospitals in Illinois coincided with modest increases in driving time and were not evenly distributed across populations. These findings provide a descriptive assessment of geographic access to obstetric care and may inform efforts to address differences in access.
Introduction:Understanding premature mortality through years of potential life lost (YPLL) is essential for identifying preventable deaths and health inequities, yet county-level spatiotemporal patterns remain understudied in states such as Mississippi that have high rates of premature mortality. This study examined spatiotemporal trends in premature mortality across Mississippi's 82 counties (2015-2025) using years of potential life lost (YPLL) before age 75 years. Methods:We determined county-level YPLL rates from County Health Rankings & Roadmaps (2015-2025) (underlying deaths from approximately 2012 to 2023). Trends were compared with US averages, stratified by education, income, and insurance status; mapped via GIS; analyzed for spatial clustering with calculated local indicators of spatial association (LISA); and modeled by using spatial autoregressive (SAR) lag models with year fixed effects. Results:From 2015 to 2025, Mississippi's YPLL rate rose 35.2% (10,918.3 to 14,763.9 per 100,000), far outpacing national trends and widening the gap between the state and the US by approximately 50%. Contrary to expectation, the largest increases occurred in high-education, high-income, low-uninsured (mostly urban/coastal) counties. Hot spots intensified in rural Delta and Mississippi River counties, while cold spots disappeared from urban and coastal areas. SAR models showed strong spatial dependence (ρ ≈ 0.32); key drivers were injury-related deaths (β = 58.9, P < .001), percentage of population that is non-Hispanic Black, and diabetes prevalence, while higher median household income was associated with lower YPLL. Conclusion:Mississippi's premature mortality pattern has shifted: rural burdens persist, but rapid deterioration in urban and more affluent counties now drives statewide worsening. Effective policy requires sustained rural investment in chronic disease control along with urban-focused interventions targeting injury and violence prevention, trauma systems, and mental health/substance-use services.
To identify the food categories contributing most to sodium intake in the US, we used 2021-2023 National Health and Nutrition Examination Survey data. Approximately one-third of total dietary sodium intake among children and adults came from deli meat sandwiches (5.0%), pizza (4.4%), savory snacks (4.4%), soups (4.4%), poultry (3.8%), pasta mixed dishes (3.8%), bread (3.1%), and cheese (2.7%). Among subgroups, the highest contributor to sodium intake among children aged 1 to 11 years was savory snacks (approximately 8%) and among non-Hispanic Asian participants, soups (8.7%). Information on current top contributors to sodium intake can be leveraged to inform sodium reduction interventions.
Introduction:Rates of human papillomavirus (HPV) vaccine are lower in rural counties than in urban areas. The objective of the minigrants evaluation was to assess HPV vaccination uptake, factors related to implementation success, and barriers to implementation. Methods:We conducted a concurrent, mixed-methods evaluation guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and CFIR (Consolidated Framework for Implementation Science) frameworks. Four health departments received funding, a toolkit with implementation strategies, and monthly technical assistance calls or a learning collaborative for 1 year. The data sources were program documents, staff interviews and surveys, immunization databases, and caregiver or young adult surveys. Key evaluation metrics were 1) reach of patients and adoption of intervention levels (patient, provider, or practice); 2) HPV vaccination effectiveness; 3) implementation perspectives from staff, caregivers, and young adults; 4) implementation barriers and facilitators; and 5) program sustainability capacity. Results:Most sites adopted 2 of 3 levels (patient, provider, or practice). Common multilevel strategies for series completion were patient education, incentives, provider training, and patient reminders. The total HPV vaccination rate increased 26.7% from 2023 to first quarter 2024, and initiation rate increase was 51.8% across the county departments. Overall, on a scale from 1 to 5, with 1 being "strongly disagree" to 5 being "strongly agree," sites reported positive experiences with program implementation and perceived the program was feasible (mean, 4.4 points), acceptable (mean, 4.4 points), and appropriate (mean, 4.2 points). Staff members also reported high ease of implementation (mean, 4.0 points) and commitment to program delivery (mean, 4.8 points). The parents or caregivers (n = 20) reported in surveys that they saw educational materials (100%), received educational materials (90%), and received a vaccine reminder (75%). CFIR-related facilitators were priority of the health issues, leadership involvement, technology infrastructure, communications about the vaccine and program, available resources, and staff training at the inner setting and external support at the outer setting. Barriers included limited resources, communication and structural characteristics (eg, technology, issues related to electronic health records), and local attitudes and conditions. The mean program sustainability capacity score was 4.2, with highest scores for evaluation, effectiveness, and workflow integration. Conclusion:Multilevel intervention strategies can successfully increase HPV vaccination rates in rural settings with implementation supports to address cancer prevalence in rural areas.
Introduction:Most tobacco use begins during adolescence. We used National Youth Tobacco Survey (NYTS) data from 2023 and 2024 to examine menthol tobacco product use among US middle and high school students. Methods:We used pooled data from the 2023 and 2024 NYTS (n = 51,930) to calculate nationally representative prevalence estimates for past 30-day menthol and nonmenthol tobacco product use, stratified by sociodemographic and mental health indicators. We used χ2 tests with Benjamini-Hochberg adjustments to compare behaviors. Results:During 2023 and 2024, 22.1% of students who currently used tobacco (representing 520,000 students) used menthol products. Overall, menthol products were used by 40.0% of students who smoked cigarettes, 18.0% who used e-cigarettes, and 11.5% who smoked cigars. Menthol tobacco use was significantly higher among males (vs females) (26.1% vs 18.3%), high schoolers (vs middle schoolers) (23.9% vs 17.0%), and those with moderate to severe anxiety or depression (vs no or mild symptoms) (25.0% vs 18.8%). By race and ethnicity, use ranged from 12.0% (non-Hispanic Black) to 28.6% (non-Hispanic multiracial). Compared with students who used nonmenthol products, a higher proportion of those who used menthol cigarettes or e-cigarettes reported younger age at first use of tobacco (<11 y) (42.5% vs 26.8% and 19.9% vs 13.2%, respectively), use on 20 to 30 of the past 30 days (38.2% vs 20.2% and 53.4% vs 33.2%, respectively), and fewer past-year smoking quit attempts (49.7% vs 63.2%, respectively). Conclusion:More than 500,000 US middle and high school students used menthol products; prevalence varied by sociodemographic and mental health indicators. Menthol tobacco use correlates with earlier initiation, higher frequency of use, and reduced past-year quit attempts. Additional efforts to reduce access to menthol products among young people may reduce tobacco use in this population.
Purpose and Objectives:We aimed to evaluate the feasibility, acceptability, and impact of the Fresh Start produce prescription (FSPRx) intervention among rural, underinsured people with type 2 diabetes. Intervention Approach:The 20-week FSPRx intervention was implemented in 15 counties in eastern North Carolina to provide 5 to 7 pounds of produce at 9 group classes and individual, telephone-based health coaching. Evaluation Methods:We evaluated feasibility by reviewing program records, acceptability by reviewing surveys and interviews, and impact by reviewing validated pre-post questionnaires on knowledge, skills, and behavior and retrospective medical record review (glycated hemoglobin A1c [HbA1c]). Quantitative data were analyzed by using descriptive statistics, the Wilcoxon signed-rank test, paired sample t tests, repeated-measures analysis of variance (ANOVA), and multiple linear regression. We analyzed interview transcripts by inductive content analysis for themes. Results:Approximately half of enrolled participants (N = 414) completed pre-post measures (n = 225) and actively participated (n = 170). Participants were majority female (65.4%) and were White (36.5%) or Black (34.3%). Program satisfaction was 96.5%. Participation was moderate for coaching encounters and class attendance (mean [SD], 3.1 [4.5] encounters; 2.0 [2.9] classes, respectively). Food literacy and consumption of fruits, vegetables, and whole grains increased significantly. Glycemic control (mean HbA1c) improved significantly, with the greatest decreases among participants with 4 or more classes and 4 or more health coaching encounters (0.44% in the full analytic sample). Group classes were the strongest predictor of improved HbA1c (B = -0.07, P = .06). Interest was high for flexible remote education (program notebook, 97.1%). Implications for Public Health:Strengths of the FSPRx intervention were acceptability and impact, while feasibility was moderate. Although participation in group classes was the strongest predictor of improved HbA1c, attendance was limited. Research is warranted to identify optimal integration of educational and behavioral support in Food Is Medicine programs, especially for rural populations.
Introduction:Louisiana has a high prevalence of smoking-related cancers. Although the 2007 Louisiana Smoke-Free Air Act restricted smoking in many public places, exemptions for bars, casinos, and other venues left many workers unprotected. Comprehensive local ordinances were later adopted in Orleans Parish (2015) and Ouachita Parish (2017). Methods:We conducted an ecological analysis of Louisiana Tumor Registry data from 2007 through 2022 to examine age-adjusted incidence of lung cancer and tobacco-related cancers. Orleans and Ouachita Parishes were compared with parishes covered only by the partial statewide law. Trends were assessed with Joinpoint regression using annual percent change (APC), average annual percent change (AAPC), and tests of parallelism. Results:In the primary parish-level analysis, lung cancer trends differed between ordinance and nonordinance parishes (P = .04). Orleans Parish declined steadily (APC, -3.02%; P < .001). Ouachita Parish showed a 2016 joinpoint, preceding implementation of the 2017 smoke-free ordinance, followed by a post-2016 decline of -7.33% annually (P = .01). In sensitivity analyses combining Orleans and Ouachita Parishes, lung cancer declined more rapidly than in the remainder of Louisiana (AAPC, -3.08% vs -1.70%; P = .004); tobacco-related cancers also declined more rapidly (-1.26% vs -0.64%; P = .02). Conclusion:Comprehensive local smoke-free ordinances were associated with more favorable long-term cancer incidence trends than Louisiana's partial statewide law. Broader statewide coverage may help reduce tobacco-related cancer burden and inequities over time.
Introduction:Excess sodium intake is a major risk factor for hypertension and cardiovascular disease. Thailand has implemented sodium-reduction strategies, including the Salt and Sodium Reduction Strategy (2016-2025), front-of-package labeling, and the Healthier Choice logo. This study aimed to describe trends in sodium content of instant foods sold in Thailand from 2018 to 2021. Methods:We conducted an analytical study using secondary data from 2 packaged-food surveys in retail stores in the Bangkok Metropolitan Region, Thailand, in 2018, 2019, and 2021 administered by the Thai Food and Drug Administration and the Low Salt Network. We applied descriptive statistics, Mann-Whitney U, Kruskal-Wallis, Wilcoxon signed-rank, and χ2 tests, with P < .05 considered significant. Results:We analyzed data for 788 products. In 2021, the median (IQR) sodium content was 1,750.0 (1,289.1-2,267.3) mg/100 g, an 11.6% decrease from 2018 (P = .02). Overall, we found significant reductions of sodium in rice porridge/soup, brand C, egg noodles, cup products, and items manufactured in Thailand and China. Conversely, among 57 identical products available in both 2018 and 2021, median sodium content did not change significantly (P = .06); 33.3% decreased, 19.3% increased, and 47.4% were unchanged. The proportion of Healthier Choice products increased from 4.5% in 2018 to 21.1% in 2021 (P < .001), including both noodles and rice porridge/soup. Conclusion:Sodium levels in instant foods in Thailand declined modestly, and Healthier Choice products increased substantially. However, most items remain above World Health Organization benchmarks, with inconsistent reformulation. Revising Healthier Choice criteria, setting mandatory sodium targets, and strengthening monitoring could accelerate sodium reduction and improve cardiovascular health.
Introduction:Food as Medicine initiatives, including produce prescription (PRx) programs, provide incentives (ie, vouchers) for participants to purchase free or reduced-cost produce. Voucher redemption is central to PRx effectiveness, yet predictors of redemption are poorly characterized. Prior evaluations often excluded nonusers, potentially overestimating effects. We applied an intent-to-treat (ITT) approach to examine the association between baseline characteristics and voucher redemption rates (VRRs) in a PRx program among primarily low-income Hispanic/Latino adults with type 2 diabetes. Methods:In this single-arm, pre-post study, 154 participants were enrolled in a 7-month PRx program offering up to $90 in fruit and vegetable vouchers for attending monthly nutrition education sessions. Binomial logistic regression assessed predictors of ITT-VRRs, including transportation access, baseline fruit and vegetable intake, and knowledge of produce preparation. Results:The sample was majority female (66.2%), Hispanic/Latino (83.1%), and low income (using public health insurance [88.9%] or food insecure [76.0%]). Most participants shared purchased produce with others in the household (61.2%). The ITT-VRR was 65.8%, versus 84.3% in per-protocol analysis. Higher odds of ITT-VRR were associated with transportation access (personal car [odds ratio, 2.28; 95% CI, 1.94-2.67]), while little/no self-reported knowledge of how to prepare fruit and vegetables was associated with lower odds (odds ratio, 0.58; 95% CI, 0.52-0.63). Conclusion:Transportation access and baseline knowledge of how to prepare fruit and vegetables were associated with voucher redemption, suggesting vouchers alone may not sustain engagement or dietary change. To enhance program equity and effectiveness, future PRx programs may consider pairing vouchers with strategies addressing transportation challenges and supporting fruit and vegetable preparation-related capability.
Introduction:Parental perceived stress (PPS) is proposed to be a factor influencing children's weight status through behavioral and environmental mechanisms. We assessed the association between PPS and weight status among Spanish children and adolescents. Methods:We used data from the first wave of the PASOS (Physical Activity, Sedentarism, and Obesity in Spanish Youth) study (2019-2020). The study included 1,023 children and adolescents whose parents completed the Perceived Stress Scale. Anthropometric measurements and data on physical activity, sleep, screen time, and dietary quality were collected. We classified parents into "low" stress (<50th percentile on Perceived Stress Scale) and "high" stress (≥50th percentile on Perceived Stress Scale). We assessed the association between PPS and obesity, adjusted for parents' perception of their own health and children's general fitness. We conducted linear regression analysis between PPS and children's body mass index (BMI) z score and waist-to-height ratio. Results:Children of parents with high PPS had higher mean BMI (19.9 [SD, 3.8] vs 19.5 [3.3]; P = .009) and poorer general fitness (P = .003) than children of parents with low PPS. The prevalence of obesity was higher among children of high-stress (vs low-stress) parents (4.0% vs 1.6%); this association remained significant after adjustment (adjusted OR = 2.76; 95% CI, 1.08-7.06; P = .03). The linear analysis showed positive associations between PPS and both children's BMI z score and waist-to-height ratio. Conclusion:Higher PPS was associated with an increased likelihood of obesity in Spanish children and adolescents. These findings underscore the importance of addressing family stress in strategies for preventing childhood obesity.
Introduction:Several US public health and clinical initiatives notify adolescents of body mass index (BMI) or weight status; however, few studies have examined whether weight perception is independently associated with objective cardiometabolic markers. We assessed cross-sectional and longitudinal associations between weight perception and cardiometabolic health among adolescents followed into emerging adulthood. Methods:We analyzed wave 4 (mean [SE] age, 19.2 [0.04] y) and wave 7 data collected 3 years later from the NEXT PLUS Generation Health Study, a nationally representative cohort of US adolescents followed into emerging adulthood (analytic n = 454 at wave 4; n = 330 at wave 7). To assess cross-sectional and longitudinal associations between weight perception (perceived their weight as overweight vs did not perceive their weight as overweight) and cardiometabolic outcomes (fasting blood glucose, hemoglobin A1c, high-sensitivity C-reactive protein, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein [LDL] cholesterol, systolic blood pressure, diastolic blood pressure, and waist circumference), linear regressions adjusting for sociodemographic variables were performed with and without additional adjustment for BMI. Results:In cross-sectional models adjusted for sociodemographic characteristics and BMI, participants who perceived their weight as overweight had higher adjusted mean total cholesterol (mean difference, 12.3 mg/dL; P = .045) and LDL cholesterol (mean difference, 8.3 mg/dL; P = .04). In longitudinal models, perceiving one's weight as overweight was not associated with cardiometabolic outcomes after adjustment for BMI. Conclusion:Perceiving one's weight as overweight is associated with worse cardiometabolic health. Health professionals should consider the possible implications of policies aimed at informing adolescents of their BMI status before implementation. Future studies are warranted to explore the causal pathway of this association.
Introduction Sugar-sweetened beverages (SSBs) are a major source of added dietary sugars in Mexico and the US and contribute to chronic disease risk. In 2020, Mexico implemented mandatory front-of-package warning labels (FoPWLs), and the US implemented updated Nutrition Facts labels that increased the salience of calories and added sugars. We compared changes in SSB intake in Mexico and the US. Methods Using 6 annual cross-sectional surveys (2018-2023) from the International Food Policy Study, we analyzed Mexican (n = 24,574) and US (n = 25,019) adults. Past-week SSB intake was summarized across 5 SSB categories. Outcomes were any SSB consumption, SSB consumption frequency, and, among SSB consumers, total volume, calories, and added sugars from SSBs. Difference-in-differences models with country-by-period interactions (2018-2019 vs 2020-2023) adjusted for sociodemographic and behavioral covariates; sex-stratified analyses were also conducted. Results From 2018-2019 to 2020-2023, any SSB consumption and SSB consumption frequency increased in the US (adjusted odds ratio, 1.26; 95% CI, 1.17-1.36; adjusted incidence rate ratio, 1.16; 95% CI, 1.10-1.22, respectively). In Mexico, any SSB consumption also increased (adjusted odds ratio, 1.11; 95% CI, 1.00-1.22), but increases were smaller than in the US for any consumption (adjusted odds ratio, 0.88; 95% CI, 0.77-0.99) and frequency (adjusted incidence rate ratio, 0.89; 95% CI, 0.84-0.95). Among SSB consumers, changes in volume, calories, and added sugars did not differ between countries overall. In sex-stratified models, Mexican women had a greater relative reduction in SSB volume than US women (adjusted regression coefficient, -304 mL/week; 95% CI, -593 to-16). Conclusion Compared with contemporaneous changes in the US, Mexico's FoPWL implementation was associated with more favorable trends in whether and how often adults consumed SSBs, but not in overall changes in volume, calories, or added sugars among SSB consumers.
Introduction Faith-based leaders are often the first people contacted by people in rural areas who are experiencing mental health crises, yet some may delay referrals. Public health professionals and mental health providers should therefore understand the perspectives of faith-based leaders on mental health. In this qualitative study, we explored the perceptions of faith-based leaders regarding mental ill ness and the role of the church in addressing stigma associated with mental illness in the rural South. Methods Using purposeful sampling, pastors and ministers (N = 10) were recruited from 3 rural Southern counties. Participants viewed a minidocumentary featuring faith-based leaders discussing their role in addressing mental health issues in the church. After viewing, participants shared their thoughts in focus groups. Results Thematic qualitative analysis identified 3 themes: 1) mental health is a broad topic involving various aspects connected to a person's overall well-being; 2) church and faith-based leaders are unprepared to address mental health stigma among church congregants; and 3) faith-based leaders expressed that they could address mental health needs by building relationships with congregants through listening and having a spirit of discernment. Conclusion Future studies with larger samples of faith-based leaders from different religious backgrounds are needed. Integrated spiritual-based and mental health prevention approaches may be beneficial to support faith-based leaders in their role in referring people to treatment.
Using 2023 national Youth Risk Behavior Survey data, we estimated the prevalence of any sunburn and frequent sunburn (≥5 times in the past year) among US high school students and examined associations with demographic and behavioral characteristics. Overall, 54.7% of students reported any sunburn, and 22.9% of students with any sunburn reported frequent sunburn. After adjustment for sex, race and ethnicity, and grade, any sunburn prevalence differed by sex, race and ethnicity, body mass index, several substance use and activity measures, diet, and social media use; factors associated with frequent sunburn partially overlapped but also differed. Persistently high adolescent sunburn prevalence supports continued youth skin cancer prevention efforts.
This study estimated accuracy of survey-reported hepatitis A and B vaccination among adults at increased risk. Survey responses from patients at 2 large health care systems in Colorado were compared with vaccination records in electronic health records and the state immunization registry. For hepatitis A vaccine, net bias was 5.6% (relative bias, 38.6%; sensitivity, 52.5%; specificity, 85.3%). For hepatitis B vaccine, net bias was 6.5% (relative bias, 28.6%; sensitivity, 43.4%; specificity, 75.1%). Despite low sensitivity, self-reported vaccination status may be sufficiently accurate for use in the development of vaccine policies and public health actions for improving hepatitis A and B coverage.
