Introduction : The decline in U.S. cancer deaths from early detection and treatment advancements has markedly increased the number of cancer survivors. Regular physical activity (PA) after cancer diagnosis has been associated with numerous health benefits, including reduction in cancer-related fatigue, quality of life, physical fitness and functioning, and improved mental health. This study aims to explore PA trends, differences, and meeting PA guidelines in adults with vs. without a cancer history using national data. Methods The study used Behavioral Risk Factor and Surveillance data from 2018-2024 to estimate survey-weighted annual PA prevalences among adults with and without a cancer history. Trends were assessed using log-linear regression. Aerobic guideline adherence and cancer-type-specific estimates were also examined for prostate, breast, colon, and other cancers. Results Among over two million adults, PA prevalence increased significantly among adults with a cancer history (67.1% to 71.6%; annual percentage change (APC) = 1.05%; 95% CI, 0.6% - 1.5%) but not those without a cancer history (76.3% to 78.3%; APC = 0.47%; 95% CI, -0.19% - 1.14%). Cancer history was associated with a 3.8 percentage-point lower adjusted prevalence of PA. Aerobic PA guideline adherence was similar by cancer history. Conclusions : Cancer survivors had a lower PA prevalence across the study time-period than those with no cancer history. Similar rates of meeting the PA guidelines for aerobic activity were observed. The higher prevalence of no PA among cancer survivors presents an opportunity to promote PA through targeted interventions for healthcare provider counseling and cancer-specific training by exercise specialists.
Background Careers in academia are difficult to navigate, especially for new faculty identifying as underrepresented minorities, women, or first-generation college students. While mentorship of diverse faculty is critical for academic professional success, opportunities are limited. Objective To evaluate a modified formation mentoring community intended to increase retention, productivity, and peer support among early-career underrepresented faculty over five years. Methods At the University of Hawai‘i at Mānoa, a formation mentoring community (FMC) was established among faculty to provide colleagues to explore both individual aspirations and collective challenges. Modifications to the community made it more constructive and less introspective, allowing faculty to build rapport while working together on concrete tasks. A retrospective, mixed-methods evaluation using the 2024 Centers for Disease Control and Prevention (CDC) Program Evaluation Framework was conducted with evidence coming from program records, member reflections, and social network analyses. Results The demonstrated impact of the FMC is summarized in terms of research activities, professional advancement, and student mentorship. The FMC grew over 5 years and demonstrates strong social connections between members. Conclusions The modified FMC supported retention, productivity, and peer support, with larger implications for improved training of diverse students for an enhanced public health workforce.
Background : Cervical cancer (CCA) is largely preventable through Human Papillomavirus (HPV) vaccination and screening; however, low- and middle-income countries (LMICs) bear approximately 80% of the global burden and experience mortality rates up to six times higher than those in high-income countries. Persistent disparities in prevention of uptake highlight the need for culturally tailored, community-engaged interventions. The Woman-to-Woman (W2W) Cervical Cancer and HPV Prevention Program was developed and piloted in Grenada; however, stakeholder-informed refinement was needed before regional scale-up across Caribbean settings. Methods This multisite qualitative descriptive study explored stakeholder perspectives to inform refinement of the W2W program for regional scale-up. A total of 31 participants (22 community members and 9 clinicians) from Grenada and Trinidad and Tobago were recruited through community coalition networks. Six focus group discussions, guided by the Consolidated Framework for Implementation Research (CFIR), examined perceptions of the W2W curriculum and contextual factors influencing cervical cancer prevention. Transcripts were analyzed using thematic analysis in MAXQDA 24 by three independent coders. Results Four themes emerged: (1) content clarity and accessibility: participants valued simple language, visual aids, and survivor narratives; (2) stigma and cultural sensitivity: associations between HPV and promiscuity discouraged care-seeking, while reframing messages as general health issues was recommended; (3) community engagement strategies: participants endorsed informal community venues, school-based education, and both digital and traditional media to reach diverse populations; and (4) training and support for lay health advisors: stakeholders emphasized the need for practical, skills-based training, including role-playing and stigma-sensitive communication. Conclusions : Stakeholders perceived the W2W program as culturally relevant, acceptable, and feasible, while identifying key areas for refinement to support broader implementation. These findings provide actionable, context-specific guidance for refining and scaling W2W across Caribbean settings and contribute to the growing evidence supporting culturally grounded, community-engaged approaches to cervical cancer prevention.
Background Clinical Research Coordinator (CRC) turnover and staffing costs pose a major challenge to sustaining research capacity in underfunded disciplines, including emergency medicine and nursing. Summer research immersion programs may offer a cost-effective strategy to offset CRC staffing needs. This paper presents a cost analysis of CRC-equivalent research labor contributed by an interdisciplinary summer program. Innovation The Interdisciplinary Collaborative Research (iCORE) Program is a 9-week summer initiative designed to sustain research capacity in emergency medicine and nursing, while building a clinician-scientist pipeline. The program integrates mentored research, structured instruction, and clinical skills training. Methods An 8-week cost analysis was conducted by calculating total program operating costs and the CRC-equivalent value of student research contributions, using market-based rates for personnel and effort. Outcomes In 2024, 69 applications were received; 22 students enrolled, contributing over 2,800 hours of research support, including data collection, patient enrollment, literature reviews, and dissemination. Total program costs were $44,586. The CRC-equivalent value of student research labor was $80,652 ($3,666 per student), generating an estimated $36,706 in cost savings. Conclusion Summer research immersion programs can provide meaningful CRC-equivalent labor and cost savings, offering an affordable, scalable approach to sustaining research capacity in underfunded clinical disciplines.
Background Although overall overdose deaths in the U.S. have plateaued in recent years, there is limited information about how recent changes in the drug landscape have affected people with HIV (PWH) on a regional and national level. The purpose of this analysis was to describe trends in cause of death among PWH, with a focus on drug‑related mortality in this population. Methods The authors aggregated cause of death data from HIV surveillance systems in 14 jurisdictions across the U.S. to compare regional trends among PWH from 2014 to 2023. Causes of death were categorized as fatal overdose, HIV-related disease, or all other causes based on underlying ICD-10 codes. Demographic characteristics, HIV care indicators, and substance use trends were also evaluated. Results Among PWH, the number of overdose deaths increased from 225 in 2014 to 993 in 2023, accounting for 15.6% of all deaths, while HIV-related deaths declined from 1,904 to 1,312, representing 20.6% of all deaths in 2023. In the Pacific Northwest and East Coast, overdose deaths surpassed HIV-related deaths in 2023. The proportion of overdose deaths among PWH attributable to opioids increased in nearly all regions. Conclusions Fatal overdose was a major contributor to mortality among PWH and, in some regions, exceeded HIV-related mortality. These findings underscore the importance of overdose prevention for PWH, who may benefit from syndemic approaches that integrate HIV care with mental health services, social support, and harm reduction interventions.
Background Infectious disease mortality among children in the United States (U.S.) has declined substantially over recent decades, but contemporary national patterns of infectious disease morbidity, mortality, and disability remain incompletely characterized. This study analyzed national trends in infectious disease incidence, mortality, and disability among children aged 0–14 years in the U.S. from 1990 to 2023 using Global Burden of Disease (GBD) 2023 estimates, focusing on communicable diseases and excluding COVID-19 and unspecified infectious conditions. Methods This retrospective analysis used GBD 2023 age- and sex-specific estimates for deaths, incidence, and disability-adjusted life years (DALYs), summarized using age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and age-standardized disability-adjusted life-year rates (ASDRs) per 100,000. Temporal trends were quantified using estimated annual percentage change (EAPC) from log-linear models. Because EAPC assumes a constant log-linear trend across the full study period, segmented log-linear regression was conducted for selected high-burden and rare disease categories to assess whether trends varied across distinct time periods. Results From 1990 to 2023, infectious disease incidence, mortality, and DALY rates among U.S. children declined across most categories. Enteric infections showed the most rapid incidence reduction (EAPC −10.05), with ASIR decreasing from 17,451.57 to 1,588.48 per 100,000. Neglected tropical diseases and malaria showed a positive relative incidence trend, but absolute incidence remained extremely low, increasing from 0.07 to 0.14 per 100,000. Regarding mortality and DALYs, HIV/AIDS showed the largest declines: deaths decreased from approximately 371 in 1990 to 41 in 2023, and ASDR decreased from 55.73 to 6.57 per 100,000. Children under five years continued to experience the highest burden, with small but persistent sex-based differences for specific infections. Segmented analyses showed that selected disease categories had nonconstant temporal patterns, supporting interpretation of EAPC as a summary trend measure rather than a complete description of year-to-year change. Conclusions U.S. pediatric infectious disease burden substantially declined from 1990 to 2023, driven largely by reductions in major infection categories. However, rare low-burden conditions such as neglected tropical diseases and malaria require cautious interpretation because small absolute changes can produce large relative trends. Sustained vaccination coverage, early-childhood prevention, and targeted surveillance for travel- or migration-associated infections remain important to maintain progress and identify emerging infectious disease signals.
Background : Tobacco use remains a significant public health concern in California, with over 3.4 million residents reporting current use. In response to growing evidence of the public health risks and youth appeal associated with flavored tobacco products (FTPs), California implemented SB793 on January 1, 2023, prohibiting the retail sale of FTPs, including menthol flavor. Objective : This study aims to assess the availability of FTPs among newer licensed retailers in California following the implementation of SB793, and to examine the extent of their digital presence through market surveillance of their websites and use of social media platforms. Methods The research was conducted in three phases: (1) obtaining a list of all licensed tobacco retailers from the California Department of Tax and Fee Administration (CDTFA) and identifying newer licensed tobacco retailers from before policy enactment in September 2023 and after policy enactment in February 2025; (2) data mining and filtering through fuzzy address match between CDTFA and Google API to identify licensees as tobacco specialty storefronts; and (3) content analysis to characterize any promotion or sale of FTPs along with other marketing and access characteristics of interest. Results : In total, 132 newer licensed tobacco specialty shops with an online presence were analyzed. Of these, 59.85% (n=79) retailers had an online e-commerce website where products could be purchased, and of these 63.29% (n=50) had no age verification upon entering the website. Across social media and/or online websites, nearly half of licensed retailers sold FTPs (n=57, 43.18%). Further, of the 50 with no age verification, 22.0% (n=11) offered FTPs. The breakdown of social media accounts identified with retailer websites included Instagram (n=30), Facebook (n=33), Twitter (n=14), YouTube (n=8), etc., where Instagram was the most commonly used platform observed marketing the sale of FTPs. Common products observed on tobacco specialty store websites included flavored electronic nicotine delivery system (ENDS), e-liquids, wraps, cigarettes, and cigars among other products. Twelve websites also sold cannabis-related products alongside tobacco products, which also included flavored cannabis products. Conclusion : The findings suggest that approximately one-fourth of newer licensed specialty tobacco stores were non-compliant with SB793, and over half of retailers with an online presence were currently selling FTPs, some with no age verification. Results from this online market surveillance study highlights the need for stronger monitoring and enforcement of tobacco retailers who enter the market after tobacco control policies are put in place to ensure proper implementation and restriction of illegal online sales.
Background Emergency departments (EDs) are key safety-net providers for sexually transmitted infections (STIs), yet diagnostic and treatment practices vary widely. Rising STI rates raise concerns about guideline adherence and disparities in antibiotic use. Methods Data from the 2010–2022 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to identify selected urogenital STI-related ED visits among patients aged ≥15 years with pathogen-specific diagnoses (chlamydia, gonorrhea, or trichomoniasis) or nonspecific genitourinary symptom- or exposure-based diagnosis codes. Syphilis-related codes were not included because syphilis diagnosis, coding, and treatment pathways differ substantially from the same-visit empiric antibiotic decisions examined in this analysis. National trends were examined, and multivariable logistic regression was conducted to evaluate factors associated with pathogen-specific diagnosis and empiric antibiotic use. Results Annual STI-related ED visits (pathogen-specific or nonspecific diagnoses) nearly doubled from an estimated 0.81 million to 1.56 million between 2010 and 2022 (92% increase). Among visits with pathogen-specific diagnoses (estimated 1.37 million), 91% occurred among female patients and 68% among Black patients. Empiric antibiotics were administered in 27% of all STI-related visits and 43% of visits with a pathogen-specific diagnosis. In adjusted models, Black patients had higher odds of a pathogen-specific diagnosis and antibiotic use than White patients. Male patients were less likely to receive a pathogen-specific diagnosis, but more likely to receive empiric antibiotics. Patients aged ≥35 years had lower odds of empiric treatment. Conclusions ED visits with STI-related diagnosis codes are rising nationally, with differences in diagnosis and empiric antibiotic use by sex and race. Findings suggest the need to address differences in STI treatment practices and expand use of rapid diagnostics in EDs.
Introduction Underserved urban U.S. communities experience a disproportionate burden of uncontrolled hypertension, driven by structural and socioeconomic barriers. Community health workers (CHWs) may support sustained improvements in hypertension control and self-management. Methods The authors systematically searched PubMed (2015–2025) for U.S.-based, urban, longitudinal CHW-led interventions recruiting participants directly from community settings with reported pre/post blood pressure outcomes. Studies conducted in rural settings, recruiting from clinical settings, or lacking pre/post blood pressure were excluded. Two investigators independently screened, extracted data, and assessed risk of bias. Heterogeneity precluded meta-analysis; findings were synthesized narratively with attention to evidence hierarchy. Results Ten studies met inclusion criteria: three RCTs, one non-RCT, and six pre-post designs. Across studies, CHW-led programs commonly reduced blood pressure and improved self-management behaviors. Six studies (60%) reported significant blood pressure reductions (SBP: 2.3–20 mmHg; DBP: 1.6–7.4 mmHg). However, only one of three RCTs demonstrated significant between-group blood pressure differences; two showed no significant effect versus controls. Interventions lasting at least 6 months consistently demonstrated significant blood pressure improvements, whereas 3-month programs were less likely to show significant change. Several studies reported improved medication adherence and increased home blood pressure self-monitoring. Conclusions Longitudinal, community-based CHW-led interventions are associated with improved hypertension control and self-management in underserved urban U.S. communities. Multicomponent, culturally tailored programs of at least 6 months that integrate medication support and linkage to care appear most effective. Future research should prioritize larger, rigorously designed RCTs, cost-effectiveness, and implementation strategies to scale effective widespread implementation of CHW models.
Introduction : Unintended pregnancy remains a significant public health issue with lasting consequences. Adverse Childhood Experiences (ACEs) are linked to risky behaviors and poor reproductive outcomes; however, limited research has examined optimal approaches to measuring ACE exposure in rural populations. This study examined the relationship between ACEs and pregnancy intendedness in North Dakota (ND) from 2017 to 2020. Methods : This cross-sectional study used ND Pregnancy Risk Assessment Monitoring System (PRAMS) data (N=2,973). A cumulative ACE score was calculated. Exploratory factor analysis identified two ACE groupings (abuse/neglect; household dynamics). Pregnancy intendedness was dichotomized as intended or unintended; sensitivity analysis supported this categorization. Multivariable logistic regression assessed associations between ACEs and unintended pregnancy, controlling for sociodemographic/behavioral factors. Models compared cumulative ACE score, factor-based groupings, and individual ACE items. Results : Compared to no ACEs (32%), unintended pregnancy was more common among women with 4+ ACEs (51%). A dose-response relationship was observed, with increasing ACE exposure associated with increased odds of unintended pregnancy. In adjusted models, younger age, being unmarried, higher parity, marijuana use before pregnancy, and higher ACE exposure were independently associated with unintended pregnancy, while no significant differences were observed by residence or maternal race. The cumulative ACE score showed greater predictive value than factor-based or item-only models. Sensitivity analyses revealed consistent ACE gradients across unintended pregnancy subcategories. Conclusions : Higher cumulative ACE exposure is associated with greater risk of unintended pregnancy. Findings support cumulative ACE measures in reproductive health research and highlight the importance of trauma-informed care and upstream strategies addressing childhood adversity.
Objectives : To evaluate associations between syringe services program (SSP) implementation and sexually transmitted and blood-borne infections (STBBIs) rates in Florida counties. Methods : A difference-in-difference analysis was conducted using surveillance data (2010–2023) to compare STBBIs rates, including bacterial STIs (i.e., chlamydia, gonorrhea, infectious syphilis), acute HCV, and HIV, pre- and post-SSP implementation in Florida counties with operational SSPs versus control counties without SSPs. Two-way fixed effects models were used to estimate average treatment effects and multiple sensitivity analyses explored the robustness of results. Results : SSP implementation was associated with significant reductions in HIV rates (-11 per 100,000, 95% confidence interval: -15.4, -6.7 in Miami-Dade County vs. control counties), and HCV rates appeared stable, while non-viral STI rates appeared to increase. Conclusions : SSPs appear effective in reducing HIV at the population level in Florida. The observed increase in STI rates may reflect improved detection facilitated by SSPs and linkage to other care. Findings support SSP expansion as a public health strategy and highlight the need for research on their broader population level impact.
Introduction Individuals with intellectual and developmental disabilities (IDD) often have limited sexual education and poor self-care that leads to elevated risks of sexually transmitted infections (STIs). The objective of this study is to examine the role of sex and mental health conditions (MHCs) for STIs-related hospitalizations among individuals with IDD. Methods Using National Inpatient Sample between 2007 and 2021, a total of 770,527 hospitalizations with IDD were identified as retrospective study. Logistic regression was applied to estimate the odds ratio (OR) of STIs-related hospitalizations. After adjusting covariates (age, race, pay source, and substance use disorder), odds of STIs-related hospitalizations were stratified by sex (male and female) and MCHs (yes and no) status. Results Overall, 9,245 (1.20%) hospitalizations were STIs-related. Males without MHCs (OR = 1.54, 95% CI 1.26 - 1.82, p < .001) were at higher risk of STIs-related hospitalizations than males with MHCs, as were females with MHCs (OR = 2.92, 95% CI 2.35 – 3.49, p < .001). Females without MHCs experienced the highest risk of STIs-related hospitalizations (OR = 2.84, 95% CI 2.33 – 3.35, p < .001). Conclusions Female sex compounds the risk of STIs-related hospitalizations in individuals with IDD and with and without MHCs. Paradoxically, males with MHCs have lower odds of STIs-related hospitalization. This might be interpreted by either earlier detection and treatment of males with MHCs or under-coding in the administrative data. This study underscores the needs of sexual health training for both individuals with IDD and healthcare workforce who serve individuals with IDD.
Introduction Mpox continues to disproportionately affect gay, bisexual, and other men who have sex with men (MSM) in the United States. Mpox testing and vaccination are critical for prevention; however, few studies have examined how knowledge of mpox transmission, fear, or stigma relate to uptake of these services. Methods 1,063 sexually active MSM provided data as part of an online, cross-sectional mpox sub-study of the American Men’s Internet Survey (AMIS) from February – April 2025. Logistic regression was used to examine if mpox transmission knowledge, fear, and stigma were associated with having ever tested for mpox and or receiving an mpox vaccine. Covariates included age, region, sexual orientation, race/ethnicity, education, employment, food security, health insurance, HIV status, and recent STI testing. Results Most participants (n=606, 57%) had received at least one dose of the mpox vaccine, while only 14% (n=144) had ever been tested for mpox. Mpox transmission knowledge was low, with fewer than half of participants correctly answering most questions and approximately one-third experienced some form of fear or stigma associated with mpox. Higher knowledge scores were associated with greater odds of testing (aOR: 1.19; 95% CI: 1.04, 1.36) and having received the vaccination (aOR: 1.14; 95% CI: 1.04, 1.26). Perceived community mpox discrimination was also associated with testing (aOR: 2.14; 95% CI: 1.26, 3.63) and being afraid of having sex due to mpox acquisition risk was associated with vaccination (aOR: 2.49; 95% CI: 1.76, 3.52). Conclusion Suboptimal mpox knowledge and experiences of fear and stigma remain common and are associated with mpox vaccination and testing among MSM. Sustained mpox-specific education and awareness that directly addresses misconceptions about transmission may improve mpox vaccination and testing uptake.
Objectives Asian Americans are the fastest growing racial group in the U.S and have seen sharp increases in firearm ownership in recent years. Yet little is known about firearm behaviors and their correlates within this population. To address this urgent gap in firearm injury prevention, this study uses a nationally weighted, probability-based mixed-frame survey to characterize firearm ownership, storage practices, and key psychosocial risk factors across Asian American communities. Methods This study utilizes the SAFER National Survey administered by Gallup in 2024. The study sample comprises of a probability sample of 1,806 Asian American adults recruited from address-based and panel sampling frames. Outcomes were personal ownership and unsecured storage (≥1 firearm stored loaded and/or unlocked). Predictors included sociodemographics, region, heavy alcohol use, mental distress, and violence exposure. Multivariable logistic regression for ownership (n=1,613) and bivariate logistic regression for unsecured storage among owners (n=175) were estimated using survey-weighted data. Results Overall, 11.6% reported personal firearm ownership. Among these, 87.9% cited protection as a motivation for owning a firearm and 67.7% reported unsecured storage (53% stored ≥1 firearm unlocked; 44% loaded; 30% both). Of the 36% of owners living with children, 66.0% reported unsecured storage (47% unlocked; 34% loaded; 8% both), with unlocked storage higher than national estimates. There was substantial variation in ownership, storage practice, and psychosocial correlates across Asian ethnicities. Heavy alcohol use was associated with ownership (aOR = 1.13; 95% CI = 1.03, 1.24) and unsecured storage (OR = 1.19; 95% CI = 1.03, 1.37). Firearm-violence exposure (OR = 1.58; 95% CI = 1.01, 2.49) was also associated with unsecured storage in bivariate analyses. Conclusions Asian American communities demonstrate marked heterogeneities in firearm ownership, storage practices, and associated psychosocial risk factors such as firearm violence exposure and heavy alcohol use. The findings underscore the need for culturally responsive, community-engaged injury prevention efforts and disaggregated data collection.
Introduction:Catechins, a type of flavonoid and a major component of green tea, are expected to serve as a complementary preventive measure against COVID-19. However, to date, clinical evidence has not been established. This study aimed to evaluate the preventive effects of green tea gargling against COVID-19 in a multicenter RCT. Methods:A total of 1,012 adults aged 18-70 years who provided written informed consent and met the eligibility criteria were randomly assigned to either a green tea or a water gargling group. Participants gargled 3 times a day for 12 weeks from December 2023 to February 2025 using commercially available green tea powder according to the package instructions. Background characteristics, incidence of COVID-19, and other preventive measures were assessed using self-administered questionnaires. Group differences were analyzed using multivariate logistic regression and Cox proportional hazards models. Results:The incidence of COVID-19 in the full analysis population was 5.4% (27 of 503) in the green tea gargling group and 5.4% (27 of 500) in the water gargling group. In the per-protocol set population with a gargling adherence ≥80%, the incidence was 4.4% (17 of 386) in the green tea group and 5.7% (23 of 403) in the water group. Multivariate logistic regression adjusted for preventive measures showed an OR of 0.818 (95% CI=0.422, 1.556), and Cox proportional hazards analysis yielded a hazard ratio of 0.824 (95% CI=0.439, 1.546). Pneumonia and hospitalization occurred in 1 participant in the water group. No gargling-related adverse events were observed during the 12-week intervention. Conclusions:In the per-protocol set population, green tea gargling showed a 22.8% relative reduction in COVID-19 incidence compared with water gargling, although the difference was not statistically significant. Further studies are needed to confirm the preventive effects of optimizing gargling frequency and catechin concentration.
Background Cardiovascular health and mental health are closely interconnected; however, the relationship between the American Heart Association’s updated Life’s Essential 8 (LE8) cardiovascular health metric and depression severity has not been fully characterized in U.S. adults. The association between LE8 and depressive symptom severity was examined in a nationally representative sample of U.S. adults. Methods Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) were analyzed. LE8 scores were calculated using behavioral (smoking, diet, physical activity, sleep health, and body mass index) and health factor (blood pressure, cholesterol, and hemoglobin A1c) components. Depressive symptoms were assessed using the Patient Health Questionnaire-9 and categorized as no/minimal (scores <10), moderate (scores 10–18), and severe (scores ≥19) depression. Survey-weighted multinomial logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for moderate and severe depression relative to no/minimal depression after adjustment for sociodemographic covariates. Results Higher LE8 scores were associated with lower odds of moderate depression, with each 1-point increase corresponding to approximately 0.4% lower odds (OR per 1-point increase, 0.996; 95% CI, 0.994–0.998; P=0.001), whereas no significant association was observed for severe depression (OR, 0.996; 95% CI, 0.988–1.003; P=0.230). Among individual LE8 components, favorable smoking status and healthy sleep duration demonstrated the strongest inverse associations with moderate depression, while healthy sleep duration was also associated with lower odds of severe depression. Male sex and higher income-to-poverty ratios were associated with lower odds of moderate depression, whereas single marital status was associated with higher odds. Conclusions Higher cardiovascular health, as measured by LE8, was associated with lower odds of moderate, but not severe, depression among U.S. adults. Behavioral cardiovascular health indicators, particularly smoking status and sleep health, showed the strongest associations with depressive symptom severity. These findings support the broader relevance of cardiovascular health in relation to mental health and highlight the need for longitudinal studies to clarify temporal and potentially bidirectional relationships between LE8 metrics and depression severity.
Background : Asthma is one of the most common reasons for emergency department (ED) visits among children in the United States. Although prior studies have found sociodemographic disparities in asthma revisit, most focus on short follow-up periods or single-state data, limiting understanding of persistent ED reliance over time. The purpose of this study was to fill this gap and understand associations between sociodemographic characteristics and the likelihood of ED revisits. Methods : This observational retrospective cohort study used ED data for the states of Florida, Maryland, and Wisconsin for the years 2016 -2019. The study identified a sample of children aged 0-17 years with asthma visits in 2016 and observed their asthma ED usage across time. Logistic regression was used to identify ED revisit predictors for the 2016 asthma cohort. Results : Among 38,331 children with an asthma-related ED visit in 2016, 32 percent of the 2016 cohort returned to the ED for additional asthma visits between 2017 and 2019, with most revisits occurring in 2017. In adjusted analyses, Black and Hispanic children, as well as younger children, particularly those aged 5-11, were associated with higher odds of revisits for asthma. Other factors contributing to higher odds of asthma ED revisits included being male, having Medicaid insurance, living in lower-income neighborhoods, and living in large metro areas. Conclusions : There are persistent sociodemographic and geographic disparities in asthma ED readmissions.
Background & Objectives Evidence on real-world performance of preschool vision screening remains limited in middle-income settings. This study evaluated a preschool-based vision screening program in Tashkent, focusing on coverage, diagnostic yield, referral completion, and selected contextual factors. Methods A prospective evaluation was conducted from January 2025 to January 2026 in 24 state preschools across all 12 districts of Tashkent. Children aged 5–7 years underwent monocular visual acuity testing and non-cycloplegic autorefraction. Screening outcomes were based on visual acuity in the worse eye; children with borderline (Vis 0.8–0.9) or reduced visual acuity (Vis < 0.8) were classified as screen-positive and referred for ophthalmologic examination. Refractive assessment followed standard international definitions. Confirmatory examination included objective refraction, with cycloplegic refraction used to confirm refractive error. Parental questionnaires and classroom illumination were analyzed descriptively. Results Among 1284 screened children (mean age 6.39 ± 0.58 years), 25.9% were screen positive and 90.4% completed referral. Confirmed refractive errors were identified in 13.7%, most commonly hyperopia (38.6%). Limited prior eye care was observed despite generally positive parental attitudes, and most classrooms had suboptimal illumination. Conclusions Preschool vision screening was feasible and yielded substantial case detection under routine urban conditions, supporting integration into preschool health services.
