Recent federal policy discussions and guidance have altered perceptions of preventive care. This study assesses the effect of recent changes in federal preventive guidance on primary care practice and patients. A national crowd-sourced survey of primary care clinicians, conducted December 4 to 11, 2025. Among 568 respondents from 47 states, over sampled for family medicine and with demographic characteristics similar to national primary care characteristics in terms of rurality, size, ownership, and percent in direct primary care, clinicians report that patients are increasingly hesitant about vaccines and preventive services. For example: 64% report patients are confused as to what vaccination guidelines they should follow; 46% report parents are expressing new hesitancy about childhood vaccinations; 36% report patients are declining preventive services they previously accepted. Most responding clinicians (58%) report spending more visit time explaining the evidence behind clinical recommendations, and 61% report patients more frequently are seeking information from non-medical sources. Findings differ by location, with 58% of rural clinicians, vs. 42% of non-rural clinicians reporting new hesitancy about childhood vaccinations. Recent changes in Federal guidance are making it more difficult to provide evidence-based preventive services on the frontlines of primary care, with worrisome potential for increases in preventable diseases, particularly in rural areas.
The 2023 Predicting Risk of Cardiovascular Disease EVENTs equations for 10-year cardiovascular disease were developed by the American Heart Association to improve upon the 2013 Pooled Cohort Equations. This study sought to compare risk reclassification using the Predicting Risk of Cardiovascular Disease EVENTs equations with and without the use of the optional predictors HbA1c and urine albumin-creatinine ratio. This was a cross-sectional study of adults aged 30-79 years participating in the National Health and Nutrition Examination Survey from 2015 to 2020. Ten-year cardiovascular disease estimates stratified by diabetes status using the base Predicting Risk of Cardiovascular Disease EVENTs equations and the enhanced Predicting Risk of Cardiovascular Disease EVENTs equations, including HbA1c and urine albumin-creatinine ratio, were examined. The study included 8,293 participants (weighted mean age of 51 years, 52% female, 13% with diabetes) representing 147.9 million U.S. adults. Estimated 10-year cardiovascular disease risks using the base and enhanced Predicting Risk of Cardiovascular Disease EVENTs equations were within 5 percentage points for 99% of adults without diabetes and 82% of adults with diabetes. Individuals with HbA1c ≥9.0% had a higher mean risk from the enhanced equations of 17.8% (95% CI=15.9%, 19.7%) than the mean risk from the base equations of 11.8% (95% CI=10.7%, 12.9%). This finding was mirrored with urine albumin-creatinine ratio. Individuals with urine albumin-creatinine ratio ≥300 mg/g had a higher mean risk from the enhanced equations at 36.1% (95% CI=33.2%, 39.1%) than the mean risk from the base equations of 23.4% (95% CI=20.0%, 26.9%). Inclusion of HbA1c and urine albumin-creatinine ratio in the Predicting Risk of Cardiovascular Disease EVENTs equations provides an opportunity for greater individualization of cardiovascular disease risk estimation in adults with diabetes but little benefit in populations without diabetes.
Since 2015, multiple investigations have identified the risks associated with deprescribing opioids for chronic pain. The use of nonprescribed cocaine and methamphetamine has also increased during this period, raising concerns about additional unintended consequences of opioid deprescribing. The objective was to determine the association between loss of access to prescribed opioids for chronic pain and subsequent cocaine or methamphetamine use. The design was a prospective longitudinal cohort study from 2017 to 2021 of 300 adults with a lifetime history of nonprescribed opioid or stimulant (cocaine or methamphetamine) use who had received long-term prescribed opioids for chronic noncancer pain within the past year in San Francisco. The main measures were receipt of prescribed opioids for chronic pain and frequency of cocaine or methamphetamine use. The odds of continuing prescribed opioids for chronic pain declined annually during the study (ORs=0.14-0.08, p<0.001). Loss of access to opioid prescriptions was independently associated with a subsequent increase in the frequency of cocaine (AOR=2.55, 95% CI=1.34, 4.87) and methamphetamine (AOR=3.40, 95% CI=1.60, 7.21) use. In addition, Black/African-American race (AOR=2.89, 95% CI=1.19, 7.01) and depression (AOR=2.23, 95% CI=1.09, 4.57) were associated with an increased frequency of cocaine use. Loss of access to opioids prescribed for chronic pain was associated with an increased frequency of cocaine and methamphetamine use, highlighting another unintended consequence of opioid deprescribing that should be considered when individualizing care decisions.
Cardiovascular disease remains the leading cause of death globally, with modifiable lifestyle factors being paramount in its prevention. However, comprehensive tools to evaluate adherence to healthy lifestyle behaviors are limited. The modified Lifestyle Medicine Health Behavior scale was developed to assess the 6 pillars of lifestyle medicine: nutrition, physical activity, sleep, stress management, social connection, and substance use (smoking status). A cohort of 447,311 individuals aged 40-70 years from the UK Biobank who were free of cardiovascular disease at baseline (2009-2012) and were followed up to 2021 was used. The modified Lifestyle Medicine Health Behavior scale score was calculated using self-reported data on its 6 pillars and had a possible range of 23-102 points (a higher score indicated a better lifestyle). Cardiovascular disease incidence was defined as primary myocardial infarction or stroke and was obtained from clinical records and death registries. Study associations were analyzed using multivariable Cox regression models. During a 12.55-year median follow-up, 16,168 events of cardiovascular disease occurred. The multivariable-adjusted hazard ratio (95% CI) comparing participants in the highest with those in the lowest quintile of the modified Lifestyle Medicine Health Behavior score was 0.66 (0.63, 0.70) for cardiovascular disease, 0.66 (0.61, 0.70) for myocardial infarction, 0.65 (0.54, 0.78) for hemorrhagic stroke, and 0.68 (0.62, 0.74) for ischemic stroke; all p-trends were <0.001. A continuous inverse dose-response association was found in the spline analysis. Results remained robust in several sensitivity analyses. Substance use, followed by sleep, nutrition, and physical activity, were the strongest contributors to cardiovascular disease risk reduction, whereas stress management and social connection showed weaker associations. In this large cohort of middle-aged and older British adults, the modified Lifestyle Medicine Health Behavior scale, a comprehensive tool for assessing lifestyle behaviors, was strongly associated with a lower cardiovascular disease risk. These findings highlight the impact of healthy lifestyle behaviors on cardiovascular disease prevention.
Preventive strategies for dysglycemia typically rely on single BMI measurements or thresholds, despite evidence that gradual weight gain precedes metabolic deterioration. Whether longitudinal BMI trajectories may help identify reproductive-age women at elevated risk for prediabetes remains unclear. A retrospective cohort study was conducted using annual occupational health checkup data collected from 2015 to 2024 at four centers in Japan. The analysis included 2,271 normoglycemic women aged 18-40 years who remained free of prediabetes during the landmark period (2015-2017). Annual BMI change during the landmark period (kg/m²/year) was estimated using within-person regression. Incident prediabetes (HbA1c 5.7%-6.4%) after 2017 was evaluated using Cox proportional hazards models, including time-dependent analyses. During a median follow-up of 7.0 years, 346 women (15.2%) developed prediabetes. Each 0.1 kg/m²/year increase in annual BMI gain was associated with higher risk of incident prediabetes (hazard ratio 1.04, 95% confidence interval 1.02-1.05). Time-dependent analyses incorporating repeated BMI measurements demonstrated that persistent BMI gain remained associated with incident prediabetes. Kaplan-Meier analyses demonstrated earlier risk separation among women with greater BMI gain, whereas women with mild BMI gain showed delayed but progressive separation after approximately 5 years, particularly among those with normal baseline BMI. Monitoring BMI trajectory in routine health checkups may improve early identification of reproductive-age women at risk for dysglycemia and support trajectory-informed preventive strategies.
British Columbia, Canada implemented a three-year pilot that decriminalized the personal possession of select illegal drugs beginning January 31, 2023. The policy was amended to prohibit drug possession in all public spaces starting May 7, 2024. The impacts of decriminalization and the subsequent decriminalization amendment on police-reported drug possession seizures were examined, which were identified on the basis of incidents in which drug possession offences were recorded as the most serious offence. Monthly, population-based crude rates of police-reported drug possession seizures of any quantity and police-reported drug possession seizures involving up to 2.5 grams were analyzed in an interrupted time series design using generalized additive models (January 2019-July 2025; Data collected and analyzed in 2026). The models tested level changes in the outcomes associated with the initial decriminalization policy and the subsequent decriminalization policy amendment relative to pre-decriminalization. Decriminalization relative to pre-decriminalization was associated with a 68% decrease in police-reported drug possession seizures of any quantity (β [95% CI]: -1.1 [-1.4, -0.9]). However, police-reported drug possession seizures of any quantity increased after the decriminalization amendment, such that they were statistically indistinguishable from pre-decriminalization (β [95% CI]: -0.2 [-0.6, 0.1]). A similar pattern of findings was observed for police-reported drug possession seizures involving up to 2.5 grams: decriminalization relative to pre-decriminalization was associated with an 87% decrease (β [95% CI]: -2.0 [-2.5, -1.6]), while the decriminalization amendment relative to pre-decriminalization was not associated with significant changes (0.4 [-0.2, 1.0]). Decriminalization was associated with decreases in police-reported drug possession seizures of any quantity and police-reported drug possession seizures involving up to 2.5 grams. The subsequent decriminalization amendment reversed this trend, as both types of police-reported drug possession seizures returned to comparable levels observed pre-decriminalization.
Social determinants of health are important drivers of health-related social needs (HRSN), affecting health outcomes and health disparities. Medicaid beneficiaries have a high burden of HRSN. Z-codes were incorporated in the 10th revision of the International Classification of Diseases in 2015 to document HRSN in electronic health records and claims. This study characterized trends in Z-codes documented in Medicaid claims nationally from 2016 to 2022. Medicaid claims data from the 2016-2022 Transformed Medicaid Statistical Information System Analytic Files were analyzed in 2024-2026. States with unusable data in the study period (MD, MS, RI, TN) were excluded. An indicator was created for Z-code use in any diagnosis code field in all service settings, and categorized Z-code claims by Z-code subtype (Z55-Z65, e.g., problems with housing). The percentage of Medicaid beneficiaries with any Z-code claim, overall and stratified by state, and the percentage of claims with each Z-code subtype overall over time were calculated. The percentage of beneficiaries with a Z-code claim was 1.15% in 2016 and 1.66% in 2022. In 45 of 46 included states, the percentage of Medicaid beneficiaries with a Z-code claim was <5% across years. Among Z-code claims, problems with housing and economic circumstances were the most documented HRSNs, ranging from 36.8% to 66.3% of Z-code claims across years. Z-codes for HRSN were rarely used in 2016-2022 Medicaid claims across 46 states with usable data, underrepresenting HSRN in this population. Limited use in claims may be driven by lack of reimbursement for Z-codes.
Data on the prognostic value of incidental coronary artery calcium (CAC) from nongated chest computed tomography scans are limited. Using paired computed tomography scans from the MESA (Multi-Ethnic Study of Atherosclerosis) exam 5, we evaluated the relationship between nongated CAC, gated CAC, and future cardiovascular events. Between April 2010 and December 2011, a total of 2601 participants underwent same-day gated and nongated chest computed tomography scans. After excluding 106 with previous coronary heart disease or cardiovascular disease and 23 for missing covariates, 2472 participants formed the study population. Gated and nongated scans were interpreted at a core laboratory, blinded to acquisition methodology. Cox regression examined associations between CAC (gated and nongated) and incident coronary heart disease/cardiovascular disease events. Correlation was assessed with Pearson coefficients, model performance with receiver operating characteristic curves and C-statistic, and overall accuracy with Brier scores. Among the 2472 participants, 53% were female, 38% white, 13% Chinese, 26% Black, and 23% Hispanic/Latino. Compared with participants with zero CAC, those with moderate (101-299) and severe (≥300) nongated CAC had higher coronary heart disease risk (hazard ratio, 2.67 [95% CI, 1.14-6.27]; hazard ratio, 5.22 [95% CI, 2.37-11.5]) and cardiovascular disease risk (hazard ratio, 1.32 [95% CI, 1.32-4.04]; hazard ratio, 2.89 [95% CI, 1.68-4.96]). Gated and nongated log-standardized CAC highly correlated (r=0.961; P<0.001). The area under the receiver operating characteristic curves, C-statistic, and Brier scores were statistically similar for gated and nongated CAC. Nongated CAC predicts cardiovascular events with performance comparable to gated CAC. Given the large number of nongated scans performed annually, incorporating their quantification into clinical practice offers a scalable approach to personalized preventive care. Our findings are particularly relevant in light of the recent 2026 American College of Cardiology/American Heart Association dyslipidemia guidelines, which endorse the use of incidental CAC from nongated computed tomography scans for atherosclerotic cardiovascular disease risk stratification and guiding lipid-lowering therapy.
Social and structural determinants of health (SDoH), including youths' lived experiences, shape exposure to stressors and access to resources associated with youth mental health and suicide risk. Although county-level indicators are commonly used to guide prevention efforts, it remains unclear how well they capture lived experiences of adversity or differentiate mental health risk. Data are from Project Lift Up, a national survey of adolescents and young adults aged 13-22 years (N=4,800 with residential ZIP code data) collected between 2022 and 2023. County-level SDoH indicators from the 2023 County Health Rankings were used to identify latent profiles representing distinct structural contexts. Self-reported SDoH included financial instability, food insecurity, poor home conditions, community disorder, barriers to mental health care, discrimination, and adversity. Multivariate regression models examined associations with depression/anxiety symptoms, lifetime suicidal ideation, suicide attempt, and perceived likelihood of living to age 35. Analyses were conducted in 2026. Seven county-level SDoH profiles characterized distinct structural contexts and showed modest associations with self-reported SDoH and mental health. Self-reported SDoH were more strongly associated with outcomes than county-level context. Inclusion of self-reported SDoH improved model fit for depression/anxiety symptoms (adjusted R²: 0.16 to 0.42). Food insecurity, discrimination, adversity, and community disorder were consistently associated with higher depression/anxiety symptoms and greater odds of suicide attempt. Mental health care barriers were strongly associated with depression/anxiety and suicidal ideation but not suicide attempt. County-level profiles showed modest associations that were further attenuated after accounting for self-reported SDoH. County-level SDoH identify geographic patterns of risk, but youths' lived experiences more strongly differentiate individual vulnerability. Prevention strategies relying solely on county-level structural indicators may miss high-risk youth, even in relatively advantaged areas. Integrating geographic targeting with screening for social adversity may improve identification of youth at risk and inform multilevel mental health prevention planning.
Whether, and if so how much, adolescent vaping increases the risk of future premature mortality is unknown. This microsimulation model and Monte Carlo analysis evaluated plausible lifetime vaping- and smoking-associated mortality outcomes with vaping and smoking initiated during adolescence for the 4.1 million U.S. 12-year-olds in 2016. Outcomes with e-cigarettes available throughout life were compared with a counterfactual in which e-cigarettes never existed. The analysis considered three ways vaping could impact mortality: (i) vaping during adolescence followed by smoking continuing into adulthood; (ii) vaping continuing into adulthood without smoking; and (iii) vaping increasing adult smoking cessation for cohort members who began smoking in adolescence. Parameters included vaping's mortality risk (5%-30% that of smoking), the smoking cessation increase attributable to vaping (0%-30%), the vaping cessation rate (1-4 times the smoking cessation rate), and years of vaping after vaping-induced smoking cessation (5-20). Data were collected in 2024 and analyzed in 2024-2025. E-cigarette availability was associated with the average cohort member's vaping-associated lifetime probability of premature mortality ranging from an increase of 0.44 percentage points to a decrease of 0.06 percentage points, corresponding, respectively, to a loss of ≤31.3 days of life expectancy to a gain of ≤2.7 days. In two illustrative model setups, individuals who smoked at age 20 years had a lifetime probability of premature mortality of 7-8%. Those who vaped but did not smoke had a probability of 0.15-0.84%. If youth vaping affects lifetime premature mortality, the increase or decrease is projected to be very small.
Preventive strategies for Type 2 diabetes include interventions aimed at modifying population-level risk factors and interventions targeting individuals at an elevated risk. However, the combined national impact of these approaches has not been quantified. This study used a simulation model to estimate the number of incident Type 2 diabetes cases and diabetes-related complications that could be prevented over 10 years by implementing evidence-based, combined preventive strategies. These included population-level sugar-sweetened beverage reduction interventions and individual lifestyle intervention programs for adults with elevated glycemic risk (HbA1c 5.7%-6.5%). Two scenarios were evaluated: (1) a moderate strategy involving a 13% reduction in sugar-sweetened beverage consumption and an online lifestyle intervention and (2) an intensive strategy involving a 55% reduction in sugar-sweetened beverage consumption and an in-person lifestyle intervention. A nationally representative cohort of U.S. adults without diagnosed diabetes was constructed using data from the 2013-2018 National Health and Nutrition Examination Survey. The moderate strategy was projected to prevent 3.7% (562,546) of new Type 2 diabetes cases over 10 years, whereas the intensive strategy would prevent 12.8% (1,958,164). The number of diabetes-related complications prevented generally aligned with the reduction in incident Type 2 diabetes cases. Across different scenarios, of the total cases prevented, 64%-98% were attributable to the sugar-sweetened beverage reduction. These findings demonstrate the potential national impact of integrating population-level strategies to reduce sugar-sweetened beverage consumption and a targeted Diabetes Prevention Program intervention to reduce the incidence of Type 2 diabetes and its complications.
Neighborhood context is an important social determinant of health behaviors, including substance use, but less is known about whether neighborhood deprivation is similarly or differentially related to prenatal use of alcohol, cannabis, and nicotine. Using electronic health record data from Kaiser Permanente Northern California, this retrospective observational study examined geographic variation in prenatal alcohol, cannabis, and nicotine use and evaluated whether neighborhood deprivation was associated with use of these substances during pregnancy. The sample included 173,578 pregnancies (November 2020-December 2024) among members with prenatal screening for substance use during early pregnancy as part of standard care. Neighborhood deprivation index (NDI) from geocoded census data was categorized into quartiles. Choropleth maps visualized tract-level prevalence of prenatal substance use, and modified Poisson regression models estimated associations between NDI quartiles and prenatal substance use using individual-level data. Data were analyzed July 2025-Feburary 2026. Prevalence of prenatal alcohol, cannabis, and nicotine was 9.6%, 8.9% and 2.0%, respectively. Compared with pregnancies in the least deprived neighborhoods, those in the most deprived neighborhoods had a lower prevalence of prenatal alcohol use (aPR [95% CI] = 0.87 [0.84, 0.92]), but higher prevalence of prenatal cannabis (aPR [95% CI] =1.80 [1.70, 1.90]) and nicotine use (aPR [95% CI] = 1.96 [1.74, 2.20]). Neighborhood deprivation showed opposing associations across substances, with lower alcohol use but substantially higher cannabis and nicotine use in more deprived neighborhoods. Findings underscore the importance of considering neighborhood context and type of substance when developing preventive interventions.
This study examines the association of HealthySteps - a two-generation, team-based pediatric primary care model - on preventive care and healthcare utilization for Medicaid-insured children and mothers, and differences across racial/ethnic groups. This retrospective cohort study used linked HealthySteps and Medicaid claims data to compare 12-month outcomes for children receiving comprehensive services with a matched group of similar Medicaid-insured children and mothers. Data used in this study were collected from 2016-2021 and analyzed from 2022-2026. HealthySteps was associated with higher rates of any well-child visit (89.0% vs. 79.6%), attendance of 6+ well-child visits by 15 months of age (64.2% vs. 54.0%), continuity of care with the same provider (65.3% vs. 52.8%), developmental screening (37.9% vs. 26.9%), and Early Intervention (13.8% vs. 8.9%). HealthySteps was also associated with greater likelihood of an emergency department visit (43.9% vs. 38.7%), though not high ED usage (2+ visits). Compared with their counterparts, preventive care increases associated with HealthySteps were larger for Black, Hispanic, and, to a lesser extent, Asian children than for White non-Hispanic children. Among mothers, HealthySteps was associated with greater family planning services (35.8% vs. 31.6%), maternal depression screening (10.9% vs. 8.8%), postpartum care (29.5% vs. 24.6%), and ED visits (36.1% vs. 33.5%), as well as fewer lactation services (6.9% vs. 9.4%). Improvements in preventive care associated with HealthySteps represent meaningful clinical impact, as timely care in the first three years is crucial for healthy development. The larger gains among Black, Hispanic, and Asian children also highlight HealthySteps potential to mitigate persistent disparities in preventive care receipt.
Hydrogen breath testing is a widely used, noninvasive method for diagnosing small intestinal bacterial overgrowth. However, diagnostic cut-offs vary across international guidelines. This study evaluated the diagnostic performance of differing criteria. We prospectively studied consecutive adults with irritable bowel syndrome who underwent glucose hydrogen breath testing. Small intestinal bacterial overgrowth was diagnosed using the Asia-Pacific consensus (rise in hydrogen ≥ 12 ppm from baseline) and the North American consensus (rise ≥ 20 ppm). Methane ≥ 10 ppm was considered methane-positive in both. Ninety subjects were included (median age 49 years; 53% female); 60% had diarrhea-predominant subtype. Small intestinal bacterial overgrowth was diagnosed in 44.4% using Asia-Pacific criteria and 37.8% using North American criteria. Hydrogen-positive cases were significantly associated with diarrhea-predominant subtype, while methane-positive cases correlated with constipation-predominant subtype. Severe irritable bowel syndrome symptoms (Symptom Severity Scale > 300) were more common in affected patients based on both Asia-Pacific (32.5% vs. 8.0%, p = 0.003) and North American (29.4% vs. 12.5%, p = 0.047) criteria. Only the Asia-Pacific criteria were significantly associated with higher symptom severity scores (median: 200 vs. 165, p = 0.009), whereas this was not significant with the North American criteria (median: 200 vs. 170, p = 0.087). Small intestinal bowel overgrowth was also linked to poorer quality of life and higher depression rates. The Asia-Pacific consensus diagnostic criteria improved detection and identified cases associated with more severe irritable bowel syndrome. These findings support using a lower hydrogen cut-off for breath testing, particularly in Asian populations.
A 2019 Medicare opioid safety policy limited initial opioid duration to 7 days and long-term daily dosage to 90 morphine milligram equivalence (MME). Because effective pain management may vary by rurality, this study examined whether the policy differentially affected opioid prescribing among rural versus urban beneficiaries with disabilities. Deidentified claims data was used to gather a rolling cohort of Medicare Advantage beneficiaries with disabilities ages 18 to 64 from 2016 to 2021. Comparative interrupted time series were used in 2025 to analyze rural-urban differences in the duration and dosages of opioid fills for new-to-opioid beneficiaries, the target of the 7-day limit (N = 526,019 person-months), and the number of high-dosage episodes for long-term opioid beneficiaries, the target of the 90-MME limit (N = 3,312,161 person-months). Despite significant reductions in initial opioid duration for both groups, the 7-day limit effect on initial opioid duration weakened over time (trend change: 0.17 [98.75% CI 0.04 to 0.30]) in the rural relative to the urban group. By the end of the study period, the rural group experienced 3.8 percentage points more initial opioid fills exceeding the 7-day limit (95% CI 0.4 to 7.3) than the urban group. Furthermore, the total dosage prescribed in subsequent fills among rural beneficiaries was 27.97 MME (95% CI -52.19 to -3.75) less than urban beneficiaries by the end of the study period. The rural and urban groups responded similarly to the 90-MME limitation. Rural relative to urban new-to-opioid beneficiaries with disabilities experienced a weakened effect on initial opioid duration after Medicare's 7-day limit, while receiving declining dosage in follow-up opioid fills, suggesting potential disparities in access to follow-up opioid prescriptions for rural versus urban beneficiaries with disabilities. Policymakers may consider more flexible opioid regulations and attention to alternative pain management for rural Medicare beneficiaries.
Parents are the primary caregivers for children with developmental disabilities in most families. Caregiving burden may manifest across multiple domains of daily living and the well-being of parents caring for children with developmental disabilities. This study assessed caregiving burden and lifetime experiences due to caregiving burden and identified health disparities between parents caring for children with developmental disabilities and the general population. A nationwide survey of 2,180 Korean parents caring for children with developmental disabilities was conducted in 2024 and analyzed in 2025. This study assessed the prevalence of health indicators, including poor self-rated health, past-year suicidal behaviors, and past-year unmet healthcare and dental care needs. To compare the prevalence of health indicators between parents caring for children with developmental disabilities and the general population, sex- and age-standardized prevalence ratios were estimated using nationally representative data from the 2023 Korea National Health and Nutrition Examination Survey. Among parents caring for children with developmental disabilities, 86.9% reported an overall caregiving burden, and 51.9% had no backup caregiver available when needed. Furthermore, 66.9% reported having ever quit a job owing to caregiving burden. In standardized prevalence ratio analyses, parents caring for children with developmental disabilities showed a higher prevalence across all indicators than the general population. The prevalence of suicidal ideation (standardized prevalence ratio=7.31, 95% CI=6.76, 7.90), suicide plans (standardized prevalence ratio=8.59, 95% CI=7.30, 10.10), and suicide attempts (standardized prevalence ratio=4.03, 95% CI=3.05, 5.33) was higher among parents caring for children with developmental disabilities than in the general population. In addition, the prevalence of unmet healthcare needs was higher (standardized prevalence ratio=6.00, 95% CI=5.66, 6.36). The findings suggest that parents caring for children with developmental disabilities had poorer health but did not receive needed healthcare compared with the general population.
Violence prevention is widely recognized as a public health priority, and law enforcement officers' (LEOs) health is important for frontline response and prevention. Yet population-based estimates of LEO health remain limited and are rarely contextualized within the broader workforce. This study assesses health outcomes and behavioral risk factors among LEOs compared with other employed adults. This study analyzed 2018-2023 Behavioral Risk Factor Surveillance System data, linking public-use health and demographic data with restricted-use Industry and Occupation modules. Analyses were conducted in 2026. Because the analyses required restricted-use data, the data were accessed through the National Center for Health Statistics Research Data Center. The analytic sample included 646,581 employed adults from 45 states. LEOs were identified using police officers, correctional officers, and six other law-enforcement-related occupation categories. Self-reported health status, reported health conditions, and health behaviors were compared between LEOs and other employed adults, adjusting for sociodemographic characteristics. Compared with other employed adults, LEOs reported a lower prevalence of fair or poor general health (aPR, 0.68; 95% CI=0.56, 0.82), frequent mental distress (aPR, 0.70; 95% CI=0.59, 0.83), and depressive disorder (aPR, 0.58; 95% CI=0.49, 0.68). However, LEOs reported a higher prevalence of overweight or obesity (aPR, 1.17; 95% CI=1.14, 1.20), diabetes (aPR, 1.25; 95% CI=1.00, 1.55), sleep deprivation (aPR, 1.31; 95% CI=1.22, 1.40), high blood pressure (aPR, 1.14; 95% CI=1.01, 1.29), smokeless tobacco use (aPR, 1.87; 95% CI=1.59, 2.20), and COVID-19 positivity (aPR, 1.24; 95% CI=1.12, 1.39). LEOs reported favorable overall and mental health profiles alongside specific vulnerabilities that may reflect occupational context such as shift work and frontline exposure. These findings underscore the need for identifying LEO-specific health risks when developing targeted prevention and intervention strategies.
Universal free school meal policies aim to improve student well-being by expanding meal access for all children regardless of income. While evidence supports increased participation in meal programs, research on educational outcomes remains limited. This study evaluated the impact of universal free school meal policies on chronic absenteeism, academic performance, graduation rates, and dropout rates in the U.S. Using a difference-in-differences approach with linear mixed-effects models, this study analyzed school-level administrative data from >10,000 schools across three periods: 2018-2019 (baseline), 2021-2022 (federal universal free school meal), and 2022-2023 (postimplementation of federal policy). Five states with state-level universal free school meal policies were compared with six matched control states that reverted to means-tested programs. A subsample of 6,500 schools that adopted the Community Eligibility Provision after the federal universal free school meal policy ended was also examined. State-level universal free school meal policies reduced chronic absenteeism by 3 percentage points (95% CI= [-5, -2]), with larger reductions in schools serving higher proportions of Black students (-4 percentage points, 95% CI = [-4, -3]). Universal free school meals were associated with improvements in English proficiency by 3 percentage points (95% CI=[1, 6]). Effects on mathematics, graduation rates, and dropout rates were not statistically significant. Schools adopting Community Eligibility Provision showed reduced absenteeism among schools with higher proportions of Black and White students but no overall improvement in test scores. Universal free school meal policies may reduce chronic absenteeism and support postpandemic educational recovery, particularly in schools serving more Black students.
Food insecurity has been linked to adverse health outcomes, but its relationship with ischemic stroke in older adults remains unclear. This study examined the association between food insecurity and ischemic stroke incidence among adults aged 65 years and older. This cohort study used data from the 2005-2006 National Health and Nutrition Survey of Israeli community-dwelling older adults, linked to the Israeli National Stroke Registry (2014-2022). Data were analyzed in 2025. Food insecurity was assessed using the 6-item United States Department of Agriculture household food security scale. First-recorded ischemic stroke events during follow-up, whether first-ever or recurrent, were included. Multivariable Fine and Gray proportional hazard models, accounting for death as a competing risk, estimated subdistribution hazard ratios (HRs) and 95% confidence intervals (CIs) for ischemic stroke by food security status: food insecure (low and very low food secure) vs. high food secure. The dataset included 1,337 participants (median age: 73 years, 57.4% women) who were alive on January 1, 2014, the start of the study follow-up. Over a mean follow-up period of 6.6±3.0 years (through the end of 2022), 82 ischemic stroke events were documented. After multivariable adjustment, food insecurity was associated with an increased risk of first-recorded ischemic stroke (HR=2.02; 95% CI: 1.12-3.65). When analyses were restricted to first-ever ischemic stroke events, the association was stronger (HR=2.65; 95% CI: 1.33-5.29). Food insecurity was associated with a higher risk of ischemic stroke among older adults. Addressing food insecurity may support stroke prevention in older populations.
Recognition of high-risk human papillomavirus (HPV) as the etiologic agent in nearly all cervical cancers has fundamentally reshaped screening strategies, driving the development and adoption of highly sensitive molecular HPV assays. Over the past several decades, cervical cancer screening guidelines have shifted from primarily cytology-based approaches toward HPV-based modalities, with primary HPV testing now recommended as the preferred method by the American Cancer Society and anticipated to be similarly endorsed by the United States Preventive Services Task Force. This article traces the evolution of cervical cancer screening, from the original Papanicolaou test to current guideline recommendations, and discusses the logistical requirements for transitioning to a primary HPV screening system, including triage strategies for HPV-positive cases. The authors additionally present an institutional experience of initiating primary HPV testing, highlighting its impact on cytopathology laboratory workflow and specimen volumes.