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Drivers in stock car racing are exposed to head acceleration events (HAEs) during racing. Currently, no head kinematic characteristic signals have been developed in a motorsport setting. Furthermore, the variability of loading in motorsport HAEs may not be adequately accounted for using common corridor-generation approaches. To address these limitations, ARCGen was employed which uses arc-length reparameterization and signal registration to develop characteristic signals in a wide range of settings. The objective of this study was to characterize HAEs in a motorsport setting using generated characteristic signals. Head kinematics were collected from 20 NASCAR Cup Series drivers over 41 races during the 2024 season using mouthpiece sensors. Each sensor was configured to collect linear and rotational head kinematics (1600 Hz, 4 g threshold). All HAEs were visually verified as either race events (i.e., during the race, not associated with a crash) or crash events (i.e., during the race, associated with a crash resulting in a caution). HAEs containing multiple head impacts exceeding the trigger threshold were segmented into individual impacts. For each individual impact, peak kinematics were calculated including peak resultant linear acceleration (PLA) and angular acceleration (PRA). Principal direction of force (PDOF) was calculated from linear velocity. Impacts were separately binned into kinematic percentiles by PLA magnitude and PRA magnitude. Impacts were grouped into distinct bins based on PDOF, kinematic percentile, and event type (race, crash) for each binning method. To account for the variability of loading in motorsport HAEs, ARCGen (an open-source software package) was used to generate characteristic signals using arc-length reparameterization and signal registration for each bin in the x, y, and z directions and x-y resultant, and x-y-z resultant signatures. Signals were generated for linear acceleration, linear velocity, rotational acceleration, and rotational velocity. All signals were aligned using the optimal warping of resultant linear acceleration. Magnitude and duration were compared using descriptive statistics and qualitative characteristics were visually analyzed. Duration was calculated using 30% and 50% thresholding methods and compared. 3,156 HAEs (n = 2,750 race, n = 406 crash) were recorded. These HAEs were segmented into 4,478 individual impacts (n = 3,818 race, n = 660 crash). The rear PDOF characteristic signal for each percentile bin exposed drivers to the highest PLA magnitude during race and crash impacts, whereas the right side PDOF signal showed the lowest PLA magnitude for race impacts. Across all kinematic percentiles for race impacts, the right side PDOF signals exhibited the longest duration when compared to all other PDOFs for both duration calculation methods. Motorsport-specific HAE characteristic signals were created. These may inform driver safety including helmet testing standards, finite element model validation, and safety system enhancements. This work facilitates cross-sport comparisons to contextualize motorsport racing HAEs relative to other environments.

End-stage kidney disease (ESKD) is often listed as a contributing rather than underlying cause of death, potentially understating its burden in underlying-cause surveillance. Using U.S. multiple-cause-of-death data, we evaluated trends, underlying-cause pathways, ESKD "penetration" into cause-specific mortality, and drivers of change in ESKD-involved deaths. Using CDC WONDER Multiple Cause of Death data (1999-2023), we identified ESKD-involved deaths among adults aged ≥25 years and calculated age-adjusted mortality rates (AAMR; 2000 U.S. standard). Joinpoint regression was performed using a log-linear model with a maximum of two joinpoints. Model selection was conducted using the Joinpoint Regression Program's default permutation-test procedure and grid-search settings. Average annual percent change (AAPC) and 95% CIs were estimated over the prespecified analysis intervals. For race-specific analyses, AAPCs were restricted to 1999-2020 bridged-race files; for urbanization analyses, AAPCs were restricted to 1999-2020. Underlying-cause composition was assessed using ICD-10 chapters and the NCHS 113 selected-cause list. ESKD penetration (Pg,t ) was estimated within each underlying-cause group, and a symmetric two-factor decomposition separated changes in ESKD-involved deaths into scale versus penetration components, comparing pre-COVID-19 and COVID-19-era periods. ESKD-involved AAMR increased from 14.51 (95% CI 14.33-14.69) per 100,000 in 1999 to 18.74 (18.58-18.91) in 2023 (AAPC 1.33%, 0.61-2.10). Increases were faster in males than females (2.06% vs. 1.07) and in adults aged ≥65 vs. 25-64 years (1.81% vs. 0.73). In race-specific analyses restricted to the 1999-2020 bridged-race files, Black individuals had the highest absolute mortality, whereas White individuals showed a significant increase. The underlying-cause structure shifted, with genitourinary causes becoming more prominent. Pg,t varied widely by cause and increased for selected categories, indicating growing ESKD co-occurrence with specific fatal pathways. Decomposition showed heterogeneous scale versus penetration contributions across causes and period-specific differences. ESKD involvement in U.S. mortality rose from 1999 to 2023 with marked subgroup inequities and shifts in underlying-cause pathways. Monitoring ESKD as a contributing cause, together with cause-structure and scale-penetration analyses, provides information beyond underlying-cause surveillance to support integrated prevention addressing CKD progression and its cardiometabolic and infectious complications.

Racial and ethnic disparities in access to medicines persist across the US. Community pharmacies serve as critical access points for prescription drugs, yet their availability varies widely, potentially contributing to health disparities. We estimated the share of the population living within ten minutes of a community pharmacy across counties, by race and ethnicity, during the period 2010-23. We linked these measures to race and ethnicity-specific, state-level estimates of age- and prevalence-standardized medication use for twenty-seven health condition categories through 2019. A 1 percent increase in people living within ten minutes of a community pharmacy at the state level was associated with 0.7 percent higher use of medications per prevalent case. This association was strongest for Asian/Pacific Islander, Black, and Hispanic populations. In addition, a 1 percent increase in ten-minute community pharmacy access was associated with a 0.52 percent decrease in racial and ethnic disparities in medication use. These findings suggest that uneven community pharmacy access may exacerbate racial and ethnic disparities in medication use. Policy makers seeking to improve medication access should consider targeted interventions to preserve or expand pharmacy availability for underserved communities.

Long COVID has debilitating effects but is inconsistently diagnosed because of subjective criteria, limited treatments, and variations in health care access. We analyzed electronic health records from the National Clinical Cohort Collaborative for patients diagnosed with acute COVID-19 in the US between January 2022 and March 2023. Using six race and ethnicity categories, we evaluated 222 symptoms and long COVID diagnoses (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, code U09.9) within twelve months after infection. We assessed the relationship between race and ethnicity and long COVID diagnosis, adjusting for patient covariates and long COVID symptomatology set to the presence of at least one documented long COVID-associated symptom. Among 2.4 million patients, Black patients were less likely to be diagnosed with long COVID than White patients under a scenario in which a symptom was present and health care monitoring was at least bimonthly. For the remaining racial and ethnic groups, we found no statistically significant differences in long COVID diagnoses compared with White patients. Although the magnitude was small, the difference in diagnosis likelihood suggests the presence of potential diagnostic bias.

High pain interference is common in heart failure (HF), yet its longitudinal relationship with changing physical function and health-related quality of life (HRQoL) remains unclear. Evaluate the relationship between changes in pain interference with changes in: 1) physical function; and 2) HRQoL. In this secondary analysis, data were used from the MEMOIR-HF trial, involving 240 participants assessed at baseline, and at 10 weeks, 4 months, and 8 months after baseline. Pain interference was measured using the Health Utilities Index Mark-3, physical function with the Timed Up and Go test, and HRQoL with the Minnesota Living with Heart Failure Questionnaire. Zero-order correlations and linear mixed models were conducted to evaluate the relationship between changes in pain interference with changes in physical function and HRQoL, adjusting for age, gender, race, intervention group, body mass index, HF severity, cardiovascular comorbidities, depression, and sleep. Mean age was 66.59 (SD 11.84) years. Gender was 44.6% men, 55.4% women. Self-reported race was 85.0% White, 13.8% Black, and 1.2% Other. From baseline to 8 months, improvements in pain interference were significantly correlated with an improvement with both physical function and HRQoL. In linear mixed models, improvements in pain interference were associated with improvements in both physical function (F = 0.33, p =.038) and HRQoL (F = 1.62, p =.003). Findings supported a relationship between changes in pain interference with changes in physical function and HRQoL in HF. Further research is needed with clearly defined chronic pain and more robust pain interference measures.

Racial and ethnic disparities in gynecologic cancer care are well documented, yet inequities in treatment timeliness and outcomes for vulvar squamous cell carcinoma (VSCC) have not been examined in large national cohorts. Treatment delay is a potentially modifiable disparity, and the role of neighborhood socioeconomic status (nSES) in shaping racial and ethnic differences in care remains unclear. We conducted a retrospective cohort study using the National Cancer Database of women aged ≥ 18 years diagnosed with FIGO stage I-IVA VSCC from 2004 to 2020. Race/ethnicity was categorized as non-Hispanic (NH) White, NH Black, Hispanic, and Asian/Pacific Islander. The primary outcome was treatment delay, defined as time to treatment initiation (TTI) > 30 days from diagnosis. Overall survival (OS) was secondary. Multivariable logistic and Cox regression models adjusted for demographic, clinical, socioeconomic, insurance, facility, and treatment factors. Interaction terms assessed whether nSES modified associations. Among 9,023 women, Hispanic patients had higher odds of treatment delay compared with NH White patients (aOR 1.31, 95% CI 1.03-1.67). No significant differences were observed for NH Black or Asian/Pacific Islander patients. nSES did not modify these associations (P = 0.44). Although NH Black patients had improved unadjusted OS, this difference was not significant after adjustment. Race/ethnicity was not independently associated with OS. Hispanic women with VSCC experience persistent treatment delays not explained by socioeconomic or clinical factors. Efforts to reduce delays through culturally responsive interventions are needed to advance equity in vulvar cancer care.

The prevalence of obstructive sleep apnea (OSA) in the general population has been rising in recent years. OSA has not only been identified as an independent risk factor for cerebrovascular disease (CVD) but is also associated with major CVD risk factors such as hypertension, obesity, and diabetes. CVD is the second leading cause of death globally, with approximately 165,000 deaths occurring annually in the United States. This study aimed to conduct a retrospective comparative analysis of CVD mortality among adults with OSA in the United States from 1999 to 2020, stratified by gender, race, urbanization, and geographic region. Age-adjusted mortality rates (AAMR) and crude mortality rates (CMR) per 100,000 population were analyzed using the CDC WONDER multiple causes of death database to assess mortality among individuals aged 25 years and older diagnosed with both OSA (ICD-10: G47.3) and CVD (ICD-10: I60-I69). Joinpoint regression was used to visualize mortality trends and calculate annual percentage change (APC) and average annual percentage change (AAPC). A total of 14,763 deaths occurred between 1999 and 2020 among individuals diagnosed with both OSA and CVD. The AAMR exhibited an upward trend, increasing from 0.1 in 1999 to 0.7 in 2020, with an AAPC of 8.97% (95% CI: 8.28-9.80). A sharp increase in AAMR was observed from 2014 onward (APC = 13.61%). Patients aged 85 and older had the highest CMR (2.11). Males (AAMR = 0.4) had a higher overall mortality rate than females (AAMR = 0.2). From 1999 to 2015, males experienced a moderate mortality increase (APC = 7.06%), but after 2015, a more pronounced rise was noted (APC = 13.25%), with an AAPC of 8.5% (95% CI: 7.55-9.50). Meanwhile, females showed a steady increase in mortality from 1999 to 2020 (APC = 10.01%) with an AAPC of 10.01% (95% CI: 9.20-11.35). Beyond gender disparities, racial differences were also observed. Non-Hispanic (NH) African Americans had the highest overall AAMR (0.39), followed by NH American Indians (0.31) and NH Whites (0.30). In contrast, NH Asians (0.12) and Hispanics (0.18) had the lowest mortality rates. Urbanization-based classification showed that the highest AAMR occurred in Small Metro (0.40) and Micropolitan areas (0.39), while Large Central Metro (0.24) and Large Fringe Metro (0.26) had the lowest AAMRs. In census regions, the highest AAMR was recorded in the Midwest (0.37) and West (0.36), followed by the South (0.26) and Northeast (0.19). Among U.S. states, Oregon (0.82) and Minnesota (0.76) exhibited the highest AAMRs. CVD mortality in individuals with OSA exhibited a pronounced upward trajectory, with the highest burden observed among males, patients aged 85 and older, NH African Americans, and small metro residents, highlighting stark demographic and geographic disparities. The disproportionate rise in mortality across gender, racial, and geographic groups warrants proactive diagnostic vigilance and integrated management strategies. Targeted interventions for high-risk populations are essential to curbing this escalating trend. These disparities underscore the urgency of unraveling their underlying drivers, paving the way for more effective and equitable prevention.

To evaluate the COVID-19 pandemic's impact on the presentation patterns, severity, and predictors of surgical intervention in pediatric orbital cellulitis. Electronic medical records of patients with orbital cellulitis presenting to Texas Children's Hospital in Houston, Texas between 2012 and 2023 were reviewed. Multivariable logistic regression identified predictors of subperiosteal abscess (SPA) occurrence and need for surgical intervention within three months, including endoscopic sinus surgery (ESS) and orbitotomy, for the full cohort and post-pandemic subgroups. In total, 389 patients were included (209 pre-pandemic, 180 post-pandemic). Average age was 7.6&#x2009;&#xb1;&#x2009;4.4&#x2009;years, with 63.8% male, 65.3% White, and 35.0% Hispanic/Latino. After pandemic onset, monthly presentation rates increased from 2.13 to 3.91 cases/month (p&#x2009;<&#x2009;0.001), while SPA occurrence declined from 75.12% to 66.11%. No significant changes in patient age, sex, race/ethnicity, or BMI were observed. Interaction models showed generally stable predictors of SPA, ESS, and orbitotomy. Superior SPA location was the only consistent predictor across all surgical outcomes. The COVID-19 pandemic was associated with increased pediatric orbital cellulitis presentations but not changes in demographic or clinical severity indicators. Superior SPA location and patient age remain key predictors of surgical complexity and need for repeat intervention.

Chronic pancreatitis (CP) is a debilitating inflammatory condition characterized by irreversible glandular destruction and intractable pain. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated anti-inflammatory properties in preclinical models, yet their impact on clinical outcomes in CP remains unexplored. In this retrospective cohort study, adult patients (&#x2265;18 years) with CP were identified from the TriNetX US Collaborative Network. Patients were stratified into the following two cohorts: those prescribed GLP-1 RAs and a control group without such prescriptions. 1:1 propensity score matching was performed to balance cohorts for age, sex, race, and key comorbidities. Primary outcomes were assessed over a 3-year observation period. Hazard ratios (HRs) were estimated using Kaplan-Meier survival analysis. After matching, 10,625 patients were included in each cohort (mean age 59.6 &#xb1; 13.1 years; 53.7% female). GLP-1 RA users had a 41% lower hazard of initiating chronic opioids (HR 0.59, 95% confidence interval [CI] 0.52-0.67; P < .001) and a 42% lower hazard of developing opioid use disorder (HR 0.58, 95% CI 0.48-0.69; P < .001). GLP-1 RA therapy was also associated with a marked reduction in the risk of requiring celiac plexus block (HR 0.51, 95% CI 0.34-0.78; P = .001) and endoscopic pancreatic interventions (HR 0.48, 95% CI 0.41-0.56; P < .001). Furthermore, the risk of undergoing major pancreatic surgery was significantly lower in the GLP-1 RA group (HR 0.44, 95% CI 0.33-0.59; P < .001). GLP-1 RA use was associated with a substantial reduction in new opioid prescriptions and invasive pancreatic interventions in CP. These findings suggest that GLP-1 RAs may be helpful in symptom control and multidisciplinary management of selected cases.

The hemoglobin-to-red cell distribution width ratio (HRR) is a biomarker associated with systemic inflammation and outcomes in critical illness. Within clinical databases, there exists an extreme-prognosis subgroup of inflammatory bowel disease (IBD) patients, those who all died within 30 days of ICU admission. Due to limitations in the database, this study can only analyze this specific subgroup. This study aims to explore and describe the association between admission HRR and the occurrence of sepsis during ICU stay in this specific subgroup of IBD patients. A retrospective cohort study was conducted using the eICU Collaborative Research Database (2014-2015), including 229 eligible patients. Multivariable logistic regression was used to assess the independent association, adjusting for confounders. The dose-response relationship was examined using restricted cubic spline (RCS) models. Subgroup and interaction analyses were performed across age, sex, and race. The sepsis group had a significantly lower admission HRR than the non-sepsis group (6.04&#x2009;&#xb1;&#x2009;1.66 vs. 6.77&#x2009;&#xb1;&#x2009;2.0, P&#x2009;=&#x2009;0.008). After full adjustment, each 1-unit increase in HRR was associated with 20.3% lower odds of sepsis (P&#x2009;=&#x2009;0.007). Compared to the lowest quartile (HRR&#x2009;<&#x2009;5.1), patients in the highest quartile (HRR&#x2009;&#x2265;&#x2009;7.85) had 66.8% lower adjusted odds of sepsis (P&#x2009;=&#x2009;0.015). RCS analysis indicated a linear, inverse relationship between HRR and sepsis (P for non-linearity&#x2009;=&#x2009;0.42). Subgroup analysis revealed the negative association was more pronounced in patients aged <65, males, and White patients. However, formal interaction tests were not statistically significant (all P for interaction >0.05), indicating the association did not differ meaningfully across these subgroups. In this specific cohort, a lower admission HRR was associated with the occurrence of sepsis. Due to inherent selection bias, this finding describes an association within this specific subgroup and cannot be generalized. This exploratory study generates the hypothesis that HRR may reflect a unique pathophysiological state in end-stage IBD, a hypothesis that requires validation in prospective, unbiased cohorts.

Cardiovascular-kidney-metabolic syndrome (CKM) is a multi-organ metabolic disorder with an increased risk of morbidity and mortality among populations worldwide. Identifying effective biomarkers for early risk assessment is important. The residual cholesterol (RC) inflammatory index (RCII), which is derived from the combination of RC and C-reactive protein (CRP), represents a novel biomarker that captures the interplay between dyslipidemia and systemic inflammation. The interaction between RCII and CKM risk in the general populations of the US and China and evaluated its dose-response pattern, nonlinear relationship, and subgroup variations were evaluated. Data were retrieved by accessing 2 nationally representative cohorts: the US National Health and Nutrition Examination Survey (NHANES, n = 10,669) and the China Health and Retirement Longitudinal Study (CHARLS, n = 9,496). Multivariate logistic regression models (Model 1-3) were constructed to determine the relationship between RCII (as a continuous and quartile-categorized variable) and CKM. Progressive adjustments were made for demographic, socioeconomic, lifestyle, and anthropometric factors. In addition, a restricted cubic spline (RCS) analysis was conducted to examine nonlinearity and stratified analyses to assess effect modification across subgroups. Increased RCII was significantly linked with increased CKM risk in both models. In fully adjusted models, each 1-unit increment in RCII was associated with a 4% increase in CKM risk in NHANES (odds ratio (OR) = 1.04, 95% CI: 1.03-1.06, P < .001) and a 3% increase in CHARLS (OR = 1.03, 95% CI: 1.02-1.05, P < .001). Quartile analysis revealed a strong dose-response pattern. In CHARLS, individuals in the highest quartile (Q4) exhibited a 9.60-fold higher CKM risk compared with that in Q1 (95% CI: 7.83-11.80). RCS models confirmed a nonlinear, upward-sloping relationship between RCII and CKM risk in both datasets. Subgroup analysis revealed robust associations across most strata, with a significant interaction by race in NHANES and by hypertension, diabetes, stroke, and smoking status in CHARLS. RCII exhibited an independent and positive association with CKM risk in the US and Chinese populations, with consistent dose-response and nonlinear trends. This index may be a practical and integrative biomarker for identifying individuals with an increased CKM risk, particularly during the early stages of metabolic dysregulation. Prospective studies are warranted to validate their predictive performance and establish clinically relevant thresholds for risk stratification.

Military personnel are routinely exposed to a range of occupational and environmental hazards (including chemical agents, radiation, physical stress, and psychological trauma) that may uniquely influence their long-term health outcomes. Emerging evidence suggests that such exposures could alter cancer risk profiles, yet comprehensive comparisons of tumor prevalence and distribution between military and civilian populations remain limited. Leveraging a nationally representative dataset, this study addresses this gap by systematically comparing cancer profiles between United States military veterans and the general population, thereby informing targeted prevention strategies and etiological research in occupational health. This study aims to compare cancer prevalence and profiles between military personnel and the general population to investigate the association between military service and tumor risk. This cross-sectional analysis utilized data from the National Health and Nutrition Examination Survey database. The primary outcome was self-reported cancer prevalence. Multivariate logistic regression analyses were conducted to assess the relationship between military service and cancer occurrence, adjusting for key demographic and lifestyle covariates including age, sex, race, smoking status, and socioeconomic factors. Among 12,174 participants, 1904 (15.64%) had a history of military service. Military veterans were significantly older (66.17&#x2005;&#xb1;&#x2005;0.43 vs 52.79&#x2005;&#xb1;&#x2005;0.31 years), had a higher proportion of White individuals (85.45% vs 69.74%), and higher smoking rates (66.01% vs 43.32%) compared to the nonmilitary population (all P&#x2005;<&#x2005;.001). Cancer prevalence was markedly higher in veterans (76.95% vs 46.87%, P&#x2005;<&#x2005;.001), with notably elevated rates of thyroid, dermatological, and skeletal cancers. After adjustment for confounders, nonmilitary individuals had significantly lower odds of tumor occurrence (adjusted odds ratio&#x2005;=&#x2005;0.40, 95% confidence interval 0.31-0.53). Military service is associated with a significantly increased prevalence of tumors, particularly thyroid cancer. The findings underscore the need for further research into the underlying mechanisms and enhanced health protection strategies for military personnel.

Medicare-funded home health care is providing critical care to homebound older adults, especially those in the last year of life. In Medicare Advantage, Hispanic and Asian or Pacific Islander decedents are less likely to receive Medicare home health compared to their counterparts in traditional Medicare. We aim to investigate if prior authorization contributes to racial and ethnic differences in Medicare home health use at the end of life. In this cross-sectional study, we used a 100% Medicare cohort of adult's age &#x2265;&#x2009;66 who died in 2019 and were enrolled in Medicare Advantage. We fit a logistic regression model with and without a Medicare Advantage plan-level fixed effects and tested interactions between decedent race and ethnicity and whether the Medicare Advantage plan required prior authorization for Medicare home health care. All models adjusted for individual and regional characteristics. In our sample of 369,195 decedents (49.3% female, mean age 84.9), 240,339, or 65.1%, were in Medicare Advantage plans that required prior authorization for home health care. Racial and ethnic differences were primarily driven by between-plan differences, with prior authorization increasing differences in utilization between racial and ethnic groups. For example, prior authorization was associated with a 5.60% (95% CI 0.08-0.03) decrease for Hispanics and a 4.05% (95% CI 0.07-0.01) decrease for Asian/Pacific Islanders. Our findings suggest that prior authorizations contribute to racial and ethnic differences in the Medicare Advantage program.

Use of oral nicotine pouches, and specifically the brand Zyn, has increased among all age groups in the United States (U.S.), and these products have a wide advertising and social media presence. The purpose of our study was to identify prevalence and correlates of oral nicotine pouch use, Zyn use, and Zyn susceptibility in the U.S. and identify sources of advertising exposure for Zyn. We conducted a cross-sectional survey. We conducted an online national survey in the U. S, through Qualtrics, from March-June 2025. Participants were 13-40-year-olds (N&#x2009;=&#x2009;5733), with a 1:1:1 ratio of people ages 13-17, 18-20, and 21-40; 66.1% were female. We asked participants about lifetime and past 30-day oral nicotine pouch use, Zyn use in particular, susceptibility to use Zyn, use of Zyn flavors, detailed patterns of Zyn use, and exposure to Zyn advertising, overall and stratified by age group. Among our sample, lifetime use of any nicotine pouch and Zyn specifically were 11.5% and 9.3%, respectively; past 30-day use of any nicotine pouch and Zyn specifically were 5.0% and 3.9%, respectively. Lifetime use and past 30-day use increased across age groups. Among those who had never used any nicotine pouch, 27.6% were susceptible to Zyn use. Using logistic regressions, we identified correlates to oral nicotine pouch use and Zyn susceptibility, including covariates for age group, sex, race/ethnicity, financial comfort, e-cigarette use, and cigarette use. Increasing age group and e-cigarette and cigarette use were associated with any oral nicotine pouch use and Zyn susceptibility. The most popular Zyn flavors ever used were mint (n&#x2009;=&#x2009;388) and drinks (n&#x2009;=&#x2009;190). On average, participants with past 30-day Zyn use reported a median of using 4.0 (interquartile range [IQR]: 4.0) pouches per day; a median of placing 2.0 (IQR: 3.0) pouches in their mouth at once; and a median of using 2.0 (IQR: 2.0) cans of Zyn per week. TikTok (18.2%, n&#x2009;=&#x2009;1044), YouTube (17.8%, n&#x2009;=&#x2009;1021), and Instagram (16.3%, n&#x2009;=&#x2009;935) were the top platforms participants reported ever seeing a Zyn advertisement or promotion. A United States national survey found substantial rates of use, susceptibility to use, and exposure to marketing for Zyn and other oral nicotine pouches. Mint and drinks were the most commonly used Zyn flavors.

Thyroid cancer mortality has varied across demographic groups in the US, but comprehensive recent analyses are limited. This population-based retrospective cohort study examines trends in thyroid cancer-related mortality from 1999 to 2023 using data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Mortality due to malignant thyroid neoplasms (ICD-10 C73) was included. Eligibility included US resident deaths recorded between 1999 and 2023 with thyroid cancer as the underlying cause. Trends in age-adjusted mortality rates (AAMR, per 100,000) across sex, age, race/ethnicity, urbanization, and geographic regions were analyzed using Joinpoint regression with Monte Carlo permutation to estimate annual percent change (APC) and average annual percentage changes (AAPC). During the study period, 53,145 deaths were attributed to malignant neoplasms of the thyroid. The overall AAMR declined from 0.86 to 0.77 per 100,000. Both sexes showed increased mortality until about 2019 and 2020, following which there were significant declines in mortality. Male patients experienced a higher mortality increase pre-2020 and steeper decline post-2020. Rural populations observed greater mortality increases compared to urban populations. Black or African American patients and White patients had consistently lower thyroid cancer-related mortality than Asian or Pacific Islander and Hispanic patients. Asian or Pacific Islander patients demonstrated relatively stable AAMRs over the study period without a statistically significant change. Older age groups, especially&#x2009;&#x2265;&#x2009;85 years, had the highest crude mortality and significant increase in mortality post-2017. The South, Midwest, and West regions had significant mortality increases with a sharp rise in the South post-2019. Despite an overall decline in malignant thyroid neoplasm related mortality since 1999, there are persistent disparities due to sex, age, urbanization, race and region. Future research should investigate the drivers of the disparities closely, and healthcare policy should also aim to improve availability and accessibility to thyroid cancer related education, screening, detection, and treatment especially to those populations with disproportionately high risk. Not applicable.

More youth mental health care in the United States is provided in schools than any other setting. So, there is a need for evidence-based psychotherapies that can work well with students in those sometimes complex environments. Transdiagnostic modular therapies may help, given their flexibility and capacity to address diverse youth disorders and problems. We tested this possibility by conducting a school-based cluster-randomized controlled trial of Child STEPs, an intervention that combines the Modular Approach to Therapy for Children with consultation and measurement-based care. One hundred forty-two elementary and middle school students (Mage = 9.78, SD = 1.76, range 7-14; 39% female; 59% White, 18% multiracial, 9% Black, 6% Asian, 4% Hispanic, 4% another race/ethnicity) from five urban and suburban school districts were treated by 57 school counselors who had been randomized to STEPs or usual counseling (UC). The full sample improved significantly across multiple multi-informant mental health measures-administered at baseline, during treatment, at posttreatment, and 6-month follow-up. STEPs counselors showed strong Modular Approach to Therapy for Children fidelity (coded from session recordings) and strong endorsement of Modular Approach to Therapy for Children effectiveness. However, there was no significant difference between STEPs and UC on any mental health outcome, and STEPs students showed poorer school engagement during treatment than UC students. STEPs did not outperform UC, despite strong STEPs fidelity by counselors; future research may test whether this finding is robust or might be altered by adapting evidence-based modular treatment for the school context. (PsycInfo Database Record (c) 2026 APA, all rights reserved).