Preventive Medicine

Binge Drinking and Prescription Opioid Misuse in the U.S., 2012–2014 Publication date: August 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 2 Author(s): Marissa B. Esser, Gery P. Guy, Kun Zhang, Robert D. Brewer Introduction Prescription opioids were responsible for approximately 17,000 deaths in the U.S. in 2016. One in five prescription opioid deaths also involve alcohol. Drinkers who misuse prescription opioids (i.e., use without a prescription or use only for the experience or feeling it causes) are at a heightened risk of overdose. However, little is known about the relationship between drinking patterns and prescription opioid misuse. Methods Data were analyzed from 160,812 individuals (aged ≥12 years) who responded to questions about prescription opioid misuse and alcohol consumption in the 2012, 2013, or 2014 National Survey on Drug Use and Health (analyzed in 2017–2018). The prevalence of self-reported past-30-days prescription opioid misuse was assessed by sociodemographic characteristics, other substance use (i.e., cigarettes, marijuana), and drinking patterns. Multiple logistic regression analyses were used to calculate AORs. Results From 2012 to 2014, 1.6% (95% CI=1.5, 1.7) of all individuals aged ≥12 years (estimated 4.2 million) and 3.5% (95% CI=3.3, 3.8) of binge drinkers (estimated 2.2 million) reported prescription opioid misuse. Prescription opioid misuse was more common among binge drinkers than among nondrinkers (AOR=1.7, 95% CI=1.5, 1.9). Overall, the prevalence of prescription opioid misuse increased significantly with binge drinking frequency (p-value<0.001). Conclusions More than half of the 4.2 million people who misused prescription opioids during 2012–2014 were binge drinkers, and binge drinkers had nearly twice the odds of misusing prescription opioids, compared with nondrinkers. Widespread use of evidence-based strategies for preventing binge drinking might reduce opioid misuse and overdoses involving alcohol.

Author Response to Letter to the Editor Regarding “Potential Problems of Using Same Race Category for Native Hawaiians, Pacific Islanders, and Asians” Publication date: August 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 2 Author(s): Ricardo A. Franco, Yunhua Fan, Stephanie Jarosek, Sejong Bae, James Galbraith

Misinformation as a Misunderstood Challenge to Public Health Publication date: August 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 2 Author(s): Brian G. Southwell, Jeff Niederdeppe, Joseph N. Cappella, Anna Gaysynsky, Dannielle E. Kelley, April Oh, Emily B. Peterson, Wen-Ying Sylvia Chou

Complex Systems Approaches to Diet: A Systematic Review Publication date: August 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 2 Author(s): Brent A. Langellier, Usama Bilal, Felipe Montes, Jose D. Meisel, Letícia de Oliveira Cardoso, Ross A. Hammond Context Complex systems approaches can help to elucidate mechanisms that shape population-level patterns in diet and inform policy approaches. This study reports results of a structured review of key design elements and methods used by existing complex systems models of diet. Evidence acquisition The authors conducted systematic searches of the PubMed, Web of Science, and LILACS databases between May and September 2018 to identify peer-reviewed manuscripts that used agent-based models or system dynamics models to explore diet. Searches occurred between November 2017 and May 2018. The authors extracted relevant data regarding each study's diet and nutrition outcomes; use of data for parameterization, calibration, and validation; results; and generated insights. The literature search adhered to PRISMA guidelines. Evidence synthesis Twenty-two agent-based model studies and five system dynamics model studies met the inclusion criteria. Mechanistic studies explored neighborhood- (e.g., residential segregation), interpersonal- (e.g., social influence) and individual-level (e.g., heuristics that guide food purchasing decisions) mechanisms that influence diet. Policy-oriented studies examined policies related to food pricing, the food environment, advertising, nutrition labels, and social norms. Most studies used empirical data to inform values of key parameters; studies varied in their approaches to calibration and validation. Conclusions Opportunities remain to advance the state of the science of complex systems approaches to diet and nutrition. These include using models to better understand mechanisms driving population-level diet, increasing use of models for policy decision support, and leveraging the wide availability of epidemiologic and policy evaluation data to improve model validation.

Housing Disadvantage and Poor Mental Health: A Systematic Review Publication date: August 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 2 Author(s): Ankur Singh, Lyrian Daniel, Emma Baker, Rebecca Bentley Context This study reviews collective evidence on the longitudinal impact of housing disadvantage (based on tenure, precarity, and physical characteristics) on mental health. It is focused on temporally ordered studies where exposures preceded outcomes, a key criterion to establishing causal evidence. Evidence acquisition A systematic review of evidence on housing disadvantage and mental health was performed. The literature search used six electronic databases including MEDLINE (PubMed and Ovid platform), Embase, PsycINFO, Web of Science, SciELO, and Sociological Abstracts. Population-based longitudinal studies where exposure to housing disadvantage (excluding exposure to homelessness) preceded mental health were included. Methodologic quality of selected studies was examined using the Newcastle–Ottawa Quality Assessment Scale. Because of definitional and methodologic heterogeneity among studies, narrative synthesis rather than meta-analysis was used to summarize research findings. Evidence synthesis Of the 1,804 unique titles identified in the literature search, 12 met the selection criteria for inclusion in the systematic review. Housing disadvantage was measured by overcrowding, mortgage delinquency, housing mobility, housing tenure, subjective perceptions of inadequate housing, eviction, and physical housing conditions. Mental health was measured as depression, psychological impairment, anxiety, allostatic load, mental strain, and psychological health. Study sample sizes ranged from 205 to 16,234 people, and the follow-up period ranged from within 1 year to 34 years. Each study indicated a positive association between housing disadvantage and mental health for at least one housing disadvantage measure and mental health outcome. Conclusions This systematic review confirms that prior exposure to housing disadvantage may impact mental health later in life.

Sexual and Gender Minority U.S. Youth Tobacco Use: Population Assessment of Tobacco and Health (PATH) Study Wave 3, 2015–2016 Publication date: August 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 2 Author(s): Sarah E. Johnson, Erin Keely O'Brien, Blair Coleman, Greta K. Tessman, Leah Hoffman, Janine Delahanty Introduction Tobacco use disparities by sexual identity are well characterized among adults, but relatively less is known about tobacco use disparities in sexual minority youth. Moreover, no national study has reported tobacco use behaviors among gender minority (e.g., transgender) youth. Methods Data from Wave 3 (2015–2016) of the Population Assessment of Health Study from youth aged 14–17 years (n=7,772), analyzed in 2018, were stratified by transgender identity, sex, and sexual identity to describe tobacco product use. Results Transgender youth (n=79) were more likely to report ever use of tobacco products compared with nontransgender youth (electronic nicotine products, 40.2% vs 23.0%; cigarettes, 33.9% vs 14.1%; and smokeless tobacco, 21.5% vs 6.0%, respectively) and more likely to report past 30-day use of these products. Similarly, female sexual minority youth, compared with straight female youth, were more likely to report ever use of electronic nicotine products (37.9% vs 20.1%); cigarettes (28.9% vs 12.0%); cigars (11.3% vs 5.2%); hookah (12.7% vs 7.6%); and past 30-day use of electronic nicotine products, cigarettes, and cigars. Among male youth, sexual minority youth were more likely to report ever use of cigarettes compared with straight youth (25.1% vs 13.5%), but they did not differ in ever or past 30-day use of any other tobacco products. Conclusions Sexual minority youth and transgender youth are more likely to use tobacco products compared with their nonminority peers. Similar to patterns among adults, this is especially true for female sexual minority youth. This information is useful for developing communication and education efforts to prevent youth tobacco initiation in these high-risk groups.

Lung Cancer Screening Utilization: A Behavioral Risk Factor Surveillance System Analysis Publication date: August 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 2 Author(s): Whitney E. Zahnd, Jan M. Eberth Introduction Lung cancer is the leading cause of cancer-related death in the U.S. The National Lung Screening Trial found that low-dose computed tomography reduced lung cancer mortality in high-risk individuals. As a result, the U.S. Preventive Services Task Force began recommending low-dose computed tomography screening for those at a high risk in 2013. Therefore, it is imperative to continually monitor lung cancer screening uptake. The objective of this study was to determine computed tomography screening uptake across ten states using 2017 Behavioral Risk Factor Surveillance System survey data. Methods In fall 2018, a cross-sectional analysis was performed on survey data from 4,374 low-dose computed tomography–eligible participants, as determined by Task Force recommendations. Weighted percentages were calculated to assess computed tomography screening utilization overall and by state, sociodemographic, and clinical characteristics; Wald chi-squared tests evaluated group differences. Results Within the study sample, 14.4% of eligible individuals had a computed tomography scan to test for lung cancer within the past 12 months. Significant state-to-state variation was identified (6.5% utilization in Nevada to 18.1% in Florida, p=0.03). Screening utilization was higher among individuals with insurance than among the uninsured (15.2% vs 4.0%, p<0.001), and it was higher among individuals with asthma (22.9% vs 12.9%, p=0.006) or chronic obstructive pulmonary disease (23.7% vs 8.5%, p<0.001) than among those without either condition. Conclusions Computed tomography screening utilization was higher than in earlier estimates. However, further research is needed to elucidate geographic variation in screening.

Use of a Preventive Index to Examine Clinic-Level Factors Associated With Delivery of Preventive Care Publication date: August 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 2 Author(s): Brigit A. Hatch, Carrie J. Tillotson, Nathalie Huguet, Megan J. Hoopes, Miguel Marino, Jennifer E. DeVoe Introduction There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applies a new measurement approach and assesses clinic-level factors associated with preventive care delivery. Methods This retrospective longitudinal cohort study of 94 community health centers used electronic health record data from the OCHIN community health information network, 2014–2015. Clinic-level preventive ratios (time covered by a preventive service/time eligible for a preventive service) were calculated in 2017 for 12 preventive services with A or B recommendations from the U.S. Preventive Services Task Force along with an aggregate preventive index for all services combined. For each service, multivariable negative binomial regression modeling and calculated rate ratios assessed the association between clinic-level variables and delivery of care. Results Of ambulatory community health center visits, 59.8% were Medicaid-insured and 10.4% were uninsured. Ambulatory community health centers served 16.9% patients who were Hispanic, 13.1% who were nonwhite, and 68.7% who had household incomes <138% of the federal poverty line. Clinic-level preventive ratios ranged from 3% (hepatitis C screening) to 93% (blood pressure screening). The aggregate preventive index including all screening measures was 47% (IQR, 42%–50%). At the clinic level, having a higher percentage of uninsured visits was associated with lower preventive ratios for most (7 of 12) preventive services. Conclusions Approaches that use individual preventive ratios and aggregate prevention indices are promising for understanding and improving preventive service delivery over time. Health insurance remains strongly associated with access to needed preventive care, even for safety net clinic populations.

Trends in Calories and Nutrients of Beverages in U.S. Chain Restaurants, 2012–2017 Publication date: August 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 2 Author(s): Johannah M. Frelier, Alyssa J. Moran, Kelsey A. Vercammen, Marian P. Jarlenski, Sara N. Bleich Introduction Although beverages comprise one third of all menu items at large chain restaurants, no prior research has examined trends in their calorie and nutrient content. Methods Beverages (n=13,879) on the menus of 63 U.S. chain restaurants were the final analytic sample obtained from a restaurant nutrition database (MenuStat, 2012–2017). For each beverage type, cluster-bootstrapped mixed-effects regressions estimated changes in mean calories, sugar, and saturated fat for beverages available on menus in all years and for newly introduced beverages. Data were analyzed in 2018. Results Traditional sugar-sweetened beverages, sweetened teas, and blended milk-based beverages (e.g., milkshakes) were significantly higher in calories from 2012 to 2017 for newly introduced beverages (p-value for trend <0.004). For all newly introduced sweetened beverages, sugar increased significantly (2015, +7.9 g; 2016, +8.2 g; p<0.004) whereas saturated fat declined (2016, −2.3 g; 2017, −1.6 g; p<0.004). For beverages on menus in all years, saturated fat declined significantly (p<0.001), whereas mean calories and sugar remained relatively constant. Significant declines were observed for sweetened coffees (−10 kcal, −0.5 g saturated fat, p<0.001), teas (−2.6 g sugar, p=0.001), and blended milk-based beverages (−28 kcal, −4.2 g sugar, −0.8 g saturated fat, p<0.001). From 2012 to 2017, the total number of beverage offerings increased by 155%, with 82% of this change driven by sweetened beverages. Conclusions Sweetened beverages available in large chain restaurants were consistently high in calories, sugar, and saturated fat and substantially increased in quantity and variety from 2012 to 2017.

Client and Provider Discomfort With an Adverse Childhood Experiences Survey Publication date: August 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 2 Author(s): Joshua P. Mersky, Chien-Ti Plummer Lee, Ross M. Gilbert Introduction Many service providers report concerns that questions about adverse events may upset clients. Studies indicate that most survey respondents answer sensitive questions without experiencing distress, although little is known about the prevalence or correlates of clients’ discomfort when they are asked similar questions by direct care providers, such as home visitors. Methods This study used data collected between 2013 and 2018 from 1,678 clients and 161 providers in a network of home visiting programs in Wisconsin. Clients and home visitors completed an adverse childhood experience questionnaire that concludes by asking about discomfort with the questions. Analyses conducted in 2018 examined overall client discomfort and associations between discomfort and the endorsement of 10 distinct adverse childhood experiences. Multilevel regressions were performed to test whether client and provider factors were associated with client discomfort. Results More than 80% of clients were not at all or slightly uncomfortable with the adverse childhood experience questionnaire, and 3% reported extreme discomfort. Bivariate results showed that each adverse childhood experience, except parental divorce, was associated with greater discomfort; sexual abuse was the only adverse childhood experience associated with discomfort in a multivariate analysis. Multiple client variables were linked to increased discomfort, including higher adverse childhood experience scores (b=0.06, 95% CI=0.04, 0.08) and depression scores (b=0.01, 95% CI=0.00, 0.02). Home visitor discomfort was positively associated with client discomfort (b=0.16, 95% CI=0.01, 0.31). Conclusions Results indicated that most clients in home visiting programs tolerated an adverse childhood experience questionnaire well. The findings point to clients who may be more likely to report discomfort and highlight an important association between client and provider discomfort.