Health Warnings on Sugar-Sweetened Beverages: Simulation of Impacts on Diet and Obesity Among U.S. Adults Publication date: Available online 17 October 2019 Source: American Journal of Preventive Medicine Author(s): Anna H. Grummon, Natalie R. Smith, Shelley D. Golden, Leah Frerichs, Lindsey Smith Taillie, Noel T. Brewer Introduction Overconsumption of sugar-sweetened beverage (SSB) is a significant contributor to obesity. Policymakers have proposed requiring health warnings on SSBs to reduce SSB consumption. Randomized trials indicate that SSB warnings reduce SSB purchases, but uncertainty remains about how warnings affect population-level dietary and health outcomes. Methods This study developed a stochastic microsimulation model of dietary behaviors and body weight using the 2005–2014 National Health and Nutrition Examination Surveys, research on SSB health warnings, and a validated model of weight change. In 2019, the model simulated a national SSB health warning policy's impact on SSB intake, total energy intake, BMI, and obesity among U.S. adults over 5 years. Sensitivity analyses varied assumptions about: (1) how warning efficacy changes over time, (2) the magnitude of warnings’ impact on SSB intake, and (3) caloric compensation. Results A national SSB health warning policy would reduce average SSB intake by 25.3 calories/day (95% uncertainty interval [UI]= −27.0, −23.6) and total energy intake by 31.2 calories/day (95% UI= −32.2, −30.1). These dietary changes would reduce average BMI by 0.64 kg/m2 (95% UI= −0.67, −0.62) and obesity prevalence by 3.1 percentage points (95% UI= −3.3%, −2.8%). Obesity reductions persisted when assuming warning efficacy wanes over time and when using conservative estimates of warning impact and caloric compensation. Benefits were larger for black and Hispanic adults than for white adults, and for adults with lower SES than for those with higher SES. Conclusions A national SSB health warning policy could reduce adults’ SSB consumption and obesity prevalence. Warnings could also narrow sociodemographic disparities in these outcomes.

Expanding Diabetes Prevention: Obstacles and Potential Solutions Publication date: Available online 15 October 2019 Source: American Journal of Preventive Medicine Author(s): Michael Bergman

Sugar-Sweetened Beverage Health Warnings and Purchases: A Randomized Controlled Trial Publication date: Available online 2 October 2019 Source: American Journal of Preventive Medicine Author(s): Anna H. Grummon, Lindsey S. Taillie, Shelley D. Golden, Marissa G. Hall, Leah M. Ranney, Noel T. Brewer Introduction Five U.S. states have proposed policies to require health warnings on sugar-sweetened beverages, but warnings’ effects on actual purchase behavior remain uncertain. This study evaluated the impact of sugar-sweetened beverage health warnings on sugar-sweetened beverage purchases. Study design Participants completed one study visit to a life-sized replica of a convenience store in North Carolina. Participants chose six items (two beverages, two foods, and two household products). One item was randomly selected for them to purchase and take home. Participants also completed a questionnaire. Researchers collected data in 2018 and conducted analyses in 2019. Setting/participants Participants were a demographically diverse convenience sample of 400 adult sugar-sweetened beverage consumers (usual consumption ≥12 ounces/week). Intervention Research staff randomly assigned participants to a health warning arm (sugar-sweetened beverages in the store displayed a front-of-package health warning) or a control arm (sugar-sweetened beverages displayed a control label). Main outcome measures The primary trial outcome was sugar-sweetened beverage calories purchased. Secondary outcomes included reactions to trial labels (e.g., negative emotions) and sugar-sweetened beverage perceptions and attitudes (e.g., healthfulness). Results All 400 participants completed the trial and were included in analyses. Health warning arm participants were less likely to be Hispanic and to have overweight/obesity than control arm participants. In intent-to-treat analyses adjusting for Hispanic ethnicity and overweight/obesity, health warnings led to lower sugar-sweetened beverage purchases (adjusted difference, −31.4 calories; 95% CI= −57.9, −5.0). Unadjusted analyses yielded similar results (difference, −32.9 calories; 95% CI= −58.9, −7.0). Compared with the control label, sugar-sweetened beverage health warnings also led to higher intentions to limit sugar-sweetened beverage consumption and elicited more attention, negative emotions, thinking about the harms of sugar-sweetened beverage consumption, and anticipated social interactions. Trial arms did not differ on perceptions of sugar-sweetened beverages’ added sugar content, healthfulness, appeal/coolness, or disease risk. Conclusions Brief exposure to health warnings reduced sugar-sweetened beverage purchases in this naturalistic RCT. Sugar-sweetened beverage health warning policies could discourage sugar-sweetened beverage consumption. Trial registration This study is registered at www.clinicaltrials.gov NCT03511937.

Disparities in Oral Cancer Screening Among Dental Professionals: NHANES 2011–2016 Publication date: October 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 4 Author(s): Avni Gupta, Stephen Sonis, Ravindra Uppaluri, Regan W. Bergmark, Alessandro Villa Introduction As early detection of oral cancers is associated with better survival, oral cancer screening should be included in dental visits for adults. This study examines the rate and predictors of oral cancer screening exams among U.S. adults with a recent dental visit. Methods Individuals aged ≥30 years who received a dental visit in the last 2 years, in the 2011–2016 National Health and Nutrition Examination Survey were analyzed in December 2018. Weighted multivariable logistic regression models examined the likelihood of intraoral and extraoral oral cancer screening exams, adjusting for age, sex, race/ethnicity, education, marital status, poverty income ratio, health insurance, tobacco smoking, and alcohol consumption. Subgroup analyses were conducted among races/ethnicities, smokers, and alcohol consumers. Statistical significance was set at p<0.01. Results A total of 37.6% and 31.3% reported receiving an intraoral and extraoral oral cancer screening exam, respectively. Minority racial/ethnic groups versus white, non-Hispanics, less-educated versus more-educated, uninsured and Medicaid-insured versus privately insured, and low-income versus high-income participants were less likely to have received intraoral or extraoral oral cancer screening exams. There was no difference in the likelihood of being screened based on smoking status. Alcohol consumers were more likely to be screened. Among subgroups, less-educated and low-income individuals were less likely to be screened. Conclusions A significantly higher proportion of minority race/ethnicity and low SES individuals report not receiving an oral cancer screening exam, despite a recent dental visit. This selective screening by dental professionals is incompliant with guidelines and concerning because these groups are more likely to present with an advanced stage of oral cancer at diagnosis. An understanding of the reasons for discriminatory oral cancer screening practices could help develop effective interventions.

Johnson SE, Holder-Hayes E, Tessman GK, King BA, Alexander T, Zhao X. Tobacco product use among sexual minority adults: findings from the 2012−2013 National Adult Tobacco Survey. Am J Prev Med. 2016;50(4):e91–e100. Publication date: October 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 4 Author(s):

MacDonald LA, Bertke S, Hein MJ, et al. Prevalence of cardiovascular health by occupation: a cross-sectional analysis among U.S. workers aged ≥45 years. Am J Prev Med. 2017;53(2):152–161. Publication date: October 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 4 Author(s):

Culp LA, Caucci L, Fenlon NE, Lindley MC, Nelson NP, Murphy TV. Assessment of state perinatal hepatitis B prevention laws. Am J Prev Med. 2016;51(6):e179–e185. Publication date: October 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 4 Author(s):

Adding Data From 2015 Strengthens the Association Between E-Cigarette Use and Myocardial Infarction Publication date: October 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 4 Author(s): Talal Alzahrani, Stanton A. Glantz

E-Cigarette Use and Myocardial Infarction: Importance of a Sound Evidence Base in the E-Cigarette Risks–Benefits Debate Publication date: October 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 4 Author(s): Michelle T. Bover Manderski, Binu Singh, Cristine D. Delnevo

Economics of Multicomponent Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening: A Community Guide Systematic Review Publication date: October 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 4 Author(s): Giridhar Mohan, Sajal K. Chattopadhyay, Donatus U. Ekwueme, Susan A. Sabatino, Devon L. Okasako-Schmucker, Yinan Peng, Shawna L. Mercer, Anilkrishna B. Thota, the Community Preventive Services Task Force Context The Community Preventive Services Task Force recently recommended multicomponent interventions to increase breast, cervical, and colorectal cancer screening based on strong evidence of effectiveness. This systematic review examines the economic evidence to guide decisions on the implementation of these interventions. Evidence acquisition A systematic literature search for economic evidence was performed from January 2004 to January 2018. All monetary values were reported in 2016 US dollars, and the analysis was completed in 2018. Evidence synthesis Fifty-three studies were included in the body of evidence from a literature search yield of 8,568 total articles. For multicomponent interventions to increase breast cancer screening, the median intervention cost per participant was $26.69 (interquartile interval [IQI]=$3.25, $113.72), and the median incremental cost per additional woman screened was $147.64 (IQI=$32.92, $924.98). For cervical cancer screening, the median costs per participant and per additional woman screened were $159.80 (IQI=$117.62, $214.73) and $159.49 (IQI=$64.74, $331.46), respectively. Two studies reported incremental cost per quality-adjusted life year gained of $748 and $33,433. For colorectal cancer screening, the median costs per participant and per additional person screened were $36.63 (IQI=$7.70, $139.23) and $582.44 (IQI=$91.10, $1,452.12), respectively. Two studies indicated a decline in incremental cost per quality-adjusted life year gained of $1,651 and $3,817. Conclusions Multicomponent interventions to increase cervical and colorectal cancer screening were cost effective based on a very conservative threshold. Additionally, multicomponent interventions for colorectal cancer screening demonstrated net cost savings. Cost effectiveness for multicomponent interventions to increase breast cancer screening could not be determined owing to the lack of studies reporting incremental cost per quality-adjusted life year gained. Future studies estimating this outcome could assist implementers with decision making.