American Journal of Preventive Medicine

Sexually Transmitted Infections and Contraceptive Use in Adolescents Publication date: Available online 17 February 2020 Source: American Journal of Preventive Medicine Author(s): Karen J. Derefinko, Sydney Ashby, Tristan Hayes, Cameron Kaplan, Zoran Bursac, Francisco I. Salgado García, Amy Madjlesi, Leah Tonkin, Michelle Bowden, Filoteia Popescu, Teresa Waters Introduction Although a number of contraception methods exist, long-acting reversible contraceptives have been recommended for female adolescents owing to their low failure rates. However, concern exists that the increasing use of long-acting reversible contraceptive among female adolescents may have unintended consequences of decreasing condom use for the prevention of sexually transmitted infections. Despite this concern, few studies have directly explored the relationship between the use of long-acting reversible contraceptive versus other forms of contraception and diagnosis of sexually transmitted infections in female adolescents. This study compares the rates of sexually transmitted infection diagnosis following various forms of contraceptive use. Methods This study was an archival data analysis of single state Medicaid claims retrieved for female adolescents, aged 14–19 years, who received a contraceptive prescription and had 1 year of follow-up data available (n=62,550) between 2011 and 2015. Incidence of sexually transmitted infections was the outcome of interest. Data analysis was conducted in 2018. Results Compared with the contraceptive pill, hormonal implant (a form of long-acting reversible contraceptives) was associated with significantly lower risk of sexually transmitted infections (hazard ratio=0.81; 95% CI=0.70, 0.93; p=0.004), and hormonal injection was associated with higher risk of sexually transmitted infections (hazard ratio=1.08; 95% CI=1.00, 1.16; p=0.040). Conclusions This analysis provides strong evidence that the risk for the acquisition of sexually transmitted infections is no higher for long-acting reversible contraceptives than for other forms of contraception. These results support the use of long-acting reversible contraceptive in female adolescents, as proposed and reaffirmed by the American College of Obstetricians and Gynecologists and American Academy of Pediatrics.

Older Adults’ Physical Activity and Healthcare Costs, 2003–2014 Publication date: Available online 14 February 2020 Source: American Journal of Preventive Medicine Author(s): Mikihiro Sato, James Du, Yuhei Inoue, Daniel C. Funk, France Weaver Introduction Research has documented the health benefits of physical activity among older adults, but the relationship between physical activity and healthcare costs remains unexplored at the population level. Using data from 50 U.S. states and the District of Columbia, this study investigates the extent to which physical activity prevalence is associated with healthcare costs among older adults. Methods Twelve-year state-level data (2003–2014) were obtained from 5 secondary sources (n=611). Healthcare costs were captured by Medicare Parts A and B spending. Fixed-effect models were estimated in 2019 to assess the relationship between the state-level physical activity prevalence and Medicare costs. The potential lagged associations were captured by lagged variables of physical activity prevalence (i.e., t−1, t−2, and t−3). Results Physical activity prevalence was not associated with Medicare costs occurring in the concurrent and subsequent year (p>0.05); however, the 2-year lagged variable (p=0.03) and the 3-year lagged variable (p=0.01) for physical activity prevalence were negatively associated with Medicare costs, indicating a time-lagged relationship. It was estimated that a 10 percentage point increase in physical activity prevalence in each state is associated with reduced Medicare Parts A and B costs of 0.4% after 2 years and 1.0% after 3 years. Conclusions Results revealed a time lag effect highlighted by a delayed inverse relationship between state-level physical activity prevalence and healthcare costs among older adults. This evidence offers governments and communities new insights to guide policymaking on long-term public investment in physical activity intervention programs.

Effect of an Intervention for Obesity and Depression on Patient-Centered Outcomes: An RCT Publication date: Available online 14 February 2020 Source: American Journal of Preventive Medicine Author(s): Lisa G. Rosas, Kristen M.J. Azar, Nan Lv, Lan Xiao, Jeremy D. Goldhaber-Fiebert, Mark B. Snowden, Elizabeth M. Venditti, Megan M. Lewis, Andrea N. Goldstein-Piekarski, Jun Ma Introduction An integrated collaborative care intervention was successful for treating comorbid obesity and depression. The effect of the integrated intervention on secondary outcomes of quality of life and psychosocial functioning were examined, as well as whether improvements in these secondary outcomes were correlated with improvements in the primary outcomes of weight and depressive symptoms. Study design This RCT compared an integrated collaborative care intervention for obesity and depression to usual care. Data were analyzed in 2018. Setting/participants Adult primary care patients (n=409) with a BMI ≥30 (≥27 if Asian) and 9-Item Patient Health Questionnaire score ≥10 were recruited from September 30, 2014 to January 12, 2017 from primary care clinics in Northern California. Intervention The 12-month intervention integrated a behavioral weight loss program and problem-solving therapy with as-needed antidepressant medications for depression. Main outcome measures A priori secondary outcomes included health-related quality of life (Short Form-8 Health Survey), obesity-specific quality of life (Obesity-Related Problems Scale), sleep disturbance and sleep-related impairment (Patient-Reported Outcomes Measurement Information System), and functional disability (Sheehan Disability Scale) at baseline and 6 and 12 months. Results Participants randomized to the intervention experienced significantly greater improvements in obesity-specific problems, mental health–related quality of life, sleep disturbance, sleep-related impairment, and functional disability at 6 months but not 12 months. Improvements in obesity-related problems (β=0.01, 95% CI=0.01, 0.02) and sleep disturbance (β= −0.02, 95% CI= −0.04, 0) were associated with lower BMI. Improvements in the physical (β= −0.01, 95% CI= −0.01, 0) and mental health components (β= −0.02, 95% CI= −0.03, −0.02) of the Short Form-8 Health Survey as well as sleep disturbance (β=0.01, 95% CI=0.01, 0.02) and sleep-related impairment (β=0.01, 95% CI=0, 0.01) were associated with fewer depressive symptoms. Conclusions An integrated collaborative care intervention for obesity and depression that was shown previously to improve weight and depressive symptoms may also confer benefits for quality of life and psychosocial functioning over 6 months. Trial registration This study is registered at clinicaltrials.gov NCT02246413.

Cardiovascular Disease Guideline Adherence: An RCT Using Practice Facilitation Publication date: Available online 14 February 2020 Source: American Journal of Preventive Medicine Author(s): Donna R. Shelley, Thomas Gepts, Nina Siman, Ann M. Nguyen, Charles Cleland, Allison M. Cuthel, Erin S. Rogers, Olugbenga Ogedegbe, Hang Pham-Singer, Winfred Wu, Carolyn A. Berry Introduction Practice facilitation is a promising practice transformation strategy, but further examination of its effectiveness in improving adoption of guidelines for multiple cardiovascular disease risk factors is needed. The objective of the study is to determine whether practice facilitation is effective in increasing the proportion of patients meeting the Million Hearts ABCS outcomes: (A) aspirin when indicated, (B) blood pressure control, (C) cholesterol management, and (S) smoking screening and cessation intervention. Design The study used a stepped-wedge cluster RCT design with 4 intervention waves. Data were extracted for 13 quarters between January 1, 2015 and March 31, 2018, which encompassed the control, intervention, and follow-up periods for all waves, and analyzed in 2019. Setting/participants A total of 257 small independent primary care practices in New York City were randomized into 1 of 4 waves. Intervention The intervention consisted of practice facilitators conducting at least 13 practice visits over 1 year, focused on capacity building and implementing system and workflow changes to meet cardiovascular disease care guidelines. Main outcome measures The main outcomes were the Million Hearts’ ABCS measures. Two additional measures were created: (1) proportion of tobacco users who received a cessation intervention (smokers counseled) and (2) a composite measure that assessed the proportion of patients meeting treatment targets for A, B, and C (ABC composite). Results The S measure improved when comparing follow-up with the control period (incidence rate ratio=1.152, 95% CI=1.072, 1.238, p<0.001) and when comparing follow-up with intervention (incidence rate ratio=1.060, 95% CI=1.013, 1.109, p=0.007). Smokers counseled improved when comparing the intervention period with control (incidence rate ratio=1.121, 95% CI=1.037, 1.211, p=0.002). Conclusions Increasing the impact of practice facilitation programs that target multiple risk factors may require a longer, more intense intervention and greater attention to external policy and practice context. Trial registration This study is registered at www.clinicaltrials.gov NCT02646488.

Tuberculosis Infection Among People With Diabetes: United States Population Differences by Race/Ethnicity Publication date: Available online 13 February 2020 Source: American Journal of Preventive Medicine Author(s): Maryam B. Haddad, Timothy L. Lash, Kenneth G. Castro, Andrew N. Hill, Thomas R. Navin, Neel R. Gandhi, Matthew J. Magee Introduction Diabetes might confer a modestly increased risk of latent tuberculosis infection, which without treatment can progress to active tuberculosis disease. Three recent analyses of the National Health and Nutrition Examination Survey found a positive association between diabetes and a positive test for Mycobacterium tuberculosis infection. This study examines whether prevalence of a positive test still varies by diabetes status after stratifying by race/ethnicity. Methods This cross-sectional analysis used the public-use National Health and Nutrition Examination Survey 2011–2012 data sets and was conducted in 2018–2019. Interview and examination results for 5,560 adult participants yielded estimates for 219 million U.S. adults in the 4 largest race/ethnicity groups. The weighted prevalence of positive tuberculin skin test or interferon-gamma release assay by diabetes status was ascertained in each group. Results Among white and black adults, diabetes was associated with no difference in positive skin test prevalence and little difference in positive interferon-gamma release assay prevalence. The positive assay prevalence difference was +14.5% (95% CI=2.3%, 26.7%) among Hispanic and +9.9% (95% CI=1.2%, 18.6%) among Asian adults, when comparing those with diabetes with those with neither diabetes nor prediabetes. Based on assay results, 23.6% (95% CI=14.0%, 36.9%) of Hispanic and 27.2% (95% CI=19.6%, 36.5%) of Asian adults with diabetes also had latent tuberculosis infection. Conclusions Hispanic and Asian subpopulation results drove much of the previously reported positive association between diabetes and a positive test for M. tuberculosis infection. Hispanic and Asian adults with diabetes might particularly benefit from screening and treatment for latent tuberculosis infection.

Perception of Safety and Its Association With Physical Activity in Adolescents in Mexico Publication date: Available online 13 February 2020 Source: American Journal of Preventive Medicine Author(s): Maria E. Hermosillo-Gallardo, Simon J. Sebire, Russell Jago Introduction Low levels of physical activity are associated with several noncommunicable diseases. In Mexico, 39.5% of adolescents do not meet WHO physical activity guidelines. Previous literature suggests an association between perception of safety and physical activity. This paper examines the association between perceived crime and pedestrian safety and physical activity in Mexican adolescents. Methods This cross-sectional study used data from 4,079 adolescents aged 15–18 years in Mexico. Physical activity was measured with the Youth Physical Activity Questionnaire and was grouped into the following 5 domains: (1) moderate-to-vigorous physical activity, (2) sports activity, (3) leisure time activity, (4) physical education class, and (5) active commuting to school. Perception of safety was measured as pedestrian safety and crime safety, using the Neighborhood Environment Walkability Scale-Youth. Confirmatory factor analysis was performed to examine the construct validity of this scale on the Mexican population. Data were collected in 2017 and analyzed in 2018. Associations between physical activity and perception of safety were examined using linear regression models. Results Low perception of pedestrian safety was associated with lower moderate-to-vigorous physical activity per week (coefficient= −0.12, 95% CI= −0.19, −0.05) and lower sports activity per week (coefficient= −0.13, 95% CI= −0.23, −0.03) in female adolescents. There was no association between perception of safety and physical activity among male adolescents. Conclusions Pedestrian safety was negatively associated with moderate-to-vigorous physical activity and sports participation in female youth. Environments with better lighting, crosswalks, and walking/cycle trails could increase physical activity in female youth.

Secondhand Smoking and Depressive Symptoms Among In-School Adolescents Publication date: Available online 12 February 2020 Source: American Journal of Preventive Medicine Author(s): Louis Jacob, Lee Smith, Sarah E. Jackson, Josep Maria Haro, Jae Il Shin, Ai Koyanagi Introduction Smoking has been linked with depressive symptoms in adolescents, but data on secondhand smoking and depressive symptoms in low- and middle-income countries are scarce. Thus, this study analyzes the association between secondhand smoking and depressive symptoms among in-school adolescents from 22 low- and middle-income countries. Methods Data from the 2003–2008 Global School-Based Student Health Survey were analyzed in June 2019. Data on past-week exposure to secondhand smoke and past-year depressive symptoms were collected. The association between secondhand smoke and depressive symptoms was studied using multivariable logistic regressions and meta-analyses. Results The sample consisted of 37,505 adolescents aged 12–15 years who never smoked. The prevalence of depressive symptoms increased from 23.0% in adolescents with no secondhand smoking to 28.9% in those with secondhand smoking every day in the past week. After adjusting for sex, age, food insecurity, and country, there was a dose–response relationship between secondhand smoking and depressive symptoms in the overall sample (0 days: reference; 1–2 days: OR=1.06, 95% CI=0.95, 1.18; 3–6 days: OR=1.38, 95% CI=1.20, 1.58; 7 days: OR=1.63, 95% CI=1.44, 1.86). The country-wise analysis showed that secondhand smoking on at least 3 days (versus <3 days) in the past week was associated with a 1.48-fold increase in the odds of depressive symptoms (95% CI=1.39, 1.59), with a low level of between-country heterogeneity (I2=4.2%). Conclusions There was a positive association between secondhand smoking and depressive symptoms among in-school adolescents from low- and middle-income countries. Further research should investigate causality and assess whether prevention of exposure to secondhand smoke can have a positive effect on the mental well-being of adolescents.

Change and Stability in the Characteristics of the Population Without Health Insurance Publication date: Available online 12 February 2020 Source: American Journal of Preventive Medicine Author(s): Edward R. Berchick Introduction The uninsured population faces greater health risks than the insured population. Although prior research has examined how the uninsured rate has changed for various sociodemographic groups, less is known about how the characteristics of the uninsured population have changed in recent years. Methods The analyses used 1-year American Community Survey data from 2013 through 2018 on the noninstitutionalized civilian population aged 19–64 years to examine trends in the characteristics of the U.S. uninsured population. Analyses also explored the importance of social and demographic change in the overall U.S. population by decomposing the change in the uninsured rate between 2013 and 2018. Results In 2018, the profile of the uninsured population differed from that of the noninstitutionalized civilian population aged 19–64 years with respect to a number of characteristics, including age, sex, and socioeconomic resources. Between 2013 and 2018, southern individuals and those with less than a high school education comprised a disproportionate share of the uninsured population. However, compositional changes did not drive the overall decline in the uninsured rate. Conclusions Although prior research has considered changes in the uninsured rate for key sociodemographic groups, fewer studies have considered how these changes affected the composition of the uninsured population in the U.S. The profile of the uninsured population, which has changed over time, can help to inform interventions to target this group.

Poor Health and Violent Crime Hot Spots: Mitigating the Undesirable Co-Occurrence Through Focused Place-Based Interventions Publication date: Available online 12 February 2020 Source: American Journal of Preventive Medicine Author(s): Beidi Dong, Clair M. White, David L. Weisburd Introduction The geographic overlap of violence and poor health is a major public health concern. To understand whether and how place-based interventions targeting micro-geographic places can reduce this undesirable co-occurrence, the study addresses 2 important questions. First, to what extent are deteriorated health conditions associated with living at violent crime hot spots? Second, through what mechanisms can focused place-based interventions break the association between living with violence and deteriorated health? Methods This study used survey data from 2,724 respondents living on 328 street segments that were categorized as violent crime hot spots (181 segments with 1,532 respondents) versus non–hot spots (147 segments with 1,192 respondents) in 2013–2014 in Baltimore, Maryland. Propensity score analysis assessed whether individuals living at violent crime hot spots had lower general health perceptions than people living at non–hot spots. Marginal structural models estimated the proportion of total effects mediated by 3 theoretically informed intervening mechanisms. Analyses were conducted in 2019. Results Respondents living at violent crime hot spots had a lower level of self-rated general health (b= −0.096, 95% CI= −0.176, −0.015) and higher levels of health limitations (b=0.068, 95% CI=0.027, 0.109) and problems (OR=2.026, 95% CI=1.225, 3.349) than those living at non–hot spots. Enhanced perceptions of safety, collective efficacy, and police legitimacy may break the association between living in places with extremely high levels of violence and deteriorated health. Conclusions Indicated or selective strategies are urgently needed to target micro-geographic locations with known increased risks, supplementing universal strategies applied to a broader community.

Prenatal Drinking in the Northern Plains: Differences Between American Indian and Caucasian Mothers Publication date: Available online 12 February 2020 Source: American Journal of Preventive Medicine Author(s): Ping Ye, Jyoti Angal, Deborah A. Tobacco, Amy R. Willman, Christa A. Friedrich, Morgan E. Nelson, Larry Burd, Amy J. Elliott Introduction Prenatal alcohol exposure is associated with adverse pregnancy outcomes such as fetal alcohol spectrum disorders. The study characterizes the pattern and risk factors of alcohol use during pregnancy for American Indian and Caucasian mothers in the Northern Plains. Methods A general population of pregnant women was recruited from 5 sites, including 2,753 Caucasians and 2,124 American Indians (2006–2017). Alcohol consumption was based on self-report using a modified Timeline Followback interview, administered 3–4 times during pregnancy and 1 month postpartum. Risk for prenatal drinking was calculated using logistic regression models after controlling for demographics, reproductive history, prenatal care, mental health, and SES. The analysis was conducted in 2019. Results More Caucasian mothers consumed alcoholic beverages during pregnancy than American Indians (63% vs 52%), whereas more American Indian mothers were binge drinkers than Caucasians (41% vs 28%). American Indian mothers had a lower risk of drinking in the second and third trimesters and postpartum, but a higher risk of binge drinking in the first trimester compared with Caucasians. Frequent relocation increased the risk of prenatal alcohol use among American Indian mothers, whereas age, marriage, income, parity, and fertility treatment affected the risk of prenatal drinking among Caucasian mothers. Conclusions Alcohol use was more prevalent among Caucasian mothers. Among those who consumed alcohol during pregnancy, American Indian mothers consumed larger quantities. Change of residence was found to be the sole risk factor for prenatal drinking among American Indian mothers, whereas different and multiple risk factors were found for Caucasian mothers.