Special Issue on Prevention Research for Inclusivity in People, Methods, and Outcomes
AJPM Focus envisions a world where preventive medicine and public health teaching, research, and practice are grounded in the principle of inclusivity in people, methods, and outcomes. The Oxford dictionary defines inclusivity as “the fact or quality of being inclusive, especially the practice or policy of not excluding any person on the grounds of race, gender, religion, age, disability, etc”. This journal embraces an expanded definition of inclusivity to also welcome diverse study methods and a variety of outcomes beyond those traditionally considered in the work of prevention. Unfortunately, much remains to be done to align prevention with this principle. This special issue presents cutting-edge prevention research evidence that reflects inclusivity across the domains of people, methods, and outcomes. In line with the journal’s scope, this issue covers the wide range of fields and subfields on the global spectrum of public health and preventive medicine research, education, and practice.
Cardiovascular Disease Risk Estimation for Transgender and Gender Diverse Patients: Cross-sectional Analysis of Baseline Data from the LITE Plus Cohort StudyCardiovascular disease is a leading cause of death among transgender and/or gender diverse people (TGD). A 30-year retrospective cohort study of adult transgender people on hormone therapy in Amsterdam found elevated cardiovascular disease-related mortality, with standardized mortality ratios as high as 2.6 among transgender women compared with cisgender women.1 In the U.S., approximately 2% of the adult population identifies as TGD.2 TGD people face a higher prevalence of poor cardiovascular health driven by intersecting structural, psychosocial, and biomedical factors.
Lung Cancer Screening Among U.S. Military Veterans by Health Status and Race and Ethnicity, 2017–2020: A Cross-Sectional Population-Based StudyLung cancer is the deadliest cancer in the U.S.1 Screening through low-dose computerized tomography (LDCT) can reduce death from lung cancer by 16%–24%2–4 among those without substantial comorbidities. Veterans are likely to benefit substantially from LCS: veterans have higher smoking prevalence5 and are of older age6 than nonveterans, which may increase lung cancer risk, and unique occupational exposures7,8 may further increase veterans’ cancer risk.9 Veterans are an important population to consider for lung cancer screening (LCS).
Heterogenous effects of local government spending on mortality across racial groups among working age adults in the USMortality among working-age adults, adults aged 25-64 years old, is higher in the United States compared to other high-income countries. Between 1990 and 2017, the United States experienced increases in mortality among working-age adults, and the gap between the US and other high-income countries widened.1 The patterns of increasing mortality among working-age adults vary by race, ethnicity, and geography. Although the Black-White gap in mortality has narrowed, Black working-age adults have consistently higher mortality rates than their White peers.
A Helmet of Her Own?: A Qualitative Study of Key Stakeholder Perspectives on Headgear in Girls’ LacrosseIn the U.S., girls’ and women's lacrosse is quickly growing in popularity across age and skill levels, seeing a nearly 54% increase in the number of high school–aged players alone between 2008 and 2018.1,2 This growth has highlighted significant concern over traumatic brain injuries (TBIs) in lacrosse, particularly over the incidence of concussions. During seasons played between 2008 and 2009 and 2018–2019, the national rate of concussions for high school girls’ lacrosse players was 3.91 per 10,000 athletic exposures.
Use of the Improvement Index to Evaluate Equitable COVID-19 Vaccine Allocation in the San Francisco Bay AreaIn the summer of 2021, the Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) became the dominant strain in the U.S.1 During this time, the Centers for Disease Control and Prevention recognized the San Francisco Bay Area as a hot spot on July 6, 2021, with rapidly increasing coronavirus disease 2019 (COVID-19) cases as well as hospitalizations and deaths.2 Although several Bay Area counties had higher vaccination coverage than the then national average of 64% in fall 2021, there were predictably large discrepancies between highly affluent and less affluent areas.
Screening for Hepatitis C Among Community Health Center Patients by Ethnicity and Language PreferenceHepatitis C virus (HCV) affects 2.4 million people in the United States and new HCV infections have tripled in recent years, 1 conjointly with the opioid crisis and rise of injection drug related infections. HCV is associated with high morbidity and mortality2, 3 impacting Latino populations disproportionately. 4-6 Chronic liver disease is a leading cause of death among Latinos in the United States (US), and Latinos experience a higher rate of HCV related deaths than non-Hispanic whites (6.8 vs 4.5 per 100,000).
Development of a Food List to Assess the Diet of South Asians Living in the U.S.: Preliminary Results From a Formative StudySouth Asians are among the fastest-growing immigrant group in the U.S.,1 with a health profile that places them at an increased risk for noncommunicable diseases.2 Our understanding of the role of diet in this increased risk remains limited. Although there are several dietary assessment methods available to assess food intake in adults and many that assess South Asian diet intake around the globe, tools that specifically examine the dietary intake of South Asian adults living in the U.S. are extremely limited.
Racial Discrimination, Social Disadvantage, and Racial–Ethnic Disparities in COVID-19 Vaccine UptakeRacism has been deemed a root cause of racial–ethnic health disparities in the U.S.1,2 During the pandemic, racial–ethnic disparities in coronavirus disease 2019 (COVID-19) infections, hospitalizations, and mortality3 are stark examples of the consequences of racism on health.4 Vaccination can reduce COVID-19 hospitalization and mortality rates, as highlighted in the 53.2 times greater risk of death among unvaccinated than among fully vaccinated individuals.5 However, early 2021 reports of COVID-19 vaccination uptake have documented much lower vaccination rates among Black and Latinx adults than among White and Asian adults.
Tetanus, Diphtheria, and Acellular Pertussis Vaccination Coverage Among Publicly Insured Pregnant Women, U.S., 2016–2019Despite consistently high vaccination coverage among children, pertussis continues to cause substantial morbidity in the U.S.; infants aged <1 year are at the highest risk of severe illness and death.1 Since 2011, the Advisory Committee on Immunization Practices (ACIP) has recommended vaccination with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) during pregnancy to protect infants against pertussis during the first 2 months of life before infant vaccinations begin.
Trends in Up-To-Date Colorectal Cancer Screening Among U.S. Adults Aged 50–75 Years and Variations by Race/Ethnicity and U.S. Census Bureau DivisionsColorectal cancer (CRC) is the third leading cause of cancer-related deaths, claiming >50,000 lives each year in the U.S.1 An estimated 150,000 new cases of CRC are projected for the U.S. in 2022,2 and most cases occur in people aged over 50 years.3,4 Screening for CRC, detection, and removal of precancerous lesions offer the opportunity to reduce CRC incidence. Hence the U.S. Preventive Services Task Force (USPSTF) recommends regular CRC screening in all adults aged 50–75 years (A recommendation) and, in 2021, updated screening guidelines to include adults aged 45–49 years at average risk for CRC (B recommendation).
A Comparison of COVID-19 Outcomes Between Reservation-Area American Indian and U.S. National StudentsThe coronavirus disease 2019 (COVID-19) pandemic has led to multiple deaths and disruptions in health, economic security, and well-being worldwide. Although youth may be at lower risk,1 they are not immune from its effects. Even when not infected, youth experience stressors, including school disruptions, home confinement, grief, and uncertainty regarding safety and security.2,3 Youth report worry related to COVID-194 depression and substance-use coping, with those reporting depressive symptoms more likely to engage in substance-related coping.
Opportunities and Challenges: Hepatitis C Testing and Treatment Access Experiences Among People in Methadone and Buprenorphine Treatment During COVID-19, Arizona, 2021Since 2014, the possibility of hepatitis C virus (HCV) elimination has emerged because of safe and effective oral curative treatment.1 Community-based rapid screening among populations at risk for HCV helped to characterize the need for innovative public health approaches and policy changes through reported implementation challenges and successful screening, which more accurately defined the need for HCV curative treatment. Although some U.S. states strengthened systems and policies to eliminate HCV in their communities,2 differences in state health policy environments continue to hamper national efforts to eliminate HCV.
A Systematic Review Evaluating Disparities in State-Run Quitline Utilization and Effectiveness in the U.S.Nearly 14% of adults smoke cigarettes in the U.S.,1 but certain population subgroups smoke at disproportionately higher rates. For example, males, American Indian and Alaskan Native individuals (AI/ANs), individuals of lower SES, and individuals who identify as sexual and gender minority (SGM) report higher cigarette usage than females, non-Hispanic White individuals, individuals of higher SES, and individuals who do not identify as SGM, respectively.1 An abundance of tobacco-related disparities persist, especially for communities that have been historically marginalized in the U.S.
Disparities and Trends in Routine Adult Vaccination Rates Among Disaggregated Asian American Subgroups, National Health Interview Survey 2006–2018Vaccine-preventable diseases cause thousands of hospitalizations and deaths in the U.S. every year.1–3 Reducing vaccine-preventable diseases and other disparities in preventive healthcare is a major goal of Healthy People 2030.4 However, racial and ethnic minorities have lower vaccination rates than White Americans.5 Although some vaccine-preventable diseases such as hepatitis B disproportionately impact Asian Americans, vaccination rates in the U.S. among Asian Americans are low.1,6,7
Group Randomized Trial of Healthy Eating and Gardening Intervention in Navajo Elementary Schools (Yéego!)School-based interventions to promote healthy eating choices and other health behaviors have been implemented across the U.S., but too few have been rigorously evaluated for their efficacy,1–3 particularly in American Indian communities.4,5 National guidelines define and promote healthy eating practices,6 yet the gap between guidelines and behavior change in the population remains large. Just as important as the rigorously derived scientific evidence that dietary choices impact health, rigorous evaluations of interventions are needed so that guidelines can be put into practice.
Measurement and Operationalization of the Social Determinants of Health and Long-Acting Reversible Contraception Use in the U.S.: A Systematic Scoping ReviewLong-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) or implants are considered some of the most innovative reproductive health technologies of contemporary medicine.1 Public health and medical professionals endorse LARC as a means of preventing unintended pregnancy because of its high effectiveness and low rate of human error.2,3 Unintended pregnancy rates across racial, ethnic, and socioeconomic groups are considered a persistent clinical and public health problem because of the association of unintended pregnancy with adverse maternal and infant health, financial outcomes, and social outcomes (e.g., decreased educational attainment).
Racial Disparities in Neighborhood and Household Socioeconomic Disadvantage Predict Postpartum Weight RetentionAlthough weight gain is a natural occurrence in pregnancy, a higher postpartum weight may be related to gestational weight gain, which has health implications, including cardiometabolic disease.1 Postpartum weight retention (PWR) is linked to both prepregnancy weight and gestational weight gain, a modifiable risk factor for pregnancy complications and future cardiovascular disease.1,2 Evidence indicates that 48% of pregnant women gain more weight than recommended by the National Academy of Medicine guidelines,3 and most women retain above 5 kg by 1 year after delivery,4,5 altering the trajectory of lifetime weight gain and incidence of cardiovascular disease.