Preventive medicine
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Preventive medicine · Sep 2021
Assessing quality-adjusted years of life lost associated with exclusive cigarette smoking and smokeless tobacco use.
The main purpose of this analysis is to quantify quality adjusted life years (QALYs) lost associated with lifetime exclusive cigarette or smokeless tobacco use among U. S. adults. Multiple waves of National Health Interview Survey (NHIS) data linked to death certificate records were used to define current exclusive cigarette and smokeless tobacco use and associated mortality risks. ⋯ Male current exclusive cigarette smokers, aged 25 to 29 years would lose 8.1 QALYs (SE = 0.09), and male current exclusive smokeless tobacco users aged 25 to 34 would lose 4.1 QALYs (SE = 0.22), compared to never users of tobacco. Current exclusive cigarette or smokeless tobacco use is associated with QALY loss. QALYs lost can be lessened through preventing the initiation of tobacco product use or helping tobacco product users quit as early in life as possible.
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Preventive medicine · Sep 2021
Body mass, cardiorespiratory fitness, and cardiometabolic risk over time: Findings from the Cooper Center Longitudinal Study.
Few studies have adequately assessed the simultaneous effects of changes in cardiorespiratory fitness (fitness) and body mass on cardiometabolic risk. Hence, the current study's aims were twofold: (1) To determine whether increases in body mass result in higher cardiometabolic risk after controlling for fitness changes; and (2) To assess whether increases in fitness result in lower cardiometabolic risk after controlling for weight changes. The study consisted of 3534 patients who came for preventive medicine visits ≥4 times over any 10-year period (1979-2019). ⋯ Moreover, body mass change was significantly related to changes in all cardiometabolic components of MetS. Fitness change was significantly associated with changes in MetS components. Future interventions should focus concurrently on increasing fitness and on body mass loss (or maintenance) to improve cardiometabolic health.
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Preventive medicine · Sep 2021
Household food insecurity and in-utero and early life smoke exposure: Data from NHANES 2003-2016.
In-utero, postnatal, and childhood smoke exposure are associated with adverse health consequences, and examining factors related to smoke exposure during these vulnerable periods are critical to inform efforts that promote maternal and child health. This study included pregnant and postpartum women aged 20-44 years and children aged 3-12 years from National Health and Nutrition and Examination Survey (NHANES) 2003-2016 cycles. Logistic regression examined association of household food insecurity with firsthand (FHS) and secondhand (SHS) exposure among pregnant and postpartum women, and SHS exposure among children, based on serum cotinine and respondent-reports. ⋯ Using respondent-reported smoking status, low food security in pregnant and postpartum women was significantly related to increased odds of FHS exposure (OR(95% CI) = 3.75(1.52, 9.23)). Further, children from marginal, low and very low food secure households had significantly higher odds of SHS exposure compared to those from food secure households. Results imply the co-occurrence food insecurity and in-utero and early life smoke exposure.
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Preventive medicine · Sep 2021
Beyond "Safe and Effective": The urgent need for high-impact smoking cessation medications.
Smoking cessation medications (SCMs) are an evidence-based cornerstone of comprehensive tobacco control programs globally. However, the impact of SCMs on population smoking prevalence is controversial, with inconsistencies between randomized controlled trials (RCTs) and population-based observational studies. We estimated SCM impact on permanent cessation and population smoking prevalence by extrapolating efficacy estimates from meta-analyses of RCTs, using the standard population impact formula: efficacy*reach. ⋯ Even under ideal conditions, the potential of current first-line SCMs to increase cessation in a substantial proportion of smokers, and reduce population smoking prevalence, is limited. In order to avert the predicted billion tobacco-caused deaths in this century, "safe and effective" medications are not sufficient: SCMs with high population impact are urgently needed. Policies to ensure the availability and accessibility of highly efficacious SCMs, with behavioral support, are crucial.
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Preventive medicine · Sep 2021
Out-of-pocket costs for preventive care persist almost a decade after the Affordable Care Act.
Higher cost-sharing reduces the amount of high-value health care that patients use, such as preventive care. Despite a sharp reduction in out-of-pocket (OOP) costs for preventive care after the implementation of the Affordable Care Act (ACA), patients often still get unexpected bills after receiving preventive services. We examined out-of-pocket costs for preventive care in 2018, almost ten years after the implementation of the ACA. ⋯ We found that in addition to premium costs meant to cover preventive care, Americans with employer-sponsored insurance were still charged between $75 million and $219 million in total for services that ought to be free to them ($0.50 to $1.40 per ESI-covered individual and $0.75 to $2.17 per ESI-covered individual using preventive care). However, some enrollees still faced OOP costs for eligible preventive services ranging into the hundreds of dollars. OOP costs are most likely to be incurred for women's services (e.g., contraception) and basic screenings (e.g., diabetes and cholesterol screenings), and by patients in the South or in rural areas.