American journal of preventive medicine
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Identification of groups with poor cardiovascular health (CVH) can inform where and how to target public health efforts. National prevalence estimates of CVH were derived for clinical (blood glucose, total cholesterol, blood pressure) and behavioral (BMI, diet quality, physical activity, smoking) factors among U.S. workers aged ≥45 years. ⋯ The prevalence of optimal CVH among middle-aged and older workers in the U.S. is low, but considerable differences exist by occupation. Targeted public health interventions may improve the CVH of at-risk older workers with different clinical and behavioral risk factor profiles employed in diverse occupational settings.
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Comparative Study
Smoking-Cessation Assistance: Before and After Stage 1 Meaningful Use Implementation.
Brief smoking-cessation interventions in primary care settings are effective, but delivery of these services remains low. The Centers for Medicare and Medicaid Services' Meaningful Use (MU) of Electronic Health Record (EHR) Incentive Program could increase rates of smoking assessment and cessation assistance among vulnerable populations. This study examined whether smoking status assessment, cessation assistance, and odds of being a current smoker changed after Stage 1 MU implementation. ⋯ Findings suggest that incentives for MU of EHRs increase the odds of smoking assessment and cessation assistance, which could lead to decreased smoking rates among vulnerable populations. Continued efforts for provision of cessation assistance among pregnant patients is warranted.
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To support claims that RCTs can reduce health disparities (i.e., are translational), it is imperative that methodologies exist to evaluate the tenability of external validity in RCTs when probabilistic sampling of participants is not employed. Typically, attempts at establishing post hoc external validity are limited to a few comparisons across convenience variables, which must be available in both sample and population. A Type 2 diabetes RCT was used as an example of a method that uses a geographic information system to assess external validity in the absence of a priori probabilistic community-wide diabetes risk sampling strategy. ⋯ Location is a highly reliable "principal variable" associated with health disparities. It serves as a directly measurable proxy for high-risk underserved communities, thus offering an effective and practical approach for examining external validity of RCTs.
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The purpose of this study was to evaluate if adding SES to risk prediction models based upon traditional risk factors improves the prediction of diabetes. ⋯ Standard diabetes risk models may underestimate risk for low-SES individuals and overestimate risk for those of high SES. Adding SES predictors helps correct this systematic misestimation, but may not improve model discrimination.
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Comparative Study
Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013-2014).
The 2009 Family Smoking Prevention and Tobacco Control Act banned characterizing flavors other than menthol in cigarettes but did not restrict their use in other forms of tobacco (e.g., smokeless, cigars, hookah, e-cigarettes). ⋯ These results add to the evidence base that flavored tobacco products may attract young users and serve as starter products to regular tobacco use.