Public Health Benefits Research Articles

"Post-Protean" Public Health and the Geroscience Hypothesis.

Despite unprecedented investments in public health and biomedical research, improvements in life expectancy and healthy life expectancy have stagnated in the United States. Part of the reason for this development can be traced back to the influence of "Protean" over "Post-Protean" public health, the names that can be given to two contrasting visions of public health advanced in the early twentieth century. Protean public health prescribes "waging a war" against disease and was successful in reducing the early-life mortality risks from infectious disease. But Protean public health has proven less effective in improving the quality of life of older persons. Post-Protean public health prioritizes the experimental method and research into the indirect methods of improving health. It articulated a vision of public heath that was given a more concrete specification by Alex Comfort in what is now referred to as the Geroscience Hypothesis. To improve the health prospects of aging populations the dominance of Protean public health must be relaxed, to enable the benefits of Post-Protean public health to be realized. Doing so means shifting public health's aspirations towards increasing the healthspan vs "saving lives" by extending the duration of time older persons can survive by managing the multi-morbidities of late life.

Equitable Access to Nature and Transformational Politics

abstract: Vietnamese Zen Master Thich Nhat Hanh's (1926–2022) account of the nearly two years he spent as a fugitive in the Dai Lao Forest among the Indigenous Highlanders of Vietnam in his memoir Fragrant Palm Leaves demonstrates the transformational political potential associated with such access to nature. Based on this and recent work like Tiya Miles's 2023 book Wild Girls: How the Outdoors Shaped the Women Who Challenged a Nation , I propose that contemporary environmental activism toward more equitable access to nature in the United States should better highlight this transformational political potential—understood as dismantling systemic ecological and social injustice—in addition to offering public and mental health benefits.

Race, Poverty Status at Birth, and DNA Methylation of Youth at Age 15.

Epigenetic studies, which can reflect biological aging, have shown that measuring DNA methylation (DNAm) levels provides new insights into the biological effects of social environment and socioeconomic position (SEP). This study explores how race, family structure, and SEP (income to poverty ratio) at birth influence youth epigenetic aging at age 15. Data were obtained from the Future of Families and Child Wellbeing Study (FFCWS) cohort, with GrimAge used as a measure of DNAm levels and epigenetic aging. Our analysis included 854 racially and ethnically diverse participants followed from birth to age 15. Structural equation modeling (SEM) examined the relationships among race, SEP at birth, and epigenetic aging at age 15, controlling for sex, ethnicity, and family structure at birth. Findings indicate that race was associated with lower SEP at birth and faster epigenetic aging. Specifically, income to poverty ratio at birth partially mediated the effects of race on accelerated aging by age 15. The effect of income to poverty ratio at birth on DNAm was observed in male but not female youth at age 15. Thus, SEP partially mediated the effect of race on epigenetic aging in male but not female youth. These results suggest that income to poverty ratio at birth partially mediates the effects of race on biological aging into adolescence. These findings highlight the long-term biological impact of early-life poverty in explaining racial disparities in epigenetic aging and underscore the importance of addressing economic inequalities to mitigate these disparities. Policymakers should focus on poverty prevention in Black communities to prevent accelerated biological aging and associated health risks later in life. Interventions aimed at eliminating poverty and addressing racial inequities could have significant long-term benefits for public health. Future research should explore additional factors contributing to epigenetic aging and investigate potential interventions to slow down the aging process. Further studies are needed to understand the mechanisms underlying these associations and to identify effective strategies for mitigating the impact of SEP and racial disparities on biological aging.

Inaction in Urban Climate Policy Undermines Health.

This paper investigates the critical intersection of urban climate policy and public health, emphasizing the pressing need for integrated strategies to address the intertwined challenges of climate change and health in urban settings. Despite cities being central to global emissions and energy consumption, a significant gap exists in the incorporation of health considerations into urban climate strategies, as evidenced by the analysis of urban content in Nationally Determined Contributions (NDCs). The paper highlights the Coalition for High Ambition Multilevel Partnerships (CHAMP) initiative and the forthcoming Intergovernmental Panel on Climate Change (IPCC) Special Report as pivotal moments for integrating climate and health agendas. However, it also points out the underwhelming response from cities in adopting comprehensive climate strategies, which undermines potential public health benefits. With substantial investments required to bridge the gap in health-focused climate resilience, the paper calls for a redefined approach to urban climate policy. This approach should prioritize health outcomes, leverage opportunities like the 15-Minute City concept, and foster the development of infrastructures that support both climate resilience and public health. The upcoming NDC revision cycle is identified as a critical opportunity for embedding health imperatives into urban climate strategies, emphasizing the need for a holistic perspective that views urban areas as ecosystems where climate and health are intricately connected. This comprehensive view aims to promote policies that are mutually reinforcing, thus contributing to healthier, more livable cities.

Characterization of the adaptive cellular and humoral immune responses to persistent colonization of Brucella abortus strain RB51 in a Jersey cow.

Brucella abortus strain RB51 is the commercial cattle vaccine used in the United States (US) and many parts of the world against bovine brucellosis. RB51 was licensed for use in 1996, and it has been shown to be safe and efficacious in cattle, eliciting humoral and cellular responses in calves and adult animals. In 2017, an epidemiological trace-back investigation performed by the Centers for Disease Control and Prevention (CDC) identified human cases of brucellosis caused by infection with RB51. These infections resulted from the consumption of unpasteurized dairy products, which were traced back to otherwise healthy animals that were shedding RB51 in their milk. At the current time, six adult Jersey cows have been identified in the U.S. that are shedding RB51 in milk. One of the RB51 shedding cattle was obtained and housed at the National Animal Disease Center (NADC) for further study. Improved understanding of host cellular and humoral immune responses to RB51 in persistently colonized cattle may be achieved by the characterization of responses in shedding animals. We hypothesized, based on the lack of RB51 clearance, that the RB51 shedder animal has a diminished adaptive cellular immune response to RB51. Our data demonstrate that in the presence of persistent RB51 infection, there is a lack of peripheral anti-RB51 CD4+ T cell responses and a concurrently high anti-RB51 IgG humoral response. By understanding the mechanisms that result in RB51 persistence, the development of improved interventions or vaccinations for brucellosis may be facilitated, which would provide public health benefits, including reducing the risks associated with the consumption of non-pasteurized milk products.

Making waves: The benefits and challenges of responsibly implementing wastewater-based surveillance for rural communities

The sampling and analysis of sewage for pathogens and other biomarkers offers a powerful tool for monitoring and understanding community health trends and potentially predicting disease outbreaks. Since the early months of the COVID-19 pandemic, the use of wastewater-based testing for public health surveillance has increased markedly. However, these efforts have focused on urban and peri‑urban areas. In most rural regions of the world, healthcare service access is more limited than in urban areas, and rural public health agencies typically have less disease outcome surveillance data than their urban counterparts. The potential public health benefits of wastewater-based surveillance for rural communities are therefore substantial – though so too are the methodological and ethical challenges. For many rural communities, population dynamics and insufficient, aging, and inadequately maintained wastewater collection and treatment infrastructure present obstacles to the reliable and responsible implementation of wastewater-based surveillance. Practitioner observations and research findings indicate that for many rural systems, typical implementation approaches for wastewater-based surveillance will not yield sufficiently reliable or actionable results. We discuss key challenges and potential strategies to address them. However, to support and expand the implementation of responsible, reliable, and ethical wastewater-based surveillance for rural communities, best practice guidelines and standards are needed.

Responses to Real-World and Hypothetical Menthol Flavor Bans Among US Young Adults Who Smoke Menthol Cigarettes.

Menthol cigarette bans have been implemented in some US states and localities, and a federal ban is being proposed by the FDA. This study asks how young adults who use menthol cigarettes respond to changes in menthol cigarette availability. An online survey of young adults ages 18-34 who reported smoking menthol cigarettes on ≥7 of 30 days around Thanksgiving 2019 (n = 734), oversampling Massachusetts-the first state with a menthol ban. Participants reported their tobacco use behavior following real-world menthol cigarette bans or predicted their behavior under a hypothetical federal ban. Most respondents who exclusively smoked versus dual used with e-cigarettes continued smoking/using combustible tobacco following real-world bans (95.3% vs. 86.9%), accessing menthol cigarettes from other jurisdictions. Fewer who smoked exclusively responded by using e-cigarettes compared to those who dual used (3.9% vs. 43.7%). Quitting all tobacco use (ie, no smoking, vaping, or any tobacco use) was uncommon for both groups (3.6% vs. 9.0%). Under a hypothetical ban, majorities of those who exclusively smoke and who dual use predicted they would continue smoking (72.2% vs. 71.8%); fewer who smoke exclusively would use e-cigarettes compared to those who dual use (14.7% vs. 41.4%). Those who smoke exclusively were more likely to report quitting all tobacco compared to those who dual use (29.6% vs. 12.4%). Under real-world and hypothetical menthol cigarette bans, most respondents continued smoking. However, more young adults continued smoking following real-world bans, reflecting the limitations of local/state restrictions when menthol cigarettes are available in other jurisdictions. This survey asked young adults who use menthol cigarettes how they responded to real-world changes in the availability of menthol cigarettes; 89% reported continuing to smoke. Those who smoked exclusively were far less likely to respond by switching to e-cigarettes compared to people who dual used both products. Under a hypothetical federal menthol cigarette ban, 72% of young adults predicted that they would continue smoking. Quitting all tobacco was less common in the real-world scenario compared to the hypothetical ban. Access to menthol cigarettes in other jurisdictions and flavored cigars likely dampen the public health benefit of menthol cigarette bans.

How Do Urban Waterfront Landscape Characteristics Influence People’s Emotional Benefits? Mediating Effects of Water-Friendly Environmental Preferences

Landscapes in urban waterfront spaces are of high societal value as they can meet people’s physical, psychological, and social needs for health and well-being, but the relationship between waterfront landscape features and public health benefits has yet to be clarified. From the perspective of blue health, this paper takes blue spaces along the Min River of Fuzhou City as the research object. It constructs the mediation model of “Waterfront landscape characteristic (WLC)→Water-friendly environmental preference (WEP)→Emotional benefit (EB)”. The role of WEP in the mechanisms linking WLC and EB in different waterfront spaces was explored through the quantification of indicators, questionnaires, and physiological measurements. The main results showed that (1) the ability of different types of waterfront spaces to arouse positive emotions in the population is characterized by blue-dominated space > co-dominated space > green-dominated space, while the opposite is true in terms of inducing negative emotions; (2) green visibility, blue visibility, naturalness, water-friendliness, and openness are all significantly related to EBs and could affect positive emotions either directly or mediated by WEPs, but openness seems not to affect negative emotions through WEPs; (3) cleanliness affects the population’s WEP for the coherence dimension, but has no significant role in improving EBs. This study could expand new ideas for research in habitat health, provide a reference for embodied evidence-based waterfront landscape design, and help promote the construction and development of healthy cities.

The perceived ecological and human well‐being benefits of ecosystem restoration

Abstract Traditionally, ecosystem restoration has focussed on standard ecological indicators like water or habitat quality, species population abundance or vegetation cover to determine success. However, there is growing interest in how restoration might impact people and communities. For example, researchers have documented positive socio‐ecological links between restoration and human well‐being indicators like property value, natural hazard mitigation, recreation opportunity and happiness. Furthermore, public health benefits from restoration have been linked to public support for programmes. Drawing from this research, the United Nations declared 2021–2030 the ‘Decade of Ecosystem Restoration’ and set a goal to promote more socio‐ecological goals in ecosystem restoration. Nonetheless, there is still a lack of information on the extent to which restoration practitioners consider well‐being because many granting programmes only require ecological goals and monitoring. To explore how restoration practitioners design, implement and measure the success of their projects, we used the federally funded Great Lakes Restoration Initiative (GLRI) as a case study. Since 2010, GLRI has awarded over $3.5 Billion to over 5300 projects across the midwestern United States, but it does not presently require human well‐being considerations. We performed an online survey targeting project managers with a sample of GLRI projects (N = 1574). We received 437 responses and found that almost half set a human well‐being goal, and more than 70% of those who did believe they reached it. In comparison, 90% of project managers believed they met their ecological goals. These documented perceptions of positive impacts for both people and nature suggest that restoration may already transcend traditional indicators and monitoring for socio‐ecological metrics could capture many ‘unseen’ benefits. Therefore, we recommend that ecosystem restoration programmes adopt a socio‐ecological lens to document the full extent of their restoration outcomes. Read the free Plain Language Summary for this article on the Journal blog.

Effectiveness of COVID-19 vaccine mandates in raising vaccination rates among the elderly and general population in Europe: Controlled interrupted time series analysis

BackgroundDuring the COVID-19 pandemic, three European countries (Austria, Greece, Italy) announced and/or implemented mandatory COVID-19 vaccination for high-risk groups in the general population. Besides the ethical justification for this policy, it is important to assess and quantify the effectiveness of the mandate in raising vaccination rates. MethodsControlled interrupted time series analysis of first-dose vaccination rates in the targeted age groups (Greece: ≥60 years; Italy: ≥50 years) relative to a control group (Greece: 50–59 years; Italy: 25–49 years) between week 35/2021 and week 50/2022. For Austria an uncontrolled analysis was performed, as the vaccine mandate targeted all adults ≥18 years. ResultsAnnouncement of mandatory vaccination substantially increased vaccination rates in the targeted age groups compared to control in both Greece (RR = 4.36, 95 % CI: 3.57–5.32) and Italy (RR = 2.90, 95 % CI: 2.37–3.56), an effect which persisted throughout the study period. There were 176,428 (95 % CI: 164,097–187,226) mandate-attributable first-dose vaccinations in Greece and 316,192 (95 % CI: 282,467–346,678) in Italy, most of which occurred before the mandate came into effect. In Austria no discernible increase in vaccination rates was observed after the announcement of mandatory vaccination. At the end of the study period, 9.5 % of ≥60 year-olds in Greece, 4.9 % of ≥50 year-olds in Italy and 13.8 % of ≥18 year-olds in Austria remained unvaccinated. ConclusionsIn Greece and Italy – though not in Austria – simple announcement of a vaccine mandate rapidly increased COVID-19 vaccination rates in the targeted age groups, without fully closing the vaccination gap. Mandatory vaccination appears to effectively target complacency but not vaccine hesitancy, and its public health benefits need to be weighted against possible detrimental effects on confidence and trust.

Impacts of coal use phase-out in China on the atmospheric environment: (2) public health and global radiative forcing

In the second of two companion papers, we quantify the potential ultimate benefits for public health and radiative forcing from the phase-out of coal use in China. With the baseline year of 2015, we estimate that the premature deaths and disability-adjusted life years (DALYs) in China will be reduced by 375,000 persons and 8.90 × 106 years (GEMM model), which is 41.7% and 54.5% of the total number of premature deaths and DALYs caused by PM2.5 from anthropogenic sources, effectively improving the health of the population. The provinces with the most significant decreases in fatalities and disabilities are concentrated in large coal-consuming provinces. Regarding age distribution, the phase-out of coal use will effectively extend the life expectancy of the elderly, especially in the age group of 65–89 years. Health benefits’ growth rate upsurges notably once more than half of coal is phased out. Based on the Parallel Offline Radiative Transfer (PORT) model, the global annual average radiative forcing due to changes in short-lived climate pollutants (SLCPs), including sulfate, black carbon, organic carbon, and O3 associated with the phase-out of coal use, is 0.34 W m−2, -0.048 W m−2, 0.00064 W m−2, and 0.00055 W m−2, respectively. The complete phase-out of coal use in China also reduces the emission of long-lived climate pollutants (LLCPs) and causes negative radiative forcing. Among them, the global annual average radiative forcing of CO2, CH4, and N2O is −0.0073 W m−2, -5.48 × 10−5 W m−2, -1.60 × 10−5 W m−2. If the lifetimes of pollutants are considered, the total global reduction in heat uptake is −2.29 × 107 J m−2 over 100 years, dominated by the decrease of CO2, which will slow the rate of global warming and thus may reduce the probability of extreme weather events. This report will incentivize relevant policymakers to remove coal significantly to achieve carbon neutrality.

From Evidence to Effectiveness: Implications of the Randomized Trial to Prevent Vascular Events in HIV Study for People With HIV in Low- and Middle-Income Settings.

The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study found a 35% reduction in major adverse cardiovascular events for people with human immunodeficiency virus who received daily pitavastatin. However, how this evidence will change practice is far from certain. Here, we outline evidence gaps and political and healthcare delivery challenges that will need to be addressed for REPRIEVE to offer public health benefits in low- and middle-income countries.

Demographics of sources of HIV-1 transmission in Zambia: a molecular epidemiology analysis in the HPTN 071 PopART study

In the last decade, universally available antiretroviral therapy (ART) has led to greatly improved health and survival of people living with HIV in sub-Saharan Africa, but new infections continue to appear. The design of effective prevention strategies requires the demographic characterisation of individuals acting as sources of infection, which is the aim of this study. Between 2014 and 2018, the HPTN 071 PopART study was conducted to quantify the public health benefits of ART. Viral samples from 7124 study participants in Zambia were deep-sequenced as part of HPTN 071-02 PopART Phylogenetics, an ancillary study. We used these sequences to identify likely transmission pairs. After demographic weighting of the recipients in these pairs to match the overall HIV-positive population, we analysed the demographic characteristics of the sources to better understand transmission in the general population. We identified a total of 300 likely transmission pairs. 178 (59·4%) were male to female, with 130 (95% CI 110-150; 43·3%) from males aged 25-40 years. Overall, men transmitted 2·09-fold (2·06-2·29) more infections per capita than women, a ratio peaking at 5·87 (2·78-15·8) in the 35-39 years source age group. 40 (26-57; 13·2%) transmissions linked individuals from different communities in the trial. Of 288 sources with recorded information on drug resistance mutations, 52 (38-69; 18·1%) carried viruses resistant to first-line ART. HIV-1 transmission in the HPTN 071 study communities comes from a wide range of age and sex groups, and there is no outsized contribution to new infections from importation or drug resistance mutations. Men aged 25-39 years, underserved by current treatment and prevention services, should be prioritised for HIV testing andART. National Institute of Allergy and Infectious Diseases, US President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation, National Institute on Drug Abuse, and National Institute of Mental Health.

Deep-Learning-Based Approach for Automated Detection of Irregular Walking Surfaces for Walkability Assessment with Wearable Sensor

A neighborhood’s walkability is associated with public health, economic and environmental benefits. The state of the walking surface on sidewalks is a key factor in assessing walkability, as it promotes pedestrian movement and exercise. Yet, conventional practices for assessing sidewalks are labor-intensive and rely on subject-matter experts, rendering them subjective, inefficient and ineffective. Wearable sensors can be utilized to address these limitations. This study proposes a novel classification method that employs a long short-term memory (LSTM) network to analyze gait data gathered from a single wearable accelerometer to automatically identify irregular walking surfaces. Three different input modalities—raw acceleration data, single-stride and multi-stride hand-crafted accelerometer-based gait features—were explored and their effects on the classification performance of the proposed method were compared and analyzed. To verify the effectiveness of the proposed approach, we compared the performance of the LSTM models to the traditional baseline support vector machine (SVM) machine learning method presented in our previous study. The results from the experiment demonstrated the effectiveness of the proposed framework, thereby validating its feasibility. Both LSTM networks trained with single-stride and multi-stride gait feature modalities outperformed the baseline SVM model. The LSTM network trained with multi-stride gait features achieved the highest average AUC of 83%. The classification performance of the LSTM model trained with single-stride gait features further improved to an AUC of 88% with post-processing, making it the most effective model. The proposed classification framework serves as an unbiased, user-oriented tool for conducting sidewalk surface condition assessments.

Mucosal and systemic immune responses after a single intranasal dose of nanoparticle and spore-based subunit vaccines in mice with pre-existing lung mycobacterial immunity.

Tuberculosis (TB) is a major global health threat that claims more than one million lives annually. With a quarter of the global population harbouring latent TB, post-exposure vaccination aimed at high-risk populations that could develop active TB disease would be of great public health benefit. Mucosal vaccination is an attractive approach for a predominantly lung disease like TB because it elicits both local and systemic immunity. However, the immunological consequence of mucosal immunisation in the presence of existing lung immunity remains largely unexplored. Using a mycobacterial pre-exposure mouse model, we assessed whether pre-existing mucosal and systemic immune responses can be boosted and/or qualitatively altered by intranasal administration of spore- and nanoparticle-based subunit vaccines. Analysis of lung T cell responses revealed an increasing trend in the frequency of important CD4 and CD8 T cell subsets, and T effector memory cells with a Th1 cytokine (IFNγ and TNFα) signature among immunised mice. Additionally, significantly greater antigen specific Th1, Th17 and IL-10 responses, and antigen-induced T cell proliferation were seen from the spleens of immunised mice. Measurement of antigen-specific IgG and IgA from blood and bronchoalveolar lavage fluid also revealed enhanced systemic and local humoral immune responses among immunised animals. Lastly, peripheral blood mononuclear cells (PBMCs) obtained from the TB-endemic country of Mozambique show that individuals with LTBI showed significantly greater CD4 T cell reactivity to the vaccine candidate as compared to healthy controls. These results support further testing of Spore-FP1 and Nano-FP1 as post-exposure TB vaccines.

PP106 Integrating Organizational Impacts Into Health Technology Assessment: How To Take Them Into Account For Medical Devices?

IntroductionThe organizational impact (OI) of new technologies is becoming a major driver for our healthcare systems and for modernizing the care pathway for the benefit of users and professionals. Some technologies give rise to a reorganization of the healthcare system, particularly in the case of connected medical devices.The Medical Device Committee at Haute Autorité de Santé (HAS) appraises medical devices (MD) in view of their reimbursement by the French health insurance scheme. The Committee’s evaluation criteria take account of the therapeutic benefit of the MD and its public health benefit. OI-related aspects are frequently claimed by health technology developers (HTD) in their MD submission dossiers. However, this aspect is rarely documented. Therefore, guidance explaining how HTD should support and structure any claim of an OI was needed.MethodsThis work was based on the HAS OI Map for Health Technology Assessment published in 2020, the analyses of specific HAS opinions, hearings with concerned stakeholders (HTD, service providers and patients), and a committee meeting focused on OI.ResultsThe HTD guide for MD submission was updated with guidance to support OI claims. For each claimed OI, the HTD should identify the criterion corresponding to the most relevant OI, the indicator to describe each selected criterion, the stakeholders concerned, and the data to be provided. The choice of method is according to the OI: if the indicator is measurable, data from validated measurement tools are expected. If not, especially in cases where the use of the MD requires a specific organization before its deployment, the absence of data must be justified and a detailed impact analysis is necessary. In this case, the development plan for the demonstration of the OI is needed.ConclusionsWith this updated guide for HTDs, claimed OI dimension shall be better supported in future MD dossiers submitted to HAS in view of their reimbursement in France.

Effect of nicotine expectancy and nicotine dose reduction on cigarette demand, withdrawal alleviation, and puff topography

BackgroundCurrent FDA plans include proposed nicotine reduction mandates by the end of 2023. Most research on reduced nicotine cigarettes has been dose-blinded, while a mandate would be known to the public. Few laboratory studies have examined specifically how low nicotine content labeling impacts behavioral response. The purpose of this within-subject, balanced-placebo, human laboratory study was to evaluate the main and interactive effects of nicotine dose expectancy and dose reduction on cigarette reinforcement, withdrawal alleviation, and puff topography. MethodsParticipants who smoke daily (N=21; 9 female) completed one practice and four experimental sessions in which expectancy (labeled “average” versus “very low” nicotine) and nicotine dose (0.80mg versus 0.03mg yield) were manipulated. Participants in acute withdrawal sampled experimental cigarettes followed by withdrawal alleviation and puff topography measures. Cigarette demand was measured using an incentivized purchase task. Analyses evaluated main and interactive effects of expectancy and nicotine dose. ResultsNicotine dose manipulation produced expected physiological effects (e.g., heart rate increases) and both reduced nicotine dose and expectation manipulations reduced perceived nicotine content. Expectation of reduced nicotine alone or in combination with reduced nicotine dose did not alter demand, withdrawal alleviation, or topography. Effective withdrawal alleviation was observed in all conditions. ConclusionsThese data inform nicotine regulation policy by suggesting limited compensatory harms caused by reduced nicotine expectations. The minimal acute effects of reduced nicotine expectancy or exposure on demand suggests that reduced nicotine standards are likely to generate their greatest public health benefit through the slowing of newly initiating cigarette smoking.

Does higher tax rate affect tobacco usage? Unravelling the nexus between tobacco regulatory control and public health concern

ObjectivesBangladesh stands as a prominent global consumer of tobacco, with alarming consequences on public health. The Global Adult Tobacco Survey reported that tobacco consumption claimed over 126 000 lives in 2018, contributing to 13.5% of all deaths in the country. This study aims to explore the effectiveness of higher tax rates and tobacco use regulation as control mechanisms in mitigating tobacco consumption and health care cost burden, with a particular emphasis on its implications for public health. MethodsThis study is based on the annual time series data over the period 2000–2020. The study employs the ordinary least square method to analyze the quantitative confirming the stationarity of data at level. This research uses different models to investigate individual effects and combined effects on both tobacco consumption and tobacco health care cost burden. ResultsThe study finds a negative relationship between tobacco tax rate and tobacco consumption. More specifically, the higher tax rate of tobacco (low (β = −0.3495), medium (β = −0.2319), high (β = −0.9033), premium (β = −0.7322), filtered (β = −0.2114), and non-filtered (β = −0.3452) categories) is significant to reduce tobacco use at 1% level of significance. The study finds similar results when it applied tobacco retail price instead of tobacco tax rate as the independent variable. Finally, the study investigates the impact on health care cost through tobacco consumption, tobacco control law, growth rate, export-import, and tobacco production. The results indicate that tobacco consumption, export-import, and tobacco production increases health care cost burden while tobacco use regulatory decreases it. By reducing tobacco consumption, higher taxes and tobacco use regulation contribute to alleviating the burden on the healthcare system, promoting healthier lifestyles, and aligning with global health objectives. ConclusionsHigher tax rate on tobacco products is necessary to increase the retail price so that tobacco users cannot consume tobacco. Specific tax and uniform tax base are needed so that tobacco users cannot switch to lower priced brands. Tobacco control laws need to revised and proper implementation should be ensured as well, to achieve the goal of tobacco free Bangladesh by 2040. Tobacco-related diseases, responsible for a significant proportion of deaths in the country, could witness a considerable decline with the successful implementation of higher tax rates and tobacco use regulation. This study provides insights that not only contribute to the economic discourse but also accentuate the broader public health benefits arising from effective tobacco taxation policies.

An Approach to Assessing the Influence of Environmental and Occupational Cancer Hazard Identification on Policy Decision-Making.

Cancer hazard identification is critical to informing decisions on preventive actions. However, the influence of cancer hazard assessments on the creation of health-protective regulations is poorly understood. Although prior studies have measured the health and economic benefits of regulatory actions in general, we are not aware of efforts to explicitly study the influence of cancer hazard identification on policy decisions in the United States. In this commentary, we present an approach to examine whether formal identification of a substance as a human carcinogen may prompt a regulatory action to reduce exposure to carcinogens and enhance public health. Further, we discuss the broader implications of cancer hazard identification on policy decision-making, including identifying gaps and providing recommendations. Using the Report on Carcinogens (RoC) as a test case, we systematically searched U.S. federal and state databases for notices of regulations mentioning the RoC from 1995 to 2023. For each regulation, we extracted information on the carcinogen(s) regulated, the regulatory agency, the regulatory purpose, the economic sector exposure sources, and the analyzed public health benefits and costs. We created a publicly available, web-based interactive tool to visualize the data. U.S. regulatory agencies have been using cancer hazard evaluations, such as the RoC, for decades to inform public health policy actions to prevent or mitigate cancer risks. Specifically, nonregulatory cancer hazard assessments have been used to prioritize chemical evaluations, support regulatory-based assessments, and trigger regulatory action. Our approach showed that assessing the influence of cancer hazard identification on science-based public health policies is feasible, informative, and needed, and our study is a first step in this direction. We recommend expanding this approach to other cancer and noncancer hazard assessments to ultimately inform our understanding of the influence of hazard classifications on policymaking. https://doi.org/10.1289/EHP12681.

Active Noise Control in The New Century: The Role and Prospect of Signal Processing

Since Paul Leug's 1933 patent application for a system for the active control of sound, the field of active noise control (ANC) has not flourished until the advent of digital signal processors forty years ago. Early theoretical advancements in digital signal processing and processors laid the groundwork for the phenomenal growth of the field, particularly over the past quarter-century. The widespread commercial success of ANC in aircraft cabins, automobile cabins, and headsets demonstrates the immeasurable public health and economic benefits of ANC. This article continues where Elliott and Nelson's 1993 Signal Processing Magazine article [1] and Elliott's 1997 50th anniversary commentary [2] on ANC left off, tracing the technical developments and applications in ANC spurred by the seminal texts of Nelson and Elliott (1991), Kuo and Morgan (1996), Hansen and Snyder (1996), and Elliott (2001) since the turn of the century. This article focuses on technical developments pertaining to real-world implementations, such as improving algorithmic convergence, reducing system latency, and extending control to non-stationary and/or broadband noise, as well as the commercial transition challenges from analog to digital ANC systems. Finally, open issues and the future of ANC in the era of artificial intelligence are discussed.