National Trends Research Articles

Disparities in child protective services involvement in pediatric traumatic brain injury.

Traumatic brain injury (TBI) is a leading cause of pediatric death and disability. Abusive head trauma confers greater morbidity and mortality compared with accidental TBI. National trends reveal disproportionate involvement of minority children in the child welfare system. The study investigates socioeconomic disparities in child protective services (CPS) involvement in pediatric TBI. Retrospective chart review was conducted for TBI patients (n = 596) admitted to an academic pediatric level I trauma center from 2015 to 2022, where institutional policy dictates automatic CPS referral for TBI patients ≤ 2years. Analysis of variance, chi-squared, and logistic regressions compared racial and ethnic groups and calculated adjusted odds of CPS case acceptance. Rates of non-accidental trauma, CPS involvement, insurance, and marital status differed across racial and ethnic backgrounds (p < 0.05). Of patients ≤ 2years, Hispanic patients (OR: 0.38, 95%CI [0.16,0.91]) had decreased odds of CPS involvement compared to non-Hispanic White patients when adjusting for confounders including injury severity, injury type, and socioeconomic status. We highlight racial and ethnic differences in incidence of pediatric TBI and CPS involvement, even in the setting of an automatic CPS referral policy for pediatric TBI patients ≤ 2years.

Metabolic and bariatric surgery outcomes in adolescents: a single center's seven-year update.

Metabolic and bariatric surgery (MBS) is gaining traction as a treatment option for adolescents with severe obesity. Since our weight center last published results in 2014, trends have shown increasingly diverse patient populations undergoing MBS and a shift from laparoscopic Roux-en-Y gastric bypass (LRYGB) to sleeve gastrectomy (LSG). We assessed outcomes including follow-up, weight loss, comorbidity resolution, and complications among our recent adolescent and young adult MBS patients. This is a retrospective cohort analysis of patients under 21years of age with severe obesity who underwent MBS at a single institution between 2014 and 2020. Data on demographics, comorbidities, body mass index (BMI), percent of total body weight loss (%TBWL) at various timepoints, and subsequent complications were collected via chart review. Regression examined associations between preoperative factors, follow-up, and %TBWL. There were 79 patients of whom 73% were female; overall, 53% were White, 24% Hispanic, and 15% non-Hispanic Black. The majority (80%) of patients underwent LSG. Three-fourths of patients had follow-up data beyond 1year, and half beyond 3years. The median %TBWL of LSG patients was 23% at a median follow-up of 3.0years, and LRYGB patients 28% at 2.4years. No preoperative factors were associated with follow-up or final %TBWL, but 6-month %TBWL predicted final %TBWL. Preoperatively, 73% of patients had at least one weight-related comorbidity, and 57% had documented improvements in at least one after surgery. There were three 30-day readmissions and no mortalities. This study, which is an update to a previous series from our center, reflects recent national trends with nearly half non-White patients and predominance of LSG over LRYGB. It adds to a growing body of evidence indicating that MBS is a safe and effective method of achieving weight loss and comorbidity resolution in adolescents with severe obesity.

Global, regional, and national burden and trends of air pollution-related neoplasms from 1990 to 2019: An observational trend study from the Global Burden of Disease Study 2019

BackgroundAir pollution-related neoplasms are a major global public health issue and are one of the leading causes of death worldwide. Air pollution is one of the important risk factors of air pollution-related neoplasms and is associated with a variety of air pollution-related neoplasms.The primary objective of this study was to estimate the epidemiological patterns of death rates and disability-adjusted life years (DALYs) associated with air pollution-related neoplasms on a global scale, covering the period from 1990 to 2019. Furthermore, we aimed to predict the trends in these epidemiological patterns up to 2050. By achieving these goals, our study seeks to provide a comprehensive understanding of the potential causes underlying the observed disparities in neoplasm-related health outcomes, ultimately contributing to the development of effective strategies for addressing this major public health issue. MethodsBased on data from the 2019 Global Burden of Disease (GBD) study, the indicators of the air pollution-related neoplasms disease burden was the numbers and age-standardized rates (ASR) of deaths and disability-adjusted life years (DALYs) from 1990 to 2019. First, we compared the burden of air pollution-related neoplasms and temporal trends by gender, age, socio-demographic index (SDI), region, and country. Furthermore, driving factors and improvement potential were evaluated using decomposition and frontier analysis. Finally, forecasting analyses of the changing trend in the burden of air pollution-related neoplasm up to 2050 was conducted based on time series forecasting models. ResultsIn 2019, air pollution-related neoplasms accounted for 387.45 million (95 % UI 288.04–490.06 million) deaths and 8951.97 million (95 % UI 6680.89–11342.60 million) DALYs globally. Deaths and DALYs demonstrated an upward trend from 1990 to 2019, while their ASR showed a downward trend. The disease burden and the decline degree of males were both significantly higher than that of females, and the high burden was mainly in the elderly groups. The middle SDI region possessed the highest burden with the most significant upward trend, while the high SDI region had the lowest burden with the most significant downward trend. Decomposition analyses represented that the increase in the overall deaths and DALYs of air pollution-related neoplasms was mainly driven by population growth. The predictive analyses expected that the deaths and DALYs of air pollution-related neoplasms will continue to rise, while their corresponding ASR will decrease by 2050. ConclusionThe global burden of air pollution-related neoplasms remained high, and deaths and DALYs will be on upward trends up to 2050, with differences among genders, ages, SDI levels, GBD regions, and countries. It is essential to understand the air pollution-related neoplasm burden and contributing epidemiological factors for implementing effective and factor-tailored interventions to reduce the global burden.

Examining Differences in Health-Related Technology Use between Millennial and Older Generations of Caregivers.

Caregivers from the Millennial generation are an emerging and understudied group of unpaid care providers in America who may benefit from digitally delivered support. To inform the design/tailoring of interventions for this group, we aimed to understand how Millennials may differ from other generations of caregivers regarding digital health-related technology use. Using the Health Information National Trends Survey (HINTS), Version 6, we conducted a cross-sectional study comparing health technology access and use across four generations of unpaid caregivers (n = 545; Millennials, Gen X, Baby Boomers, and Silent Generation) of adults with chronic conditions using chi-square and Kruskal-Wallis non-parametric tests. Compared to Baby Boomer and Silent Generation caregivers, Millennial caregivers more frequently reported having a cellular internet connection, using a wearable activity device, a health/wellness mobile application, choosing telehealth appointments for convenience, and most frequently used social media in general and to view health-related videos (ps < 0.005). Additionally, Millennials were more likely to report possessing a smartphone (compared to Gen X and Silent Generation) and more frequently used social media for peer interaction about health (compared to all older generations; ps < 0.005). Millennials differ from older generations of caregivers regarding health-related technology access and use, which may have implications for intervention design and tailoring.

National Trends and Disparities in Suicidal Ideation, Attempts, and Health Care Utilization Among U.S. Adults

National Trends and Disparities in Suicidal Ideation, Attempts, and Health Care Utilization Among U.S. Adults

PUBLIC EXPENDITURE AND AGRICULTURAL DEVELOPMENT: INSIGHTS FROM KARNATAKA

This study examines public expenditure on agriculture in Karnataka from 1990 to 2023, highlighting trends and patterns in spending. It reveals that while Karnataka’s total expenditure on agriculture has increased significantly, the focus remains predominantly on revenue expenditure rather than capital expenditure. This contrasts with national trends, where there's a gradual shift towards more balanced spending. The Compound Annual Growth Rate (CAGR) for Karnataka shows significant variability, including a recent decline, while other states like Maharashtra exhibit higher and more stable growth rates. The analysis includes a comparative review with other Indian states, showing Karnataka's strong emphasis on operational costs and lower capital investment compared to states with larger agricultural sectors. This study underscores the need for a more balanced approach in agricultural investment to support long-term growth and development. KEY WORDS: Public Expenditure, Agriculture, Revenue Expenditure and Capital Expenditure

Global, regional, and national burdens of Alzheimer's disease and other forms of dementia in the elderly population from 1999 to 2019: A trend analysis based on the Global Burden of Disease Study 2019

AbstractDementia represents a significant health issue, afflicting both patients and their families. To assess the global trends in the incidence, prevalence, mortality, and disability‐adjusted life years (DALYs) of Alzheimer's disease (AD) and other dementias in the elderly population, the Global Burden of Disease Study (1999−2019) was used. The average annual percentage change (AAPC) was estimated using linear regression. Stratified analysis of the global trends by age, sex, region, national level, and social development index (SDI) were also performed. The global incidence of AD and other dementias increased from 507.96 per 100,000 in 1990 to 569.39 per 100,000 in 2019, showing a significant increase in this period. In males, the incidence increased from 387.56 per 100,000 population in 1990 to 462.40 per 100,000 in 2019 (AAPC = 0.61), whereas females experienced a slower rise (AAPC = 0.31) and had a higher incidence in 2019 (662.93 per 100,000 population). The most significant increase was observed in individuals aged 60−64 and those in the middle‐SDI quintile. Regionally, the high‐income Asia Pacific had the highest incidence (890.01 per 100,000 population) and DALYs (3043.86 per 100,000) in AD and other dementias in 2019. As for national trends, Japan had the most pronounced increase in the incidence and DALYs of AD and other dementias during the 1990−2019 period. These findings highlight the growing burden of dementias on life expectancy at a population level, which is significant for healthcare professionals and decision‐makers to conduct the ongoing debate on the policy of AD and other dementias.

Abstract A113: National trends in cervical cancer screening by sexual orientation and race/ethnicity in cisgender women

Abstract Background: Lesbian, gay, and/or bisexual (LGB) women have decreased rates of cervical cancer screening compared to heterosexual women which may be due to barriers accessing care. This difficulty accessing care is magnified in racial/ethnic minority LGB women. Objective: To estimate changes in guideline-concordant cervical cancer screening (CCS) over time by sexual orientation and race/ethnicity using National Health Interview Survey (NHIS) data from 2013, 2015, 2019 and 2021(full cohort). Methods: This retrospective, population-based, cross-sectional analysis included cisgender (denotes gender identity corresponding with sex assigned at birth) women aged 21-65 without history of hysterectomy. Respondents who self-identified as lesbian, gay, or bisexual or an identity other than straight, lesbian, or bisexual were coded as lesbian, gay, or bisexual (LGB). Respondents who self-identified as straight were coded as heterosexual. Up to date (UTD) CCS was determined based on NHIS questions “When did you have your most recent Pap test?” and “Did you have a human papillomavirus (HPV) test with your most recent Pap test?”. If most recent screening test was within the intervals defined by the US Preventive Services Task Force screening guidelines for respective ages and modalities, they were considered UTD. We performed joinpoint analysis to characterize piecewise log-linear time calendar trends in the proportion of UTD CCS and calculated Annual Percent Change (APC) from 2013 to 2021. Results: Overall, there were 40,818 participants in the full cohort, of which 4.32% identified as LGB. 70.64% of the LGB participants reported UTD CCS in contrast to 78.92% of the heterosexual participants. In 2013, 80.87% of the heterosexual participants were UTD for CCS in comparison to 70.59% of LGB participants. In 2021, UTD screening rates fell to 75.4% for heterosexual participants and 68.86% in LGB participants. In trend analysis only heterosexual participants had a significant APC in screening of -0.97% (p=.002) from 2013- 2021, and there was no significant trend for LGB individuals. When evaluating screening rates by sexual orientation and race, we found that heterosexual Hispanic and non-Hispanic (NH) White women had decreased in UTD CCS (APC of -1.52, p=0.008 and -0.63, p=0.02, respectively). Additionally, LGB NH Black women had a significant decrease in UTD screening over the study period (APC of -2.67, p&amp;lt;0.005) falling from 85.22% in 2013 to 67.91% in 2019. Conclusions: In 2021 there were approximately 19.72 million cisgender women aged 21-65 who were potentially not UTD with CCS. Of these, 1.76 million LGB women were not UTD for CCS, and a greater proportion of these women identified as NH Black. Future efforts need to improve screening in cisgender populations regardless of sexual orientation, and specific attention should be aimed at LGB and Black identifying cisgender women. Citation Format: Kelley Baumann, Caryn E Peterson, Stacie Geller, Saria Awadalla, Hunter K Holt. National trends in cervical cancer screening by sexual orientation and race/ethnicity in cisgender women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A113.

Abstract C035: Immunotherapy for triple-negative breast cancer in the US: National trends, racial/ethnic disparities, and oncologic outcomes

Abstract Background: Triple-negative breast cancer (TNBC) is aggressive and disproportionately affects Black women. Immunotherapy (IO) improves outcomes in early-stage and metastatic TNBC and has been increasingly used since the accelerated approval of atezolizumab for metastatic TNBC in March 2019. However, whether there are racial/ethnic disparities in IO receipt and oncologic outcomes for TNBC is unclear. Methods: Data came from TNBC patients in the National Cancer Database. Trends in IO use were assessed from 2017-2021. For early-stage TNBC, we included stage II-III patients with neoadjuvant chemotherapy in 2021 and performed logistic regression to examine pathologic complete response (pCR) by race/ethnicity. In the metastatic cohort, patients diagnosed with TNBC from 2019-2021 were included and examined for racial/ethnic differences in overall survival using Cox regression. Racial/ethnic groups included American Indian, Alaska Native, or Other (AIANO), Asian or Pacific Islander (API), Black, Hispanic, and White. Results: Overall, IO use increased from 5.3% in 2017 to 33.1% in 2021 for metastatic TNBC and from 4.2% in 2017 to 48.0% in 2021 for early-stage TNBC (all P-trend&amp;lt;.001). Of 7,655 early-stage TNBC diagnosed in 2021, 53.5% of API patients received IO, followed by 48.5% Hispanic, 48.3% AIANO, 48.2% White, and 45.9% Black. After controlling for demographic and clinical factors, there were no differences in IO use comparing API (adjusted odds ratio [AOR]=1.04; 95% CI=0.79-1.37), Hispanic (AOR=1.00; 95% CI=0.80-1.24), Black (AOR=0.96; 95% CI=0.83-1.12), AIANO (AOR=0.92; 95% CI=0.64-1.34) with White patients. However, Medicare enrollees had lower odds of IO receipt than those privately insured (AOR=0.84; 95% CI=0.70-0.99); comprehensive community programs had lower odds of IO use than academic/research programs (AOR=0.80; 95% CI=0.70-0.92). Among those who received IO, we found no difference in pCR rate by race/ethnicity. Of 4,533 metastatic TNBC diagnosed from 2019-2021, 35.4% of Hispanic patients received IO, followed by 34.3% API, 30.6% White, 26.7% AIANO, and 24.7% Black. In the adjusted model, Black patients with metastatic TNBC had lower odds of IO receipt than White patients (AOR=0.66; 95% CI=0.53-0.82) while no differences were observed between other minority and White patients. Among those who received IO, overall survival rates were similar between Black and White patients (adjusted hazard ratio=0.88; 95% CI=0.63-1.22). Conclusions: IO receipt was lower in Black patients with early-stage TNBC, which was influenced in part by facility type and insurance status – highlighting key targets to reduce these disparities. In the metastatic cohort, Black patients were less likely to receive IO even after confounder adjustment – etiologies of these disparities, such as inequitable treatment access or racial differences in PD-L1 status, require further exploration. In both cohorts, Black patients receiving IO attained equivalent outcomes to White patients, suggesting that access to IO can mitigate racial disparities in TNBC treatment outcomes. Citation Format: Jincong Q. Freeman, Dezheng Huo, Sarah P. Shubeck, Nan Chen, Sudha R. Yarlagadda, Rita Nanda, Frederick M. Howard. Immunotherapy for triple-negative breast cancer in the US: National trends, racial/ethnic disparities, and oncologic outcomes [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C035.

Abstract A016: Understanding the Impact of Numerous Cancer Prevention Guidelines on Public Adherence

Abstract Background: Organizations like the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) have developed comprehensive cancer prevention guidelines focusing on nutrition, physical activity, cancer screening, and vaccination with a goal of reducing cancer incidence and improving cancer health outcomes. However, the abundance and complexity of these guidelines can lead to public confusion and potentially hinder adherence. This study investigates public perception of the multitude of cancer prevention guidelines and their potential impact on compliance. Methods: Data were derived from the 2020 Health Information National Trends Survey (HINTS 5, Cycle 4, 2020), conducted via a mail survey from February to June 2020. We examined public perception about cancer prevention recommendations and if the number of recommendations made it more difficult to determine which ones to follow. Multivariable Logistic regression was used to examine the factors that are associated with agreement with the statement: “there are so many different recommendations about preventing cancer, it's hard to know which ones to follow.” Results: Survey respondents consisted of 3,747 U.S. adults. Approximately 74.1% of respondents agreed with the statement, "There are so many different recommendations about preventing cancer, it's hard to know which ones to follow." Non-Hispanic Black respondents had the highest proportion of agreement (80.6%) Level of education was statistically significantly associated with agreement with the statement "there are so many different recommendations about preventing cancer, it's hard to know which ones to follow." As education level increased, the odds of agreeing with the statement decreased. Specifically, college graduates (aOR 0.58; 95% CI: 0.36-0.94), and those with postgraduate education had an aOR of 0.38 (95% CI: 0.22-0.67). Conclusion: The study highlights significant public perception challenges regarding the abundance of cancer prevention guidelines. These findings suggest a need for streamlined communication and education strategies to enhance guideline adherence and optimize cancer prevention efforts. Citation Format: Tochukwu Nzeako, Onyema Chido-Amajuoyi. Understanding the Impact of Numerous Cancer Prevention Guidelines on Public Adherence [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A016.

Abstract A123: Awareness of human papillomavirus (HPV) and its vaccine and telehealth: Results from the Health Information National Trends Survey (HINTS) 6, 2022 in the United States

Abstract Background: Human Papillomavirus (HPV) vaccination is essential to prevent occurrences of a variety of HPV associated cancers. The awareness of HPV and its vaccine could be associated with the use of telehealth. The aims of this study were to examine the association between awareness of HPV and HPV vaccine with receiving telehealth for health care within the past year. Methods: Data from the Health Information National Trends Survey (HINTS) 6 (N=5,887) were utilized. Dependent variable was awareness of HPV and HPV vaccine. The independent variable was those who received care from a doctor or health professional using telehealth. Weighted multivariable logistic regression was performed to determine association of awareness of HPV and its vaccine with receiving healthcare using telehealth while adjusting for age, gender, race, education, and census region. Results: The study sample consisted of 68.28% awareness of HPV and 63.47% awareness of HPV vaccine. After controlling for covariates, we found those who were aware of HPV and HPV vaccine have received telehealth care (aOR=1.40, 95%CI:1.11-1.78; aOR= 1.40, 95%CI:1.09 -1.80), respectively. In the adjusted model, the awareness of HPV for being female (aOR=2, 95%CI:1.60-2.48) and college graduates (aOR=3.80, 95%CI: 2.59-6.56). In the adjusted model, the awareness of HPV vaccine for being female (aOR= 2.68, 95%CI:2.13-3.36) and college graduates (aOR=4.68,95%CI:2.77-7.91). HPV and HPV vaccine awareness, Non Hispanic Whites had significantly higher adjusted odds compared to other race/ethnicity groups. Conclusion: Hence public health programs could be directed to promote use of telehealth to increase awareness of HPV causing cancers, reduce stigma associated with vaccination, boost healthcare recommendation and uptake of HPV vaccination considering socio demographic factors. Citation Format: Manali Desai, Iman Igab, Ogochukwu Ezeigwe, Devesh Malgave. Awareness of human papillomavirus (HPV) and its vaccine and telehealth: Results from the Health Information National Trends Survey (HINTS) 6, 2022 in the United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A123.

The decline and transformation of smallholders in Chinese agriculture: national trends

ABSTRACT Using data from official statistical sources and a nationally representative survey, we find that since 2001, China’s agricultural labor force has declined by over 50 percent—a loss of over 200 million smallholders, probably the largest in human history. This trend is the most pronounced in livestock sectors: from 2012 to 2021, 62.5 million smallholder units have disappeared. The 150 million remaining smallholders are mostly commodity producers, participating widely in commodity relations to access agrochemicals, machinery, rental land, and wage labor to produce for markets. The ageing smallholder population also face challenges in intergenerational reproduction, which will accelerate its decline.

National Trends in the Prevalence of Unmet Health Care and Dental Care Needs During the COVID-19 Pandemic: Longitudinal Study in South Korea, 2009-2022.

Although previous studies have investigated trends in unmet health care and dental care needs, most have focused on specific groups, such as patients with chronic conditions and older adults, and have been limited by smaller data sets. This study aims to investigate the trends and relative risk factors for unmet health care and dental care needs, as well as the impact of the COVID-19 pandemic on these needs. We assessed unmet health care and dental care needs from 2009 to 2022 using data from the Korea Community Health Survey (KCHS). Our analysis included responses from 2,750,212 individuals. Unmet health care or dental care needs were defined as instances of not receiving medical or dental services deemed necessary by experts or desired by patients. From 2009 to 2022, the study included 2,700,705 individuals (1,229,671 men, 45.53%; 673,780, 24.95%, aged 19-39 years). Unmet health care needs decreased before the COVID-19 pandemic; however, during the pandemic, there was a noticeable increase (βdiff 0.10, 95% CI 0.09-0.11). Unmet dental care needs declined before the pandemic and continued to decrease during the pandemic (βdiff 0.23, 95% CI 0.22-0.24). Overall, the prevalence of unmet dental care needs was significantly higher than that for unmet health care needs. While the prevalence of unmet health care needs generally decreased over time, the β difference during the pandemic increased compared with prepandemic values. Our study is the first to analyze national unmet health care and dental care needs in South Korea using nationally representative, long-term, and large-scale data from the KCHS. We found that while unmet health care needs decreased during COVID-19, the decline was slower compared with previous periods. This suggests a need for more targeted interventions to prevent unmet health care and dental care needs.

The Role of Social Determinants of Health in Self-Reported Psychological Distress among United States Adults Post-COVID-19 Pandemic.

Psychological distress, an emotional condition with symptoms of anxiety and depression, leads to impaired function, behavior, and personal traits. The current study examined the association between social determinants of health and the severity of psychological distress among adults in the United States after the COVID-19 pandemic. Using multinomial multivariable logistic regression, we analyzed data from 5106 (n = 5106) participants in the Health Information National Trends Survey (HINTS) 6. Compared to non-Hispanic Whites, African Americans (AOR = 0.62, CI = 0.42-0.93) had lower odds of reporting mild psychological distress rather than no stress. Other variables associated with a higher likelihood of reporting moderate to severe psychological distress, rather than no distress, are being in the 50-64 years age group (AOR = 2.77, CI = 1.45-5.28), divorced (AOR = 2.50, CI = 1.70-3.69), and widowed (AOR = 3.78, CI = 2.15-6.64). Respondents living in an urban area had lower odds of reporting moderate to severe psychological distress (AOR = 0.56, CI = 0.39-0.80) compared to those living in rural areas. Our findings identify several risk factors for psychological distress by sociodemographic characteristics such as age, race, marital status, and urban living, providing empirical evidence for interventions in behavioral health. These findings suggest there is an utmost need for a multi-sectoral approach to address the social determinants of health associated with psychological distress post-COVID-19 pandemic.

National trends in pediatric drowning — insights from the Israeli Ministry of Health registry-based cohort

This study analyzes the epidemiology of pediatric drowning in Israel from 2010 to 2022, focusing on differences across age groups, sex, and regions. We conducted a retrospective cohort study using data from the Ministry of Health’s administrative databases, covering all children aged 0–17 years who were seen in the emergency department, discharged after hospitalization, or died at the scene due to drowning, excluding cases of intentional harm or suicide. The primary outcome was the annual drowning rate per 100,000 children, categorized by age, sex, and region, along with hospitalization duration, intensive care unit admissions, and mortality rates. A total of 2101 drowning incidents were identified, with 9% resulting in death. Higher drowning rates were found in younger children (1–4 years) and teenagers (15–17 years), with notable differences by sex. Drowning rates were higher in coastal regions and more frequent during winter and spring. An increase in drowning rates was observed over the last 3 years of the study (2020–2022). Children hospitalized for more than 3 days had significantly higher mortality rates, both in general wards and intensive care units.Conclusions: Pediatric drowning is a persistent public health concern in Israel, with distinct seasonal, regional, age-specific, and sex-specific patterns in incidence and mortality. This study underscores the need for a comprehensive prevention strategy that includes year-round public education, environmental safety measures, and targeted interventions for high-risk groups to reduce drowning incidents and fatalities among children effectively.What is Known:• Pediatric drowning represents a significant public health challenge globally, with varying rates.• In Israel, pediatric drowning is the second leading cause of death from all injury-related deaths. Thus far, the measures and interventions to reduce fatalities were not proven effective enough.What is New:• Pediatric drowning in Israel, with a 9% mortality rate, revealed a biphasic rate varied by sex and is higher in coastal regions and during winter and spring.• There was a notable increase in drowning incidents during the last 3 years of the study period (2020–2022), coinciding with the COVID-19 pandemic.

Exploring Cervical Cancer Screening Uptake among Women in the United States: Impact of Social Determinants of Health and Psychosocial Determinants.

Several non-medical factors, such as income, education, and access to care, directly or indirectly affect adherence to cancer screening guidelines. We examined the impact of social determinants of health (SDOH) and psychosocial factors on screening behavior in a nationally representative sample of women in the US. A retrospective population-level cross-sectional sample was extracted from the 2022 Health Information National Trends Survey. The dependent variables were the interest in cervical cancer screening and the screening behavior. The independent variables included SDOH and psychosocial factors. Descriptive statistics were calculated for demographics and covariates, and population-based estimates with 95% confidence intervals (CI) were produced for Pap testing behaviors. Logistic regression models assessed differences in Pap testing based on SDOH and psychosocial factors, adjusting for covariates. The study included 2224 women with a mean age of 46.96. Results showed that 90% of women were interested in cervical cancer screening, with an 80% screening rate. Screening rates varied by age and rurality. SDOH and psychosocial factors influenced both interest and actual screening, with 3% and 1% impacts, respectively. These findings suggest that SDOH and psychosocial factors are associated with cervical cancer screening uptake, highlighting the need for policies to address these disparities. Policies must be directed at bridging the gap created by these SDOHs. Public health professionals and researchers can design interventions using the SDOH and psychosocial frameworks to increase cervical cancer screening uptake.

Trends in Norwegian adolescents’ substance use between 2014 and 2022: socioeconomic and gender differences

BackgroundSubstance use is a global health concern and early onset among adolescents increases health risks. We explore national overall trends in prevalence and trends in socioeconomic inequalities in past year alcohol intoxication, cannabis use, and use of other illicit drugs among Norwegian adolescents (ages ∼ 15–19 years of age) between 2014 and 2022.MethodThe present study builds on data from a nationwide repeated cross-sectional survey collected in 2014–2016 (T1), 2017–2019 (T2), 2021 (T3) and 2022 (T4). In total 415,560 adolescents (50.3% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).ResultsWhile the prevalence of alcohol intoxication remained fairly stable, the prevalence of cannabis and other illicit drug use increased between 2014 and 2022 among upper secondary school boys (13.3–17.6%, and 2.0–5.2%, respectively) and girls (8.8–12.8%, and 1.1–2.7%, respectively). Similar trends were observed among 10th-grade adolescents. Boys were more likely than girls to use cannabis or other illicit drugs, but the gender gap in cannabis use narrowed during the study period. Among upper secondary girls, use of cannabis and other illicit drugs was higher among those from less affluent backgrounds, with absolute and relative inequalities in cannabis use increasing between 2014 and 2022. Small inequalities in cannabis use and decreasing relative inequalities in the use of other illicit drug were observed among upper secondary boys.ConclusionsThe increasing use of cannabis and other illicit drugs among Norwegian adolescents is concerning. Future studies should explore the underlying causes of this rise and explore the complex factors influencing adolescent substance use behaviours. A comprehensive understanding of these factors is essential for developing targeted and effective interventions.

Identifying the determinants of E-commerce offerings among grocery store locations in the United States: A spatial econometric analysis

This paper leverages store location data and analysis software from retail industry vendors to analyze the unique geographies of electronic commerce (e-commerce) offerings among major grocery chains in the United States. Join-Count statistics are calculated to identify patterns of clustering among offerings, and a spatial probit model is implemented to regress various trade area characteristics on a given grocery banner's decision to offer some form of e-commerce (pickup, delivery, or both) or no offering at a given store location. A regional case study of the Southeastern United States demonstrates how model results can shift based on scale, pointing to unique regional dynamics that deviate from broader national trends. This analysis carries implications for location planning and competitive defense strategies in the grocery industry, and also establishes avenues for future research.

Turning to digital: Examining the relationship between offline healthcare barriers and U.S. older adults’ emotional well-being via online patient–provider communication and perceived quality of care (2017–2020)

PurposeTo examine the association between offline healthcare barriers and emotional well-being and assess the mediation roles of online patient–provider communication (OPPC) and perceived quality of care. This study also investigates the trends in offline healthcare barriers, OPPC, perceived quality of care, and emotional well-being over four years among the old population in the U.S. MethodsData from the Health Information National Trends Survey (HINTS) 5 Cycles 1, 2, and 4 were used. Mediation analysis and comparison analysis were employed. ResultsThe results indicated an increment in OPPC and a decline in patient’s perceived quality of care between 2017 and 2020. Across the three years, offline healthcare barriers were consistently negatively associated with emotional well-being, and perceived quality of care remained a mediator in such a relationship. Moreover, the serial mediating roles of OPPC and perceived quality of care between offline healthcare barriers and emotional well-being turned from statistically non-significant (2017) to significant (2018, 2020). ConclusionOur results witness the growing adoption of OPPC among older adults and the evolution of OPPC as a complementary communication modality. The findings can support interventions to augment OPPC utilization and enhance the perception of quality care of older adults, contributing to their increased emotional well-being.

Strategic framework and global trends of national smart education policies

Integrating intelligent technology to promote smart education, had become a focus of education policies in many countries. However, there was little literature on strategies and trends of smart education policies at the national level. This study investigated the framework for developing national smart education strategies and trends of national policy making on smart education. Based on the Delphi technique method, a National Smart Education Framework was developed, consisting of four essential leveraging points: (1) forward-thinking governance and policy initiatives, (2) digital learning environments conducive to smart education, (3) transformative teaching and learning enabled through technology, and (4) overarching considerations. Additionally, a textual analysis method was employed to analyze 24 smart education policies from 24 countries or organizations, to uncover the strategies and policy trends of smart education in accordance with the proposed smart education framework. Promoting high-quality, inclusive, and accessible education, increasing Internet connectivity and access to digital tools, enhancing digital skills, ensuring information security and privacy, implementing new digital pedagogies, providing real-time feedback, emphasizing critical thinking, problem-solving, and creativity, etc. were the main trends for smart education policy making. The findings of this study provide valuable insights for policymakers and educators in shaping smart education policies and practices worldwide to promote sustainable development.