Self-perceived bodyweight status among adults who are overweight or have obesity, with and without high cardiovascular risk.

Association between the hemoglobin-to-red cell distribution width ratio and poor sleep quality in US adults.

Although the recent proliferation of telemental health care has transformed delivery of outpatient mental health care for many patients, little is known about population-level access to telehealth, hybrid, and in-person outpatient mental health care in the US. The objective of this report is to characterize patterns of all telehealth, hybrid, and all in-person outpatient mental health care by US adults. An analysis is presented of 2021-2022 Medical Expenditure Panel Survey data (n=39,561) focusing on annual percentages of adults receiving all telehealth, hybrid, and all in-person outpatient mental health care. Results are presented overall and stratified by sociodemographic characteristics. Differences are reported in average marginal estimates from logistic regressions for each sociodemographic characteristic controlling for age group, sex, and psychological distress (Kessler-6). Approximately 12.0% of adults annually received outpatient mental health care, including 3.3% all telemental health care, 2.6% hybrid, and 6.1% all in-person mental health care. After controlling for age, sex, and distress, unemployed adults 65 years of age or younger were less likely than employed adults to receive all mental health care (-1.0 percentage points, 95% CI: -1.6 to -0.4), and uninsured individuals were less likely than those with private insurance (-2.8 percentage points, 95% CI: -3.6 to -1.9). By contrast, college graduates were 3.2 percentage points (95% CI: 2.3-4.0) more likely than those with less than a high school diploma, higher-income individuals were 1.6 percentage points (95% CI: 0.8-2.30) more likely than those below the poverty level, and urban residents were 1.9 percentage points (95% CI: 1.1-2.7) more likely than rural residents to receive all telemental health care. These national patterns highlight differences in US telemental health care access across employment, education, income, insurance, and geographic groups.

Objectives. To investigate if anticipated survey context (e.g., national government health survey, local community health survey, health care provider form) would affect participants' likelihood of (1) responding to sexual orientation, gender identity, sex assigned at birth, and intersex status (SOGISI) questions or (2) changing their responses to SOGISI questions. Methods. We performed an online study of people across sexual orientations and gender identities in the United States (n = 851) testing the hypotheses that individuals with minoritized identity would be less likely to respond and more likely to change their responses to questions about their SOGISI identity. Results. Overall, results were significant and in the expected direction, indicating that there was a dependent relation between identities and type of question being asked. Conclusions. Within this sample, participants with minoritized sexual and gender identities were more likely to change their answer on the basis of the context of data collection, highlighting important considerations for individuals who utilize surveys to collect SOGISI data. Public Health Implications. Results from this study can be used to provide recommendations for questions to use in surveys for collection of SOGISI data and important considerations when collecting data from sexual and gender minorities. (Am J Public Health. 2026;116(4):533-543. https://doi.org/10.2105/AJPH.2025.308376).

Binational association between polyunsaturated fatty acid intake and depression in Korea and the US: A cross-national cross-sectional study.

The impact of cannabis co-use and cannabis use disorder on interest in and barriers to tobacco cessation.

Individuals with chronic respiratory disease, heart disease, or diabetes are highly susceptible to complications from viral respiratory infections (VRI). This survey aimed to gain insight into the attitudes toward vaccines and antivirals for VRI among adults in the US with these conditions. This cross-sectional anonymous online survey was conducted from March 31-April 18, 2025. Individuals ≥18years living in the US with a self-reported diagnosis of chronic respiratory disease, heart disease, or diabetes were eligible to participate. Of the 3024 survey participants, most (60%) participants felt their chronic health condition put them at increased risk of VRI or their complications. Approximately half (48%) of participants had ever taken a prescription antiviral to prevent getting sick and 60% reported that they would be likely or very likely to take a prescription antiviral if their healthcare provider offered it. The majority (68%) of participants received a yearly influenza vaccination and 64% received a COVID-19 vaccine/booster. Opinions about vaccines were overall favorable. Participants who frequently had serious complications (i.e., hospitalization) with VRI were more likely to have taken prescription antivirals than those with less frequent hospitalizations. Participants who felt that their chronic health condition put them at increased risk of VRI or their complications were more likely to have received recommended vaccinations. Attitudes toward VRI prevention were overall favorable in this survey population. Improving patient understanding of VRI-related risk may increase acceptance of prophylactic interventions among individuals with chronic health conditions.

Association between weekend catch-up sleep and Metabolic dysfunction-associated steatotic liver disease in US adults.

Lumbar fusion is a common procedure to help treat trauma, deformities, tumors, infections, and degenerative diseases of the spine by improving mechanical stability. The rate of non-tobacco nicotine, also known as e-cigarette, use among US adults has recently been increasing. This study seeks to take a collective look at fusion outcomes to address this problem by quantitatively evaluating the effects of non-tobacco nicotine dependence (NTND) on postoperative outcomes following lumbar fusion surgery. A retrospective cohort study using the TriNetX database identified patients undergoing lumbar fusion, categorized into NTND, tobacco-dependent, and non-nicotine users. Propensity score matching (1:1) controlled for demographics and comorbidities. Primary outcomes were 90-day postoperative and 2-year implant-related complications. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Within 90days, the NTND group had higher rates of pneumonia (RR 1.83; 95% CI 1.24-2.69), renal failure (RR 1.71; 95% CI 1.21-2.42), and sepsis (exclusive to NTND), but lower transfusion rates (RR 0.78; 95% CI: 0.66-0.91) compared to controls. At 2years, NTND patients had increased pseudarthrosis (RR 1.37; 95% CI 1.09-1.73) and post-laminectomy syndrome (RR 1.36; 95% CI 1.06-1.75), but less adjacent segment disease (RR 0.56; 95% CI: 0.35-0.89). Compared to tobacco users, NTND patients had higher pseudarthrosis (RR 1.59; 95% CI 1.15-2.21), lower adjacent segment disease (RR 0.40; 95% CI 0.22-0.72), and less foot drop (RR 0.54; 95% CI 0.31-0.93). NTND patients experienced higher complication rates following lumbar fusion than non-nicotine users, with continued risks compared to both groups. These findings suggest non-tobacco nicotine may negatively impact surgical outcomes, underscoring the need for preoperative assessment and counseling.

Purpose Travel to tropical destinations offers valued culinary experiences but also exposes tourists to health risks such as Ciguatera Fish Poisoning (CFP). This study aims to examine how threat and countermeasure awareness shape US travelers’ food choices. Design/methodology/approach Using protection motivation theory (PMT), a cross-sectional Pollfish survey (May–June 2024) collected data from 600 US adults planning travel to the Caribbean, assessing knowledge of CFP symptoms, transmission and prevention. Findings Most respondents held inaccurate knowledge, including the belief that cooking removes CFP toxins. Countermeasure awareness exerted a stronger influence than threat awareness on threat and coping appraisals, with misconceptions associated with lower protection motivation and riskier fish consumption. Practical implications The findings emphasize the need for clear, culturally sensitive risk communication in hospitality settings to correct misconceptions about CFP prevention and support safer seafood choices. Originality/value This study advances PMT by conceptualizing threat awareness and countermeasure awareness as distinct predictors of protective behavior, extending research on foodborne illness and climate-related health risks in hospitality settings.

The objective of this study was to investigate how the experience of a cancer diagnosis impacts sleep duration among Cancer Prevention Study-3 (CPS-3) participants. CPS-3 is a prospective cohort of US adults aged 30-65years. At baseline (2006-2013), 2015, and 2018, participants reported their average sleep duration during the prior year. Cancer incidence was determined via linkage to state registries. Participants who experienced a cancer diagnosis during study follow-up with complete sleep data prior to (pre-reference) and after cancer diagnosis (post-reference) were included. We matched individuals with a cancer diagnosis to participants without a cancer diagnosis during follow-up (1:4 ratio) based on age, sex, cohort entry year, and timepoint of sleep duration measures. Change in sleep duration was calculated as the difference between average sleep duration measurements at two survey timepoints (pre- and post-reference) (decrease, no change [ref], increase). We used multivariable multinomial logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between receiving a cancer diagnosis (exposure) and change in sleep duration (outcome) adjusted for demographic, lifestyle, and health factors. Among the 20,210 included CPS-3 participants (4,042 cancer survivors), participants who received a cancer diagnosis had higher odds of increasing sleep duration (OR = 1.16, 95% CI 1.07, 1.27) compared to participants who did not receive a cancer diagnosis. Restricting to female participants with a diagnosis of any cancer and breast cancer only showed similar results. The experience of a cancer diagnosis may contribute to increased sleep duration beyond expected age-related changes.

Although electronic cigarettes (e-cigarettes) have demonstrated efficacy for quitting combustible cigarette smoking, they also convey inherent risks. How the public views e-cigarettes and their potential harm may influence how e-cigarettes are used. We therefore evaluated perceptions of e-cigarettes over a recent 10-year period. Longitudinal data from a multiyear cross-sectional nationally representative survey, Health Information National Trends Survey, were analyzed to assess changes in perceptions of e-cigarettes' harm relative to cigarettes and factors affecting perceptions among US adults from 2012 to 2022. We used interrupted time series regression analysis to determine possible associations with key public health events. A total of 20 771 survey respondents were included in the analysis. From 2012 to 2022, the proportion perceiving e-cigarettes as more harmful than combustible cigarettes increased from 2.8% (95% CI, 1.8%-3.9%) to 30.4% (95% CI, 28.2%-32.7%). Likewise, perceptions of e-cigarettes as less harmful decreased from 50.7% (95% CI, 47.6%-53.9%) to 16.7% (95% CI, 14.9%-18.6%). Perceptions changed significantly following the national rollout of anti-vaping campaigns (p < .001) and the e-cigarette or vaping product use-associated lung injury outbreak (p < .001). Public perceptions of e-cigarettes have shifted markedly over the past decade, with increasing proportions of US adults viewing e-cigarettes as more harmful than combustible cigarettes. These changes appear closely linked to major public health events and campaigns. Understanding how such events influence perceptions is essential for guiding risk communication, public health policy, and future tobacco control strategies. How the public views electronic cigarettes (e-cigarettes) and their potential harm may influence how e-cigarettes are used. Although e-cigarettes convey risks, they have also demonstrated efficacy for quitting combustible cigarette smoking. We found that perceptions of e-cigarettes have shifted markedly over the past decade, with increasing proportions of US adults viewing e-cigarettes as more harmful than combustible cigarettes. How such perceptions influence smoking behavior represents an important consideration for risk communication, public health policy, and tobacco control strategies. Clear, evidenced-based messaging may reduce uptake of e-cigarette use, support harm-reduction efforts for current smokers, and promote trust in public health institutions.

ObjectivesWith an aging population and rural workforce shortages, family caregivers face growing demands. Caregivers' ability to continue providing care depends on their own underlying health and access to home- and community-based services (HCBS). This study examines rural caregiver needs within the Veterans Health Administration.MethodsWe conducted a qualitative study using data from family caregivers (N = 19). Content analysis was used to identify key themes.ResultsKey emergent themes included (1) Dyadic health: significant health concerns for both caregiver and Veteran; (2) Tension of pride vs. support needs as a caregiver; and (3) Patchwork of community supports: limited access to healthcare, respite, and transportation.DiscussionThis study highlights challenges in supporting rural family caregivers of older Veterans with complex health needs. Addressing transportation burdens, dual caregiver-care recipient needs require innovative, dyad-focused approaches. Future research using dyadic data can deepen understanding and guide community-based, caregiver-informed solutions.

Social Risks Among Adults with Communication Disabilities: Findings from the National Health Interview Survey (2020-2023).

Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with cardiomyopathy (CM), associated with worse cardiovascular outcomes. This study aims to provide a comprehensive, national-level analysis of AF and CM-related mortality in the United States. The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was utilized, using death certificates from 1999 to 2024. The study included patients aged ≥15 years with CM and AF. Statistical analyses were conducted to calculate age-adjusted mortality rates (AAMRs) per 100,000 individuals and annual percent changes with 95% confidence intervals (CIs). Between 1999 and 2024, CM with concomitant AF accounted for 134,470 deaths among individuals aged 15 years or older. The overall AAMR rose from 1.5 per 100,000 in 1999 to 2.3 in 2024. From 1999 to 2016, the AAMR rose modestly (1.5-1.8), followed by a pronounced rise from 2016 to 2022 (1.8-2.5), and a relative decline by 2024 (2.5-2.3). Compared with 2019, mortality in 2020 demonstrated a 15% relative increase (incidence rate ratio = 1.15; 95% CI: 1.11-1.19). Males had disproportionately higher AAMRs compared to females. By race, the highest AAMRs were observed in non-Hispanic (NH) Black and White populations (1.8 each). Regionally, the West and Midwest exhibited the highest AAMRs (1.9 each). Urban-rural stratification revealed higher AAMRs among rural areas (2.2) when compared with urban (1.8) areas. Targeted public-health interventions and resource allocation to address this growing cardiovascular mortality burden, particularly in high-risk demographic groups, are needed.

Inhaled corticosteroid (ICS)-long-acting β-agonist (LABA) inhalers are generally considered therapeutically equivalent when treating chronic obstructive pulmonary disease (COPD). However, metered-dose inhalers in the class are associated with substantially higher greenhouse gas emissions than dry powder formulations, and studies have raised questions about potential intraclass differences in clinical outcomes among patients receiving ICS-LABAs. To analyze COPD exacerbations and pneumonia hospitalizations associated with once-daily fluticasone furoate-vilanterol dry powder inhalers, twice-daily fluticasone propionate-salmeterol dry powder inhalers, and twice-daily budesonide-formoterol metered-dose inhalers in adults with COPD. This cohort study was conducted using longitudinal commercial claims data of US adults aged 40 years or older with COPD. Patients were 1:1 pairwise propensity score matched into 3 cohorts: (1) new users receiving fluticasone furoate-vilanterol vs budesonide-formoterol between January 1, 2014, and February 29, 2024; (2) new users receiving fluticasone furoate-vilanterol vs fluticasone propionate-salmeterol between January 1, 2014, and February 29, 2024; and (3) new users receiving fluticasone propionate-salmeterol vs budesonide-formoterol between January 1, 2007, and February 29, 2024. Receipt of a once-daily fluticasone furoate-vilanterol dry powder inhaler (Breo Ellipta; GSK), twice-daily fluticasone propionate-salmeterol dry powder inhaler (Advair Diskus; GSK), or twice-daily budesonide-formoterol metered-dose inhaler (Symbicort; AstraZeneca). The primary outcomes were first moderate or severe COPD exacerbation and first pneumonia hospitalization. Hazard ratios and 95% CIs were estimated using Cox proportional hazards regression models. The cohorts included 38 070 matched pairs of patients receiving fluticasone furoate-vilanterol vs budesonide-formoterol (58.8% women; mean [SD] age, 71.0 [9.0] years), 20 471 matched pairs of patients receiving fluticasone furoate-vilanterol vs fluticasone propionate-salmeterol (58.3% women; mean [SD] age, 69.9 [9.2] years), and 55 627 matched pairs of patients receiving fluticasone propionate-salmeterol vs budesonide-formoterol (56.2% women; mean [SD] age, 68.3 [9.0] years). Patients receiving fluticasone furoate-vilanterol had a 9% lower risk of moderate or severe COPD exacerbations compared with those receiving budesonide-formoterol (hazard ratio [HR], 0.91 [95% CI, 0.88-0.94]; number needed to treat [NNT] = 40) and a 6% lower risk compared with those receiving fluticasone propionate-salmeterol (HR, 0.94 [95% CI, 0.89-0.98]; NNT = 40). The risk of moderate or severe COPD exacerbation was similar for patients receiving fluticasone propionate-salmeterol and budesonide-formoterol (HR, 0.98 [95% CI, 0.95-1.01]). No differences were observed in the risk of pneumonia hospitalization across the 3 cohorts (fluticasone furoate-vilanterol vs budesonide-formoterol: HR, 1.03 [95% CI, 0.96-1.11]; fluticasone furoate-vilanterol vs fluticasone propionate-salmeterol: HR, 0.93 [95% CI, 0.85-1.03]; and fluticasone propionate-salmeterol vs budesonide-formoterol: HR, 1.04 [95% CI, 0.98-1.10]). In this cohort study of new ICS-LABA users with COPD, once-daily dry powder fluticasone furoate-vilanterol inhalers were associated with slightly improved clinical outcomes compared with twice-daily metered-dose budesonide-formoterol inhalers and twice-daily dry powder fluticasone propionate-salmeterol inhalers. Further studies are needed to explore potential intraclass differences among inhalers used to treat COPD.

Secondhand smoke (SHS) is a pervasive health concern increasingly associated with tooth loss, yet studies assessing its population-level associations and potential heterogeneity are limited. This study aimed at estimating the average and subgroup-specific effects of SHS exposure on tooth loss among US adults using modern causal inference-based methods. This study analyzed cross-sectional data from 6,019 nonsmokers aged ≥20 y, representing 48.2 million individuals, in the National Health and Nutrition Examination Survey (2009 to 2018). SHS was defined by serum cotinine. This study quantified the association between SHS exposure and tooth loss using targeted minimum loss estimation, a doubly robust estimator that enhances confounding adjustment in observational data. Confidence intervals were obtained via bootstrap resampling. Heterogeneity of the association was evaluated by a data-adaptive causal forest method that identifies subgroup-specific variation. SHS exposure was associated with having 0.74 fewer teeth (average association, -0.739; 95% CI, -1.053 to -0.426) and with a 4.6-percentage higher probability of having <20 teeth (average association, 0.046; 95% CI, 0.027 to 0.065). Larger associations were observed among adults aged ≥45 y, those with lower socioeconomic position, individuals with higher sugar intake or medical comorbidities, and participants at the extremes of flossing frequency. This study found that SHS exposure was associated with greater tooth loss, with disproportionate burdens observed among adults facing socioeconomic disadvantages or chronic health conditions. These findings underscore the potential value of integrating oral health outcomes into tobacco control initiatives and guiding targeted prevention for groups at elevated risk.

Background: Population genetic screening (PGS) serves an essential role in identifying individuals at higher risk for hereditary cancer and cardiovascular disease. Nevertheless, the current lack of insurance coverage for screening costs might pose a barrier to its adoption. Health systems might contemplate covering these test expenses, but individuals covered by Medicaid and Medicare may not qualify for cost-free screening due to constraints related to the Beneficiary Inducement Statute. Methods: A cross-sectional online survey was administered to 602 US adults in January 2023. Andersen’s model guided variable selection. An ordered probit model was deployed to explore the association between insurance type and willingness to pay (WTP) for PGS, controlling for demographic and healthcare characteristics. Results: Among the 602 respondents, 524 (87%) were included in our analysis. Over 70% (n = 373) of participants expressed WTP for genetic testing. A similar proportion of respondents with Medicare and Medicaid expressed WTP for screening (68%, and 70%, respectively). Insurance type was not significantly associated with WTP for genetic testing. Notably, lower trust levels and absence of family cancer history were associated with a lower probability of expressing high WTP compared to the reference categories (high levels of trust and having a family cancer history). Conclusions: WTP for genetic testing was not significantly associated with insurance type. Almost 30% of our sample were unwilling to pay for PGS, suggesting variability in WTP for PGS and adding to the limited literature on how individuals value genomic screening tests.

The non-high-density lipoprotein to high-density lipoprotein cholesterol ratio (NHHR) is an emerging lipid index linked to cardiovascular and metabolic risk. High-sensitivity C-reactive protein (hs-CRP) serves as a well-established marker of systemic inflammation. However, the association between NHHR and hs-CRP in the general population remains unclear. This study aimed to investigate their relationship using nationally representative US data. We analyzed data from 5994 adults aged ≥20 years from the 2015 to 2018 National Health and Nutrition Examination Survey (NHANES). NHHR was calculated as (total cholesterol – high-density lipoprotein cholesterol [HDL-C])/high-density lipoprotein cholesterol. Survey-weighted multivariable linear regression models were used to evaluate the association between NHHR (both continuous and quartiles) and hs-CRP levels. Restricted cubic spline analysis assessed nonlinear patterns. Subgroup and interaction analyses were conducted by age, sex, body mass index, diabetes, and hypertension. After full adjustment, NHHR was positively associated with hs-CRP (β = 0.91, 95% CI: 0.42–1.40, P = .002). Participants in Q3 and Q4 had significantly higher hs-CRP levels than those in Q1. Restricted cubic spline analysis revealed a significant nonlinear (inverted U-shaped) relationship (P for nonlinearity < .001). Subgroup analyses showed stronger associations in women and individuals with hypertension (P for interaction < .05). In this exploratory, cross-sectional analysis, our findings suggest that NHHR may be independently associated with hs-CRP and may exhibit a nonlinear relationship in US adults, suggesting its potential utility as an accessible marker of low-grade systemic inflammation; however, longitudinal cohort studies are needed to confirm these associations and to evaluate its potential predictive value and clinical applicability.

ABSTRACT Purpose To compare the patterns of association between two subtypes of open-angle glaucoma, primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG), and systemic cardiovascular, neurologic, and autoimmune conditions in a large sample. Materials and Methods This cross-sectional study generated propensity score-matched cohorts of patients with and without the above systemic conditions, based on International Classification of Diseases (ICD) encounter diagnosis codes, using the TriNetX platform, containing data from >120 million patients. Patients were matched across age, sex, race, and ethnicity. Cohorts for autoimmune conditions were additionally matched for long-term corticosteroid use. Primary outcomes were odds of either POAG or NTG. OR threshold of significance was defined as >1.1 or <0.9 to improve signal-to-noise ratio. Results The only systemic conditions associated with POAG were autoimmune disorders, namely Raynaud’s syndrome (OR = 1.15, 95% CI 1.08–1.23), giant cell arteritis (OR = 1.15, 95% CI 1.06–1.24), and Graves’ disease (OR = 1.26, 95% CI 1.18–1.34). POAG was not associated with cardiovascular or neurologic conditions. NTG was positively associated with conditions across all three categories of systemic conditions, with stronger positive associations with each condition compared to POAG. Conclusion POAG was not associated with cardiovascular or neurological conditions in a very large, propensity score-matched sample, but was positively associated with certain autoimmune conditions. NTG was positively associated with conditions across multiple organ systems. These findings indicate that both glaucoma subtypes likely have multifactorial etiologies of disease, one component of which may be auto-inflammatory.