The presence of a bunion (hallux valgus) deformity is a recognized risk factor for falls among older adults; however, it is uncertain whether surgical correction of the foot deformity can help mitigate this risk. We conducted a retrospective cohort study of US adults aged 50 and over with hallux valgus using commercial, state, and federal healthcare claims obtained from a national database (PearlDiver, Inc.). Patients who underwent bunion surgery were compared to those treated nonoperatively for their bunion deformities from January 2011 to April 2022. Claims-based falls (all-cause) were tracked using diagnosis codes for up to 11 years. Group differences in fall risk were examined using both one-year and long-term adjusted hazard ratios (aHR) and corresponding absolute risks. 127,990 people were diagnosed with hallux valgus and 17,406 (13.6%) underwent surgery. The median follow-up time was 2905 and 2298 days for the surgery and non-surgery groups, respectively. A smaller proportion of people fell in the surgery versus non-surgery group (5 vs 8% at one year; 16 vs 21% over total follow-up). Furthermore, after controlling for important covariates, patients who underwent bunion surgery were 16% less likely to fall in the first year (aHR 0.84, 95% CI 0.76 to 0.92) and 42% less likely to fall over the 11-year follow-up (aHR 0.58, 95% CI 0.52 to 0.63) compared to those with uncorrected hallux valgus deformity. Among older adults in whom surgery is already indicated, a potential ancillary benefit may be a reduction in injurious falls over time.

Depression is recognized as being linked to atherosclerosis and adverse cardiovascular outcomes; however, robust evidence from nationally representative cohorts regarding its association with myocardial infarction (MI) is still insufficient. This study aimed to investigate the relationship between depressive symptoms, measured by the PHQ-9, and the odds of having a history of MI using data from NHANES 2005-2020, while further exploring possible nonlinear patterns and potential modifiers of this association. We included 37,139 adults aged 20 years or older (1,574 with MI) and performed weighted analyses accounting for the NHANES complex survey design. Exposure was defined as PHQ-9 scores, analyzed both continuously and by severity categories (none, mild, moderate, severe), with self-reported MI as the outcome. We fitted three progressively adjusted weighted logistic regression models and employed restricted cubic spline (RCS) analysis to evaluate nonlinearity. We further performed prespecified subgroup and interaction analyses, along with a series of sensitivity analyses. Higher depressive burden was significantly associated with higher odds of MI, with MI prevalence rising progressively across depression severity groups (2.89% vs. 4.39% vs. 5.80% vs. 7.08%, p < 0.001). In the unadjusted model, every 1-point increase in PHQ-9 score corresponded to a 6.2% increase in the odds of MI (OR = 1.062, 95% CI: 1.047-1.077; p < 0.001), while severe depression was linked to approximately a 2.56-fold higher odds compared with non-depressed participants. The association remained robust after sequential full adjustment for potential confounders. Restricted cubic spline analysis revealed no evidence of nonlinearity (p > 0.05), supporting an approximately linear association. Subgroup analyses demonstrated consistent associations across most strata; however, significant interactions were detected for CHF, CHD, and higher V/MPA groups (P for interaction < 0.05), indicating attenuated associations in these groups. In a nationally representative sample of US adults, depressive burden was strongly associated with prevalent MI, with cardiovascular comorbidities and physical activity acting as potential modifiers of this association. These findings underscore the importance of integrating routine depression screening and holistic mind-body management into both general and high-risk populations, and highlight the necessity of prospective and interventional studies to clarify the temporal sequence and evaluate potential causality.

ABSTRACT Classic theories of religious pluralism theorized that religions compete for plausibility and acceptance based on the assumption that individuals can only have one religious identity or none. Religious identification in the United States has long been conceptualized as exclusive in nature, and surveys have in turn tended to only allow an individual to identify with a single religion. Recent research has questioned these assumptions, and there are theoretical reasons to expect that some individuals would be more likely to identify with multiple religions. The study presented here utilizes data from a probability survey of US adults in which respondents were allowed to select all the religions with which they identify to test hypotheses concerning patterns of multiple identification. A multinomial logistic regression model finds that childhood exposure to different world religions is positively associated with multiple identification relative to single identification, whereas self‐reported religiosity and political conservatism are negatively associated with multiple identification relative to single identification.

Serum Cotinine-Defined Tobacco Exposure and Its Association With Stroke, Mortality, and Cognitive Outcomes: Evidence From NHANES 2003 to 2018.

Background This study examines the correlates of NP use to attempt quitting tobacco and e-cigarettes, as well as overall NP use patterns (current [past-month], former, and never use) and commonly used NP brands in a nationally representative US adult sample. Methods We used the Population Assessment of Tobacco and Health (PATH) Study Wave-7 data collected between 2022 and 2023 (n = 30,801). We cross-sectionally investigated the correlates of NP-use and their use for quitting and switching tobacco-use. We also report NP brands among current users. Weighted multivariable logistic regression models were used to describe the relationship between NP measures, demographics, and tobacco-use behaviors. Results Among US adults, 3.3% had used NPs, while 1.6% and 0.8% were past-year and past-month consumers, respectively. Among individuals who used tobacco and made a quit attempt, 5.9% attempted to quit tobacco with NPs, and 3.6% intended to switch from cigarettes to NPs. Correlates of attempting to quit tobacco with NPs were having people one considered important (vs. none) using NPs (AOR: 4.7; 95% CI: 1.3, 16.3) and past year use (vs. no use) of smoking cessation treatment (AOR:2.9; 95% CI:1.4, 5.9). The most common NP brand used by past-month users was Zyn (57.9%, 95% CI: 50.2, 65.3). Conclusion Use of nicotine pouches for attempting tobacco cessation or switching was more common among individuals who had engaged with FDA-approved cessation treatments and those with social networks that included pouch users. These findings suggest that NPs are being used alongside traditional cessation treatments and their use may be influenced by social exposure.

Approximately one-third of US adults have tattoos, yet the dosimetric impact of intradermal tattoo pigments during radiation therapy remains uncharacterized. Commercial tattoo inks contain unregulated metallic impurities including chromium, lead, and nickel, raising concerns about dose perturbations in tattooed skin. This work quantifies radiation dose perturbations induced by high-atomic-number (Z) tattoo pigments under clinically relevant radiotherapy conditions. Monte Carlo simulations (TOPAS) modeled layered skin phantoms with a 0.3-mm intradermal tattoo layer embedded at 1.25–1.55 mm depth. Three commercial inks were evaluated: carbon-based (black) and metal-containing (Fe-rich brown, Al-containing orange) at pigment loadings of 5–100 vol% within the tattoo layer, to establish upper-bound effects. Electron (6, 18 MeV) and photon (6, 18 MV) beams were simulated with standard clinical geometry (1 × 1 cm² field, SSD = 100 cm). Photon irradiation produced pronounced, depth-localized dose enhancement, with peak dose enhancement factor (DEF) reaching 2.5 for brown ink at 18 MV, a 62% mean increase relative to non-tattooed skin driven by high-Z–mediated secondary electron production. Electron beams exhibited energy-dependent behavior: 6 MeV produced modest enhancement (peak DEF ~ 1.07), while 18 MeV unexpectedly generated dose deficits (DEF < 1.0) due to enhanced lateral scattering. Critically, all perturbations remained depth-confined without lateral propagation, preserving spatial dose uniformity across tattooed and non-tattooed regions. Tattoo pigments containing toxic metals create substantial localized dose enhancements under photon irradiation but minimal perturbations under electron therapy. These modality-dependent effects represent a previously unrecognized source of dose uncertainty in radiotherapy and warrant consideration in treatment planning for the growing population of tattooed patients.

Falls are a leading cause of morbidity and loss of independence in adults. The association between overactive bladder (OAB) and fall risk has not been thoroughly investigated. This study evaluated the association between OAB and fall history in a nationally representative sample of US adults aged 20-69 years. We performed a cross-sectional analysis of adults aged 20-69 years from the 2021-2023 National Health and Nutrition Examination Survey (NHANES). OAB was classified using a composite symptom severity score that assessed urge urinary incontinence and nocturia. Fall history was assessed by self-reporting (only in participants aged 20-69 years), where a recent fall was defined as experiencing at least one fall within the past year. Survey multivariable logistic regression was used to estimate adjusted odds ratios (aOR) for the association between fall history and OAB after controlling for sociodemographic and clinical covariates. Among 4118 participants, the population-weighted prevalence of OAB was 19.6% (standard error [SE]: 1.1%), and the prevalence of a recent fall was 28.3% (SE: 1.3%). The prevalence of a recent fall was higher among those with OAB (39.7% [SE: 1.6%] vs. 25.7% [SE: 1.5%]). The prevalence of a recent fall increased progressively with OAB symptom severity (24.3% in those with no symptoms vs. 52.4% in those with severe symptoms). In the fully adjusted model controlling for sociodemographic and clinical covariates, OAB was independently associated with a 42% higher odds of experiencing a recent fall (aOR, 1.42; 95% CI, 1.10 to 1.83; p = 0.01). OAB is independently associated with an increased risk of a recent fall in US adults aged 20-69 years, with a strong positive relationship between OAB severity and fall risk. These findings suggest that screening for OAB may be a useful adjunct to fall risk assessment. Future studies are needed to determine whether OAB management reduces the risk of falls.

Adults with arthritis face an elevated risk of all-cause mortality. While baseline-reported metformin use is associated with lower mortality in other chronic conditions, whether a similar association exists in this high-risk population remains unknown. We therefore aimed to evaluate the association between baseline-reported metformin use and all-cause mortality in a large, population-based cohort of US adults with arthritis. This cohort study analyzed data from 14,633 participants with self-reported arthritis in the National Health and Nutrition Examination Survey, 1999-2018. Participants were categorized as baseline-reported metformin users or non-users based on the 30-day prescription medication inventory collected during the baseline in-home interview. The study outcome was all-cause mortality, ascertained via linkage to the National Death Index. We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs), complemented by propensity score-based analyses, including inverse probability of treatment weighting. The cohort, with a mean age of 62.87years and 59.61% female, was followed for a median of 95months, during which 4412 deaths occurred. After multivariable adjustment, baseline-reported metformin use was associated with a significantly lower risk of all-cause mortality (HR, 0.77; 95% confidence interval [CI] 0.68-0.86; P < 0.001). Propensity score analyses substantiated these findings, yielding an HR of 0.76 (95% CI 0.67-0.86, P < 0.001). The association was consistent across different arthritis subtypes and in various sensitivity analyses. Our study found that baseline-reported metformin use was associated with a significantly lower risk of all-cause mortality among US adults with arthritis. Given the observational nature of this study and potential confounding by indication, these findings should be interpreted as associative rather than causal. Additional research is required to substantiate these findings. Key Points • Baseline-reported metformin use was associated with a significantly lower risk of all-cause mortality in adults with arthritis. • The association between baseline-reported metformin use and lower all-cause mortality was consistent across different arthritis subtypes.

ABSTRACT Physical Activity (PA) is crucial for the management of diabetes. Since PA participation has a positive effect on mental health, it was hypothesized that PA and depression could be associated in individuals with diabetes. The aim of this research was to study whether there are associations of PA with depression and depressive symptoms in diabetics. Additionally, a potential dose-response relationship of PA with depression and depressive symptoms and the risk of suffering depression and depressive symptoms according to PA group were explored. This cross-sectional study is based on data from the NHANES 2011–2020, the study sample was formed by 3017 (1585 males and 1432 females) US adults with diabetes. Associations were studied through the Chi-squared test. The Kruskal Wallis test was used to study differences in depression scores. Correlations were studied through Spearman´s rho, and the odds ratios were calculated using a binary logistic regression model. Associations of PA with depression prevalence (p < 0.001) and the frequency of depressive symptoms (p < 0.05) were found. Greater incidence of major depression, depressive symptoms and greater depression scores in the PHQ-9 were found for inactive diabetes patients. Correlations of PA group and METs with PHQ-9 scores and the frequency of depressive symptoms for each item of the PHQ-9 were found, except for the 7th item (concentration problems). Increased odds of suffering major depression (OR = 1.957 (CI95% = 1.310–2.923)) and all the depressive symptoms studied were found for physically inactive diabetes patients compared to those from the moderate PA group. The association of PA with depression and the frequency of suffering depressive symptoms in US adults with diabetes were confirmed. Greater prevalence of depression and greater frequency of depressive symptoms were found for physically inactive diabetes sufferers. A dose-response relationship between PA and frequency of depressive symptoms is suggested.

Health-related social needs (HRSNs) may impede colorectal cancer (CRC) screening among US adults, yet population-based evidence on these associations remains limited. To examine associations between HRSNs and CRC screening uptake overall and by age group among US adults. This cross-sectional study used data from the 2023 National Health Interview Survey. Participants were US civilian, noninstitutionalized adults aged 45 to 75 years eligible for CRC screening. Age-stratified analyses were conducted for adults aged 45 to 49 years, 50 to 64 years, and 65 to 75 years. Data analysis was performed from April 2025 to February 2026. Self-reported HRSNs, including housing instability, food insecurity, transportation barriers, and number of unmet needs. The primary outcome was being up to date with CRC screening according to US Preventive Services Task Force recommendations. Survey-weighted logistic regression models estimated adjusted odds ratios (aORs) and 95% CIs overall and by age group. The analytic sample included 14 528 adults aged 45 to 75 years, and most participants were aged 50 to 64 years (6940 individuals [52.42%]), female (7788 individuals [51.36%]), insured (13 750 participants [94.07%]), and reported no unmet HRSNs (12 370 participants [85.40%]). Overall, 2158 adults (14.60%) reported at least 1 unmet HRSN. The proportion up to date with CRC screening was 63.91% (9758 adults) overall and increased with age, from 31.01% (586 adults) among adults aged 45 to 49 years to 64.24% (4539 adults) among those aged 50 to 64 years, and 80.85% (4633 adults) among those aged 65 to 75 years. In adjusted models, housing instability (aOR, 0.82; 95% CI, 0.67-0.99) and transportation barriers (aOR, 0.78; 95% CI, 0.64-0.95) were associated with lower odds of being up to date with CRC screening. Screening odds declined with increasing number of unmet HRSNs, including among adults reporting 1 unmet need (aOR, 0.84; 95% CI, 0.72-0.98). Associations were most pronounced among adults aged 50 to 64 years, among whom housing instability (aOR, 0.77; 95% CI, 0.61-0.97), transportation barriers (aOR, 0.71; 95% CI, 0.56-0.91), and reporting 1 HRSN (aOR, 0.80; 95% CI, 0.66-0.97) were associated with lower odds of being up to date with screening. In this cross-sectional study, unmet HRSNs were associated with lower CRC screening uptake, particularly among adults aged 50 to 64 years. Addressing HRSNs may support age-specific strategies to improve CRC screening.

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

This study examined trends in clinical and preclinical obesity prevalence among US adults and their association with social determinants of health (SDOH) from 1999 to 2023. We analyzed data from 60,506 adults aged ≥ 20 years in 11 cycles of the National Health and Nutrition Examination Survey (1999-2023). Clinical obesity was defined per the Lancet Diabetes & Endocrinology Commission on the definition and diagnosis of clinical obesity and preclinical obesity by excess adiposity without obesity-attributable complications. Eight SDOH domains were assessed individually and as a cumulative burden score. Age-standardized prevalence and associations were estimated using survey-weighted regression models. From 1999-2000 to 2021-2023, age-standardized prevalence of clinical obesity nearly doubled (14.3% to 26.6%; p < 0.001), driven by increases in class III obesity. Preclinical obesity increased modestly (17.1% to 20.6%; p = 0.038). Disparities widened significantly between those with highest (> 6) vs. lowest (< 3) cumulative SDOH burdens. In multivariable-adjusted analyses, unemployment (OR 1.50), food insecurity (OR 1.38), and high cumulative SDOH burden (OR 1.48) were strongly associated with clinical versus preclinical obesity, particularly class II-III severity. Clinical obesity increased dramatically, showing a strong dose-response relationship with social disadvantage and widening SDOH-based disparities, underscoring the need for targeted interventions addressing structural determinants among vulnerable populations.

Association of cardiovascular-kidney-metabolic syndrome with cardiovascular, cancer, and all-cause mortality among US adults: A prospective study.

BackgroundRural US adults experience disparities in meeting the physical activity guidelines (PAGs). Little is known about preferred types of leisure-time physical activity (LTPA), nor their relationship with meeting the PAGs. This study aimed to identify the most prevalent LTPAs among US adults, the relationship between LTPA types and meeting PAGs, and how these differed by residential status.Methods2019 Behavioral Risk Factor Surveillance Study data were analyzed. Age-adjusted prevalence of 75 LTPAs and 11 categories of LTPAs that respondents spent the “most time” and “next most time” in during the previous month were compared by residential status (metropolitan; non-metropolitan). Logistic and multinomial logistic regression analyses adjusted for a variety of factors were used to compare the prevalence of meeting aerobic-, muscle strengthening, and combined PAGs by residential status. Age-adjusted prevalence of meeting the combined PAGs by 11 LTPA categories was compared by metropolitan status.ResultsWalking was the most prevalent LTPA (44.1%). Lawn/garden, hunting/fishing, household, farm/ranch work, childcare, and winter activities were more prevalent among non-metropolitan (rural) residents. Walking, running/jogging, weightlifting, conditioning, other activities, sports, bicycling, water activities, and dance were more prevalent among metropolitan (urban) residents. Non-metropolitan residents were less likely to meet the minimal aerobic-, muscle-strengthening, and combined PAGs, and were more likely to be inactive. Among adults that engaged in walking, roughly 25% met the combined PAGs and about 22% did not meet either PAG.ConclusionsWhen creating targeted rural PA interventions, LTPA preferences could be embraced and augmented or the non-preferred LTPAs could be adapted.

Systemic inflammation occurs when the immune system is chronically active due to repeated harmful exposures or dysregulation of the immune process. It is associated with the prevalence and poorer prognoses of many chronic diseases. Like many health indicators, its burden is often found to be greater in those of lower socioeconomic status. Little is known about how levels of systemic inflammation have changed over time in populations, nor how such changes may relate to socioeconomic status. This study uses data from National Health and Nutrition Examination Surveys (NHANES) to evaluate inflammation trends in the US population between the 1970s and 2010s. The results indicate a shift in structural immunity for the US adult population that corresponds with increasing systemic inflammation over time, with the trend being modestly stronger at lower income levels.

Life's Essential 8 and Mortality in US Adults with Diabetes: Greater Risk Reduction Compared to Those Without Diabetes.

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

Social Isolation and Loneliness Among U.S. Adults with Self-Reported Hospitalization.

Clinical Trial Skepticism and Political Ideology Among US Adults and Cancer Survivors

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.