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).

Patients immunosuppressed because of disease and/or therapy are at increased risk of developing herpes zoster (HZ) and related complications. However, HZ risk due to immunosuppressive medication remains underexplored across a broad spectrum of medication classes and conditions. To estimate HZ risk among US adults initiating immunosuppressive therapy, across underlying conditions. This retrospective study used administrative claims from the Optum Research Database (October 1, 2015, to December 31, 2022) to identify incident HZ diagnoses and the proportion of HZ with complications. Included patients were aged 18years or older and had at least a 12-month baseline period of continuous enrollment with medical and pharmacy benefits. Analyses produced incidence rates (IRs) of HZ during periods of immunosuppression and nonimmunosuppression and compared patients initiating immunosuppressive therapy (immunosuppressed subcohort) vs matched controls who did not (nonimmunosuppressed subcohort). Cox regression analyses compared HZ hazards and a logistic regression model compared the difference in the occurrence of postherpetic neuralgia (PHN) following HZ diagnosis. In patients initiating immunosuppressive medications (N = 528,283), the overall HZ IR was 18.2 (95% CI = 17.9-18.4) per 1,000 person-years. Patients with the highest IRs were those treated with Janus kinase inhibitors (30.5 [95% CI = 25.0-36.9] per 1,000 person-years), rituximab (27.8 [95% CI = 25.2-30.6] per 1,000 person-years), or cyclophosphamide (27.5 [95% CI = 19.3-38.1] per 1,000 person-years). Patients had a higher HZ risk when using immunosuppressive medications (adjusted hazard ratio 2.86 [95% CI = 2.76-2.95]) and with increasing numbers of immunosuppressive medication classes (one vs none: 2.45 [95% CI = 2.37-2.54]; at least 2 vs none: 4.04 [95% CI = 3.87-4.21]). The immunosuppressed subcohort had a higher HZ hazard (adjusted hazard ratio: 1.39 [95% CI = 1.35-1.43]), higher frequency of HZ complications (21.4% vs 18.8% of HZ cases developed PHN, P < 0.001), and increased odds of PHN (adjusted odds ratio: 1.22 [95% CI = 1.14-1.31]) compared with the nonimmunosuppressed subcohort. Immunosuppressive medication use was associated with a higher risk of HZ and HZ-related complications. Measures to prevent HZ before immunosuppressive treatment initiation should be considered according to Advisory Committee on Immunization Practices recommendations and other professional organizations.

Obesity affects over 40% of US adults, with severe obesity on the rise. Despite recognition of obesity as a chronic disease, it remains underdiagnosed and undertreated. Access to evidence-based obesity treatment is limited, leading to increased obesity severity and related complications. Barriers to obesity treatment include socioeconomic disparities, limited clinician training, stigma, and restrictive or absent reimbursement policies. FDA-approved obesity medications offer significant health benefits, prompting the need for updated, evidence-based guidance. The Obesity Society (TOS), the Obesity Medicine Association (OMA), and the Obesity Action Coalition (OAC) convened a multidisciplinary panel, including patient representatives and obesity care providers, to develop a guidance statement using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Systematic evidence synthesis was conducted via Epistemonikos databases, with outcomes prioritized for clinical relevance, including weight reduction, quality of life, adverse events, and improvements in obesity complications. Recommendations were developed through consensus workshops and graded as strong or conditional based on evidence certainty, benefits, harms, equity, and feasibility using the GRADE Evidence-to-Decision framework. The panel issued recommendations on FDA-approved obesity medications including orlistat, bupropion-naltrexone, phentermine, phentermine-topiramate, liraglutide, semaglutide, tirzepatide, and setmelanotide. Strong recommendations were made for bupropion-naltrexone, semaglutide, tirzepatide, and setmelanotide, with moderate-certainty evidence. Conditional recommendations were made for other agents and specific obesity complications (obstructive sleep apnea, heart failure with preserved ejection fraction, metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis, osteoarthritis, major adverse cardiovascular events, and type 2 diabetes). Continuing obesity medications during weight maintenance received a strong recommendation. Obesity is a chronic, often progressive, disease requiring comprehensive, long-term, and person-centered care. Effective obesity medications exist but remain underutilized due to systemic barriers. Expanding access, reducing stigma, and ensuring equitable coverage are essential to translating scientific advances into population health gains. Future priorities include access and integration of comprehensive obesity care in the primary care setting, improving affordability, addressing research gaps, conducting head-to-head trials, and updating guidance as evidence evolves.

Inflammation is recognized as a critical component in the pathogenesis of lower extremity peripheral arterial disease (PAD); however, the association between novel immune-inflammatory biomarkers - neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI) - and PAD risk in the general population remains unexplored. This study examines the associations between PAD and NLR, PLR, MLR, SII, SIRI, and AISI. This study was a cross-sectional observational study based on the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. PAD was diagnosed using an Ankle-Brachial Index (ABI) ≤0.9. Finally, 6314 participants aged ≥40 years with complete information about ABI, blood cell counts, and other covariates were analyzed. Logistic regression analysis was used to examine the associations between inflammatory biomarkers and PAD. The predictive ability of inflammatory biomarkers for PAD was compared using receiver operating characteristic (ROC) curves. Subsequent mediation analysis examined the indirect effects of immune-inflammatory biomarkers on PAD via estimated glomerular filtration rate (eGFR). Finally, we performed propensity score matching (PSM) between PAD and non-PAD participants to verify the robustness of results. In 6314 US adults aged ≥40 years, 548 were diagnosed with PAD. Significant associations were observed between PAD and NLR (odds ratio [OR]: 1.02; 95% confidence interval [CI]: 1.01-1.04), MLR (OR: 1.02; 95% CI: 1.00-1.04), SII (OR: 1.02; 95% CI: 1.00-1.03), SIRI (OR: 1.03; 95% CI: 1.01-1.04), and AISI (OR: 1.02; 95% CI: 1.01-1.03), according to logistic regression. PSM further validated the robustness of primary results. Mediation analysis revealed eGFR mediated portions of the relationship between PAD and NLR, MLR and SIRI (4.69%, 7.11% and 3.69% respectively). Additionally, ROC showed that SIRI exhibited a greater identification of PAD compared with other immune-inflammatory biomarkers. NLR, MLR, SII, SIRI, and AISI demonstrated independent associations with PAD risk, with SIRI showing a stronger association with PAD.

Out-of-hospital cardiac arrest (OHCA) survival is lower in neighborhoods with low (vs high) socioeconomic status. While emergency medical services (EMS) practices of intra-arrest transport (IAT) vary, it is unknown whether neighborhood-level factors are associated with these transport patterns. To determine the association between greater neighborhood socioeconomic vulnerability and odds of IAT among adults with OHCA. This cohort study used a large national database of deidentified EMS electronic health record data. The cohort comprised US adults (aged ≥18 years) with attempted EMS resuscitations for nontraumatic OHCA between January 1, 2022, and December 31, 2022. Data were analyzed between December 2023 and December 2024. The exposure was the Social Vulnerability Index (SVI) of the EMS encounter within a US Census tract. Neighborhoods were stratified into quartiles based on SVI percentile. Higher SVI percentiles indicated greater socioeconomic vulnerability. The primary outcome was the odds of IAT. The association between SVI quartile and EMS transport pattern was assessed using marginal logistic regression modeling. A total of 61 524 patient encounters were included. Patients had a median (IQR) age of 65 (52-76) years and included 38 546 males (62.6%). Bystander resuscitation was administered in 23 124 encounters (37.6%), while 23 492 patients (38.2%) received IAT and 38 032 patients (61.8%) received continued on-scene resuscitation. Adults in neighborhoods in the highest SVI quartile had a higher occurrence of IAT than those in the lowest SVI quartile (7052 [41.1%] vs 4000 [32.8%]; P < .001). After adjustment, patients in the highest SVI quartile had greater odds of receiving IAT than those in the lowest SVI quartile (adjusted odds ratio, 1.35; 95% CI, 1.15-1.57). In this cohort study of EMS resuscitations of adults for nontraumatic OHCA, greater neighborhood socioeconomic vulnerability was associated with increased odds of IAT. This association may contribute to socioeconomic disparities in OHCA outcomes and warrant further investigations into factors in EMS transport decisions for OHCA, particularly in marginalized communities.

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

Intergroup anxiety can undermine positive intergroup relations. This Registered Report presents two preregistered online studies testing a mental contrasting intervention to reduce intergroup anxiety towards Black individuals. Previous work aimed to inoculate anxiety by having participants imagine a threatening intergroup experience followed by a positive one, compared to only imagining positive interactions. In Study 1 (N = 300), White US adults were randomly assigned in a 2 × 2 design to imagine either a negative-then-positive interaction (intervention) or positive-only interactions with an outgroup (Black) or ingroup (White) member. State anxiety was measured immediately before and after the second imagined interaction, followed by prejudice and contact intentions. Study 2 (N = 149) replicated the outgroup conditions and tested whether imagining a neutral-then-positive interaction reduced anxiety relative to imagining positive-only interactions. Contrary to preregistered predictions, Study 1 showed higher intergroup anxiety in the intervention condition and a significant condition × time interaction. These effects did not replicate in Study 2. Across both studies, the intervention did not significantly reduce prejudice or increase contact intentions. Overall, the preregistered tests did not support the hypothesis that this intervention reduces intergroup anxiety or related outcomes, constraining claims regarding its robustness and generalizability.

Cross-sectional and longitudinal associations between circadian alignment and stroke in US adults.

Stroke has a multifactorial etiology, and phthalates, as widely used environmental chemicals, may play an underexplored role in cerebrovascular health. This study aimed to evaluate the association between urinary phthalate metabolites and stroke risk using data from the National Health and Nutrition Examination Survey (NHANES), complemented by network toxicology, molecular docking, and machine learning approaches. We analyzed data from 10,771 adult participants in NHANES (2003-2018) who had complete records of stroke status, urinary phthalates, and clinical covariates. Multivariable logistic regression and restricted cubic spline (RCS) models were used to assess associations. We constructed protein-protein interaction networks and performed molecular docking to identify potential toxicological targets. Five machine learning algorithms were employed to develop predictive models for phthalate-related stroke risk. Higher levels of MECPP, MCPP, MNBP, and MEOHP were significantly associated with increased stroke prevalence. Network toxicology identified SRC as a key target, and molecular docking confirmed strong binding affinity between MBZP and SRC. Among the machine learning methods, Random Forest achieved the highest predictive performance (AUC = 0.833). Notably, moderate coffee consumption (≤ 170g/day) was significantly associated with a reduced risk of stroke (OR = 0.63, 95%CI: 0.51-0.77), suggesting potential dietary mitigation against phthalate-related stroke risk. Our findings demonstrate that certain phthalates may increase stroke risk via molecular pathways involving SRC. Furthermore, moderate coffee consumption may mitigate the adverse cerebrovascular effects of these environmental pollutants.

Although portal vein thrombosis (PVT) is well-characterized in the pretransplant setting, de novo PVT after liver transplantation (LT) remains poorly defined. Little is known about its incidence, timing patterns, or impact on long-term outcomes in adult deceased-donor LT (DDLT). Using a national multicenter electronic health record network (~101 million US adults), this retrospective cohort identified DDLT recipients without preexisting or intraoperative PVT (1995 to 2025). De novo PVT was defined as new thrombosis after postoperative day 1 (POD 1) and classified as early (POD 1 to 30) or late (>POD 30). Propensity score matching (1:1) balanced demographics, comorbidities, medications, and laboratory data. Outcomes included all-cause mortality, retransplantation, early allograft dysfunction, all-cause hospitalization, and rejection. Risks were estimated using Cox and logistic regression, with survival evaluated by Kaplan-Meier analysis. Among 21,758 DDLT recipients, 1,049 (4.8%) developed de novo PVT, 71% after POD 30. After matching (1,018 per group), de novo PVT was associated with higher 5-year risks of mortality (adjusted hazard ratio [aHR] 1.29; 95% CI 1.03 to 1.63), retransplantation (aHR 2.08; 1.51 to 2.88), all-cause hospitalization (aHR 1.19; 1.08 to 1.31), and rejection (aHR 1.57; 1.37 to 1.79). Early allograft dysfunction odds were also increased (adjusted odds ratio 1.46; 1.22 to 1.75). Risk patterns persisted across 1-, 3-, and 5-year follow-up. Kaplan-Meier showed lower overall survival (p = 0.027) and reduced freedom from retransplantation (p < 0.0001) in the PVT group. Early and late PVT had comparable mortality and hospitalization risks, but late PVT carried higher rejection risk. De novo PVT affects ~5% of DDLT recipients and is associated with worse outcomes. This underrecognized complication warrants closer surveillance and further study.

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

ObjectiveHigh-sensitivity C-reactive protein, a key inflammatory biomarker, can indicate the risk of cardiovascular diseases. The cardiometabolic index has been associated with metabolic and cardiovascular outcomes; however, its direct relationship with high-sensitivity C-reactive protein remains unclear. This study aimed to explore this association and identify influencing factors in adult population.MethodsThis retrospective cross-sectional study used data from the 2015-2018 National Health and Nutrition Examination Survey. A multivariate logistic regression model was applied to assess the association between cardiometabolic index and high-sensitivity C-reactive protein levels (>3.0 mg/L) in 3970 adults, with adjustment for demographic characteristics, comorbidities, and lifestyle factors.ResultsCardiometabolic index was independently associated with high-risk high-sensitivity C-reactive protein (adjusted odds ratio = 1.11, 95% confidence interval: 1.03-1.19, p = 0.007). Subgroup analyses indicated that the association was more pronounced in females and non-Hispanic Black participants (p values for interaction were <0.001 and 0.004, respectively). Restricted cubic spline curves confirmed a nonlinear relationship between cardiometabolic index and high-risk high-sensitivity C-reactive protein (nonlinearity p < 0.001).ConclusionCardiometabolic index demonstrated a significant positive association with high-risk high-sensitivity C-reactive protein in US adults, serving as a marker linking cardiometabolic status to chronic inflammation. Further studies are needed to validate causality and explore cardiometabolic index-guided prevention.

Efficacy of front-of-package nutrient labels designed for mandatory implementation in the USA: an online randomised controlled trial.

Psychological distress (PD) affects health and healthcare utilization. This study uses a novel, comprehensive social determinants of health (SDOH) risk score to examine the association between cumulative social disadvantage and PD in a large, nationally representative sample from the National Health Interview Survey (NHIS). Data from the 2013 to 2017 NHIS was employed, including 124,361 adults aged ≥ 18 years. The Kessler 6 scale was used to assess PD. We measured SDOH across five domains: economic stability, education, healthcare system, neighborhood, and food security. An SDOH aggregate score was calculated, representing the cumulative number of individual unfavorable SDOH. Multivariable models were utilized to examine the association between SDOH score quartiles and PD. A total of 124,361 adults (mean [SD] age 50.2 [18.1] years; 67,035 women [53.9%]) were included in the analysis. In models fully adjusted for age, sex, ethnicity, region, cardiovascular risk factors, atherosclerotic cardiovascular diseases, and comorbidities, participants in the highest quartile of adverse SDOH burden (Q4) were associated with higher odds of moderate PD (OR, 3.67; 95% CI, 3.42-3.93) and severe PD (OR, 15.23; 95% CI, 11.97-19.36), respectively, than those in Q1. At nearly each quartile, a higher prevalence rate of PD was observed among females, middle-aged, and non-Hispanic White adults compared to their counterparts. In a large, nationally representative sample of US adults, adverse SDOH was associated with increased PD. Assessing and mitigating the multifaceted adverse SDOH could serve as a strategy to help identify individuals with PD and improve existing PD prevention frameworks.

Eviction risk and mental health outcomes among the US adults during and after the COVID-19 pandemic.

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.

Five years since the scientific and patient communities first identified the syndrome now known as Long COVID, affected individuals lack treatments, and the US lacks population-based data on its disability burden and correlation with National Institutes of Health (NIH) funding. Moreover, akin to other debilitating conditions it often co-occurs with, e.g., Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and dysautonomia, Long COVID disproportionately impacts females whose concerns are often marginalized. We quantify Long COVID years lived with disability (YLDs= prevalence x disability weight) in US adults and its actual/YLD-commensurate average annual NIH FY2022-2024 funding versus 68 comparator conditions, by sex predominance. We derive Long COVID prevalence from Census Bureau surveys (9/2022-8/2023) and apply disability weights from the Global Burden of Disease Study. Long COVID YLDs approximate those of Alzheimer's and Asthma. Long COVID received 14% of its disability commensurate funding: $106 million vs. $739.8 million. ME/CFS is the most under-funded condition, receiving <1% of its YLD proportionate funding. Among conditions analyzed, 24 are female-predominant (we estimate Long COVID funding two ways), 12 male-predominant, and 33 show no sex predominance. Among the 12 below-median funded/above-median YLD conditions, 7/12 are female-predominant, none are male-predominant. Median funding/per YLD is 5.2 times higher for male- vs. female-predominant conditions (7.0 vs 1.3 million per YLD, p = 0.007). Overall, YLDs explain 6.5% of funding variance in a linear regression model using YLD as the sole predictor (Adjusted R-squared: 0.065). With chronic conditions like Long COVID rising, disability burden merits greater consideration in funding decisions, as does biological sex.

Research shows that genetic literacy varies as a function of individual-level factors, but these factors may not account for all observed differences in genetic literacy. We tested the hypothesis that neighborhood opportunity-a structural factor-is associated with genetic literacy. We analyzed nationally representative cross-sectional data on a weightedsample of 606 US adults from the 2024 Measurement of Genetic Literacy Survey. The Genetic Literacy and Comprehension measure assessed genetic literacy ( = 0.87). The Childhood Opportunity Index 3.0 measured overall neighborhood opportunity and three domains (Education, Health and Environment, Social and Economic resources). Unadjusted and adjusted weighted linear regression models quantified the associations between neighborhood opportunity and genetic literacy. Among the weighted sample (mean age = 48, SD = 18), 52% were female, and 61% were as non-Hispanic White. Very low overall neighborhood opportunity was significantly associated with lower genetic literacy (β = - 0.70, 95% CI: - 1.40 to - 0.04, p = 0.037), adjusting for demographic characteristics, health-related factors, and receipt of genetic testing. We observed a similar pattern for exposure to very low social and economic resources (β = - 0.95, 95% CI: - 1.60 to - 0.31, p = 0.004). There was no evidence of a statistically significant association between the Health and Environment domain and genetic literacy in the final model (β = - 0.13, 95% CI: - 0.64 to - 0.38, p = 0.62). Findings indicate that neighborhood opportunity is associated with genetic literacy. These results reinforce the importance of assessing structural factors along with individual-level characteristics in genetic literacy research.

Hospitalization costs on human metapneumovirus (hMPV) are needed to inform healthcare priorities, including vaccine and treatment development. Among 5775 adult hospitalizations with hMPV or respiratory syncytial virus (RSV), hMPV was associated with shorter length of stay but greater frequency of pneumonia, resulting in adjusted mean costs comparable to RSV hospitalization.

End-of-life decision-making poses unique challenges for individuals with dementia and their family caregivers as cognitive decline shifts decision-making responsibility to surrogates. Using 2010-2022 Health and Retirement Study (HRS) exit interview data, we compared advance directive completion, decision-making needs near death, involvement of others in decision-making, and concordance between expressed preferences and care received among decedents with and without dementia. Analyses incorporated HRS exit interview sampling weights, primary sampling units, and strata to account for the complex multistage probability design of HRS and produce nationally representative estimates of U.S. older adult decedents (≥50 years). Weighted descriptive statistics and design-adjusted Wald tests were used to compare groups. Among 5,389 decedents, 1,010 (weighted 17.7%) had dementia prior to death. Decedents with dementia were more likely to have completed advance directives than those without dementia (81.3% vs. 69.1%, p<.001). However, they also had significantly higher decision-making needs in the final days of life (54.3% vs. 47.2%, p<.001). Children or grandchildren were more frequently involved in care decisions for decedents with dementia (63.9% vs. 45.6%, p<.001). Despite differences in decision-making processes, most decedents in both groups expressed preferences for comfort-focused care, and preference-care concordance exceeded 90% in both groups. Findings suggested that dementia reshaped the structure and intensity of the shared decision-making process by increasing surrogate engagement and decisional demands, underscoring the importance of early advance care planning and structured support for family caregivers to sustain goal-concordant care.