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Changes in material use, energy use and emissions profiles of industry are the result of complex interrelationships among a multitude of technological and economic drivers. To better understand and guide such changes requires that attention is paid to the time-varying consequences that technology and economic influences have on an industry's choice of inputs and its associated (desired and undesired) outputs. This paper lays out an approach to improving our understanding of the dynamics of large industrial systems. The approach combines engineering and econometric analysis with a detailed representation of an industry's capital stock structure. A transparent dynamic computer modeling approach is chosen to integrate information from these analyses in ways that foster participation of stakeholders from industry and government agencies in all stages of the modeling process-from problem definition and determination of system boundaries to generation of scenarios and interpretation of results. Three case studies of industrial energy use in the USA are presented-one each for the iron and steel, pulp and paper, and ethylene industry. Dynamic models of these industries are described and then used to investigate alternative carbon emissions and investment-led policies. A comparison of results clearly points towards two key issues: the need for industry specific policy approaches in order to effectively influence industrial energy use, fuel mix and carbon emissions, and the need for longer time horizons than have typically been chosen for the analysis of industrial responses to climate change policies.

In 2008, the National Institutes of Health's (NIH) Undiagnosed Disease Program (UDP) was initiated to provide diagnoses for individuals who had long sought one without success. As a result of two international conferences (Rome 2014 and Budapest 2015), the Undiagnosed Diseases Network International (UDNI) was established, modeled in part after the NIH UDP. Undiagnosed diseases are a global health issue, calling for an international scientific and healthcare effort. To meet this demand, the UDNI has built a consensus framework of principles, best practices and governance; the Board of Directors reflects its international character, as it includes experts from Australia, Canada, Hungary, Italy, Japan and the USA. The UDNI involves centers with internationally recognized expertise, and its scientific resources and know-how aim to fill the knowledge gaps that impede diagnosis. Consequently, the UDNI fosters the translation of research into medical practice. Active patient involvement is critical; the Patient Advisory Group is expected to play an increasing role in UDNI activities. All information for physicians and patients will be available at the UDNI website., (Copyright © 2015. Published by Elsevier Inc.)

Background: Since the inception of the environmental movement early in the 1970s, the majority of regulation, laws, and standards regarding pollutants have focused on the release of pollutants into our air and water rather than on the extent of exposure. As a consequence, the actual amounts of toxic pollutants to which humans are continually exposed have long been ignored. Moreover, regulation and assessment of pollution have focused primarily on ambient environmental levels. This fails to adequately examine the state of indoor air. This is of particular concern and deserving of more attention, considering that a majority of people spend the majority of their time at home,, Results: Studies on indoor air quality suggest that, within the home, people are exposed to high levels of numerous pollutants. Of particular concern are the levels of polycyclic aromatic hydrocarbons and volatile organic compounds because many of these are known carcinogens. While the need for further study is clear, what evidence there is already warrants the establishment of indoor air regulation and the implementation of preventive measures. For such measures to be effective, a great deal of education and outreach will be necessary. Also, health care providers must play an active role., (Copyright 2000 American Health Foundation and Academic Press.)

Introduction: Individuals with epilepsy are at greater risk for tobacco use, which may exacerbate their health challenges. This study examines the prevalence and sociodemographic correlates of electronic nicotine delivery systems (ENDS), cigarette, and dual use among US adults with and without epilepsy., Methods: Data from the 2021-2023 National Health Interview Surveys were analyzed (N = 86,655 adults aged ≥ 18 years), including 1,579 (1.89 %, estimated 14.5 million US adults) with self-reported epilepsy (outcome variable). Participants were categorized into mutually exclusive groups: never-use of either product [reference group], current (used on some days or daily) cigarette-only use, ENDS-only, dual-use, former cigarette-only, former ENDS-only, and former dual-use. Weighted logistic regression models assessed the relationship between epilepsy and tobacco use, adjusting for sociodemographic characteristics., Results: Adults with epilepsy had higher rates of cigarette-only (16.51 % vs. 9.27 %), ENDS-only (5.56 % vs. 3.95 %), and dual use (3.53 % vs. 1.50 %) compared to those without epilepsy. Relative to never use, current cigarette-only use (AOR = 1.66, 95 %CI: 1.36-2.01), current ENDS-only use (AOR = 1.51, 95 %CI: 1.08-2.13), and current dual use (AOR = 2.29, 95 % CI: 1.56-3.48) were associated with higher odds of epilepsy after adjusting for demographic and health factors. Among adults with epilepsy, identifying as gay, lesbian, or bisexual was linked to higher odds of cigarette, ENDS, or dual use compared to straight individuals. Lower levels of education were associated with higher odds of cigarette smoking, while having health insurance was associated with lower odds among adults with epilepsy. Adults ≥ 35 were more likely to smoke cigarettes and less likely to use ENDS compared to younger age groups., Conclusion: Cigarette, ENDS, and dual use rates were higher in adults with epilepsy than in those without epilepsy. Social factors like sexual orientation, education, and insurance status further influence tobacco use within this population. Tailored cessation interventions are warranted for this vulnerable population to reduce disease burden., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: National mandates require screening for and addressing health-related social needs (HRSNs) in healthcare settings. However, differences in HRSN screening process (i.e., completed screenings, screening results, documented offer of assistance, documented assistance request) have been reported by population subgroup. Knowledge of the most effective HRSN screening and intervention methods is limited. We sought to describe differences in completed HRSN screenings, screening results, and assistance request rates across patient and healthcare visit characteristics., Methods: We examined data from all patients aged ≥18 years and residing in the US receiving services at a large, Midwestern healthcare system with a goal to screen all patients for HRSN at least once annually between July 2021-June 2023 (n = 1,190,488). We examined the proportion of patients with any HRSN screening, with any reported HRSN, asked whether they wanted assistance, or who requested assistance for a reported HRSN stratified by patient demographics and healthcare visit characteristics (i.e., payer, screening location, who completed the screening)., Results: Less than half of eligible patients (47.0 %) were screened for HRSNs. About one-sixth (16.9 %) reported any HRSN. Although most patients reporting HRSNs were asked whether they wanted assistance, only about one-quarter (26.8 %) responded affirmatively. Proportions included in each step of the HRSN screening process significantly differed by patient and healthcare visit characteristics., Discussion: This study is one of the first to investigate various steps of a population-wide HRSN screening program. Our findings suggest that examining differences in HRSN screening process by population subgroup is key to addressing HRSNs through a health equity lens., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Maintaining health preventive behaviours in later life reduces the risk of non-communicable diseases. However, these behaviours often require effort and discipline to adopt and may be prone to procrastination. This study examined whether procrastination affected engagement in health preventive behaviours among older adults., Methods: We applied generalised additive models to data from the 2020 wave of the United States Health and Retirement Study. Our analytic sample consisted of adults aged 50+ (n = 1338; mean = 68.24; range = 50-95). Our analysis focused on six health preventive behaviours: prostate exams, mammograms, cholesterol screenings, pap smears, flu shots, and dental visits., Results: Procrastination was associated with less frequent engagement in mammograms and cholesterol screenings among women, though it had no significant association with pap smears or flu shots. Additionally, procrastination interacted with depression reducing the likelihood of prostate exams in men and dental visits in both men and women, such that individuals with high procrastination and low depression were associated with less frequent engagement in both preventive health behaviours., Conclusions: Procrastination may be a behavioral risk factor for maintaining optimal health in older adults. Given that procrastination is a potentially modifiable behaviour, interventions aimed at reducing procrastination, such as simplifying tasks or providing default appointment, could improve engagement in critical health preventive behaviours., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Our study aimed to assess the heart failure/cardiomyopathy-related population-level mortality trends among patients with obesity in the United States and disparities across demographics., Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among adults aged ≥25 from 1999 to 2019. Heart failure/cardiomyopathy were listed as the main causes of death, with obesity as a contributing cause. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and estimated the average annual percent change (AAPC). We also evaluated the social vulnerability of United States counties (2014-2018)., Results: There were 29,334 deaths related to heart failure/cardiomyopathy among patients with comorbid obesity. The overall AAMR increased from 0.41 in 1999 to 0.94 in 2019, with an AAPC of 3.78 (95 % CI, 3.41-4.14). The crude mortality rate increase for heart failure/cardiomyopathy was greater in individuals with comorbid obesity than in those without. Males had a higher AAMR than females (0.78 vs 0.55). African Americans also had higher AAMR than Whites (1.35 vs 0.62). The AAMR was higher in rural areas than in urban regions (0.76 vs 0.66). The overall AAMR was higher in counties with social vulnerability index-Quartile 4 (SVI-Q4) (most vulnerable) (1.08) compared to SVI-Q1 (least vulnerable) (0.63) with a risk ratio of 1.71 (95 % CI: 1.61-1.83)., Conclusion: Heart failure/cardiomyopathy mortality in individuals with comorbid obesity was rising. Males, African Americans, and individuals from rural regions had higher AAMR than their counterparts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Premature atherosclerotic cardiovascular disease (ASCVD) is increasing in young adults (<55 years old). While research suggests females who smoke cigarettes have a higher risk of ASCVD than males, studies on the impact of exclusive e-cigarette and dual use on premature ASCVD are limited. This study investigated the association between tobacco use and self-reported premature ASCVD and explored potential sex differences., Methods: Using pooled data from 480,317 adults (ages 18-54; ∼50 % female) from the 2020-2022 Behavioral Risk Factor Surveillance System from the United States, logistic regression models assessed associations between cigarette and e-cigarette use patterns and self-reported premature ASCVD. Tobacco use categories were defined as: non-use, former use (cigarettes, e-cigarettes), and current use (cigarettes, e-cigarettes) and dual use. Self-reported premature ASCVD was defined as self-reported angina or coronary heart disease, heart attack, or stroke. Weighted analyses were conducted for the overall sample and stratified by sex., Results: After controlling for potential confounders, former exclusive cigarette (adjusted OR: 1.47 [95 % CI 1.29, 1.67]), current exclusive cigarette (1.68 [1.47-1.94]) and current dual (2.03 [1.69-2.44]) use were associated with higher odds of self-reported premature ASCVD. There was no significant association for e-cigarette use. Sex-specific analyses revealed similar patterns but the magnitude of these associations varied between males and females., Conclusion: Both sexes showed higher odds of self-reported premature ASCVD for dual and exclusive cigarette use. Although the cross-sectional design precludes causal inferences, the findings suggest comprehensive tobacco cessation programs tailored to diverse use patterns are needed to reduce the burden of premature ASCVD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: Despite the well-established health benefits of fruits and vegetables, U.S. consumption remains far below the WHO's recommended 400 g per day. Understanding how culinary techniques influence intake could elucidate strategies for improving dietary habits., Objective: To explore whether the use of cooking techniques for fruits and vegetables is associated with increased consumption of these foods and the corresponding variation in total fiber intake among the U.S., Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2009-2010, participants (n = 9754) were categorized into groups based on their self-reported cooking frequency. Cooking techniques were classified into types. The mean consumption of fruits and vegetables was segmented into quartiles. Cooking frequency was evaluated, and differences between groups were assessed using chi-square tests and mean comparison tests. The study also assessed the prevalence of cooking techniques for different food groups. Additionally, linear regression analyses were conducted to adjust the mean daily per capita consumption of fruits, vegetables, and dietary fiber, considering cooking frequency and other socioeconomic variables as predictors., Results: The studied population's mean consumption of fruits and vegetables was 302.9 g, with half of this amount consisting of fruits. Individuals from households with frequent cooking practices (≥5x a week) consumed, on average, 48.2 g more fruits and vegetables daily than those from households with less frequent cooking (<5x a week). The use of diverse cooking techniques significantly improved vegetable intake, showing a fivefold increase in consumption among those employing multiple techniques. Moreover, frequent home cooking was associated with a 1.0-g increase in daily fiber intake., Conclusion: Public policies aimed at improving fruit and vegetable intake among the U.S. population should consider, in addition to cooking frequency, the role of cooking techniques in influencing the consumption of these food groups., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

There has been a recent surge in global interest in drilling offshore wells in pursuit of new reserves of crude oil, with much of this activity focused on deepwater. One concern related to this uptick in activity is the potential for very large damages that could obtain were a major oil spill to occur. For example, when the Macondo well in the Gulf of Mexico suffered a blowout in 2010 a very large amount of oil flowed from the well into the Gulf causing enormous harm. In response, the United States Government proposed significant regulatory changes related to offshore oil and gas exploration and production. This paper proposes a framework for thinking about the risks associated with deepwater exploration and production, and uses this framework to construct an estimate of society's necessary willingness to pay to protect ecosystems. Applying this framework to the BP oil spill case study, benefits resulting from a reduction in the risk of a major spill exceeds these costs under a range of potential reductions in risk., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Although studies have found nicotine and cannabis vaping to be individually associated with respiratory symptoms, little is known about the harm of dual vaping. We aim to assess the association of nicotine-only, cannabis-only, and dual vaping with respiratory symptoms., Methods: Using a national sample of 8033 U.S. young adults (ages 18-24) interviewed in 2021, we employed multivariable logistic regressions to assess the association between vaping behaviors and past 12-month respiratory outcomes., Results: Of all participants, 75.4 % did not vape, 15.0 % vaped nicotine only, 4.7 % vaped cannabis only, and 4.9 % vaped both. Compared with no vaping, nicotine-only vaping was associated with sounding wheezy (aPR = 1.75, 95 % CI, 1.28-2.39) and dry cough at night (aPR = 1.43, 95 % CI, 1.19-1.72). Cannabis-only vaping was also associated with these two symptoms, with aPRs at 1.82 (95 % CI, 1.15-2.88) and 1.61 (95 % CI, 1.18-2.21), respectively. In addition to these two symptoms (aPR = 2.24, 95 % CI, 1.42-3.54 for sounding wheezy, and aPR = 1.50, 95 % CI, 1.01-2.22 for dry cough at night), dual vaping was associated with wheezing or whistling (aPR = 1.93, 95 % CI, 1.23-3.04) and high level of respiratory symptoms (aPR = 2.02, 95 % CI, 1.24-3.32). Compared with non-frequent vaping, cannabis-only and dual frequent vaping were associated with higher risks of wheezing or whistling., Conclusions: Nicotine-only and cannabis-only vaping were associated with two respiratory symptoms while dual vaping with four. The elevated respiratory risk of dual vaping warrants future research on the underlying mechanisms of different vaping behaviors and respiratory outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Achieving public conservation objectives often requires voluntary conservation on private land. However, some landowners are reluctant to participate in voluntary conservation programs, even when offered financial incentives. Heterogeneity in willingness to participate suggests that policymakers can improve conservation outcomes by strategically targeting subsidy program outreach, messaging, and design to landowners who are more likely to enroll, which we call "social targeting." This paper informs social targeting a subsidy to farmers to construct wetlands in the Western Lake Erie Basin in the United States. We use a discrete choice survey and a latent class model to identify preference heterogeneity and farmer attributes associated with willingness to construct wetlands. Willing respondents prefer larger projects, but fully subsidized construction is vital for participation. Simulation results highlight that even the most willing farmers are unlikely to install a wetland if construction is not fully subsidized. Policy practitioners should target outreach to younger farmers and larger farms. Outreach strategies should focus on private benefits from the wetland, such as aesthetic values and hunting opportunities, highlight farmer responsibility for Lake Erie water quality, and promote positive social norms surrounding wetland construction., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aims: This study aimed to examine the individual and joint associations of adverse childhood experiences (ACEs) and maternal work and non-work related stressors with the risk of gestational diabetes mellitus (GDM)., Methods: Working pregnant individuals (n = 1163) from a United States (U.S.) prospective cohort conducted in South Carolina between 2016 and 2021 were included in the study. ACEs were assessed at study enrollment before 20 gestational weeks (GW), while maternal stressors were assessed in late pregnancy and GDM diagnosis occurred between 24 and 30 GW. Multivariable logistic regressions were performed to assess associations of ACEs and maternal stressors with GDM., Results: Childhood abuse, an ACE subdomain, was associated with an elevated but statistically insignificant risk of GDM (adjusted OR = 1.47; 95 % CI: 0.85-2.53). Only maternal work stressors were associated with an increased risk of GDM (adjusted OR = 2.11; 95 % CI: 1.17-3.79) and the association became much stronger among those with childhood abuse experiences (adjusted OR = 3.80; 95 % CI:1.68-8.60)., Conclusion: Among U.S. working pregnant individuals, having work stressors during pregnancy was associated with an elevated risk of developing GDM, particularly among those who had childhood experience of abuse., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: Asian Americans have the highest ovarian cancer survival across the major racial groups although it is unclear whether this survival advantage is observed when each Asian ethnic subgroup is examined separately. Disaggregated survival analyses of this heterogeneous population is needed to ensure ethnic-specific disparities are not overlooked., Methods: Data on ovarian cancer cases diagnosed from 2006 through 2020 from the Surveillance, Epidemiology, and End Results (SEER) Program were analyzed. Age-standardized five-year cause-specific survival was calculated for Non-Hispanic Whites and seven Asian ethnic subgroups in the U.S. (Asian Indian/Pakistani, Chinese, Filipino, Hawaiian/Pacific Islander, Japanese, Korean, Vietnamese) by stage and histotype. Multivariable Cox regression analyses using a weighted approach were conducted to calculate average hazard ratios (AHRs) and 95 % confidence intervals (CIs) to quantify the risk of ovarian cancer death comparing each Asian ethnic subgroup to Non-Hispanic Whites., Results: Hawaiian/Pacific Islanders were the only Asian subgroup to show lower five-year cause-specific survival than Non-Hispanic Whites (44.99 % versus 47.90 %, respectively); Asian Indian/Pakistanis showed the highest survival (56.12 %). After adjusting for sociodemographic, tumor, and treatment characteristics, Asian Indian/Pakistani ovarian cancer patients were 17 % less likely to die from their disease whereas Hawaiian/Pacific Islander patients were 28 % more likely to die when compared to Non-Hispanic Whites (AHR = 0.83, 95 % CI 0.75-0.92 and AHR = 1.28, 95 % CI 1.07-1.53, respectively)., Conclusions: There are clear ethnic-specific survival disparities among Asian American ovarian cancer patients that are missed when the population is examined as a single group, further highlighting the need for data disaggregation in future ovarian cancer research., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To examine the relationship between perceived neighborhood social cohesion (NSC) and intentions to obtain seasonal influenza and COVID-19 vaccines among US adults post COVID-19 pandemic., Methods: We conducted a cross-sectional, nationally representative survey of US residents (N = 2189) in May 2023 on their perceived NSC, COVID-19 and seasonal influenza vaccination intentions, healthcare access, perceived risk of COVID-19 or flu infection, loneliness, and trust in doctors. We used bivariate probit regressions to examine joint associations between perceived NSC and intentions to receive influenza and COVID-19 vaccines, controlling for several participant characteristics (e.g., race)., Results: 2164 respondents provided consent to study questions. Trust-related NSC (trust in neighbors) was positively associated with intentions to become vaccinated against both influenza and COVID-19 viruses. Higher relational NSC (perception of a close-knit neighborhood) was positively associated while higher value-based NSC (perception that neighbors share the same values) was negatively associated with intentions to become vaccinated against COVID-19. Healthcare access, perceived risk of infection (COVID-19 or flu), and trust in doctors were positively associated with intentions to become vaccinated against both viruses., Conclusions: In a post-pandemic era, higher trust-related and relational, perceived NSC (vaccine-dependent), greater access to healthcare, higher perceived risk of infection, and greater trust in doctors were related to higher influenza and COVID-19 vaccination intentions, while higher value-based NSC was related to lower COVID-19 vaccination intentions among US adults. Thus, specific aspects of NSC, healthcare access barriers, misinformation on infection risk, and medical mistrust may influence an individual's willingness and ultimate decision to become vaccinated., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To analyze the occurrence of adverse drug events (ADEs) associated with Stiripentol (STP) use in children aged 0-17 years in real-world clinical settings., Methods: ADE reports on STP in children aged 0-17 years were collected from the WHO Global Case Safety Pathology Reporting Database (VigiBase), the U.S. Food and Drug Administration's Spontaneous Adverse Event Reporting System database (FAERS), and the European Medicines Agency's Pharmacovigilance database (Eudra Vigilance). Pharmacovigilance signals were identified through Reporting Odds Ratio (ROR), and Proportional Reporting Ratio (PRR)., Results: In total, 31,990 ADEs were reported with "Stiripentol" as the primary suspect drug. This includes 595 ADEs from the Eudra Vigilance, 1,353 ADEs from the FAERS, and 998 ADEs from the VigiBase. All three databases indicate a higher incidence of ADEs related to STP in the categories of nervous system disorders, general disorders and administration site conditions, injury, poisoning and procedural complications, and metabolism and nutrition disorders. A higher proportion of children aged 3-11 years reported (16.48 %-32.44 %). The FAERS data shows that cerebellar atrophy (PRR of 332.94, ROR of 532.10) is the strongest signal for children aged 0-2 years, while changes in seizure presentation (PRR of 110.76, ROR of 121.06) is the strongest signal for children aged 3-11 years. For children aged 12-17 years, seizures (PRR of 46.99, ROR of 47.40) and decreased appetite(PRR of 45.51, ROR of 45.96) are the strongest signals. The Eudra Vigilance results show that boys have higher ADEs than girls for investigations, blood and lymphatic system disorders, hepatobiliary disorders, infections and infestations in children aged 0-17 years. On the other hand, girls have higher ADEs than boys for skin and subcutaneous tissue disorders, injury, poisoning and procedural complications, general disorders and administration site conditions, and gastrointestinal disorders., Conclusion: In the clinical application of STP in pediatrics, it is important to examine ADEs in Nervous system disorders, Injury, poisoning and procedural complications, General disorders and administration site conditions, and Metabolism and nutrition disorders. Further studies should confirm whether there are age and gender differences in different ADEs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Brachytherapy (BT) is recommended for vaginal cancer treatment, particularly cases of bulky and/or recurrent disease. However, previous studies noted a decline in utilization rates. This study examines recent trends in BT utilization to assess for reversal in trends., Material and Methods: This study analyzed the National Cancer Database (NCDB) of patients with FIGO stage I to IVA vaginal cancer treated between 2004 and 2021. A log binomial regression with robust variance was used to estimate incidence rate ratios (IRRs) of BT utilization over time and identify potential factors associated with receipt., Results: Brachytherapy use increased from 48.0 % in 2004 to 63.3 % in 2021. Factors associated with increased brachytherapy use included, receiving care at an academic/research program (IRR: 1.35 95 % CI: 1.18-1.55), integrated cancer program (1.22 [1.06-1.41]), and diagnosis after 2018 (1.31 [1.21-1.42]). Factors associated with decreased use included American Indian or Alaskan Native race (0.55 [0.31-0.97]) when compared to white race, age over 70 (≥ 70-79 years: 0.91 [0.83-0.99]; ≥ 80 years: 0.68 [0.61-0.76]) when compared to age less than 50, and stage II (0.91 [0.86-0.96]), III (0.71 [0.67-0.75]), or IVA (0.43 [0.37-0.50]) disease when compared to stage I. Finally, geographic differences were also observed in BT use., Conclusions: In patients with stage I - IVA vaginal cancer from 2004 to 2021, brachytherapy utilization has significantly increased. These results indicate a recent start of the reversal of previously identified declining use of brachytherapy. However, more work is needed to ensure equitable use across demographic strata., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Dr. Viswanathan receives funding through NCI R01 237005., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to examine the association between food insecurity and substance use among young adults aged 18-25 in the U.S., Methods: A cross-sectional online survey was completed by a diverse sample of 1024 young adults (50.2 % female; 62 % non-white; m age = 21.7[SD = 2.26]) between January-April 2022. Logistic regression analyses were used to examine the association between food insecurity and current cigarette use, Electronic Nicotine Delivery System (ENDS) use, cannabis use, alcohol use, and binge drinking controlling for socio-demographic and economic factors, mental health, and experiences of discrimination., Results: Nearly 70 % of participants reported being food insecure over the past year. Substance use was also common: 45.9 % of participants reported current cigarette use, 50.9 % ENDS use, 57 % cannabis use, 65.9 % alcohol use, and 50.4 % engaged in binge drinking in the past two weeks. Being food insecure was associated with greater odds of cigarette use (OR = 2.49, 95 % CI = [1.77, 3.50]), ENDS use (OR = 2.18, 95 % CI = [1.58, 3.01]), cannabis use (OR = 1.73, 95 % CI = [1.26, 2.37]), alcohol use (OR = 1.60, 95 % CI = [1.16, 2.19]) and binge drinking (OR = 1.98, 95 % CI = [1.44, 2.72]), controlling for all other factors., Conclusion: Food insecurity may serve as an important indicator of substance use among young adults. Practitioners should consider screening for food insecurity, providing information about food access, and developing interventions to address food insecurity among the young adults with whom they work. Future research should examine these associations prospectively to better understand how food insecurity may contribute to the initiation and/or escalation of substance use., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Despite the well-documented benefits of physical activity (PA), globally, only 20 % of youth engage in sufficient PA. Reviews support the benefits of PA prescriptions on promoting adults' PA, but no comparable reviews exist on studies among youth. This systematic review 1) assesses the state of the evidence regarding PA prescriptions from healthcare practitioners on youths' PA; and 2) identifies gaps to inform future research and practice., Methods: A search of five databases in October 2023 identified 3067 articles. After title and/or abstract reviews, 64 full articles were reviewed for inclusion criteria. Study, sample, and PA prescription characteristics and findings regarding youths' PA were extracted., Results: Nine articles published 2001-2023 from the United States (n = 6), Spain (n = 1), Northern Ireland (n = 1), and the United States and Mexico (n = 1) were identified. Seven occurred in medical settings and two in schools. Study designs were generally strong (e.g., randomized controlled trials) and study durations were generally short (3-4 months). All but two studies measured youths' PA with self-report questionnaires. Most PA prescriptions were provided in verbal and written forms and tailored based on youths' baseline PA. Overall, healthcare practitioner-delivered PA prescriptions show minimal effects on youths' PA. Neither of the two studies that objectively measured PA found significant PA increases in objectively measured PA., Conclusions: There is insufficient research on healthcare practitioner delivered PA prescriptions to promote youths' PA to determine effectiveness. Future research with objectively measured PA and more diverse youth samples would advance the evidence., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To describe the changes in Food and Drug Administration (FDA)-approved non-intravenous rescue benzodiazepine (non-IV-rBZD) use and cost after the introduction of intranasal midazolam and intranasal diazepam., Methods: Retrospective descriptive study using the MarketScan Database between the years 2016 and 2022. We considered patients who had at least one non-IV-rBZD prescription before the introduction of intranasal rescue medications and at least one non-IV-rBZD prescription after the introduction of intranasal rescue medications., Results: There were 4,444 patients (45.8 % female, median (p 25 -p 75 ) age of 10.0 (5.0-15.0) years). 2,255 of 4,444 (50.7 %) patients switched from rectal diazepam to either intranasal midazolam (1,110 (25.0 %)) or intranasal diazepam (1,145 (25.8 %)) as their last non-IV-rBZD. The change from rectal to intranasal non-IV-rBZDs has been increasing over the years from 2019 to 2022. On multivariable analysis, having a non-IV-rBZD for epilepsy (rather than for other reasons including febrile seizures), the year of the last rescue medication, urban (non-rural) patient's residence, and certain regions of the United States were the factors most strongly associated with a change from rectal diazepam to intranasal non-IV-rBZDs. After adjusting for inflation, the median (p 25 -p 75 ) average wholesale price (AWP) of the last non-IV-rBZD was higher than that of the first non-IV-rBZD [702 (406-748) versus 417 (406-426), Wilcoxon signed rank test p < 0.0001)]. This difference was mainly driven by the patients who changed from rectal diazepam to intranasal non-IV-rBZD [748 (714-755) versus 417 (406-426), Wilcoxon signed rank test p < 0.0001)]. After adjusting for inflation, the median (p 25 -p 75 ) patient cost of the last non-IV-rBZD was higher than that of the first non-IV-rBZD [16 (3-55) versus 12 (6-31), Wilcoxon signed rank test p < 0.0001)]. This difference was mainly driven by the patients who changed from rectal diazepam to intranasal non-IV-rBZD [41 (6-83) versus 12 (6-30), Wilcoxon signed rank test p < 0.0001)]., Conclusion: Approximately half of patients changed from rectal diazepam to intranasal midazolam or intranasal diazepam and that transition has been progressively increasing from the year 2019 to the year 2022. The inflation-adjusted AWP and patient cost increased, especially among those patients who changed from rectal to intranasal rescue medication., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Food cravings during pregnancy are highly common, yet no measure of cravings has been validated among pregnant women. The current study evaluated the psychometric properties of the Food Craving Inventory (FCI) for use during pregnancy. U.S. military active-duty Service women (N = 192; 29.5 ± 3.8 years old; 44% Army, 36% Air Force, 15% Navy, and 4% Marine Corps) were recruited from the community at 12-27 weeks' gestation. Participants completed a modified version of the FCI validated for adults with binge-eating disorder, which included 13 additional items assessing cravings for foods that women commonly report experiencing during pregnancy (e.g., pickles, sour cream, hot or spicy wings). Additional measures also assessed disinhibited eating behaviors (i.e., loss of control eating and emotional eating). A series of confirmatory factor analyses were conducted to examine model fit for a four-factor structure of: (1) the FCI validated for binge-eating disorder (excluding the pregnancy-oriented food items) and (2) the FCI modified for pregnancy (with the pregnancy-oriented food items added). The previously validated four-factor structure of the FCI for binge-eating disorder demonstrated poor model fit in the current sample of pregnant women. After examining the structure of the FCI modified for pregnancy, several items were removed due to high cross-loading across multiple subscales. The resulting 16-item, four-factor (Fats, Sweets, Carbohydrates, Spicy/Strong foods) FCI for pregnancy (FCI-P) demonstrated generally good model fit (CFI = .95, TLI = .94, SRMR = .04, RMSEA = .09) and good-to-excellent internal consistency (Cronbach's alphas: .83-.96). Convergent validity was supported by significant correlations between the FCI-P scores and the disinhibited eating behavior scores (ps < .001). Results highlight the importance of psychometrically evaluating eating-related measures for use during pregnancy to appropriately capture the potentially unique experiences of the perinatal period., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The emergence of highly pathogenic avian influenza strain A (H5N1) in the USA is a high concern. Here, we illustrated the evolution, divergence, transmission pattern, infection pattern, entropy diversity, nucleotide diversity, and mutational landscape of HPAI(H5N1). We depicted three phylogenetic trees, i.e., from three perspectives: considering the HPAI H5N1 genome of the current outbreak in the USA (n = 971), considering the HPAI H5N1 spared in different hosts (cattle, hunan, avian, and nonhuman primates) and using the global genome sequences (n = 3154). We found that the clade 2.3.4.4b was responsible for the present infection. We noted that the USA's divergence rate is 3.43e- 3 subs per site per year, and the global divergence rate is 5.21e- 3 subs per site per year. We reported significant nucleotide changes to illustrate the genome. Similarly, we observe several point mutations in some proteins, such as PB2, PA, HA, NA, and NS1. Among point mutations, some common mutations are noted in PB2 (E362G, M631L) and PA (L219I, K497R). However, elimination strategies should be a high priority for dairy farm workers, domestic cattle, and poultry birds to limit future outbreaks., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: As society strives to curb gun violence among adolescents, understanding the risk factors associated with gun carrying is of critical importance. The current study seeks to examine the relationship between perceived neighborhood disorder and adolescents' susceptibility to carrying a gun to school. More specifically, the aim of the current study was threefold: (1) to examine the direct relationship between perceived neighborhood disorder and exposure to violence, (2) to investigate the association between perceived neighborhood disorder and gun carrying, and (3) to test the mediating effect of exposure to violence on the relationship between perceived neighborhood disorder and gun carrying., Methods: Data from waves I and II (1994-1996) of the National Longitudinal Study of Adolescent to Adult Health was analyzed (N = 11,887). Due to the binary nature of the mediating and dependent variables (i.e., exposure to violence and gun carrying) a series of logistic regression models were estimated., Results: Our analyses revealed that perceived neighborhood disorder is positive and significantly associated with, both, exposure to violence and gun carrying. The relationship between perceived neighborhood disorder and gun carrying was fully mediated by exposure to violence., Conclusions: While neighborhood disorder is a risk factor for gun carrying among youth, exposure to violence explains the relationship between perceived neighborhood disorder and carrying a gun to school. To reduce the prevalence of gun carrying and gun violence among the adolescent population, mental health resources should be provided to those who reside in communities with high levels of disorder and violence., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This Special Issue (SI) of Preventive Medicine is the 11th in an annual series on behavior change, health, and health disparities. The theme of this 2024 issue is Smoking and Other Tobacco Use among Women and Girls. Cigarette smoking remains the single most preventable cause of death in the U.S., causing the premature death of more than 200,000 U.S. women annually, a mortality rate that far exceeds levels from conditions more commonly associated with premature death in women (e.g., breast cancer). Of course, cigarette smoking among women and girls is also a well-known cause of intergenerational adverse health effects. Women and girls are also using e-cigarettes and many other tobacco products that are flooding the U.S. tobacco marketplace. This SI includes eleven peer-reviewed articles that advance knowledge across a wide range of topics on disproportionate adverse effects, prevalence, and risk factors for cigarette smoking and other tobacco use in women and girls., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [Journal name] and was not involved in the editorial review or the decision to publish this article., (Copyright © 2024. Published by Elsevier Inc.)

Background and Objectives: The purpose of this study was to develop national consensus based on expert opinion on the optimal outpatient care model of pediatric psychogenic nonepileptic seizures (PNES)., Methods: A core working group (CWG) within the PNES special interest group of the Pediatric Epilepsy Research Consortium was established. The CWG developed a rigorous scoring rubric to select experts in pediatric PNES within the United States of America and a three-round Delphi study was conducted to assess consensus on key components of the management of pediatric PNES in the outpatient setting., Results: Eighteen experts representing neurology, psychology, psychiatry, social work and nursing participated in the study. Strong consensus was reached that the multidisciplinary clinic (MDC) model is the gold standard for the outpatient management of pediatric PNES. Consensus was obtained that a neurologist, psychologist and social worker are essential members of the MDC and in the setting of unlimited resources, psychiatry and nursing are also recommended. Further consensus was established on the roles of specific personnel, structure of the clinic, billing practices, trainee inclusion, patient inclusion and exclusion, and end of visit management. While consensus was reached that a new term should be developed for this diagnosis, consensus was not reached on the ideal term., Discussion: Expert consensus was established for the multidisciplinary management of pediatric PNES in the outpatient setting. Specific recommendations were provided that can facilitate the development and implementation of MDCs in other institutions. Further prospective studies are warranted to validate this practice model., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Understanding the relationship between urban form and CO 2 emissions is essential for developing mitigation measures. However, most studies so far have been limited to examining the urban form at the macro level. Existing studies have limitations, such as a lack of granularity and a standardized approach, and focus on a limited set of urban form indicators. To address these issues, this study employs the Local Climate Zones (LCZ) framework to investigate the relationship between urban form and CO 2 emissions at the micro level in three American cities: Baltimore, Indianapolis, and Los Angeles. Results indicate that LCZ offers a valuable framework for mapping emissions at the building and street level and facilitates a better understanding of different urban forms' emission behavior. According to the findings, emission intensity in compact areas with few or no trees and limited green space is up to 3.5 times higher than in areas characterized by open layouts, scattered trees, and abundant plant cover. Also, per capita emissions in compact areas are, on average, two times higher than in areas with more open layouts. Additionally, the results show that compact high-rise and mid-rise areas without trees and greenery (LCZ 1 and 2), particularly in Baltimore and Indianapolis, experience higher emissions levels than other LCZs during the daytime. The findings suggest that the LCZ framework holds promise for understanding the link between urban form and emissions in intricate urban settings, as well as for low-carbon urban planning and climate change mitigation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

New energy vehicles (NEVs), owing to their low carbon emission, have gained immense importance to achieve the net-zero emission target. The global NEVs market has grown significantly over the last decade. China, the United States (US), and Europe are the leading markets for NEVs. This study systematically and critically reviews NEV literature on consumer behavior pertaining to NEV adoption. An attempt is made to uncover the current research trends, research settings, theoretical perspectives, and key factors influencing consumer behavior towards NEVs. These factors are further categorized into five broad factors: (a) economic factors, (b) policy and regulatory factors, (c) psychological factors, (d) infrastructural and technological factors, and (e) demographic factors. Through a critical analysis of existing theories, this study delineates the complex phenomenon of consumer behavior towards NEV adoption, offering a holistic understanding of the key factors influencing consumer behavior. This review suggests that purchasing price, charging infrastructures, consumers' attitudes towards the environment, and government policies are decisive to NEV adoption. This study contributes to the NEV adoption literature by proposing an integrated theoretical framework. Further, it outlines the managerial and policy implications for transitioning towards NEVs to achieve net-zero emission targets., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Projected increases in wildfire frequency, size, and severity may further stress already scarce firefighting resources in the western United States that are in high demand. Machine learning is a promising field with the ability to model firefighting resource usage without compromising dataset size or complexity. In this study, the Categorical Boosting (CatBoost) model was used with historical (2012-2020) wildfire data to train three models that calculate predicted daily counts of 1) total assigned personnel (total personnel), 2) assigned personnel that are at the fire (ground personnel), and 3) assigned personnel that either work with aircraft or in management (air/overhead personnel) based on daily wildfire characteristics. The main drivers behind personnel assignment under current management practices included structures threatened, acres burned, point of fire origin, and fire priority. While contextual variables such as preparedness level and the presence of other large fires were among the least important, the importance of fire priority reveals that factors beyond the features of the fire itself are influential in personnel assignment. CatBoost model predictions provide an historical context to firefighting resource assignment and could also be used to inform decision-makers and managers about future issues facing firefighting resources in the western United States given projected changes in climate., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Kevin Young reports financial support was provided by Oak Ridge Institute for Science and Education. Erin Belval reports a relationship with USDA Forest Service Rocky Mountain Research Station that includes: employment. Karin Riley reports a relationship with Rocky Mountain Research Station Missoula Fire Sciences Laboratory that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

In light of growing concerns about climate change and environmental issues, investor interest has surged in the new green economy market. However, the existing literature is limited regarding potential price bubbles and co-bubbles within this new domain. This study examines price bubbles and co-bubbles in the new green economy market, covering 31 indexes classified into three groups: the green economy market and its components, geographical regions, and sectors. Using daily data from August 31, 2005, to May 31, 2024, a test procedure is first applied to detect periods of price bubble in the various indexes, then logistic regressions are employed to examine price co-bubble behaviours. The results show evidence of price bubbles in the green economy market, particularly in solar and wind indexes, with peaks during the COVID-19 pandemic and Russia-Ukraine conflict, whereas the water index is the least prone to price bubbles. Regarding geographical region, the USA market exhibits a higher tendency for price bubbles than the Asian or European markets. Several sectors are resistant to price bubbles. The co-bubble analysis reveals a strong reliance of wind index on price bubbles in the solar and water indexes. Price bubbles in Asia significantly influence price bubbles in Europe and the USA. These findings have implications for investment portfolio management and risk management strategies in the new green economy market., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The ongoing adjustment and fluctuation of energy, climate, and economic policies leads to potential policy uncertainty. The potential uncertainty arising from these policies has a wide range of effects on renewable energy technology, leading to changes in investment decisions or consumption patterns. Hence, given the worldwide shift towards sustainable technologies, it is critical to assess how these policy uncertainties will affect renewable power. Given this backdrop, this study delves into the impact of energy policy uncertainty, climate policy uncertainty, economic policy uncertainty, and government effectiveness on renewable energy in the United States. The cross-quantilogram (CQ) methodology is employed by using monthly data from 2002 to 2022. The outcomes reveal that energy policy uncertainty effectively promotes renewable energy in the short run, whereas it serves as a barrier to the adoption of renewables in the long run. Economic policy uncertainty reduces renewable energy consumption in the short run, but it increases in the long run. Moreover, climate policy uncertainty accelerates the transition to low-carbon energy sources. Finally, government effectiveness is a significant supportive element of the energy transition towards renewables., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The Resource Conservation and Recovery Act of 1976 (RCRA) is a cornerstone of environmental policy in the United States. The law regulates the generation, transportation, storage, and disposal of hazardous chemicals. Although regulated, hazardous releases can still occur at RCRA sites due to flawed equipment, human error, and dated historical practices. Releases are investigated and remediated through what is known as a Corrective Action (CA). Using Census data and a novel dataset of RCRA facilities across the contiguous U.S., we examine the possibility of systematic inequities with regards to the (i) siting of RCRA facilities, (ii) occurrence of releases and CAs, (iii) duration of CAs, and (iv) permanence of remediation methods. We find evidence of disproportionate impacts across racial, ethnic, and income dimensions. The results vary, however, depending on the different aspects of the siting and cleanup process, thus highlighting the need for multi-layered analyses to identify and fully understand potential inequities associated with environmental programs., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dennis Guignet reports financial support was provided by Oak Ridge Institute for Science and Education. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To examine the impact of the COVID-19 pandemic on cervical cancer screening rates of Hispanic individuals compared to non-Hispanic White (NHW) individuals in the United States, whether a responsive surge in catch-up screenings occurred as society adapted to pandemic changes, and to investigate the sociodemographic characteristics between the study populations., Methods: Using cross-sectional data from the All of Us Research Program, which incorporates electronic health record data and survey data from a demographically, geographically, and medically diverse participant group, we assessed the annual cervical cancer screening rates during 2019-2021 by race/ethnicity among eligible individuals ages 21-64., Results: Among 116,052 unique individuals (78,829 NHW and 37,223 Hispanic), Hispanic individuals had lower annual cervical cancer screening rates than NHWI across the three years studied. They experienced a more significant decrease in screening from 2019 to 2020 (39.27 %) compared to NHWIs (21.15 %) and less of a rebound increase in the following year, 2021 (10.33 % vs 13.83 %). Hispanic individuals aged 50-64 experienced the sharpest decline in screening rates (-43.01 % from 2019 to 2020). Hispanic individuals also experienced greater adverse social conditions, including lack of insurance or employment, lower educational attainment, and lower household income., Conclusions: Hispanic individuals experienced a more significant decrease in cervical cancer screening rates with the onset of the COVID-19 pandemic compared with NHW individuals and did not experience a robust rebound in cervical cancer screening rates in 2021. As a result, the disparity in cervical cancer screening rates between NHW and Hispanic individuals considerably worsened with the COVID-19 pandemic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Electronic cigarettes (e-cigarette) entered the United States marketplace in 2007. Because of the chemical composition of e-cigarette liquid, there are concerns related to its effects on respiratory illnesses., Methods: Using Wave 4 (2016-2018) of the adult (≥18 years of age) Population Assessment of Tobacco and Health study, logistic regression was used to quantify the association between e-cigarette use and any respiratory illness (asthma, chronic bronchitis, COPD, emphysema, or other lung or respiratory conditions). Age, gender, and the use of other tobacco products were assessed as modifiers of this relationship via interactions on the additive and multiplicative scales., Results: After adjustment, ever e-cigarette use was associated with a 1.32 (95 % confidence intervals [CI]:1.03, 1.69) greater odds of any respiratory illness compared with never e-cigarette users among U.S. adults. When comparing ever and never e-cigarette users, older adults (Odds Ratio [OR] = 1.65, 95 %CI:1.20, 2.26), and ever users of other tobacco products (OR = 1.77, 95 %CI:1.37, 2.29) had greater odds of reporting any respiratory illness than younger adults and those who never used other tobacco products. Among never e-cigarette users, men (OR = 1.51, 95 %CI:1.12, 2.04) were less likely to report any respiratory illness than women. Only the joint effect of age and e-cigarette use on any respiratory illness was statistically significant, suggesting this effect was greater than expected on the additive and multiplicative scales., Conclusion: These findings suggest that the relationship between e-cigarette use and any respiratory illness varies with age. Interventions and policies to reduce e-cigarette use should target high-risk groups for any respiratory illness., Competing Interests: Declaration of competing interest A.M. Eugene and L.N. Borrell declare no competing financial interests or personal relationships that could appear to influence the work reported in this paper. However, L.N. Borrell is the Editor in Chief for Preventive Medicine., (Copyright © 2024. Published by Elsevier Inc.)

Significance: A growing number of adults use more than one tobacco product, with dual use of cigarettes and e-cigarettes being the most common combination. Monitoring sex disparities in tobacco use is a public health priority. However, little is known regarding whether dual users differ by sex., Methods: Data came from Waves 4-6 (12/2016-11/2021) of the Population Assessment of Tobacco and Health Study, a US nationally-representative longitudinal survey. This analysis included current adult dual users of cigarettes and e-cigarettes. We used weighted generalized estimating equations to assess the association between sex and (1) making a cigarette quit attempt (n = 1882 observations from n = 1526 individuals) and (2) smoking cessation (n = 2081 observations from n = 1688 individuals) across two wave pairs, adjusting for age, education, ethnicity, time-to-first cigarette after waking, and e-cigarette use frequency., Results: Among US dual users, 14.1% (95% Confidence Intervals [Cl] = 11.9-16.4) of females and 23.4% (20.0-26.9) of males were young adults (aged 18-24), 11.7% (9.2-14.2) of females and 14.4% (11.6-17.2) of males had

Objectives: Unlike the United States general population, veteran women - as opposed to veteran men - have greater smoking prevalence; yet, little is known regarding factors that influence smoking in veteran women. The purpose of this study was to begin examining the relationship between a psychological concept known as moral injury and demand for cigarettes among veteran women., Methods: Veteran women who smoke (n = 44) were recruited for this cross-sectional study from Amazon MTurk, Reddit, and a veteran-serving non-profit organization in June-July 2023. Consenting participants received $2 for completing the cigarette purchase task (CPT), Fagerstrom Test for Nicotine Dependence (FTND), and the military version of the Moral Injury Symptom Scale (MISS-M-SF). We examined five CPT demand indices and calculated a modified exponential demand model stratified by moral injury severity status (i.e., probable vs. unlikely)., Results: Probable morally injured women exhibited significantly higher relative reinforcing value (RRV) for smoking than unlikely morally injured women (F 1, 920  = 9.16, p = 0.003). Average cigarette consumption at $0 (i.e., Q 0 ) was 48.56% higher (M = 22.24 vs. M = 13.55) in probable compared to unlikely morally injured women (p = 0.04, Hedge's g = 0.74). FTND scores were significantly correlated with P max (i.e., demand elasticity point) and O max (i.e., maximum expenditure) values in both populations (rs = 0.42-0.68, ps < 0.05)., Conclusions: We provide preliminary evidence of the relatively high RRV of smoking in morally injured veteran women. Continued research is needed to refine the characterization of this relationship., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study explores the applicability of the Environmental Kuznets Curve (EKC) hypothesis in the United States (US) from 2006 to 2020, employing the Spatial Durbin Model (SDM) to analyze the cross-border effects of pollution among states. The results indicate that although economic growth initially decreases environmental degradation, it subsequently contributes to more significant environmental degradation, challenging the EKC hypothesis's validity at the US state level. Factors such as higher energy prices and reliance on fossil fuels are also identified as significant drivers of environmental deterioration, with varying impacts observed across states. Conversely, adopting renewable energy sources is crucial in mitigating pollution levels. The study underscores the importance of coordinated state-level efforts to harmonize economic growth with sustainable environmental practices. It highlights the complexities of policymaking in balancing economic development with environmental conservation and emphasizes the need for targeted interventions to address environmental challenges effectively. This research enhances our understanding of sustainable development pathways amidst diverse regional dynamics within the US by providing empirical evidence and policy insights., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Food insecurity related to immigration status remains largely underexplored. This study examined trends and disparities in household food insecurity by immigration status in the United States (US)., Methods: We analyzed data from 427,942 households from the US Current Population Survey Food Security Supplement from 2011 to 2021. Immigration status categories included recent immigrants (< 5 years), long-term immigrants (≥ 5 years), naturalized citizens, and US-born citizens. Food insecurity was assessed using validated questions on consistent access to enough food for an active and healthy life., Results: From 2011 to 2021, food insecurity prevalence declined from 14.9 % (95 % CI, 14.5 %-15.3 %) to 10.2 % (95 % CI, 9.8 %-10.6 %). Among recent immigrants, prevalence decreased from 25.2 % (95 % CI, 23.1-27.4) in 2011 to 15.0 % (95 % CI, 12.8 %-17.2 %) in 2019, then increased to 17.7 % (95 % CI, 14.7 %-20.2 %) in 2020 and 17.4 % (95 % CI, 14.7 %-20.2 %) in 2021. Long-term immigrants' prevalence dropped from 20.4 % (95 % CI, 16.9 %-24.0 %) in 2011 to 10.2 % (95 % CI, 7.2 %-13.1 %) in 2018, then increased to 17.7 % (95 % CI, 13.7 %-21.7 %) in 2021. Naturalized citizens' prevalence decreased from 14.4 % (95 % CI, 12.9 %-15.9 %) to 9.5 % (95 % CI, 8.2 %-10.9 %). US-born citizens' prevalence decreased from 14.2 % (95 % CI, 13.8 %-14.6 %) to 9.7 % (95 % CI, 9.3 %-10.2 %). Compared to the US-born citizens, the adjusted prevalence ratio was 1.63 (95 % CI,1.57-1.69) for recent immigrants, 1.22 (95 % CI, 1.13-1.31) for long-term immigrants, and 0.94 (95 % CI, 0.90-0.98) for naturalized citizens. Significant disparities exist in subgroups., Conclusions: The findings provide insights for stakeholders to address food insecurity among vulnerable immigrant groups in the US., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Precarious employment is a plausible stressor, which may adversely affect health. We investigated the association between multidimensional precarious employment and perceived and biological stress in the U.S., Methods: We used data from waves 4 (2008-2009) and 5 (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health. Eight indicators were mapped to five dimensions of precarious employment to create a continuous score (PES, range: 0-5): material rewards, working-time arrangements, stability, workers' rights, and interpersonal relationships. Perceived stress was constructed from the four-item Cohen's perceived stress score (PSS; range: 0-16; wave 4). We measured biological stress in waves 4 and 5 via C-reactive protein (CRP). Given variability in CRP collection between waves, we treated wave 4 and 5 as cross-sectional. We employed adjusted linear regression models to estimate whether the PES was associated with the PSS in wave 4 (n = 11,510) and CRP in waves 4 (n = 10,343) and 5 (n = 3452)., Result: Individuals were aged 28 and 37 years on average in wave 4 and 5, respectively. Half were female and most identified as non-Hispanic (NH)-White (∼73 %), followed by NH-Black (∼14 %), Hispanic (∼9 %) and NH-other (∼4 %). Average PES was inversely related to education. The PSS averaged 8.1 (Interquartile Range [IQR] = 7.0,9.0). Average CRP was 4.4 mg/L (IQR = 0.8,5.0) in wave 4 and 3.6 mg/L (IQR = 0.8,4.2) in wave 5. The PES was associated with perceived stress (β=0.06; 95 % CI = 0.01,0.10) and CRP in wave 5 (β=0.34; 95 % CI = 0.07,0.62)., Conclusions: Given the deleterious effects of stress on health, policies to reduce precarious employment warrant consideration., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To determine whether risk stratification can optimize the benefits of flexible sigmoidoscopy (FSG) screening., Methods: The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial was conducted from 1993 to 2001 in the United States. A colorectal cancer (CRC) risk stratification tool was developed in the control arm (n = 64,207) from the PLCO cohort and validated in the UK Biobank (n = 270,726). PLCO participants (n = 130,021) were classified into low-, medium-, and high-risk groups. Cumulative incidence and mortality were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between screening and CRC incidence and mortality., Results: The CRC risk stratification tool was based on age, gender, body mass index, smoking status, family history of CRC, diabetes, regular use of aspirin, and CRC screening history. Compared with the control arm, FSG screening was significantly associated with a reduction in mortality in both the medium-risk (HR = 0.76, 95% CI = 0.63-0.92) and high-risk groups (0.58, 0.46-0.73), but not in the low-risk group (0.85, 0.61-1.19). FSG screening also reduced distal CRC incidence and mortality in the medium-risk and high-risk groups. Furthermore, it was associated with a reduction in incidence (0.74, 0.59-0.92) and mortality (0.59, 0.40-0.87) of proximal colon cancer in the high-risk group., Conclusions: FSG screening yielded more benefits for the high-risk group than for the low-risk and medium-risk groups, supporting the development of a risk-stratified CRC screening strategy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Asian American and Pacific Islanders (AAPI) are the fastest growing racial group in the United States. Data on AAPI communities, however, are significantly limited. The oversimplification and underreporting of this ethnically and socioeconomically heterogenous population through the use of aggregated data has deleterious effects and worsens disparities in patient treatment, outcomes, and experiences. Gynecologic oncology disparities do not exist in a vacuum, and are rooted in larger cultural gaps in our understanding and delivery of healthcare. In this paper, we aim to demonstrate how AAPI data inequities have negative downstream effects on research and public health policies and initiatives, and also provide a call to action with specific recommendations on how to improve AAPI data equity within these realms., (Copyright © 2024. Published by Elsevier Inc.)

Background: Uric acid (UA) serves as a crucial endogenous antioxidant in the body, offering protection against oxidative stress, whichmaycontributetoepilepsypathogenesis. The association between serum UA levels and epilepsy remains uncertain. This study aimed to examine the potential connections between serum UA levels and epilepsy in US adults., Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2013-2018, a cross-sectional analysis was conducted. Weighted logistic regression analyses were employed to assess the potential link between serum UA levels and the risk of epilepsy. Additionally, sensitivity analyses were conducted to evaluate the reliability of the results., Results: We included 15,373 participants, of whom 136 (0.79 %) had epilepsy. Following adjustment for multiple variables, participants with serum UA levels <4.1 mg/dl had an odds ratio of 2.24 (95 % CI: 1.12-4.47, P = 0.023) for epilepsy compared to those with serum UA levels of 5.8-6.5 mg/dl. The results of the sensitivity analyses corroborated the initial findings., Conclusions: Our study revealed a significant association between lower serum UA levels and heightened risks of epilepsy, suggesting that low UA levels may serve as an independent risk factor for epilepsy. A marginal increase in UA levels within the normal range may act as a protective factor against epilepsy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)