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Background: Adult-led organized settings for children (eg, classrooms) provide opportunities for physical activity (PA). The structure of setting time may influence inequalities (ie, unequalness) in the distribution of PA. This study examined differences in PA inequality by setting and time-segment purpose in time-segmented organized group settings for children. Methods: PA and setting meetings were assessed using accelerometer and video observation data from school, before-/after-school, and youth club groups (n = 30) for third- through sixth-grade children (n = 699) in 2 rural US communities. Meetings (n = 130) were time-segmented into smaller units (sessions; n = 835). Each session was assigned a purpose code (eg, PA). Accelerometer data were paired with the meetings and sessions, and the Gini coefficient quantified inequality in activity counts and moderate to vigorous PA minutes for each segment. Beta generalized estimating equations examined differences in PA inequality by setting and session purpose. Results: Activity count inequality was lowest (P <.05) during youth club meetings (Gini = 0.17, 95% CI, 0.14–0.20), and inequality in moderate to vigorous PA minutes was greatest (P <.01) during school (Gini = 0.34, 95% CI, 0.30–0.38). Organized PA sessions (Gini = 0.20, 95% CI, 0.17–0.23) had lower activity count inequality (P <.0001) than academic (Gini = 0.30, 95% CI, 0.27–0.34), enrichment (Gini = 0.31, 95% CI, 0.27–0.36), and nonactive recreation (Gini = 0.30, 95% CI, 0.25–0.34) sessions. Inequality in moderate to vigorous PA minutes was lower (P <.05) in organized PA (Gini = 0.26, 95% CI, 0.20–0.32) and free play (Gini = 0.28, 95% CI, 0.19–0.39) than other sessions. Conclusions: PA inequality differed by setting time structure, with lower inequality during organized PA sessions. The Gini coefficient can illuminate PA inequalities in organized settings and may inform population PA improvement efforts in rural communities. [ABSTRACT FROM AUTHOR]

Background: Active transportation (AT), described as self-powered modes of travel (eg, walking and cycling), is an important source of health-promoting physical activity. While AT behaviors have been measured on national health surveys in Canada for over 2 decades, historic prevalence has not been previously reported. We aimed to document the measures of AT on Canada's various national health surveys, examine AT over time, and interpret them within the context of evolving methods of assessment. Methods: We compiled and summarized the questions used to measure AT among Canadians on 4 national health surveys: National Population Health Survey (1994–1998), Canadian Community Health Survey (2000–2020), Canadian Health Measures Survey (2007–2019), and the Health Behaviour in School-aged Children Study (2010–2018). Among youth and adults (12+ y), we summarized over time: (1) the prevalence of AT participation and (2) time spent in AT (in hours per week) among those who report any AT participation. Where possible, we reported separate estimates of walking and cycling and produced an aggregate estimate of total AT. We stratified results by age group and sex. Results: Changes in AT survey questions over time and between surveys limit the interpretation and comparability of temporal trends. Nevertheless, a consistently higher proportion of females report walking, while a higher proportion of males report cycling. Irrespective of mode, males report spending more total time in AT. Participation in AT tends to decrease with age, with youth reporting the highest rates of AT and young adults often spending the most time in AT. Conclusions: Monitoring trends in AT can help assess patterns of behavior and identify whether promotion strategies are needed or whether population interventions are effective. Our evaluation of AT over time is limited by questions surveyed; however, consistent differences in AT by age and sex are evident over time. Moving forward, ensuring consistency of AT measurement over time is essential to monitoring this important behavior. [ABSTRACT FROM AUTHOR]

Background: The built environments in which we work, live, and play can influence physical activity behaviors, and perceptions of these environments are associated with walking behavior. This study's objective is to compare national-level data on perceptions of the near-home walking environment from the 2015 and 2020 National Health Interview Survey. Methods: Adults in 2015 (n = 30,811) and 2020 (n = 29,636) reported perceptions of walkable supports (roads, sidewalks, paths, or trails; sidewalks on most streets), destinations (shops, stores, or markets; bus or transit stops; movies, libraries, or churches; places that help you relax, clear your mind, and reduce stress), and barriers to walking (traffic; crime; animals). Age-adjusted prevalence estimates, prevalence differences, and 95% confidence intervals were calculated overall and by demographic characteristics. Results: The reported prevalence of roads, sidewalks, paths, or trails for walking increased overall (85.3% in 2015 to 88.0% in 2020) and for many subgroups. Perceived places to walk to for relaxation, to clear your mind, and to reduce stress increased overall (72.1% in 2015 to 77.1% in 2020) and for all subgroups. Perceptions of crime as a barrier to walking decreased overall (12.5% in 2015 to 11.2% in 2020) and for some subgroups. From 2015 to 2020, the proportion of adults perceiving roads, sidewalks, paths, or trails; places to relax; and crime as a barrier to walking improved. Conclusions: Continuing to monitor perceptions of the walking environment could contribute to progress toward national walking and walkability goals in the United States. [ABSTRACT FROM AUTHOR]

Background: Studying effective interventions already operating at scale is critical to improving physical activity intervention research translation. The free, weekly, timed 5-km run or walk parkrun represents a unique opportunity to examine successful organic dissemination. We conducted an ecological analysis to identify patterns of growth in Australian parkrun participation and their correlates from 2011 to 2020. Method: Outcome variables were (1) weekly counts of walkers/runners and (2) monthly number of new parkrun registrants. We used latent class analysis to characterize growth trajectories followed by logistic regression on class membership. Covariates included parkrun course characteristics (eg, surface type and route), site-level aggregate participant profile (eg, proportion women and mean age), and surrounding area characteristics (eg, population density and physical activity norm). Results: Three hundred and sixty-three parkruns were included (n = 8,388,695 participation instances). Sixty-nine percent followed a low-growth and 31% a high-growth participation pattern. High growth was associated with greater participation by women, concrete/bitumen surface type, lower area socioeconomic status, and greater volunteer heterogeneity. Odds of being in the slow-growth class were higher if the course contained >1 km of repetition, higher average age of participants, better average parkrun performance, and higher running group membership. Two patterns of new registration were identified: high start followed by steep decline; and low start, slow decline with similar correlates to participation. Conclusions: Parkruns with a less competitive social milieu may have more rapid dissemination. As a free and regular event, parkruns in low socioeconomic areas have the potential to improve the activity levels of those with fewer resources. [ABSTRACT FROM AUTHOR]

Health equity is fundamental to improving the health of populations, but in recent decades progress towards this goal has been mixed. To better support this mission, a deeper understanding of the local heterogeneity within population-level health equity is vital. This analysis presents trends in average health and health equity in the United States at the local level from 1990 to 2019 using three different health outcomes: mortality, self-reported health status, and healthy days. Furthermore, it examines the association between these measures of average health and health equity with several structural factors. Results indicate growing levels of geographic inequality disproportionately impacting less urbanized parts of the country, with rural counties experiencing the largest declines in health equity, followed by Medium and Small Metropolitan counties. Additionally, lower levels of health equity are associated with poorer local socioeconomic context, including several measures that are proxies for structural racism. Altogether, these findings strongly suggest social and economic factors play a pivotal role in explaining growing levels of geographic health inequality in the United States. Policymakers invested in improving health equity must adopt holistic and upstream approaches to improve and equalize economic opportunity as a means of fostering health equity.

Purpose: Sexual and gender minority (SGM) people are at greater risk for substance use than heterosexual and cisgender people, but most prior work is limited by cross-sectional analyses or the examination of single substance use. This study examined substance use over time among SGM people to identify patterns of polysubstance use at the intersection of sex and gender. Methods: Data were collected annually over 4 years from SGM respondents (n = 11,822) in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Differences in substance use patterns (any prior 30-day use of 15 substances) by gender subgroup were examined with latent class analysis, and multinomial regression models tested relationships between gender subgroup and substance use. Results: Eight classes of substance use were observed. The three most common patterns were low substance use (49%), heavy episodic alcohol use (≥5 alcoholic drinks on one occasion) with some cannabis and tobacco use (14%), and cannabis use with some tobacco and declining heavy episodic alcohol use (13%). Differences observed included lower odds of patterns defined by heavy episodic alcohol use with some cannabis and tobacco use in all gender subgroups relative to cisgender men and persons with low substance use (odds ratios [ORs] 0.26-0.60). Gender expansive people assigned female at birth, gender expansive people assigned male at birth, and transgender men had greater odds of reporting cannabis use with small percentages of heavy episodic alcohol and tobacco use (ORs: 1.41-1.60). Conclusion: This study suggests that there are unique patterns of polysubstance use over time among gender subgroups of SGM people.

To accelerate medical breakthroughs, the All of Us Research Program aims to collect data from over one million participants. This report outlines processes used to construct the All of Us Social Determinants of Health (SDOH) survey and presents the psychometric characteristics of SDOH survey measures in All of Us. A consensus process was used to select SDOH measures, prioritizing concepts validated in diverse populations and other national cohort surveys. Survey item non-response was calculated, and Cronbachs alpha was used to analyze psychometric properties of scales. Multivariable logistic regression models were used to examine associations between demographic categories and item non-response. Twenty-nine percent (N = 117,783) of eligible All of Us participants submitted SDOH survey data for these analyses. Most scales had less than 5% incalculable scores due to item non-response. Patterns of item non-response were seen by racial identity, educational attainment, income level, survey language, and age. Internal consistency reliability was greater than 0.80 for almost all scales and most demographic groups. The SDOH survey demonstrated good to excellent reliability across several measures and within multiple populations underrepresented in biomedical research. Bias due to survey non-response and item non-response will be monitored and addressed as the survey is fielded more completely.

PURPOSE: Data are limited on sodium glucose co-transport 2 inhibitors (SGLT2-is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among real-world cohorts of underrepresented patients. We examined these therapies and glycemic control in US adults with diabetes mellitus (DM) by atherosclerotic cardiovascular disease (ASCVD) risk and sociodemographic factors. METHODS: In the NIH Precision Medicine Initiative All of Us Research Program, we categorized DM as (1) moderate risk, (2) high risk, and (3) with ASCVD. We examined proportions on DM therapies, including SGLT2-i or GLP-1 RA, and at glycemic control by sociodemographic factors and CVD risk groups. RESULTS: Our 81,332 adults aged ≥ 18 years with DM across 340 US sites included 22.3% non-Hispanic Black, 17.2% Hispanic, and 1.8% Asian participants; 31.1%, 30.3%, and 38.6% were at moderate risk, high risk, or with ASCVD, respectively. Those with DM and ASCVD were most likely on SGLT2-i (8.6%) or GLP-1 RA (11.9%). SGLT2-i use was

Disparities in data underlying clinical genomic interpretation is an acknowledged problem, but there is a paucity of data demonstrating it. The All of Us Research Program is collecting data including whole-genome sequences, health records, and surveys for at least a million participants with diverse ancestry and access to healthcare, representing one of the largest biomedical research repositories of its kind. Here, we examine pathogenic and likely pathogenic variants that were identified in the All of Us cohort. The European ancestry subgroup showed the highest overall rate of pathogenic variation, with 2.26% of participants having a pathogenic variant. Other ancestry groups had lower rates of pathogenic variation, including 1.62% for the African ancestry group and 1.32% in the Latino/Admixed American ancestry group. Pathogenic variants were most frequently observed in genes related to Breast/Ovarian Cancer or Hypercholesterolemia. Variant frequencies in many genes were consistent with the data from the public gnomAD database, with some notable exceptions resolved using gnomAD subsets. Differences in pathogenic variant frequency observed between ancestral groups generally indicate biases of ascertainment of knowledge about those variants, but some deviations may be indicative of differences in disease prevalence. This work will allow targeted precision medicine efforts at revealed disparities.

Objective: To evaluate the impact on rural Veterans' access to social work services of a Department of Veterans Affairs (VA) national program to increase social work staffing, by Veterans' rurality, race, and complex care needs. Data Sources and Study Setting: Data obtained from VA Corporate Data Warehouse, including sites that participated in the social work program between October 1, 2016 and September 30, 2021. Study Design: The study outcome was monthly number of Veterans per 1000 individuals with 1+ social work encounters. We used difference‐in‐differences to estimate the program effect on urban, rural, and highly rural Veterans. Among rural and highly rural Veterans, we stratified by race (American Indian or Alaskan Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and White) and complex care needs (homelessness, high hospitalization risk, and dementia). Data Collection: We defined a cohort of 740,669 Veterans (32,434,001 monthly observations) who received primary care at a participating site. Principal Findings: Average monthly social work use was 8.7 Veterans per 1000 individuals. The program increased access by 49% (4.3 per 1000; 95% confidence interval, 2.2–6.3). Rural Veterans' social work access increased by 57% (5.0; 3.6–6.3). Among rural/highly rural Veterans, the program increased social work access for those with high hospitalization risk by 63% (24.5; 18.2–30.9), and for Veterans experiencing homelessness, 35% (13.4; 5.2–21.7). By race, the program increased access for Black Veterans by 53% (6.1; 2.1–10.2) and for Asian Veterans by 82% (5.1; 2.2–7.9). Conclusions: At rural VA primary care sites with social work staffing below recommended levels, Black and Asian Veterans and those experiencing homelessness and high hospitalization risk may have unmet needs warranting social work services. [ABSTRACT FROM AUTHOR]

Background: Intellectually disabled individuals have been observed to lead sedentary lifestyles resulting in poor health. Physical fitness has been positively correlated to better health outcomes with small changes in fitness translating to major health changes among unfit older adults with intellectual disability. However, there is currently no literature on safe exercise regimens for the intellectually disabled population. Methods: In this article, a retrospective review was conducted using the Special Olympics Athlete database and analyzed the mean differences of various performance metrics based on self-reported exercise frequency. Results: These results demonstrated that those who exercised daily performed significantly better in flexibility, static balance and functional strength as compared to those who did not exercise. No statistically significant differences were found among athletes and self-reported exercise frequency for aerobic fitness. Conclusion: Overall, these findings suggest that 3-6 days-a-week of moderate exercise would be a recommended exercise dose to see significant improvement in performance and physiological adaptations. [ABSTRACT FROM AUTHOR]

The purpose of this project was to implement intentional spiritual care in a community population with chronic illness in the United States to reduce risk of depression. A convenience sample (n = 10) of members of a congregation participated in scheduled spiritual care for 12 weeks. The PHQ-9 depression screening tool was given pre and postimplementation to evaluate efficacy of the spiritual care sessions on risk of depression. Quantitative and qualitative data was collected. All participants identified as having at least one chronic illness and considered themselves to be spiritual. Initial PHQ-9 scores indicated all participants had mild to moderately severe risk of depression. Postimplementation PHQ-9 scores indicated a decrease in score ranging from no risk to moderate risk of depression. Postimplementation PHQ-9 scores indicated a decrease in depression score of 2.8 points on average. The paired samples t-test result for the before versus after PHQ-9 were statistically significant with p <.01 and t(9) = 4.882. During this project, no participant experienced an increase or worsening of their illness. These results showed that identifying individual spiritual needs and incorporating intentional spiritual care can reduce the risk of depression and decrease exacerbation episodes in chronically ill patients. [ABSTRACT FROM AUTHOR]

Background and Rationale: Dental care systems have the potential to influence population oral health and patterns of socioeconomic inequalities. Therefore, understanding the impact of the ways in which countries fund, provide, and organize their dental care services is key in the analysis of determinants of oral health. In this commentary we offer a synopsis of recent typologies of healthcare systems, based on a rapid review, and highlight that none of them fit dental care services given the separation of dental care from general healthcare provision in many countries. The paper also summarizes evidence on dental care systems as determinants of population oral health and argues why a new typology of dental care systems is needed. Challenges and Ways Forward: We argue that a typology must consider institutional arrangements, structures, and processes behind the provision of dental care, and that specific dimensions/variables that inform the typology should result from a process of discussion and consensus. Some methodological considerations for developing typologies are also discussed, including the challenges in the collection and analysis of data followed by an advanced cluster analysis. Despite their limitations, typologies have evolved into an essential tool for comparing the similarities and differences of healthcare systems across countries. Therefore, a dental specific typology for health systems will be useful for researchers, policymakers, and dental professionals to characterize the provision of dentalcare services in different countries. This will also enable examining their potential role as determinants of population oral health and inequalities. [ABSTRACT FROM AUTHOR]

Health is an integral feature of immigration, providing not only insight into population health but also a critical lens into immigrant integration and the power structure in receiving countries. The goal of this article is to chart the trajectory of scholarship on immigrants' health, focusing on the formative shift away from dominant individualistic perspectives focused on cultural and behavioral explanations toward a profoundly structural understanding of immigrants' health. Focusing primarily on the US context, we synthesize theoretical and empirical advances in structural perspectives of immigrants' health. We anchor these advances in the concept of exclusion, detailing how it undergirds structuralist perspectives of immigrants' health. We review common ways in which exclusion has been measured in the empirical literature on immigrants' health and highlight recent evidence linking exposure to exclusion to immigrants' health outcomes across the life course. We conclude by discussing key directions and challenges for future research. [ABSTRACT FROM AUTHOR]

Background: Public health dietitians navigate complex professional landscapes amid dwindling resources, organisational disruptions and limited advancement opportunities. Cultivating systems thinking and structural empowerment competencies may enable this workforce to address multifaceted public health challenges more effectively. This study explored the extent to which public health dietitians apply systems thinking and perceive access to structural empowerment and the relationship between these constructs. Methods: A quantitative online survey incorporating the systems thinking scale (STS) and conditions for work effectiveness questionnaire‐II (CWEQ‐II) was conducted among US public health dietitians who worked in governmental public health. Data were collected from September 2022 to October 2022. Descriptive and inferential statistical analyses were conducted. Results: Among 216 respondents, 98% demonstrated moderate‐to‐high systems thinking competency (mean STS score = 60.3 ± 8.74, range 28–78). Over 88% reported moderate‐to‐high perceived structural empowerment (mean CWEQ‐II score = 18.3 ± 0.96, range 8–29). Higher systems thinking scores were associated with greater decision‐making authority (p = 0.01) but not budget oversight. Higher structural empowerment scores correlated with increased job responsibilities and decision‐making authority (p < 0.001). A significant positive correlation existed between systems thinking and structural empowerment (r = 0.24, p < 0.001). Public health dietitians exhibited substantial systems thinking capabilities and perceived access to organisational power structures. Conclusions: This study offers baseline understanding of systems thinking and structural empowerment among public health dietitians. The positive interplay between these constructs underscores their potential to drive systems‐level change and influence population health outcomes. Integrating systems thinking and structural empowerment into dietetic education and professional development may enhance the workforce's preparedness for navigating complexities. Key points: Respondents demonstrated moderate‐to‐high systems thinking competency and perceived structural empowerment.Higher systems thinking scores were associated with greater decision‐making authority, whereas higher structural empowerment scores correlated with increased job responsibilities and decision‐making authority.The positive association between systems thinking and structural empowerment among public health dietitians underscores their potential to drive systems‐level change and influence population health outcomes.Integrating systems thinking and structural empowerment into dietetic education and professional development may enhance the workforce's preparedness for navigating complexities. [ABSTRACT FROM AUTHOR]

Purpose: Macronutrient intakes vary across people and economic status, leading to a disparity in diet-related metabolic diseases. This study aimed to provide insight into this by: (1) identifying dietary patterns in adults using reduced rank regression (RRR), with macronutrients as response variables, and (2) investigating the associations between economic status and macronutrient based dietary patterns, and between dietary patterns with central obesity (waist circumference) and systemic inflammation (C-reactive protein [CRP]). Methods: 41,849 US participants from the National Health and Nutrition Examination Survey (NHANES), 1999–2018 were included. The percentages of energy from protein, carbohydrates, saturated fats, and unsaturated fats were used as response variables in RRR. Multivariable generalized linear models with Gaussian distribution were employed to investigate the associations. Results: Four dietary patterns were identified. Economic status was positively associated with both the high fat, low carbohydrate [βHighVsLow = 0.22; 95% CI: 0.16, 0.28] and high protein patterns [βHighVsLow = 0.07; 95% CI: 0.03, 0.11], and negatively associated with both the high saturated fat [βHighVsLow = -0.06; 95% CI: -0.08, -0.03] and the low alcohol patterns [βHighVsLow = -0.08; 95% CI; -0.10, -0.06]. The high saturated fat pattern was positively associated with waist circumference [βQ5VsQ1 = 1.71; 95% CI: 0.97, 2.44] and CRP [βQ5VsQ1 = 0.37; 95% CI: 0.26, 0.47]. Conclusion: Macronutrient dietary patterns, which varied by economic status and were associated with metabolic health markers, may explain associations between economic status and health. [ABSTRACT FROM AUTHOR]

Background: Community-based coalitions are a common strategy for community engagement efforts targeting the improvement of a variety of population health outcomes. The typical processes that coalitions follow to organize efforts include steps that are sequential, slow, and time intensive. These processes also limit local decision-making to the selection of evidence-based policies or programs. Methods: We present a process control theory-based Community Action Process, Investigate-Design-Practice-Reflect (IDPR), where community hubs (i.e., coalitions) organize agile efforts in a non-sequential, rapid, and efficient manner to harness local assets and data to make decisions regarding the provision and production of population health services. Using qualitative methods, we illustrate and analyze the use of IDPR in a one community case study as part of Wellscapes, a Type 3-hybrid implementation-effectiveness community randomized controlled trial to improve children's population health physical activity. Results: We found community members followed the IDPR Community Action Process to rapidly design, organize, deliver, and receive feedback on a community-based, children's population physical activity prototype, an afterschool Play-in-the-Park opportunity for all children. Discussion: Following IDPR afforded the community coalition timely learning through feedback within a process that coordinated decisions regarding what community services met community needs (provision decisions) and how to organize the production of the population health services (production decisions). [ABSTRACT FROM AUTHOR]

Value-based healthcare payment models are an alternative insurance payment system that compensates healthcare providers based on their patients' outcomes rather than the individual services healthcare workers provide. This shift from the current fee-for-service model that predominates our medical system has received renewed popularity and attention within organized medicine such as the American Medical Association. Advocates believe that this new payment model will address many of the unsolved issues in healthcare such as medical waste and unsustainable healthcare costs. In practice, however, this model is plagued with a myriad of unresolved issues of its own. In this commentary, we outline these issues and suggest that the intentions of those advocating for value-based payment models are either misguided or disingenuous. We then offer solutions that preserve our current fee-for-service model while making necessary changes that will benefit both physicians and patients nationwide. [ABSTRACT FROM AUTHOR]

Background: Incidence-based multistate models of population health are commonly applied to calculate state expectancies, such as a healthy life expectancy (HLE), or unhealthy life expectancy (UHE). These models also allow the computation of other summary indices, such as the distributions of healthy or unhealthy lifespans. Objective: We aim to show how a multistate health model implies a multistate death distribution, giving joint information on years lived in good and poor health. We also propose three aggregate indices of joint health and mortality inequality. Methods: We propose a double-accounting approach to increment-decrement life table methods to intuitively derive a multistate health distribution over age and cumulative duration spent in each state. We then define a variety of summary lifespan inequality indices based on different distance metrics, namely Euclidean, Chebyshev, and Manhattan distances. Results: We apply the method to multistate transition probabilities between health states based on the activities of daily living index for Italian women from the Survey of Health, Ageing and Retirement in Europe in 2015-2017. We demonstrate the added value of accounting for joint years lived in health states in multistate models for our understanding of the period health and mortality conditions from the perspective of health-specific lifespans of individuals. Conclusions: Multivariate state distributions and summary indices derived from them give a holistic representation of population health inequality. We offer selected summary indices of the multivariate distribution with different demographic interpretations from the measures derived from univariate distributions. Although more theoretical and methodological work is required to motivate a single comprehensive population health inequality index, this direction is a promising path for a better understanding of population health dynamics and relationships between univariate statistics. [ABSTRACT FROM AUTHOR]

Background: Disparities in hypertension control across race, ethnicity, and language have been a long-standing problem in the United States. Objective: To assess whether a multi-pronged intervention can improve hypertension control for a target population and reduce disparities. Design: This stepped wedge cluster randomized trial was conducted at 15 adult primary care clinics affiliated with Massachusetts General Hospital. PCPs were randomized to receive the intervention in twelve groups. Participants: The target population was patients who met one of the following criteria based on self-identification: (1) Asian, Black, Indigenous, multi-racial, or other race; (2) Hispanic ethnicity; or (3) preferred language other than English. Reference population was White, English-speaking patients. Interventions: PCPs were given access to an online equity dashboard that displays disparities in chronic disease management and completed an equity huddle with population health coordinators (PHCs), which involved reviewing target patients whose hypertension was not well controlled. In addition, community health workers (CHWs) were available in some practices to offer additional support. Main Measures: The primary outcome was change in the proportion of target patients meeting the hypertension control goal when comparing intervention and control periods. Key Results: Of the 365 PCPs who were randomized, 311 PCPs and their 10,865 target patients were included in the analysis. The intervention led to an increase in hypertension control in the target population (RD 0.9%; 95% CI [0.3,1.5]) and there was a higher intervention effect in the target population compared to the reference population (DiD 2.1%; 95% CI [1.1, 3.1]). Conclusions: Utilizing data on disparities in quality outcome measures in routine clinical practice augmented by clinical support provided by PHCs and CHWs led to modest, but statistically significant, improvement in hypertension control among BIPOC, Hispanic, and LEP patients. Trial Registration: ClinicalTrials.gov Identifier: NCT05278806. [ABSTRACT FROM AUTHOR]

Healthcare conversion foundations (CF) are charitable entities with endowments of varying sizes that are created as the result of a sale of a hospital or health system. Limited current research focuses on the impacts of CF grant-making and philanthropy within the communities they serve. In this study, we use a panel analysis of CF financial information from 2011 to 2021 to characterize CF investments by geography, and as compared to required tax-exempt hospital community benefit spending. Of the 51 foundations included in the analysis, CFs invested over $382 million into the communities they served through contributions, gifts, and grants in fiscal year 2021 alone. On average, CFs invested $20.21 per-capita on contributions, gifts, and grants in their communities, with CFs that serve non-metropolitan areas investing significantly more per-capita than those that serve only metropolitan areas ($32.97 vs $10.09, respectively), although non-metropolitan CFs may represent a larger proportion of overall community charitable investment as compared to metropolitan CFs within a given community. In conjunction with prior evidence, findings from the current study suggest that CF investments in the communities they serve appear to be on a similar scale as community benefit spending of tax-exempt hospitals, although there is significant heterogeneity in spending across both CFs and tax-exempt hospitals. Further understanding of the impacts of conversion foundations within the communities they serve and how they may change over time in response to changing communities, health care context, and regulations is important to understanding the scope and impact of philanthropic funding for population health. [ABSTRACT FROM AUTHOR]

ABSTRACT Cost‐effectiveness analysis for health interventions is traditionally conducted in a risk‐neutral way, insensitive to risk attitudes in the population, which are potentially non‐neutral. While the standard outcome metric of quality‐adjusted life years (QALYs) aims to be deferential to people's valuations of health states, cost‐effectiveness analysis of risky interventions using the QALY metric is not similarly deferential to people's risk attitudes. I argue that there is no good justification for this practice. Non‐neutral attitudes to risk, especially where they concern individually life‐changing interventions need not be irrational, and so imposing neutrality is not justifiable as a way of debiasing preferences. Many common justifications for deference to health state preferences extend to risk attitudes. But even if reasons for deference do not extend, imposition of risk neutrality as opposed to any other rationally permissible risk attitude is under‐motivated as default practice. Thus, either methods for measuring risk attitudes separately and incorporating them into cost‐effectiveness analysis should be used more widely or a richer set of information should be presented to political decision‐makers and the public to enable them to decide how to take into account the individual risks faced by members of the population, on top of aggregate effects on population health. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implications for the profession Impact To describe nurses' and community‐based organization representatives' collaborative strategies for advancing climate justice with communities.This study used a descriptive, qualitative research design.Data were gathered from August 2022 to February 2023 with nurses (n = 8) and their community partners (n = 5) in the United States. Community partners were representatives of community‐based organizations. Photovoice provided greater context for the thematic analysis of collaborative strategies discussed in semi‐structured interviews.Nurse participants worked in academic or non‐profit settings. Nurse‐community partnerships addressed corporate pollution and promoted Indigenous sovereignty and multispecies justice. Themes included investigating disease and health events, identifying at‐risk populations and connecting them with resources, providing health teaching and counseling, organizing communities and coalitions, and advocating for policy development and enforcement. Self‐care supported resilience and well‐being in the long struggle for climate justice.Findings from this study indicated that nurses and their community partners strategize to transition communities away from systems of extraction towards local and regenerative systems that support resilience. Nurses and their community partners recognized the importance of applying an expansive understanding of climate justice, including intersections of pollution and multispecies justice, to promoting planetary health.Findings from this study support nurse‐community collaboration in policy work to advance planetary health. This study also supports nurses' collective action with their community partners to address the effects of white supremacy and colonization. Future research is needed to evaluate the outcomes of nurse‐community partnerships for planetary health.Nurses have called for action on climate justice; however, evidence of effective nursing strategies that advance climate justice is sparse. This study is the first to describe the collaborative strategies nurses implement with community partners to support the transition from injustice to justice in communities most burdened by climate change and industrial pollution. [ABSTRACT FROM AUTHOR]

The article discusses the persistent inequities in children's health, development, and well-being, despite global efforts over the past decade. It emphasizes the need to address these inequities to generate substantial savings across budgets and improve societal productivity. The text suggests a path forward that involves multidisciplinary collaborations and radical pragmatism to close the child equity gap within a generation. It also highlights the importance of data systems and key indicators to inform more precise and effective approaches in addressing and monitoring inequities. [Extracted from the article]

Background: The 24-hour movement guidelines (24-HMG) include screen time (ST), sleep duration, and physical activity. Previous studies have explored the associations of adherence to the 24-HMG with depression and anxiety symptoms among adolescents, ignoring changes in behaviors. This study aimed to examine whether changes in adherence to the 24-HMG were associated with depression and anxiety symptoms among adolescents. Methods: We recruited adolescents from Shenzhen, China in 2021 and followed them up 1 year later. Changes in adherence to the individual 24-HMG were categorized into four groups: persistent non-adherence, adherence to non-adherence, non-adherence to adherence, and persistent adherence. Changes in the numbers of adherence to the overall 24-HMG were obtained by subtracting the number of guidelines adhered to in wave 2 from that in wave 1. Results: We included 12,570 participants aged 9–18 years with 52.2% boys. Compared with persistent non-adherence for the ST/sleep duration guideline, non-adherence to adherence and persistent adherence were associated with lower depression and anxiety symptoms, but adherence to non-adherence was not. Changes in adherence to the physical activity guideline were not related to outcomes. The β coefficients (95% CIs) for each point increase in changes in the numbers of adherence to guidelines were − 0.58 (− 0.69, − 0.47) and − 0.43 (− 0.53, − 0.33) for depression and anxiety symptoms, respectively. The association of persistently adhering to sleep guideline with anxiety symptoms and the associations of changes in the numbers of adherence to the 24-HMG had sex differences. Conclusions: Maintaining and strengthening healthy movement behaviors to meet more guidelines of the 24-HMG, especially sleep and ST, may be beneficial for preventing depression and anxiety symptoms in adolescents. [ABSTRACT FROM AUTHOR]

Introduction: The concept of the commercial determinants of health (CDH) is used to study the actions of commercial entities and the political and economic systems, structures, and norms that enable these actions and ultimately influence population health and health inequity. The aim of this study was to develop a typology that describes the diverse set of activities through which commercial entities influence population health and health equity across industries. Methods: We conducted a scoping review to identify articles using CDH terms (n = 116) published prior to September 13, 2022 that discuss corporate activities that can influence population health and health equity across 16 industries. We used the qualitative constant comparative method to inductively code descriptions and examples of corporate activities within these articles, arrange the activities into descriptive domains, and generate an overarching typology. Results: The resulting Corporate Influences on Population Health (HEALTH-CORP) typology identifies 70 corporate activities that can influence health across industries, which are categorized into seven domains of corporate influence (i.e., political practices, preference and perception shaping practices, corporate social responsibility practices, economic practices, products & services, employment practices, and environmental practices). We present a model that situates these domains based on their proximity to health outcomes and identify five population groups (i.e., consumers, workers, disadvantaged groups, vulnerable groups, and local communities) to consider when evaluating corporate health impacts. Discussion: The HEALTH-CORP typology facilitates an understanding of the diverse set of corporate activities that can influence population health and the population groups affected by these activities. We discuss how the HEALTH-CORP model and typology could be used to support the work of policy makers and civil society actors, as well as provide the conceptual infrastructure for future surveillance efforts to monitor corporate practices that affect health across industries. Finally, we discuss two gaps in the CDH literature that we identified based on our findings: the lack of research on environmental and employment practices and a dearth of scholarship dedicated to investigating corporate practices in low- and middle-income countries. We propose potential avenues to address these gaps (e.g., aligning CDH monitoring with other occupational health monitoring initiatives). [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a complex disease that affects the global population's health, with dyslipidemia being one of its major complications. High density lipoprotein (HDL) is regarded as the "hero" in the bloodstream due to its role in reverse cholesterol transport, which lowers cholesterol levels in the blood and prevents atherosclerosis. However, in the complex internal environment of CKD, even this "hero" may struggle to perform its beneficial functions and could potentially become harmful. This article reviews HDL heterogeneity, HDL subclasses, functional changes in HDL during the progression of CKD, and the application of HDL in CKD treatment. This review aims to deepen understanding of lipid metabolism abnormalities in CKD patients and provide a basis for new therapeutic strategies. [ABSTRACT FROM AUTHOR]

Steady and significant improvements in life expectancy have been a bright spot for human progress for the last century or more. Recently, this success has shown signs of faltering in some high‐income countries, where mortality improvements have slowed or even reversed since the early 2010s. Combined with the large mortality shock of the COVID‐19 pandemic, guaranteed forward progress feels less certain. We review mortality trends in high‐income countries since 2000 through the COVID‐19 pandemic. While deteriorating mortality in the United States has received the most attention, countries including the United Kingdom, Canada, the Netherlands, Greece, and Germany are also seeing slowdowns. Before COVID‐19, these slowdowns largely reflected stalling improvements in cardiovascular disease mortality and increases in deaths from external causes in young and midlife for the worst‐performing countries. We discuss prospects for the future of mortality in high‐income countries, including lingering impacts of the COVID‐19 pandemic, challenges and opportunities related to the obesity epidemic, and emerging reasons for both optimism and pessimism. While biological limits to increased life expectancy may eventually dominate long‐term trends, human‐made social factors are currently holding many countries back from already achievable best‐practice life expectancy and will be key to near‐term improvements. [ABSTRACT FROM AUTHOR]

The discipline of geography is an increasingly necessary lens required to understand population-level diseases. Syndemics, or co-occurring diseases or epidemics within a specific population, are contextualized by place--preexisting social, economic, and political structures. Nurse practitioners are well-positioned to critically assess the impact of geography on patient health and well-being. This perspective provides a brief summary of syndemic crises, with a case example in the West Virginia coalfields. The position of this paper is one that supports geography, in addition to social determinants of health, as a framework for syndemics. A geographic perspective provides a more comprehensive picture of marginalized populations and regions facing the phenomenon. Given the significance of holistic nursing, attention to the role of geography in syndemics provides an increased dimension of care and treatment. [ABSTRACT FROM AUTHOR]

Background: Impaired health states can limit a person's mobility, often progressively for people with life-limiting illnesses. Quantifying mobility changes is crucial for individual clinical care and service planning. Objective: To explore any correlation between EQ-5D-5L's mobility dimension ratings and Life-Space Assessment (LSA) from a population sample. Methods: An online population survey of Australian adults, nationally-representative by key demographics. An analysis of variance examined each level of the EQ-5D-5L mobility dimension rating against its LSA scores; Kendall's Tau assessed correlation. Results: Participants (n = 6366) were 53% women, mean age 46.1 years (SD 18.6), and mean LSA score 78.0 (SD = 27.5; possible range 0–120). At each EQ-5D-5L mobility dimension level there was a significant difference between LSA scores (p < 0.001), and a moderate negative correlation (Kendall's tau b = −0.342) between the two measures. Conclusion: Given the relationship defined, EQ-5D-5L mobility dimension ratings may prompt clinicians to consider further evaluation with the more detailed Life-Space Assessment.. [ABSTRACT FROM AUTHOR]

Evaluating the effectiveness of policy interventions using observational data can produce misleading results when studies do not adequately account for bias. Target trial emulation is an approach to designing rigorous nonexperimental studies by "emulating" key features of a clinical trial and is most commonly used outside of policy contexts. In this article, the authors discuss the application of the target trial emulation framework in the policy evaluation context. Target trial emulation is an approach to designing rigorous nonexperimental studies by "emulating" key features of a clinical trial. Most commonly used outside of policy contexts, this approach is also valuable for policy evaluation as policies typically are not randomly assigned. In this article, we discuss the application of the target trial emulation framework in a policy evaluation context. The policy trial emulation framework includes 7 components: the units and eligibility criteria, definitions of the exposure and comparison conditions, assignment mechanism, baseline ("time zero") and follow-up, outcomes, causal estimand, and statistical analysis and assumptions. Policy evaluations that emulate a randomized trial across these dimensions can yield estimates of the causal effects of the policy on outcomes. Using the policy trial emulation framework to conduct and report on research design and methods supports transparent assessment of threats to causal inference in nonexperimental studies intended to assess the effect of a health policy on clinical or population health outcomes. [ABSTRACT FROM AUTHOR]

On 26 September 2023, the National Institutes of Health designated persons with disabilities a population with health disparities. The authors of this commentary outline 3 opportunities for advancing disability inclusion in forthcoming research on disability-specific health and health care inequities. [ABSTRACT FROM AUTHOR]

The increased frequency and severity of extreme weather events (EWEs) have underscored the need to strengthen climate-resilient health systems and capacity. Community health workers (CHWs) are integral health systems actors with the potential to protect and improve population health in a changing climate. The aim of this review was to synthesize the literature on the roles of CHWs amid EWEs in low- and middle-income countries, the barriers and facilitators to implement these roles, and program supports to strengthen CHW capacity and health system functions. Scoping review. Four academic databases and gray literature published between January 2000 and June 2023 were searched. Data were thematically analyzed using a deductive-inductive approach guided by the World Health Organization's (WHO's) Operational framework for building climate-resilient health systems. Thirty sources were included. Amid EWEs, CHW roles included: 1) delivery of diagnostic, treatment, and other clinical services; 2) support with access, utilization, or navigation of health services and/or referrals; 3) community education and health promotion; 4) data collection and health surveillance; 5) psychosocial supports; and 6) weather-related health emergency response. Facilitators and barriers to the provision of CHW supports amid EWEs were categorized within WHO's building blocks of health systems. Considerations for strengthening CHW programs to enhance climate-resilient health systems are also discussed. CHWs are uniquely positioned to provide health-related supports amid EWEs that extend to emergency preparedness and response to climate-health challenges. These efforts can contribute to the community and health systems resilience to climate change. [ABSTRACT FROM AUTHOR]

Introduction: E‐cigarette use has rapidly increased amongst young people in Australia, however the prevalence of use amongst pregnant people is not known. The aim of this study was to examine the prevalence of e‐cigarette use and dual use of e‐cigarettes and tobacco cigarettes, characteristics associated with use and reasons for use amongst a sample of pregnant Australian people attending public antenatal clinics. Methods: A cross‐sectional survey was conducted with 4024 pregnant people attending antenatal appointments, between July 2021 and December 2022, in one local health district in New South Wales, Australia. Main outcome measures were current use of e‐cigarettes, dual use with tobacco cigarettes, participant characteristics associated with use and reasons for use. Results: 1.24% of pregnant people used e‐cigarettes, 34% of these were dual smokers. Being a current smoker (OR 39.49; 95% CI 9.99–156.21) or ex‐smoker (OR 29.86; 95% CI 8.75–101.95) were associated with e‐cigarette use. Quitting smoking was the most reported reason for use (52%). Discussion and Conclusions: This study is the first to report on the prevalence of e‐cigarette use amongst pregnant people in Australia. We found that a small proportion of pregnant people use e‐cigarettes and that many are dual users or ex‐smokers. E‐cigarette use and rates of dual use in pregnancy in Australia appear lower than internationally, however they are similarly being used as a smoking‐cessation aid by many. As regulatory environments relating to e‐cigarette access change in Australia, large‐scale studies are required to continue to monitor e‐cigarette use and dual use in pregnancy. [ABSTRACT FROM AUTHOR]

The Public Health Nursing discipline plays a crucial role in promoting sustainable health services. The establishment of competency frameworks and practice standards pertaining to Public Health Nursing has emerged as a cornerstone for guiding practice, education, and research. This study aimed to identify contemporary Public Health Nursing competency frameworks and practice standards and establish a robust list of competency domains. This will inform a subsequent phase of this project that will conduct a review of recent scholarly literature to discern prevailing research trends and delineate strategic directives and research priorities for the discipline. A systematic search of three databases and a grey literature search was undertaken by incorporating keywords to identify existing Public Health Nursing‐specific competency frameworks and practice standards. Through screening and selection based on our inclusion criteria, three documents were analyzed. A comprehensive document analysis was conducted to generate a unified domain list and associated descriptors. Three competency‐based frameworks and practice standards emanating from two countries, the United States of America and the Republic of Ireland met the inclusion criteria. The document analysis identified 16 individual domains. There was consistent evidence of similarity across the three documents. There were minimal divergences featured within the frameworks which are discussed and compelling justifications for inclusion as universal domains are provided. This document analysis has generated a list of 16 common Public Health Nursing competency domains which will be utilized in phase two of this project as a foundational framework for the purpose of analyzing research trends, influencing research priorities, and enhancing the focal areas for future research agendas within the discipline. [ABSTRACT FROM AUTHOR]

Purpose: Engagement in CME/CPD has a positive impact on healthcare professionals' (HCPs) knowledge, skills, and performance, and on patient outcomes, therefore it is critical to better understand the components of CME/CPD systems that foster engagement, high-quality education, and impact. Methods: An assessment of CME/CPD systems was conducted using a mixed-methods approach that included interviews with in-country subject matter experts and qualitative and quantitative data from practicing in-country physicians. Results: Results demonstrate areas of consistency in CME/CPD systems across world regions that included: types of educational providers; types of credit; educational formats; self-tracking of participation; high-degree of compliance when education is mandatory; overall satisfaction with available education; strong support for interprofessional education; and lack of alignment or evaluation of engagement in education with population health outcomes. Areas of variation included: whether engagement in education is required as a condition to practice medicine; whether regulations are uniformly applied; if mechanisms to ensure independence existed; and physician perceptions of independence. Conclusion: Results of this assessment maybe used by a variety of different stakeholders to assess how well country-level CME/CPD systems are meeting the needs of practicing physicians and determine what, if any, changes might need to be implemented to improve outcomes. [ABSTRACT FROM AUTHOR]

The dual-factor model of mental health proposes that high wellbeing and low distress are necessary to define mental health. This study used latent profile analysis to identify mental health profiles in a sample of 3,587 Australian grade 6 students and explored the association between mental health profiles and school outcomes measured in grades 7 and 9. Six mental health profiles were identified: complete mental health (i.e. high wellbeing and low distress; 30%), moderately mentally healthy (i.e. average wellbeing and low distress; 18%), symptomatic but content (i.e. high wellbeing and above-average distress; 19%), vulnerable (i.e. low wellbeing and below-average distress; 6%), moderately troubled (i.e. below-average wellbeing and high distress; 19%), and troubled (i.e. low wellbeing and high distress; 8%). After statistical adjustment for potential confounders (gender, language background, socio-economic status, and geographical remoteness), students with complete mental health showed significantly higher academic achievement and school engagement one and three years later compared with students with all other mental health profiles. Students with vulnerable and troubled profiles experienced the poorest school outcomes sustained over time (grade 7 and grade 9). Implications for school-based interventions to support the mental health and wellbeing of students are discussed. [ABSTRACT FROM AUTHOR]

Background: Pain recognition and assessment in individuals with profound intellectual disabilities are challenging. Exploring effective methods of addressing this is essential. This study aims to discover current nursing practice in this area of care as the first of a four‐phased appreciative inquiry study, to inform further research and practice. Methods: Data from individual and focus group interviews with co‐researching nurses were collated and developed into themes. Results: Six themes were identified: unconditional positive regard, honouring of relationship, creative best practice, pain through a competing lens, accurate assessment—an impossible task? Medicating pain—oversimplified and undervalued? Conclusion: Relationship is essential, in recognising pain and distress. There is an understanding of the multifaceted nature of pain in the care of this population; however, physical pain recognition and assessment are prioritised, to prevent serious ill health and death. Formal methods of assessment and communication between professionals are needed. [ABSTRACT FROM AUTHOR]

The article explores the integration of intersectionality in understanding the health disparities faced by Limited English Proficiency (LEP) populations in relation to their legal status. Topics discussed include the impact of immigration status on access to healthcare, the role of language barriers in exacerbating health inequities, and the necessity of adopting an intersectional framework to inform policy and practice.

Background: We investigated the implementation process of an Integrated Community Approach (ICA) applied in four low socio-economic status neighbourhoods in Maastricht, the Netherlands. The ICA is a Population Health Management initiative and aims to improve population health, quality of care, professional's satisfaction and decrease costs of care. This study addresses the facilitators and barriers for implementing the ICA from a stakeholder perspective, including steering group members, professionals and citizens. Methods: We conducted a mixed-methods study using a triangulation of methods to investigate the implementation from 1 December 2016 to 31 December 2020. The Consolidated Framework for Implementation Research guided data collection and data-analysis for evaluating the implementation process. In total, 77 interviews, 97 observations, seven focus groups, 65 collected documents and two surveys with open-ended questions were conducted. Results: Facilitators for implementation were the use of citizen science to bring residents' needs into sharp focus, the integration of the ideology of Positive Health into the working routines of the professionals and leadership at the steering group level to overcome barriers in the ICA. The existing accounting and financial infrastructure obstructed combining budgets at neighbourhood level. Conclusions: Engaging citizens and professionals at an early stage is an important facilitator for implementation. The use of a shared vision on health also worked as a facilitator since it created a shared language among professionals, which is important in Population Health Management initiatives where multiple professionals are expected to collaborate. Trial Registration: NTR 6543; registration date, 25 July 2017. [ABSTRACT FROM AUTHOR]

Purpose: Increasing the perceived need for CRC screening can facilitate undertaking CRC screening. This study aims to identify factors associated with the need for CRC screening in rural populations. Design: A cross-sectional online survey. Setting: The survey was conducted in June - September 2022 in the rural areas of Alaska, Idaho, Oregon, and Washington, US. Subjects: The subjects of this study were 250 adults (completion rate: 65%) aged 45-75 residing in rural Alaska, Idaho, Oregon, and Washington. Measures: Perceived need for CRC screening, internet usage for health purposes, demographics, and intrapersonal, interpersonal, community, and environmental characteristics. Results: Perceived need for CRC screening were negatively associated with patient-provider miscommunication (β = −.23, P <.001) and perceived discrimination (β = −.21, P <.001), cancer fatalism (β = −.16, P <.05), individualism (β = −.15, P <.05), and dependence on community (β = −.11, P <.05), but positively with compliance with social norms (β =.16, P <.05), trust in health care providers (β =.16, P <.05), knowledge about colorectal cancer (β =.12, P <.05). Conclusions: Our study showed potential individual and situational characteristics that might help increase colorectal cancer screening. Future efforts might consider addressing discrimination in health care settings, improving patient-provider communication, and tailoring messaging to reflect the rural culture. [ABSTRACT FROM AUTHOR]

This study shows that the solution of the existing and expected and future shortage of health professionals is essential to protect the health of the population globally. In this regard, the international migration of health professionals and the shortage of skilled health workforce, as well as the growing disparity between population needs, health care supply and demand, is a topical problem for health systems.The mobility and shortage of highly qualified specialists are characteristic of the top of the pyramid. There is a significant shortage in the medium and low levels of the pyramid of healthcare professionals and some non-medical majors. In both cases, there are internal and external imbalances, most often caused by increased migration to economic centers in the country or countries with a high standard of living. [ABSTRACT FROM AUTHOR]

Objectives: To estimate changes in the incidence of clinically diagnosed type 2 diabetes in Australia, overall and by age, sex, socio‐economic disadvantage, geographic remoteness, and country of birth. Study design: Population‐based study; analysis of National Diabetes Services Scheme (NDSS) data (age–period–cohort models). Setting, participants: Data were extracted for incident cases of type 2 diabetes, 1 January 2005 to 31 December 2019, in residents of the Australian Capital Territory, New South Wales, Queensland, and Victoria aged 20 years or older registered with the NDSS. The numbers of people at risk were obtained from the Australian Bureau of Statistics. Main outcome measures: Changes in the incidence of type 2 diabetes, 2005–2019, by age, postcode‐level socio‐economic disadvantage (Index of Relative Socioeconomic Disadvantage) and remoteness (major city, inner regional, outer regional/remote/very remote), and country of birth, stratified by sex. Results: During 2005–2019, 741 535 people aged 20 years or older with incident type 2 diabetes were registered with the NDSS; 421 190 were men (56.8%). Overall, the incidence of type 2 diabetes increased with age (until about age 70 years) and socio‐economic disadvantage for both sexes; it was higher in inner regional areas than in major cities or outer regional/remote/very remote areas during 2005–2015, but highest among people in major cities after 2015. The age‐standardised incidence of type 2 diabetes increased during 2005–2010, both among men (annual percentage change [APC], 4.4%; 95% confidence interval [CI], 3.6–5.2%) and women (APC, 2.9%; 95% CI, 2.2–3.7%); it declined during 2010–2019 among both men (APC, –5.2%; 95% CI, –5.4% to –4.9%) and women (APC, –6.5%; 95% CI, –6.8% to –6.2%). In general, similar patterns (but of differing magnitude) applied to all age, sex, socio‐economic disadvantage, and remoteness groups. However, the incidence of type 2 diabetes increased during 2011–2019 among people born in Asia, North Africa and the Middle East, and the Pacific Islands. Conclusions: The incidence of type 2 diabetes in Australian adults declined during 2010–2019 across all age, sex, socio‐economic disadvantage, and remoteness groups, but increased among people from Asia, North Africa and the Middle East, and the Pacific Islands. [ABSTRACT FROM AUTHOR]

Objective: To estimate the potential economic burden of long COVID in Australia. Design: A stock‐and‐flow model of weekly estimated numbers of people with long COVID (January 2021 to June 2023); application of proxy cost estimates from people living with myalgic encephalomyelitis/chronic fatigue syndrome; time series analysis of labour market and social security datasets. Setting: The working age Australian population. Main outcome measures: The likely number of Australians severely impacted by long COVID; the economic cost of long COVID; and the impacts of long COVID, determined by analysis of labour market data. Results: At its peak in late 2022, between 181 000 and 682 000 Australians may have experienced some long COVID symptoms, of whom 40 000–145 000 may have been severely affected. Severe cases potentially decreased to affecting 10 000–38 000 people by June 2023. The likely economic burden of long COVID in Australia during 2022 was between $1.7 billion and $6.3 billion (some 0.07% to 0.26% of gross domestic product). Labour market data suggest that between 25 000 (February 2023) and 103 000 (June 2023) more working age Australians reported being unable to work due to long term sickness than would have been predicted based on pre‐COVID‐19 trends. This does not appear to have translated into increased claims for Disability Support Pensions, but numbers of working age Carer Allowance recipients have grown markedly since 2022. Conclusions: Long COVID likely imposed a small but significant aggregate toll on the Australian economy, while exposing tens of thousands of Australians to substantial personal economic hardship and contributing to labour market supply constraints. Yet while some signal from long COVID is discernible in the labour force data, Australia lacks adequate direct surveillance data to securely guide policy making. [ABSTRACT FROM AUTHOR]

To study the proportion and predictors of outpatient physician follow-up within 60 days of substance-related emergency department (ED) visits for Ontario youth. We examined administrative data on substance-related ED visits before and during the COVID-19 pandemic among youths aged 10–24 years in Ontario, Canada. Substance-related visits were identified using International Classification of Diseases-10-CA codes. We described demographic characteristics, receipt of mental health services in the year before the ED visit, disposition from the ED, and follow-up services within 60 days of the ED visit. Between April 1, 2017, and May 31, 2021, 64,236 youth had at least one ED visit for substance use. Visits for alcohol were the most common (49%), followed by cannabis (32.3%). ED visits for all substances were more prevalent during the pandemic than prepandemic, except visits for alcohol. The receipt of follow-up physician care for substance use was low (33.2% prepandemic) but increased during the pandemic (41.7%; adjusted odds ratio 1.34, 95% CI 1.28, 1.39) and varied between substances. Mental health service history in the year before the substance-related ED visit had the strongest association with receipt of follow-up physician care within 60 days (adjusted odds ratio 6.86, 95% CI 6.57, 7.17). Youth frequently do not receive physician follow-ups within two months of the substance-related ED visit, although higher follow-up proportions were seen during the pandemic after the implementation of virtual care. Further research is required to understand why follow-up is low and to examine interventions that can increase connection to care. [ABSTRACT FROM AUTHOR]

Data sharing, the act of making scientific research data available to others, can accelerate innovation and discoveries, and ultimately enhance public health. The National Cancer Institute Implementation Science Centers in Cancer Control convened a diverse group of research scientists, practitioners, and community partners in three interactive workshops (May–June 2022) to identify and discuss factors that must be considered when designing research for equitable data sharing with a specific emphasis on implementation science and social, behavioral, and population health research. This group identified and operationalized a set of seven key considerations for equitable data sharing—conceptualized as an inclusive process that fairly includes the perspectives and priorities of all partners involved in and impacted by data sharing, with consideration of ethics, history, and benefits—that were integrated into a framework. Key data-sharing components particularly important for health equity included: elevating data sharing into a core research activity, incorporating diverse perspectives, and meaningfully engaging partners in data-sharing decisions throughout the project lifecycle. As the process of data sharing grows in research, it is critical to continue considering the potential positive and adverse impact of data sharing on diverse beneficiaries of health data and research. [ABSTRACT FROM AUTHOR]