American journal of preventive medicine
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Despite the heavy toll of alcohol use disorder (AUD) in the U.S., efficacious medications for AUD (MAUD) are rarely used. Minimal research has explored clinician prescribing practices involving MAUD. ⋯ Most clinicians prescribing MAUD in a year did so rarely. Policy and health system change is needed to improve clinicians' pharmacologic treatment of AUD, with a focus on primary care physicians, with whom individuals with AUD may have the most frequent contact.
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Many U.S. states expanded the generosity of Medicaid insurance coverage of tobacco dependence treatment over the last fifteen years, but little is known about how coverage impacts cigarette smoking, especially for individuals with substance use disorder. ⋯ Comprehensive tobacco dependence treatment coverage had no differential effect on smoking cessation among ever smokers with or without substance use disorder, and its expansion was not associated with changes in smoking behaviors for Medicaid beneficiaries with substance use disorder. Other multilevel interventions may be needed to impact smoking cessation rates, such as awareness and education campaigns of expanded tobacco dependence treatment coverage benefits, and interventions that reduce social and structural barriers to treatment.
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Physicians and nurses have lower annual mortality rates than the general population. One explanation for the low mortality rates of these healthcare workers emphasizes their specialized medical knowledge and greater access to healthcare while a second emphasizes their generally higher level of education. We evaluated the extent to which general educational level accounts for the lower all-cause mortality rates of US healthcare than non-healthcare workers. We also compared cause-specific mortality risks of healthcare and non-healthcare workers. ⋯ Higher educational attainment accounted for the longer life expectancy of US healthcare workers than other workers. Nevertheless, healthcare work relative to non-healthcare work was associated with lower hazards of deaths due to cardiovascular diseases and lung cancer, but higher hazards of deaths due to external causes.
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About 25% of people who currently smoke cigarettes in the U.S. smoke nondaily, and relatively little is known about their intentions or attempts to quit. Active surveillance is essential to identify services needed to support smoking cessation efforts and reduce the burden of disease. ⋯ Given the substantial number of adults who smoke nondaily in the U.S. and their interest in quitting, developing targeted interventions and communication is an important public health priority.
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Quantifying the use of emerging tobacco products such as nicotine pouches (NPs) and heated tobacco products (HTPs) is crucial for informing public health interventions and measuring their potential effects on tobacco use morbidity, mortality and benefits from complete tobacco cessation. ⋯ Continued surveillance of emerging tobacco products such as HTPs and NPs can inform public health approaches and support future research to better quantify the health consequences from these products.