Preventive Medicine

Layered Tobacco 21 and smoke-free laws reduce adolescent smoking

This analysis linked Monitoring the Future data (2014–2020) with county-level Tobacco 21 and smoke-free coverage for US 10th and 12th graders. Counties with universal Tobacco 21 plus smoke-free workplace laws had lower 10th-grade smoking initiation than counties with less coverage (ME −0.011; 95% CI −0.037, −0.006). Among 12th graders, universal coverage was associated with lower past 30‑day smoking for workplace (ME −0.035) and hospitality (ME −0.039) smoke-free laws. Layering Tobacco 21 with comprehensive smoke-free policies appears more effective than partial coverage for reducing adolescent cigarette use. 1

Prediabetes elevates 5-year ASCVD risk, especially in young and obese adults

This Kaiser Permanente cohort included 1,358,882 adults without baseline diabetes or ASCVD, about half with prediabetes. Over 4.1 years, prediabetes independently increased ASCVD risk by 21% after adjustment (HR 1.21; 95% CI 1.18–1.25) versus normoglycemia. Relative risk was highest at ages 18–34 years (HR 1.54; 95% CI 1.18–2.02), indicating early vulnerability. Prediabetes with obesity carried greater 5‑year ASCVD risk (HR 1.32) than prediabetes without obesity (HR 1.22) compared with metabolically healthier peers. Findings support early, intensive lifestyle and cardiometabolic risk management for prediabetes, especially in younger and obese adults. 2

ACA Medicaid expansion linked to lower severe maternal morbidity

National Medicaid analytic files captured 6,976,586 delivery hospitalizations in states expanding Medicaid by July 2016. Severe maternal morbidity, defined by CDC’s 21-indicator measure, declined after Medicaid expansion in these states. Deliveries occurring at least 21 months post-expansion had lower odds of severe maternal morbidity versus pre-expansion deliveries (OR 0.79 including transfusion; 0.76 excluding transfusion). Results suggest Medicaid expansion improves maternal safety among Medicaid enrollees, consistent with better preconception and prenatal access. 3