November 2021 highlights from the American Journal of Public Health

Date: Nov 19 2021

To request a full copy of any of these studies or for information on scheduling interviews with an expert, contact APHA Media Relations.

American Journal of Public Health November issue highlights:

  • Pandemic led to drop in adult, childhood vaccinations
  • Suboptimal diets linked to disparities in cancer burden
  • Length of workplace leave tied to breastfeeding duration
  • Traffic deaths involving mix of cannabis, alcohol on rise

Pandemic led to drop in adult, childhood vaccinations

Immunizations declined for both children and adults in the first year of the pandemic, according to new findings in the November AJPH.

The findings are based on data from the Michigan immunization registry between 2018 and September 2020. Researchers found that doses administered overall decreased beginning in February 2020, with peak declines in April 2020 of more than 63%. Decreases in adult vaccine doses administered were reported in all settings, except in pharmacies and OB-GYN offices. Local health departments reported a more than 66% decrease in doses.

For children, the total number of sites administering childhood vaccines went down, while vaccination coverage declined more than 4% overall and nearly 6% among children with Medicaid coverage.

During the peak decline in April 2020, the largest decreases in vaccination were among adolescents, followed by children ages 2 to 8, adults, and children ages 2 and younger.

“As vaccination coverage has dropped, susceptible population are accumulating, which could lead to outbreaks of (vaccine-preventable diseases) not seen in recent times,” the study stated. “The susceptibility gap for all of the (vaccine-preventable diseases) needs to be closed as soon as possible.”

[Author contact: Angela Shen, Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. “Vaccine Coverage Across the Life Course in Michigan During the COVID-19 Pandemic: January-September 2020”]

Suboptimal diets linked to disparities in cancer burden

People’s diets contribute to substantial disparities in the health and economic burdens of cancer, finds a new study published in the November issue of AJPH.

To conduct the study, researchers estimated the number of new U.S. cancer cases and deaths, as well as the economic costs of 15 diet-related cancers attributable to the suboptimal intake of seven dietary factors. Those factors were: low intake of fruits, vegetables, dairy and whole grains and high intake of red and processed meats and sugar-sweetened drinks.

They estimated that suboptimal diet contributes to about 3 million new cancer cases, nearly 1.75 million cancer deaths and $254 billion in economic costs among U.S. adults ages 20 and older over a lifetime. Diet-attributable cancer burdens were higher among younger adults, men, Black people, and people with lower educational attainment and income levels. The biggest disparities were connected to high intake of sugar-sweetened drinks and low consumption of whole grains.

“Optimizing dietary intake could be a cost-effective strategy for cancer prevention,” the study stated.

[Author contact: Fang Fang Zhang, Tufts University Friedman School of Nutrition Science and Policy, Boston, Massachusetts. “Disparities in Health and Economic Burdens of Cancer Attributable to Suboptimal Diet in the United States, 2015-2018”]

Length of workplace leave tied to breastfeeding duration

Women who get more workplace leave after having a baby also report longer periods of breastfeeding, which is considered a key source of nutrition for infants’ optimal growth and development.

In a new study in November’s AJPH, researchers examined the association between workplace leave and breastfeeding using 2016-2018 data from the U.S. Pregnancy Risk Assessment Monitoring System. Among the 12,300 postpartum women who planned to or had already returned to their jobs, about 42% reported taking unpaid leave, 37.5% reported paid leave, about 18% reported both types of leave and about 2% reported no leave.

More than 66% of women reported taking less than three months of leave, which was associated with shorter duration of breastfeeding than women with three or more months of leave. The study noted that in 2018, almost two-thirds of women who had given birth in the last year were in the U.S. workforce.

“Despite efforts to increase support of breastfeeding in the workplace, we found that leave length was associated with breastfeeding outcomes,” the study stated.
[Author contact: Katherine Kortsmit, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. “Workplace Leave and Breastfeeding Duration Among Postpartum Women, 2016-2018”]

Traffic deaths involving mix of cannabis, alcohol on rise

The percentage of traffic fatalities involving cannabis, or both cannabis and alcohol, doubled from 2000 to 2018, finds a new study in the November issue of AJPH.

Using data from the Fatality Analysis Reporting System, researchers found that motor vehicle crash fatalities involving alcohol remained the same. However, the percentage of fatalities involving cannabis or alcohol and cannabis went up from 9% in 2000 to 21.5% in 2018 and from just less than 5% in 2000 to more than 10% in 2018, respectively. Alcohol was consistently involved in about 40% of motor vehicle crash deaths during the study period.

Researchers noted that cannabis use was also a risk factor for alcohol-involved traffic deaths even at levels of alcohol below the legally permissible driving limit. Cannabis involvement was more prevalent in fatalities that involved alcohol than those that did not.

“Future research is needed to understand how cannabis and alcohol relate to cannabis and alcohol policies, both separately and together,” the study stated.

[Author contact: Marlene Lira, Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts. “Trends in Cannabis Involvement and Risk of Alcohol Involvement in Motor Vehicle Crash Fatalities in the United States, 2000-2018”]

Check out the full list of AJPH research papers that published online in our First Look area.

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at ajph.org.

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