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August 2021 highlights from the American Journal of Public Health

Date: Jul 01 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 August issue highlights:

  • COVID-19 pandemic disrupted access to abortion services
  • Excess deaths from cardiovascular disease paralleled COVID-19 deaths
  • Primary care settings could significantly boost HIV testing
  • Professionals misuse bedbug pesticides less than nonprofessionals, but gaps remain

COVID-19 pandemic disrupted access to abortion services

The COVID-19 pandemic resulted in the delay of all kinds of time-sensitive health care, including abortion, according to a new study published in August in AJPH.

Researchers focused on Louisiana, analyzing data from abortion clinics in the state, as well as neighboring states, between January 2018 and May 2020. They found the number of abortions per month among Louisiana residents and in Louisiana clinics declined 31% after COVID-19 arrived, while the odds of having a second-trimester abortion went up. The decline in abortions in Louisiana was not offset by an increase in out-of-state abortions.

Researchers noted that examining pandemic-related disruptions to abortion access is especially relevant, pointing to a January U.S. Supreme Court ruling reinstating a Trump administration prohibition on receiving medication abortion pills via mail. In April, the U.S. Food and Drug Administration lifted the prohibition, but only temporarily.

“There are health implications of the decreased number of abortions associated with pandemic onset,” the study stated. “People unable to obtain clinic-based abortions postpone seeking abortion; attempt to self-manage their abortions, which may put them at legal risk; or continue their pregnancies, which increases risks of adverse health outcomes.”

[Author contact: Sarah C. M. Roberts, Advancing New Standards in Reproductive Health, University of California-San Francisco, San Francisco, California. “Disruptions to Abortion Care in Louisiana During Early Months of the COVID-19 Pandemic”]

Excess deaths from cardiovascular disease paralleled COVID-19 deaths

Excess deaths from conditions such as cardiovascular disease and diabetes began to inch up early in the COVID-19 pandemic, finds a new study in August’s AJPH.

Researchers used weekly mortality data for 2020 from the National Center for Health Statistics at both the national level and within four states. They found that the trajectory of number of excess deaths due to cardiovascular disease was highly parallel to the trajectory of excess deaths from COVID-19. At the same time, excess deaths from diabetes, influenza and other respiratory diseases, and malignant neoplasms stayed relatively stable over the study period.

Early in the U.S. outbreak, the study did find that excess deaths due to cardiovascular disease, the flu and other respiratory diseases went up. Excess deaths from diabetes also increased early on in the pandemic, but then stabilized. Among the four states studied, the trajectory of excess deaths due to cardiovascular disease was highly aligned with excess deaths from COVID-19, especially in California and Florida.

“The parallel trajectory of excess mortality from (cardiovascular disease) and COVID-19 over time reflects the fact that essential health services for noncommunicable diseases were reduced or disrupted during the COVID-19 pandemic, and the severer the pandemic, the heavier the impact,” researchers wrote.

[Author contact: Dongshan Zhu, Centre for Health Management and Policy Research, Shandong University Cheeloo College of Medicine, Jinan, China. “Disease-Specific Excess Mortality During the COVID-19 Pandemic: An Analysis of Weekly US Death Data for 2020”]

Primary care settings could significantly boost HIV testing

Fully integrating HIV testing into primary care would greatly increase the number of U.S. adults who get screened for the disease, according to new findings in the August issue of AJPH.

To conduct the study, researchers used data from the 2019 Behavioral Risk Factor Surveillance System to determine prevalence of adults ever tested for HIV and prevalence of missed opportunities to test adults who had never been screened for HIV. They found that in 2019, nearly 50% of U.S adults had ever been tested for HIV, while more than 34% had a missed opportunity, meaning they had had a routine checkup in the last year but had never had a HIV test.

Increases in the prevalence of having ever been screened for HIV was highest among people ages 35 to 54, Black people, women, people with health insurance, and people reporting HIV risk behaviors. Researchers estimated that a 50% increase in HIV testing at routine checkups would increase the prevalence of ever getting an HIV test to 84%.

According to the Centers for Disease Control and Prevention, an estimated 1.2 million people in the U.S. had HIV as of 2018, with about one in seven unaware of their HIV status.

“Continued efforts to promote HIV testing, including implementing routine screening in clinical settings, will help ensure that all U.S. adults know their HIV status,” the study stated.

[Author contact: Deesha Patel, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. “Estimating Gains in HIV Testing by Expanding HIV Screening at Routine Checkups”]

Professionals misuse bedbug pesticides less than nonprofessionals, but gaps remain

Both professionals and nonprofessionals misuse bedbug pesticides, which can lead to harmful exposures for people, according to a new study in August’s AJPH.

Using 2013-2017 data from the U.S. National Pesticide Information Center, researchers set out to compare outcomes between professional, licensed pesticide applicators and nonprofessionals. They found that misapplications were more than twice as likely to be reported in cases involving nonprofessional pesticide application, compared to professionals. Human exposures to pesticides were reported much more often when pesticides were misapplied than when there was no apparent misapplication.

Researchers also found that about one-third of professional applications included in the study were characterized as “incidents,” which means they involved an unintended exposure, a spill or a misapplication of pesticide.

Harmful exposure to pesticides can lead to a number of adverse health effects, including vomiting, nausea, headache, weakness and dizziness. Surveys of pest control professionals find that prevalence of bedbugs is increasing.

“Federally required certification and licensing for pesticide applicators is intended to prevent product misuse and unintended human exposures,” the study stated. “Our data suggest that regulatory licensing programs are successfully lowering risk, but there is room for improvement.”

[Author contact: Amy Cross, National Pesticide Information Center, Oregon State University, Corvallis, Oregon. “Pesticides Misused for Bed Bug Control: Comparing Professional and Nonprofessional Applications Reported to the National Pesticide Information Center, 2013-2017”]

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.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to APHA Media Relations. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single-issue access is $30, and online single-article access is $22 at AJPH.org. For direct customer service, call 202-777-2516, or email us.

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