Objectives. To examine the distribution of high utilizers of pediatric health care across New York State (NYS). Methods. We performed a cross-sectional study using the 2022 NYS inpatient and emergency department data sets for children younger than 18 years. We used a principal component analysis- derived composite adverse utilization index to identify high utilizers (top 5% of the distribution). We used negative binomial models to identify county-level deviation among high utilizer rates. Results. Among 663 006 children, high utilizers accounted for 34.5% of hospital days, 57.3% of admissions, 62.5% of costs, and 5.0% of emergency department visits. High utilizers were more likely to have medical complexity and ambulatory care-sensitive conditions. Bronx and St. Lawrence counties had significantly higher-than-expected rates of high utilizers after adjustment. Conclusions. Pediatric health care burden in NYS is concentrated among a subset of children within identifiable counties. A utilization index offers a pragmatic, reproducible way to target care coordination and community prevention resources, thus informing precision social medicine strategies where need and impact are greatest. (Am J Public Health. Published online ahead of print July 9, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308486).

Objectives. To examine how statewide e-cigarette flavor bans (flavor bans) are associated with changes in e-cigarette use among US adults before and after implementation of flavor bans. Methods. This quasi-experimental study used data from 251 677 US adults across 2 waves-2018-2019 (preban) and 2022-2023 (postban)-from the Tobacco Use Supplement to the Current Population Survey. Weighted multilevel logistic regression models with an interaction between state ban status and time assessed associations between flavor bans and current e-cigarette use. Secondary analyses further examined the associations of flavor type and age group with e-cigarette use. Results. Prevalence of current e-cigarette use among adults increased from 2.3% (2018-2019) to 3.0% (2022-2023). The implementation of flavor bans was associated with a smaller relative increase in e-cigarette use compared with states without a ban (adjusted odds ratio for interaction = 0.86; 95% confidence interval = 0.74, 0.98). Age-group analyses indicated significant lower likelihood in e-cigarette use among adults aged 25 to 44 years after the ban. Conclusions. Flavor bans may help slow increases in adult e-cigarette use, with the potential for differential effects across age groups. (Am J Public Health. Published online ahead of print July 9, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308645).

Public health depends on trust with the communities it seeks to serve, and yet this trust has historically been difficult to establish within conservative-leaning communities and individuals. Much of the current mistrust of public health professionals is a partisan phenomenon, one that may reflect the progressive slant of programming and policy development within modern public health. In response, we discuss why it would be beneficial to include more conservatives within the profession of public health. We further discuss 6 conservative values-the importance of religious communities and moral narratives, the rich varieties of community expression, the role of the family and other social orders in promoting health, an emphasis on local decision-making, an appreciation for procedural justice, and a cautious approach to large-scale social change-that could help enrich public health theory, research, and practice. We propose several practical strategies for expanding the representation of conservatives within the profession, including surveys of political affiliation, institutions of civil discourse, and intentional recruitment. Public health's mission of serving all people demands a pluralistic, trust-centered approach that explicitly welcomes conservative voices, communities, and ideas. (Am J Public Health. Published online ahead of print July 9, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308532).

Objectives. To gain a more comprehensive understanding of the morbidity associated with pedestrian risk in Chicago, Illinois, by probabilistically matching the data of injured pedestrians in standardized police traffic crash reports to their associated emergency department (ED) visit record. Methods. Between 2018 and 2022, we extracted information on pedestrians injured by vehicles as recorded by the Chicago Police Department pedestrians seen at a city ED for injuries sustained by a vehicle. Among matched records, we used descriptive statistics to describe temporal, geographic, and demographic patterns in ED-attended pedestrian injury. We used multivariable regression modeling to calculate incidence rates of ED-attended pedestrian injury across Chicago communities of varying economic hardship. Results. Among 2631 ED patients matched to a police department crash record, 73.9% were initially recorded by police with nonincapacitating injuries or less at the crash scene. Five of the 6 communities with the highest combination of crash frequency and injury severity were among the 40% most economically disadvantaged communities. Conclusions. Incorporation of ED data highlighted pedestrian injuries that would have been missed with police crash data alone, which disproportionately affects economically vulnerable neighborhoods. Public Health Implications. Regular incorporation of pedestrian-injury data from local EDs could help jurisdictions better understand broader public health implications and disparities in pedestrian risk and identify additional opportunities for intervention. (Am J Public Health. Published online ahead of print July 9, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308516).

Objectives. To estimate the number of US transgender women living with HIV and compare determinants of health between US transgender women and presumed cisgender men. Methods. We analyzed cross-sectional interview and medical record data (2015-2022) from the Medical Monitoring Project, a nationally representative sample of people living with HIV in the United States. Results. Weighted estimates suggest that 21 088 US transgender women are living with HIV. Across nearly every domain, transgender women reported greater barriers to care than did presumed cisgender men, including higher rates of hunger or food insecurity (34% vs 18%), unstable housing or homelessness (33% vs 18%), and lower rates of viral suppression (66% vs 74%). Conclusions. Transgender women living with HIV face greater and distinct barriers to wellness and care engagement across multiple domains than their cisgender male counterparts. Public Health Implications. Transgender identity is a critical factor in HIV-related health equity. Future research is urgently needed to understand how to support transgender women living with HIV in accessing the services they need to live healthy lives. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308497).

This analysis assesses the domestic health security, economic, and governance implications of prospective US withdrawal or sustained retrenchment from the World Health Organization (WHO) and identifies policy-relevant options for continued engagement. WHO provides irreplaceable global public goods, including international surveillance networks and emergency convening. Evidence indicates that episodic or unpredictable funding of WHO is associated with coordination failures, delayed threat detection, supply chain disruptions, and higher emergency response costs. Reduced US participation may increase import risks, reduce visibility into emerging threats, and diminish leverage over governance reforms. Sustained US participation in core WHO functions strengthens domestic health security and represents a fiscally prudent risk management strategy. US policy should prioritize multiyear funding for core WHO capacities globally. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e7. https://doi.org/10.2105/AJPH.2026.308463).

Objectives. To evaluate the risks of mortality, cardiovascular events, and pulmonary complications among cancer patients who quit, continued smoking, or switched to e-cigarettes after diagnosis. Methods. Using the Korean National Health Insurance Service database (2015-2022), we identified 46 834 cancer patients who were smoking at diagnosis. Patients were categorized as continued smokers (n = 17 418), quitters (n = 25 909), or e-cigarette users (n = 3507) after diagnosis. We used multivariable Cox proportional hazards models to assess associations. Results. During a median 4.2 years of follow-up, all-cause mortality was significantly lower in quitters (hazard ratio [HR] = 0.92; 95% confidence interval [CI] = 0.86, 0.98) and e-cigarette users (HR = 0.84; 95% CI = 0.72, 0.99) than continued smokers. Both groups also showed lower cardiovascular event risks (HR = 0.64; 95% CI = 0.57, 0.72 and HR = 0.72; 95% CI = 0.53, 0.97, respectively). Compared with quitters, e-cigarette users had increased pulmonary complication risk (HR = 1.26; 95% CI = 1.00, 1.58). Conclusions. E-cigarette use was associated with lower mortality and cardiovascular risks than continued smoking, though complete cessation conferred greater benefits. Elevated pulmonary complications in e-cigarette users warrant caution. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e12. https://doi.org/10.2105/AJPH.2026.308512).

Objectives. To examine trends in sexual behaviors, condom use, and pregnancy prevention methods among female adolescents. Methods. We analyzed national and state Youth Risk Behavior Surveillance System data (2007-2023) among US female high school students (≥ 14 years). Outcomes included current sexual activity, condom use, and use of pregnancy prevention methods. We estimated weighted prevalence and trends overall and by region, age, and race/ethnicity and examined adolescent birthrates using Centers for Disease Control and Prevention data. Results. The proportion of respondents who were currently sexually active declined (2007-2011: 35.1%; 2019-2023: 23.8%; P < .01). Among those sexually active, nonuse of condoms increased (45.8% to 52.4%; P < .01), whereas nonuse of moderately or highly effective pregnancy prevention decreased (73.0% to 63.0%; P < .01), reflecting increased uptake of effective methods. The proportion using no pregnancy prevention method remained stable. Declines in sexual activity reduced population-level sexual risk indicators. Racial/ethnic disparities persisted. Birthrates declined substantially. Conclusions. Declines in adolescent birthrates are driven largely by reduced sexual activity, whereas condom use has declined and disparities in contraceptive use persist, indicating uneven improvements in sexual health behaviors. Public Health Implications. Efforts should strengthen comprehensive sexual health education and access to effective contraception and condoms, with targeted strategies for younger adolescents, the South, and non-Hispanic Black and Hispanic populations. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308511).

Objectives. To evaluate site-specific testing and isolation procedures for preventing on-site SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infections among unaccompanied migrant children in federal congregate care settings. Methods. From August 2021 to May 2023, the Increasing Community Access to Testing, Treatment, and Response (ICATT) program administered 385 234 rapid antigen and nucleic acid amplification tests to 68 674 children at 2 emergency intake sites in Texas. We used logistic regression, the χ[2] test, and Kaplan-Meier survival analysis to estimate the number of infections acquired on-site and the number of cases prevented via implementation of ICATT comprehensive testing and isolation protocols. Results. ICATT protocols identified 83% of cases at intake, and our analyses projected that 92% of cases were isolated before on-site transmission could occur. Testing and isolation measures prevented an estimated 1335 to 2377 on-site infections, reducing caseloads by 15% to 23% and transmission by 68% to 79%. Conclusions. Site-specific, algorithmic testing and isolation protocols substantially reduced SARS-CoV-2 transmission among children in federal congregate care settings. Public Health Implications. Enhanced testing and isolation strategies should be considered to mitigate within-facility transmission among temporary residents in congregate care settings. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308488).

Objectives. To use syndemic theory and system dynamics to describe how systemic racism shapes interrelationships among interpersonal violence, alcohol and substance misuse, and reproductive health among American Indian and Alaska Native communities. Methods. We conducted a community-based system dynamics study in a Great Plains metropolitan area. Using purposive and key informant sampling, we interviewed 110 participants (2018-2024) to develop causal loop diagrams. We aggregated 19 diagrams into a synthesized model, refined it through 5 additional group sessions (n = 28), and applied rigorously interpreted quotation analysis. Results. The final causal loop diagrams included 65 variables across 8 domains spanning health care, justice, child welfare, and social determinants. Collective trauma and discriminatory experiences emerged as central drivers. Reinforcing feedback loops linked systemic racism to increased trauma, substance misuse, interpersonal violence, and involvement with punitive systems. Balancing loops highlighted the potential of culturally sensitive services but were often offset by mistrust and barriers to care. Conclusions. Systemic racism operates through interconnected feedback loops that sustain co-occurring health inequities among American Indian and Alaska Native populations. Public Health Implications. Addressing inequities requires coordinated, culturally grounded, community-led strategies that target structural drivers and improve trust in systems. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308506).