Objectives. To quantify the prevalence of and trends in tobacco and alcohol use and key social inequities among US adults across 3 nationally representative health surveys over time. Methods. We analyzed repeated cross-sectional data among US adults in 3 nationally representative surveys (2011-2024). We estimated annual prevalence of, absolute change over time, and temporal trends in current cigarette, electronic nicotine delivery systems (ENDS), and past-30-day binge alcohol use, and frequency of alcohol use, by year-overall and by subgroup (i.e., age, sex, race/ethnicity, education, income)-incorporating survey weights. Results. Cigarette smoking prevalence decreased and ENDS use prevalence increased across the study period in all surveys. Alcohol use showed more heterogeneous patterns across surveys and over time. In subgroup analyses, inequities in tobacco and alcohol use exhibited dynamic patterns over time. Conclusions. Further research is needed to understand mechanisms underlying these trends, as well as policy and clinical interventions to promote equitable delivery of evidence-based treatment. Differences by survey highlight the benefits of corroborating findings across data sets. (Am J Public Health. Published online ahead of print August 6, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308612).

Objectives. To determine whether oral nicotine pouches (ONPs) are used by young people to initiate nicotine use. Methods. Incidence rate ratios (IRRs) for nicotine initiation using ONPs or other products were calculated among nicotine-naïve respondents (aged 15-30 years) using 5 waves (2021-2024) of a national, probability-based cohort survey (n = 6411) in the United States. Other past 30-day product use and primary reason for using ONPs were assessed. Results. Of 2539 nicotine-naïve respondents at wave 3 (W3), 320 (12.6%) initiated any nicotine use by wave 5 (W5). Of these, 7% initiated nicotine using ONPs and 6% used ONPs and another product. Nicotine initiation with ONPs was higher for W3-W5 respondents (2022-2024) compared with W1-W3 respondents (2021-2023; IRR = 2.10; P = .007). Among all respondents who started using ONPs in W3 through W5 (n = 790), 63.2% currently used another tobacco product at W3, W4, or W5 (e-cigarettes, 53.9%; cigarettes, 24.7%; cigars, 11.8%). Self-reported reasons for ONP use included physiological effects, harm reduction, and peer use. Conclusions. Initiation of nicotine use with ONPs was relatively low, but poly use of ONPs with other products is common. Strengthened regulation of the nicotine product market is needed. (Am J Public Health. Published online ahead of print August 6, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308601).

Democratic responsiveness can promote healthier populations. Expanding the electorate by increasing political participation in new and underrepresented voters is one way to bolster both democratic responsiveness and, in the process, public health and population health. In this analytic essay, we argue that health care-based get-out-the-vote efforts can reach new and underrepresented voters. We conducted an observational analysis utilizing 2022 data from Vot-ER, a health care worker-led voter registration organization in the United States, and from the Cooperative Election Study, a nationally representative survey of US adults. Compared with candidate and party campaigns, Vot-ER reached higher rates of unregistered voters, individuals younger than 35 years, and women, as well as Asian, Black, and Hispanic individuals. These findings suggest that health care-based voter registration initiatives can engage populations historically passed over by candidate and party campaigns. Health care worker-led voter mobilization provides a creative and pragmatic avenue for broadening democratic participation, even during midterm elections that historically have lower participation rates. Furthermore, expanding the electorate can help promote responsiveness to these more marginalized voters, cultivating an environment suited for better public and population health outcomes. (Am J Public Health. Published online ahead of print August 6, 2026:e1-e7. https://doi.org/10.2105/AJPH.2026.308599).

Public health practice has traditionally addressed discrete problems with targeted interventions: surveillance, risk mitigation, program implementation, and evaluation. This approach has yielded enormous gains, yet it is increasingly inadequate in the face of complex, interdependent crises such as climate change. The climate crisis exposes the limitations of siloed, problem-specific solutions and requires a more fundamental reconceptualization of public health approaches, one that treats health as an emergent property of social, economic, and environmental systems. In this perspective, we argue that climate change is not merely another public health threat, but a paradigmatic challenge that requires upstream, structural interventions capable of addressing multiple health outcomes simultaneously. Drawing on examples from the fields of mental health, political economy, and environmental justice, we contend that public health policy must reorient toward root cause solutions that prioritize people over profit and reassert collective responsibility for managing shared risks. (Am J Public Health. Published online ahead of print August 6, 2026:e1-e6. https://doi.org/10.2105/AJPH.2026.308615).

Objectives. To examine individual-, school-, and neighborhood-level factors associated with COVID-19 primary and booster vaccination among New York City public school students. Methods. We analyzed data from a population-based cohort study of 917 062 students aged 5 to 18 years enrolled in 2021/2022. Enrollment data were linked to the Citywide Immunization Registry, Medicaid claims, and neighborhood indicators (January 2020-July 2023). We assessed multivariable regression associations between vaccination status and demographic, clinical, school, and contextual characteristics. Results. Overall, 51.3% of all students completed the primary series and 10.8% received a booster. Uptake was highest among non-Hispanic Asian students (72.1%; 95% confidence interval [CI] = 71.9, 72.3) and lowest among non-Hispanic Black (42.2%; 95% CI = 42.0, 42.4) and non-Hispanic White students outside Manhattan (39.7%; 95% CI = 39.5, 40.0). Students with preexisting conditions were modestly more likely to have received vaccination than peers (54.9%; 95% CI = 54.8, 55.1 vs 49.8%; 95% CI = 49.7, 49.9). Uptake increased with older age and proximity to vaccination sites but was lower among Medicaid-enrolled students. Conclusions. Coverage in the largest US school district was lower than national pediatric estimates, with only modestly higher coverage among children at elevated medical risk, despite their prioritization in vaccination efforts. Public Health Implications. Children at elevated medical risk remained undervaccinated. Addressing barriers in insurance, neighborhood, and care delivery systems is critical to improving vaccine uptake. (Am J Public Health. Published online ahead of print August 6, 2026:e1-e11. https://doi.org/10.2105/AJPH.2026.308604).

Participant-based studies face fragmented workflows. We describe implementation of the Aims Innovations Research Management System, a cloud-based unified platform that supports the operations pipeline and includes participant-facing AI agents for outreach, screening, consent, and follow-up. Controls include private AI endpoints with no-training assurances, study isolation, human handoff thresholds, HIPAA (Health Insurance Portability and Accountability Act) safeguards, and tamper-evident audit logging. As of June 2026, 10 academic institutions completed governance reviews and initiated studies across diverse research designs. An initial pilot suggests there are efficiency gains, which warrants multisite evaluation. (Am J Public Health. Published online ahead of print August 6, 2026:e1-e6. https://doi.org/10.2105/AJPH.2026.308603).

Suicide deaths in the United States have increased for a generation with no current evidence of meaningful decline. With advances in data collection and accumulation, suicide prevention research has started utilizing artificial intelligence (AI) tools, predominantly machine learning, predictive analytics, and language models, to help mainly in prediction of suicide by utilizing large electronic health record data sets. The National Violent Death Reporting System (NVDRS) compiles significant amounts of structured and unstructured data about suicide decedents, including narrative information about the death (i.e., death narrative) that summarizes details such as the scene, decedent characteristics, and witness and next-of-kin details from interviews. Over the last 20 years, the NVDRS has accumulated hundreds of thousands of suicide death narratives-more than any human can (or would care to) read because of their grim, and sometimes graphic, nature. This analytic essay briefly reviews how AI tools have been applied to suicide prevention research. It also summarizes an example of how AI tools (e.g., language models) can expedite analysis using 756 645 narratives from 483 303 suicide deaths contained in the 2003-2023 NVDRS. (Am J Public Health. Published online ahead of print August 6, 2026:e1-e7. https://doi.org/10.2105/AJPH.2026.308618).

Objectives. To examine overdose mortality by nativity and national origin among Hispanic and Black adults. Methods. We analyzed population-based overdose mortality data from the Florida Department of Health (2021-2024). Hispanic decedents were disaggregated by national origin and nativity; non-Hispanic Black decedents were classified as US-born or Caribbean-born. Age-adjusted mortality rates were calculated by sex. Negative binomial regression models adjusted for age, sex, and education estimated mortality rate ratios (MRRs). Results. Among men, overdose mortality was highest among non-Hispanic Whites (59.5 per 100 000), followed by non-Hispanic Blacks (30.8) and Hispanics (20.5). Within Hispanics, Puerto Rican-born adults (39.6) and US-born Hispanics (33.6) had the highest mortality, whereas foreign-born Hispanic subgroups had lower mortality. Overdose mortality among US-born Blacks exceeded that among Caribbean-born Blacks (40.8 vs 6.3). In adjusted models, mortality was elevated among US-born Hispanics (MRR = 3.8; 95% confidence interval [CI] = 3.0, 4.8) and Puerto Rican-born adults (MRR = 3.8; 95% CI = 2.9, 4.9) relative to South American-born adults, and among US-born Blacks compared with Caribbean-born Blacks (MRR = 6.4; 95% CI = 4.7, 8.6). Lower educational attainment was associated with higher overdose mortality. Conclusions. Overdose mortality in Florida is patterned by nativity and education, with national-origin disaggregation identifying high-risk US-born populations obscured in aggregate analyses. (Am J Public Health. Published online ahead of print July 30, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308586).

One of the Trump administration's first executive orders, issued on January 20, 2025, was framed as an effort to defend women from "gender ideology extremism." It defines sex as binary and attempts to erase gender as a scientific topic of inquiry. In this essay, we argue that these efforts are unscientific and unrealistic. In contrast to the White House's contention that sex is strictly binary, this essay points out that human gonadal development is more complicated and multifaceted, and that gender shapes exposure to health risks, access to care, interactions with health workers, resource allocation, and service availability within health systems, ultimately affecting health outcomes. The denial of gender as a scientific concept undermines decades of work toward evidence-based standards such as the Sex and Gender Equity in Research (SAGER) guidelines, which aim to strengthen scientific rigor by systematically integrating sex and gender analyses. More importantly, such measures are detrimental to the health of all populations, as neglecting sex and gender dynamics compromises evidence, skews public health responses, and deepens inequities. (Am J Public Health. Published online ahead of print July 30, 2026:e1-e6. https://doi.org/10.2105/AJPH.2026.308574).

Objectives. To assess differences in social determinants of health identified through International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision (ICD-10-CM) codes between lesbian, gay, bisexual, and other nonheterosexual ("sexual minority") veterans and heterosexual veterans who utilize primary care services in the US Veterans Health Administration. Methods. We used the Veterans Health Administration Survey of Healthcare Experiences of Patients, weighted descriptive statistics, and multivariable logistic regression to examine differences in sociodemographic characteristics and social determinants of health-related ICD-9-CM and ICD-10-CM code domains by sexual orientation (sexual minority vs heterosexual). Results. Of the 455 165 veterans surveyed, roughly 3% (n = 14 065) identified as sexual minority. Compared with heterosexual veterans, sexual minority veterans were often younger and more likely to be racially/ethnically diverse, live in urban areas, and identify as female. All sexual minority groups had a greater risk of issues related to housing, economic circumstances, and other psychosocial circumstances than heterosexual veterans. Conclusions. Sexual minority veterans had increased vulnerabilities across various social determinants of health ICD-9-CM and ICD-10-CM code domains associated with health and well-being. Future research should continue to explore this relationship and develop evidence-based interventions to support sexual minority veterans effectively. (Am J Public Health. Published online ahead of print July 30, 2026:e1-e11. https://doi.org/10.2105/AJPH.2026.308563).

Objectives. To examine changes in travel time to later abortion services after the 2022 Dobbs v Jackson Women's Health Organization decision. Methods. Using data on facilities providing procedural abortions at 14 or more and 24 or more weeks' gestation, we compared county-level driving times to the nearest facility across the contiguous United States in 2021 and 2024. We used population-weighted regression to evaluate changes nationally and by US Census region. Results. Between 2021 and 2024, national median driving times to facilities offering abortion care at 14 weeks or more increased from 25 to 45 minutes (P < .01), with substantial regional disparities ranging from decreases in the Northeast (-2 minutes) to large increases in the South (4 hours, 15 minutes). In the case of abortions at 24 weeks or more, national median travel times rose slightly (from 3 hours, 7 minutes in 2021 to 3 hours, 15 minutes in 2024; P = .09), with changes ranging from decreases in the Midwest (-1 hour, 1 minute) to increases in the South (1 hour, 55 minutes). Conclusions. The Dobbs decision led to increases in travel times for later abortion care at or after 14 weeks, especially in regions with abortion bans, exacerbating existing barriers and inequalities. (Am J Public Health. Published online ahead of print July 30, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308595).

The United States is struggling with the intersecting crises of substance use disorder (SUD), mental illness, and homelessness. In 2023, California expanded involuntary treatments to address these issues, including adding SUD as a qualifying diagnosis. We present experience with California's revised law and review challenges affecting its implementation. Involuntary treatment of SUD lacks high-quality evidence and remains controversial. Although the revised law expands the criteria for involuntary treatment, its impact has been limited by bottlenecks in an overburdened system. To maximize the benefit of this law while minimizing attendant harms, we recommend using the least restrictive means possible, avoiding divestment from voluntary treatments, employing evidence-based interventions, improving transitions to community-based care, understanding bottlenecks for involuntary treatment, and promoting collaboration across specialties. (Am J Public Health. Published online ahead of print July 30, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308584).