In September 2025, President Donald J. Trump directed the Department of Health and Human Services and the Food and Drug Administration to strengthen enforcement of prescription drug advertising regulations. In response, plans were announced to close digital loopholes in direct-to-consumer advertising, pursue regulatory violations, and eliminate the 1997 "adequate provision," which permits advertisements to omit key safety information. Although these reforms aim to promote "radical transparency," their impact on prescribing patterns is uncertain. Direct-to-consumer advertising is designed to elicit a strong positive emotional response that affects one's ability to properly weigh risk. Even if direct-to-consumer advertisements are required to disclose more information regarding potential risks, the emotional response elicited will still positively influence demand. This is not speculation: there is ample evidence before the implementation of the 1997 adequate provision showing that pharmaceutical advertising influenced prescribing behavior. Accordingly, it is unlikely that pending regulatory and enforcement changes will meaningfully reduce overdiagnosis, overtreatment, or health care spending. However, given the current momentum to confront these problems, public health scholars should seize the opportunity and advance evidence-based policy solutions. (Am J Public Health. Published online ahead of print May 21, 2026:e1-e6. https://doi.org/10.2105/AJPH.2026.308469).

Objectives. To evaluate equity in wastewater-based infectious disease surveillance, including equity of inclusion, outbreak detection, and disease forecasting. Methods. We assessed New York State's wastewater surveillance network using census tract-level data to compare social vulnerability and environmental burden across included, sewered but excluded, and unsewered communities during the scale-up of the network (2020-2024) and under changing coverage scenarios. We modeled outbreak detection equity by estimating outbreak sizes required for 95% confidence in the detection of hypothetical pathogens and assessed forecasting equity using county-level COVID-19 hospitalization predictions in relation to population size, coverage, and vulnerability. Results. We found similar vulnerability distributions between included and sewered but excluded communities. The 25% most vulnerable communities required median outbreak sizes 3.45 times larger for detection than did the 25% least vulnerable. At medium sensitivity, more than 80% of individuals living in poverty and minoritized populations lived in areas where outbreaks exceeded 10 infections before detection. Forecasting accuracy was lower in smaller (< 20%) than in larger urban (> 60%) counties and increased with population size and network coverage (P < .001). Conclusions. Wastewater surveillance was equitable in population coverage but not in outbreak detection and forecasting performance. Public Health Implications. Strategies such as upstream sampling, expanded wastewater treatment plant participation in smaller communities, and improved modeling for low-population areas may reduce inequities and enhance the utility of wastewater surveillance. (Am J Public Health. Published online ahead of print May 21, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308472).

Objectives. To describe mortality rates by occupation among working-age men in the United States in 2022 and 2023. Methods. I obtained data on the occupation of decedents from death certificate data published by the National Center for Health Statistics for men aged 20 to 64 years. I calculated mortality rates and rate ratios for occupation groups. Results. Mortality rates were more than double for construction and extraction workers compared with all other workers. Mortality rates and rate ratios for workers in manual, blue-collar occupations were significantly higher than those for workers in other occupations. Conclusions. There were notably higher mortality rates for workers in manual, blue-collar occupations. Occupation groups with higher mortality rates also generally had a larger share of men in their workforce. Public Health Implications. Further research should examine work-related risk factors for occupational disparities in all-cause mortality. The workplace can be a convenient setting for interventions to prevent premature death among working-age men. Including occupation at the time of death in public health data can improve the validity and precision of future studies of the occupational causes of mortality. (Am J Public Health. Published online ahead of print May 14, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308528).

In December 2022, Singapore implemented mandatory Nutri-Grade front-of-pack labels for beverages. Using household scanner data (April 2019-March 2024), we evaluated changes in sugar purchases and product formulation. Households reduced sugar purchases by 3.1 grams per day (-18%), and purchases of unhealthy beverages fell 44%. Reformulation and reassortment lowered sugar content by 1.16 grams per 100 milliliters (-21%) but increased sweetener and lactose use. Higher-income and nutritionally literate households showed larger reductions. Findings support mandatory labeling but highlight equity concerns and supplier substitution risks. (Am J Public Health. Published online ahead of print May 14, 2026:e1-e5. https://doi.org/10.2105/AJPH.2026.308476).

Objectives. To evaluate whether incarceration history is associated with mortality risk among older adults in the United States. Methods. We used data from the 2012/2014-2022 Health and Retirement Study, a nationally representative longitudinal panel of US adults aged 51 years and older. We estimated mortality risk using Gompertz proportional hazards models and calculated average marginal effects to estimate predicted years of life lost. Additional models examined results for men and age groups. We used matched analyses to assess robustness. Results. Incarceration history was associated with an 88% higher hazard of death (hazard ratio = 1.88; 95% confidence interval [CI] = 1.51, 2.35) after adjusting for sex, race/ethnicity, and childhood health and socioeconomic factors. Marginal predictions reveal individuals with previous incarceration were estimated to die 5.8 years earlier on average (95% CI = -8.26, -2.51), with stronger associations observed for men and adults younger than 75 years. Conclusions. Incarceration history is a durable determinant of premature mortality in later life. Public Health Implications. Accounting for incarceration exposure in aging and mortality research is critical for addressing structural drivers of health inequality in the United States. (Am J Public Health. Published online ahead of print May 14, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308449).

Objectives. To examine the magnitude of heat-related emergency medical services (EMS) activations across the United States and identify factors that increase the risk of heat exposure illness. Methods. We extracted heat-related EMS activations from April through September for 2020 through 2024 from the National Emergency Medical Services Information System (NEMSIS) database. We linked information from the 2022 Centers for Disease Control and Prevention (CDC) Social Vulnerability Index with heat-related EMS activations using county of residence. Our analysis focused on heat-related illness by patient demographic, geographic, and EMS system factors. Results. Among the 79 077 804 EMS activations meeting study inclusion criteria, 261 687 (0.3%) were heat related. The rate of heat-related EMS activations was 16.46 per 100 000 population, with higher rates among older adults, males, African Americans, and Native Hawaiians/Pacific Islanders. Rates were higher in rural counties and in counties characterized by the CDC Social Vulnerability Index as having relatively worse socioeconomic or environmental conditions. Heat-related EMS activations were commonly reported in the afternoon and in indoor locations. Conclusions. The NEMSIS database provides novel information that improves our ability to monitor heat-related adverse health outcomes. Public Health Implications. The timely collection and sharing of data provide critical situational awareness to inform public health response efforts during a heat wave. (Am J Public Health. 2026;116(6):798-805. https://doi.org/10.2105/AJPH.2026.308513).

Objectives. To examine trends in meningococcal B (MenB) vaccination coverage among US adolescents aged 16 and 17 years. Methods. We conducted cross-sectional and longitudinal analyses of 2018 to 2023 National Immunization Survey-Teen data to calculate the annual percentage of eligible adolescents who received the MenB vaccine and to assess changes over time. Results. Only 19.8% of the 41 505 eligible adolescents initiated MenB vaccination between 2018 and 2023. A total of 24.5% (95% confidence interval [CI] = 22.5, 26.6) of adolescents received 1 or more MenB vaccinations in 2023, as compared with 13.2% (95% CI = 11.7, 14.6) in 2018. Among initiators, most received only 1 dose. Conclusions. MenB vaccination coverage among 16- and 17-year-old adolescents increased modestly between 2018 and 2023. As of 2023, approximately 3 out of 4 adolescents in this age group had not received the MenB vaccine. Public Health Implications. As of 2023, less than one quarter of 16- and 17-year-old adolescents had initiated MenB vaccination. Given that MenB has accounted for most meningococcal disease among adolescents and young adults since 2013, efforts to improve uptake are warranted. (Am J Public Health. 2026;116(6):851-854. https://doi.org/10.2105/AJPH.2026.308459).