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American Journal of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse.

Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. Additionally, the journal publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community. 


Matthew L. Boulton, MD, MPH

Dr. Boulton is Professor of Epidemiology, Health Management & Policy, and Preventive Medicine in the University of Michigan School of Public Health and Professor of Internal Medicine, Infectious Diseases Division, in the University Medical School. He completed his MD at the University of Nevada, his clinical and preventive medicine residency training at the University of Michigan, and his MPH in epidemiology and international health at the University of Michigan School of Public Health. He also currently serves as the Associate Dean for Global Public Health and was Director of the university’s preventive medicine residency for 13 years. Prior to his faculty appointment at the University of Michigan, he was the governor’s Chief Medical Executive and the State Epidemiologist for the Michigan Department of Health which was preceded by several years’ work in local health departments as a Medical Director. Dr. Boulton has received research and training funding from NIH, CDC, HRSA, APTR, RWJF, Kresge Foundation, Trehan Foundation, and the Public Health Foundation. He an active research and has published on infectious disease epidemiology and control, vaccine preventable diseases and immunization coverage, global health especially in China and India, and the public health workforce. 

Current Articles 

Adolescent Health Lifestyles and Educational Risk: Findings From the Monitoring the Future Study, 2010–2016Open in a New Window

Research has linked educational risk to various risky health behaviors (e.g., drug use, violence, risky sexual behaviors). This study builds upon this research by examining the link between additional health lifestyle indicators—nutritional risk factors, low sleep quantity, and low exercise frequency—and academic risk factors among a recent, nationally representative sample of adolescents.


U.S. Adults’ Attitudes Toward Lowering Nicotine Levels in CigarettesOpen in a New Window

This study assessed U.S. adults’ attitudes toward lowering the nicotine levels in cigarettes to make them less addictive.


Frequent Nutritional Feedback, Personalized Advice, and Behavioral Changes: Findings from the European Food4Me Internet-Based RCTOpen in a New Window

This study tested the hypothesis that providing personalized nutritional advice and feedback more frequently would promote larger, more appropriate, and sustained changes in dietary behavior as well as greater reduction in adiposity.


Client and Provider Discomfort With an Adverse Childhood Experiences SurveyOpen in a New Window

Many service providers report concerns that questions about adverse events may upset clients. Studies indicate that most survey respondents answer sensitive questions without experiencing distress, although little is known about the prevalence or correlates of clients’ discomfort when they are asked similar questions by direct care providers, such as home visitors.


The Baltimore Community-Based Organizations Neighborhood Network: Enhancing Capacity Together (CONNECT) Cluster RCTOpen in a New Window

This cluster RCT aimed to reduce healthcare utilization and increase the referral of patients between an academic health center and local community-based organizations (CBOs) that address social determinants of health.


Insurance Reimbursements for Routinely Recommended Adult Vaccines in the Private SectorOpen in a New Window

Financial concerns are frequently cited by providers as a barrier to adult vaccination. This study assessed insurance reimbursements to providers for administering vaccines to adults in the private sector.


Family Physical Activity Planning and Child Physical Activity Outcomes: A Randomized TrialOpen in a New Window

Regular moderate-to-vigorous physical activity and high physical fitness are extremely important to the health of children and track to positive health profiles in adulthood. Family-based interventions to improve moderate-to-vigorous physical activity are essential given that children live within a structure of parental influence. The purpose of this study was to examine the effect of a parent planning skills intervention to support child physical activity on the subsequent moderate-to-vigorous physical activity (primary outcome) and fitness of their children across 26 weeks (primary endpoint).


Lung Cancer Screening Utilization: A Behavioral Risk Factor Surveillance System AnalysisOpen in a New Window

Lung cancer is the leading cause of cancer-related death in the U.S. The National Lung Screening Trial found that low-dose computed tomography reduced lung cancer mortality in high-risk individuals. As a result, the U.S. Preventive Services Task Force began recommending low-dose computed tomography screening for those at a high risk in 2013. Therefore, it is imperative to continually monitor lung cancer screening uptake. The objective of this study was to determine computed tomography screening uptake across ten states using 2017 Behavioral Risk Factor Surveillance System survey data.


Causes of Excess Mortality in Veterans Treated for Posttraumatic Stress DisorderOpen in a New Window

Published research indicates that posttraumatic stress disorder (PTSD) is associated with increased mortality. However, causes of death among treatment-seeking patients with PTSD remain poorly characterized. The study objective was to describe causes of death among Veterans with PTSD to inform preventive interventions for this treatment population.


Misinformation as a Misunderstood Challenge to Public HealthOpen in a New Window

The concept of misinformation as a problem appears prominently in recent academic literature and public discourse, as researchers have raised concerns about the spread of inaccurate information online, decision making based on problematic information, and even the acceptance of medical conspiracy theories.1–4 Misinformation is false or inaccurate information regardless of intentional authorship, and yet much discussion about misinformation has focused on malicious acts to infect social media platforms with false information.


City-Specific Air Quality Warnings for Improved Asthma Self-ManagementOpen in a New Window

This study presents a framework for identifying “high-risk” days for asthma attacks associated with elevated concentrations of criteria pollutants using local information to warn citizens on days when the concentrations differ from Environmental Protection Agency Air Quality Index (AQI) warnings. Studies that consider the unique mixture of pollutants and the health data specific to a city provide additional information for asthma self-management. This framework is applied to air pollution and asthma data to identify supplemental warning days in Houston, Texas.


Alcohol Policies and Alcohol Involvement in Intimate Partner Homicide in the U.S.Open in a New Window

Intimate partner violence (IPV) results in deaths of both primary and corollary (i.e., nonintimate partner) victims. Alcohol use is a known risk factor for IPV, yet the relationship between alcohol policies and IPV homicides is unclear. This repeated cross-sectional study characterizes alcohol involvement, and the relationship between alcohol policies and alcohol involvement, among victims of IPV homicides in the U.S.


Geographic, Temporal, and Sociodemographic Differences in Opioid PoisoningOpen in a New Window

Not enough is known about the epidemiology of opioid poisoning to tailor interventions to help address the growing opioid crisis in the U.S. The objective of this study is to expand the current understanding of opioid poisoning through the use of data analytics to evaluate geographic, temporal, and sociodemographic differences of opioid poisoning– related hospital visits in a region of New York State with high opioid poisoning rates.


Binge Drinking and Prescription Opioid Misuse in the U.S., 2012–2014Open in a New Window

Prescription opioids were responsible for approximately 17,000 deaths in the U.S. in 2016. One in five prescription opioid deaths also involve alcohol. Drinkers who misuse prescription opioids (i.e., use without a prescription or use only for the experience or feeling it causes) are at a heightened risk of overdose. However, little is known about the relationship between drinking patterns and prescription opioid misuse.


Desirability of Personalized Guns Among Current Gun OwnersOpen in a New Window

Personalized guns are touted as a technology that could substantially reduce firearm-related deaths. However, limited research has examined the desirability of personalized guns among current gun owners or the factors influencing the likelihood of purchase if personalized guns were available.


Preventive Medicine Physicians and the Centers for Disease Control and Prevention's 6|18 InitiativeOpen in a New Window

The American College of Preventive Medicine (ACPM) collaborated with the Centers for Disease Control and Prevention (CDC) in a cooperative 5-year agreement to improve population health through primary care and public health integration. As part of the last 2 years of the cooperative agreement, the CDC's 6|18 Initiative was identified as a critical project for ACPM to promote among its membership. Information on the CDC's 6|18 Initiative is available here:


Beyond Race Disparities: Accounting for Socioeconomic Status in Diabetes Self-CareOpen in a New Window

Among patients with type 2 diabetes, racial disparities are prevalent across a variety of outcomes; however, inconsistent disparities in determinants of outcomes warrants exploring the impact of other, related factors. This study sought to examine whether disparities in health literacy, numeracy, self-care behaviors, and HbA1c persisted between non-Hispanic blacks and non-Hispanic whites after applying a robust adjustment for socioeconomic status (SES).


Lay Advisor Interventions in Rural Populations: A Systematic Review and Meta-analysisOpen in a New Window

Age-adjusted death rates for heart disease are higher in rural areas than in urban areas. Lay advisors could potentially facilitate improvement in cardiovascular health outcomes. The aim of this systematic review and meta-analysis is to estimate lay advisor intervention effects on cardiovascular health metrics in rural populations.


Summer School, School Disengagement, and Substance Use During AdolescenceOpen in a New Window

Youth who fall behind academically are at increased risk for school disengagement, school dropout, and substance use. Summer school is an opportunity for youth to complete needed coursework yet has not been utilized as a venue for substance use prevention. To date, little is known about the rates of summer school attendance among adolescents or the relationship between summer school attendance, school disengagement, and substance use. The purpose of this study is to assess the characteristics of summer school attendance over the past 20 years and to examine the associations between summer school attendance, indicators of school disengagement, and recent substance use among eighth-grade students.


Cancer Symptom Recognition and Anticipated Delays in Seeking Care Among U.S. AdultsOpen in a New Window

Early stage diagnosis strongly predicts cancer survival. Recognition of potential symptoms of cancer may improve survival by reducing time to seeking care.


Interactivity in a Decision Aid: Findings From a Decision Aid to Technologically Enhance Shared Decision Making RCTOpen in a New Window

Colorectal cancer screening (CRCS) remains underutilized. Decision aids (DAs) can increase patient knowledge, intent, and CRCS rates compared with “usual care,” but whether interactivity further increases CRCS rate remains unknown.


An Educational Intervention to Improve Statin Use: Cluster RCT at the Primary Care Level in ArgentinaOpen in a New Window

Statins are essential drugs for high cardiovascular disease (CVD) risk management; however, there is still low adherence to good clinical practice guidelines for statin use at the primary care level in low- and middle-income countries. This study aimed to test whether a complex intervention targeting physicians improves treatment and control of hypercholesterolemia among patients with moderate to high CVD risk in Argentina.


An RCT of Dating Matters: Effects on Teen Dating Violence and Relationship BehaviorsOpen in a New Window

Teen dating violence is a serious public health problem with few effective prevention strategies. This study examines whether the Dating Matters comprehensive prevention model, compared with a standard of care intervention, prevented negative relationship behaviors and promoted positive relationship behaviors.


Association of Worksite Food Purchases and Employees’ Overall Dietary Quality and HealthOpen in a New Window

Most Americans spend half their waking hours at work and consume food acquired there. The hypothesis was that the healthfulness of worksite food purchases was associated with employees’ overall diet and health.


Medicaid Coverage of Sexually Transmitted Disease Service VisitsOpen in a New Window

Chlamydia and gonorrhea are the most commonly reported notifiable infections in the U.S., with direct medical costs for the treatment of these infections exceeding $700 million annually. Medicaid currently covers approximately 80 million low-income Americans, including a high percentage of racial and ethnic minorities. Studies have shown that racial and ethnic minority populations, particularly those with low SES, are at an increased risk of acquiring a sexually transmitted disease. Therefore, as Medicaid expands, there will likely be a greater demand for sexually transmitted disease services in community-based physician offices.


Novel Smartphone Game Improves Physical Activity Behavior in Type 2 DiabetesOpen in a New Window

Many type 2 diabetes patients show insufficient levels of physical activity and are often unmotivated to change physical activity behaviors. This study investigated whether a newly developed smartphone game delivering individualized exercise and physical activity promotion through an elaborate storyline can generate sustained improvements in daily physical activity (steps/day).


Changes in Breast and Colorectal Cancer Screening After Medicaid Expansion Under the Affordable Care ActOpen in a New Window

Medicaid expansions following the Affordable Care Act have improved insurance coverage in low-income adults, but little is known about its impact on cancer screening. This study examined associations between Medicaid expansion timing and colorectal cancer (CRC) and breast cancer (BC) screening.


Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among VeteransOpen in a New Window

To inform overdose prevention, this study assessed both recent trends in opioid overdose mortality across opioid categories and receipt of prescription opioid analgesics among Veterans who died from overdose in the Veterans Health Administration.


Parent eReferral to Tobacco Quitline: A Pragmatic Randomized Trial in Pediatric Primary CareOpen in a New Window

Quitlines are effective in helping smokers quit, but pediatrician quitline referral rates are low, and few parents who smoke use the service. This study compared enrollment of parents who smoke in the quitline using electronic referral with that using manual referral.


Association of Fitness With Racial Differences in Chronic Kidney DiseaseOpen in a New Window

Non-white minorities are at higher risk for chronic kidney disease than non-Hispanic whites. Better cardiorespiratory fitness is associated with slower declines in estimated glomerular filtration rate and a lower incidence of chronic kidney disease. Little is known regarding associations of fitness with racial disparities in chronic kidney disease.


Dietary Guidance and New School Meal Standards: Schoolchildren's Whole Grain Consumption Over 1994–2014Open in a New Window

Since 2005, the federal government's Dietary Guidelines for Americans have recommended at least half of total grain intake be whole grains. Beginning with the 2012–2013 school year, the U.S. Department of Agriculture updated school meal regulations to align with this recommendation.


Neighborhood Food Environment and Physical Activity Among U.S. AdolescentsOpen in a New Window

Few U.S. adolescents meet physical activity guidelines. Although several neighborhood characteristics influence physical activity, the role of food-related features as potential drivers of adolescent physical activity remains understudied. Using representative U.S. data, authors examined the effect of the neighborhood food environment on adolescents’ out-of-school physical activity.


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